ABSTRACT
Background: Patients with severe respiratory failure come to the hospital emergency room, where they are triaged to support lung ventilation. Coagulation markers are one of the important methods for triage. The main method used so far is DDIM. Their elevation is due to the activation of coagulation with prothrombogenic potential, which manifests itself mainly in the microcirculation. These processes lead to the excessive release of Von Willebrand factor (VWF) from the Weibel Palade bodies and its cleavage by ADAMTS13, which is thus consumed. Aim(s): The aim of our study was to assess the effect of ADAMTS13 levels on the prognosis of patients with acute respiratory failure due to COVID-19 infection. Method(s): 46 patients coming to the emergency department were examined and admitted to the intensive care unit to support lung function based on clinical symptoms and elevated D-Dimers. These patients were retrospectively examined for ADAMTS13. Result(s): The levels of ADAMTS13 showed a statistically significant difference (P = 0.02) that corresponded to the clinical course of severe respiratory failure due to COVID-19 infection. Ninghteen patients with a relatively mild course had an ADAMTS13 level of 0.74 IU/ml (0.28 -1.14 IU/ml), in contrast to a skip of 27 patients with a severe course, which had an ADAMTS13 level of 0.54 IU/ml (0.25 -1.01 IU/ml). Conclusion(s): The levels of D-Dimer as a commonly used marker in triage of the COVID-19 severity infection is mainly due to the activation of coagulation and its manifestations, especially in the microcirculation. The level of ADAMTS13 is a key marker in the early prognosis of the severity of COVID-19 due to pulmonary insufficiency, whereas D-DIm is only a consequence of this process.
ABSTRACT
Background : The new, pandemic disease of Severe Acute Respiratory Syndrome Coronairus 2 (SARS-CoV-2) causes a variety of symptoms in infected individuals, from very mild flu-like symptoms to fatal severe pneumonia and organ failure. However, it is very interesting that we are seeing an increase in thrombotic microagiopathies (TMA) in connection with the disease caused by the new coronavirus (Covid 19). The persistent action of coronavir activates the complement system, including activation of coagulation. This is accompanied by the production of antibodies against ADAMTS13, which leads to a reduction in ADAMTS13 activity and the development of TMA with microthrombotizations in blood vessels, tissues and organ failure. Aims : Description of two case reports of hospitalized patients in the intensive care unit with Covid 19 and subsequently developed thrombotic microangiopathy. Methods : To diagnose TMA, two patients with Covid 19 infections had the following tests: blood count, platelet count (PLT), schistocyte count, lactate dehydrogenase, urea, creatinine, ADAMTS13 activity, and ADAMTS13 inhibitor. Results : Case report 1 -male 68 years old, Covid 19 positive, on the 5 day TMA is developed, PLT is 49 x 109/l, schistocytes 68/1000 erythrocytes, ADAMTS13 activity 43%, inhibitor 12 IU/ml. After exchange plasmapheresis patient's condition improves. Case report 2 -male 64 years old, Covid 19 positive, on the 8 day TMA is developed, PLT is 16 x 109/l, schistocytes 64/1000 erythrocytes, ADAMTS13 activity 29%, inhibitor 68 IU/ml. After exchange plasmapheresis patient's laboratory finding improves, but condition is very serious and patient die. Conclusions : Covid 19 infection can damage the endothelium, activate coagulation and complement, and subsequently develop thrombotic microangiopathy. Covid 19 brings a wide range of overlapping signs and symptoms, making it difficult to diagnose severe TMA. For this reason, treatment is often started late and some patients die.