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CC BY 4.0 · TH Open 2021; 05(01): e89-e103
DOI: 10.1055/s-0041-1723784
Original Article

Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients

Joseph M. Sweeney
1   Department Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, United States
,
Mohammad Barouqa
2   Department of Pathology Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
,
Gregory J. Krause
3   Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Institute of Aging Studies, Albert Einstein College of Medicine, Bronx, New York, United States
,
Jesus D. Gonzalez-Lugo
5   Division of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
,
Shafia Rahman
5   Division of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
,
Morayma Reyes Gil 
2   Department of Pathology Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
› Author Affiliations
Funding The authors would like to acknowledge the MSTP Training grant for partial support of J.M.S.'s effort (T32GM007288).
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Abstract

The causes of coagulopathy associated with coronavirus disease 2019 (COVID-19) are poorly understood. We aimed to investigate the relationship between von Willebrand factor (VWF) biomarkers, intravascular hemolysis, coagulation, and organ damage in COVID-19 patients and study their association with disease severity and mortality. We conducted a retrospective study of 181 hospitalized COVID-19 patients randomly selected with balanced distribution of survivors and nonsurvivors. Patients who died had significantly lower ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity, significantly elevated lactate dehydrogenase levels, significantly increased shistocyte/RBC fragment counts, and significantly elevated VWF antigen and activity levels compared with patients discharged alive. These biomarkers correlate with markedly elevated D-dimers. Additionally, only 30% of patients who had an ADAMTS13 activity level of less than 43% on admission survived, yet 60% of patients survived who had an ADAMTS13 activity level of greater than 43% on admission. In conclusion, COVID-19 may present with low ADAMTS13 activity in a subset of hospitalized patients. Presence of schistocytes/RBC fragment and elevated D-dimer on admission may warrant a work-up for ADAMTS13 activity and VWF antigen and activity levels. These findings indicate the need for future investigation to study the relationship between endothelial and coagulation activation and the efficacy of treatments aimed at prevention and/or amelioration of microangiopathy in COVID-19.

Keywords

von Willebrand factor - ADAMTS13 - COVID-19 - schistocytes - coagulopathy

Authors' Contributions

M.R.G. designed and performed the research, analyzed and interpreted data, and wrote the manuscript. J.M.S. performed the research, analyzed and interpreted the data, and helped in manuscript writing. M.B. analyzed and interpreted the data and helped in manuscript writing. G.J.K. performed the research and analyzed the data. J.D.G. and S.R. performed chart review.


Note

M.R.G. and J.M.S. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


Supplementary Material



Publication History

Received: 31 October 2020

Accepted: 29 December 2020

Article published online:
09 March 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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