Mendel Arielle, Fritzler Marvin J, St-Pierre Yvan, Rauch Joyce, Bernatsky Sasha, Vinet Évelyne
Division of Rheumatology, McGill University Health Centre, Montreal, Canada.
Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada.
Res Pract Thromb Haemost. 2023 Jan;7(1):100041. doi: 10.1016/j.rpth.2023.100041. Epub 2023 Jan 7.
The significance of antiphospholipid antibodies (aPL) in COVID-19 remains uncertain.
We determined whether aPL are associated with COVID-19 and/or thrombosis or adverse outcomes during hospitalization for COVID-19.
Symptomatic adults tested for SARS-CoV-2 for clinical reasons (March-July 2020) with either ≥1 positive polymerase chain reaction (COVID-19+) or all negative (non-COVID-19) results were recruited to a biobank collecting plasma, clinical data, and outcomes. We tested baseline plasma samples (days 0-7) of all subjects (and day-30 samples in the COVID-19+ subjects, when available) for aPL (anticardiolipin immunoglobulin [Ig]M/IgG, anti-β2-glycoprotein I IgM/IgG, antiphosphatidylserine/prothrombin IgM/IgG, and lupus anticoagulant). We compared the baseline prevalence of aPL between the COVID-19+ and non-COVID-19 subjects. Among hospitalized COVID-19+ subjects, multivariable logistic regression was used to evaluate the association of aPL (and their subtypes) with arterial or venous thromboembolic events, acute kidney injury, intensive care unit admission, mechanical ventilation, and death after adjusting for potential confounders.
At baseline, 123 of 289 (43%) COVID+ subjects had ≥1 aPL versus 116 of 261 (32%) non-COVID-19 subjects (difference, 10%; 95% CI, 3%-18%). Among 89 COVID+ subjects with repeated samples, aPL persisted on day 30 in 15 of 34 (44%) subjects with baseline aPL positivity, and half of those without aPL at baseline developed one or more new aPL. In hospitalized COVID-19 subjects ( = 241), baseline aPL positivity was associated with acute kidney injury (odds ratio [OR], 1.8; 95% CI, 1.1-3.2) and mechanical ventilation (OR, 3.2; 95% CI, 1.5-6.8) but not death (OR, 1.2; 95% CI, 0.6-2.5). In secondary analyses, medium-to-high titers of anticardiolipin IgG (>40) were associated with thromboembolic events (OR, 7.3; 95% CI, 1.8-30.1).
In patients with COVID-19, aPL may help identify an increased risk of thrombosis and other adverse outcomes.
抗磷脂抗体（aPL）在新型冠状病毒肺炎（COVID-19）中的意义仍不确定。
我们确定aPL是否与COVID-19和/或血栓形成或COVID-19住院期间的不良结局相关。
因临床原因（2020年3月至7月）接受严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测的有症状成年人，若聚合酶链反应结果≥1次为阳性（COVID-19+）或全部为阴性（非COVID-19），则被纳入一个生物样本库，该样本库收集血浆、临床数据和结局。我们检测了所有受试者的基线血浆样本（第0 - 7天）（以及COVID-19+受试者第30天的样本，若有）中的aPL（抗心磷脂免疫球蛋白[Ig]M/IgG、抗β2糖蛋白I IgM/IgG、抗磷脂酰丝氨酸/凝血酶原IgM/IgG和狼疮抗凝物）。我们比较了COVID-19+和非COVID-19受试者之间aPL的基线患病率。在住院的COVID-19+受试者中，多变量逻辑回归用于评估aPL（及其亚型）与动脉或静脉血栓栓塞事件、急性肾损伤、重症监护病房入住、机械通气和死亡之间的关联，并对潜在混杂因素进行了校正。
基线时，289例COVID+受试者中有123例（43%）有≥1种aPL，而261例非COVID-19受试者中有116例（32%）有aPL（差异为10%；95%可信区间[CI]，3% - 18%）。在89例有重复样本的COVID+受试者中，34例基线aPL阳性的受试者中有15例（44%）在第30天aPL仍持续存在，而基线时无aPL的受试者中有一半出现了一种或多种新的aPL。在住院的COVID-19受试者（n = 241）中，基线aPL阳性与急性肾损伤（比值比[OR]，1.8；95% CI，1.1 - 3.2）和机械通气（OR，3.2；95% CI，1.5 - 6.8）相关，但与死亡无关（OR，1.2；95% CI，0.6 - 2.5）。在二次分析中，中高滴度的抗心磷脂IgG（>40）与血栓栓塞事件相关（OR，7.3；95% CI，1.8 - 30.1）。
在COVID-19患者中，aPL可能有助于识别血栓形成和其他不良结局风险增加的情况。
