ADAMTS13 activity to von Willebrand factor antigen ratio predicts acute kidney injury in patients with COVID-19: Evidence of SARS-CoV-2 induced secondary thrombotic microangiopathy.
Int J Lab Hematol
; 43 Suppl 1: 129-136, 2021 Jul.
Article
in English
| MEDLINE | ID: covidwho-998961
ABSTRACT
INTRODUCTION:
Severe COVID-19 is often compounded by a prothrombotic state that is associated with poor outcomes. In this investigation, we aimed to evaluate ADAMTS13 activity, von Willebrand factor level (VWFAg), and the corresponding ADAMTS13 activity/VWFAg ratio, in patients with COVID-19 and for associations with disease progression and acute kidney injury (AKI).METHODS:
Patients presenting to the emergency department (ED) with COVID-19 were enrolled in this prospective, observational study. ADAMTS13 activity and VWFAg were measured at index ED visit. The primary endpoint was severe AKI defined by KDIGO stage 2 + 3 criteria, while the secondary endpoint was peak 30-day COVID-19 severity.RESULTS:
A total of 52 adult COVID-19 patients were enrolled. Overall, we observed that 23.1% of the cohort had a relative deficiency in ADAMTS13 activity, while 80.8% had elevated VWFAg. The ADAMTS13 activity/VWFAg ratio was significantly lower in patients with severe AKI (P = .002) and those who developed the severe form of COVID-19 (P = .020). The ADAMTS13 activity/VWFAg ratio was negatively correlated with age (P < .001) and LDH (P < .001), while positively correlated with hemoglobin (P = .041). After controlling for confounders, a one-unit increase in ADAMTS13/VWFAg ratio was associated with 20% decreased odds of severe AKI.CONCLUSION:
A low ADAMTS13 activityVWFAg ratio at ED presentation is associated with progression to severe COVID-19 disease and severe AKI, with a pattern suggestive of a secondary microangiopathy. Further interventional studies should be conducted to assess the restoration of ADAMTS13VWFAg ratio in hospitalized patients with COVID-19.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Von Willebrand Factor
/
Thrombotic Microangiopathies
/
Acute Kidney Injury
/
ADAMTS13 Protein
/
SARS-CoV-2
/
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Int J Lab Hematol
Journal subject:
Hematology
Year:
2021
Document Type:
Article
Affiliation country:
Ijlh.13415
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