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.
Highlights
The main hypothesis of this retrospective study is that von Willebrand factor (VWF) biomarkers are associated with coagulation in COVID-19
We performed a balanced retrospective study of COVID-19 hospitalized patients with similar demographics and comorbidities and a wide range of D-dimer levels to study how VWF biomarkers correlate with coagulation, intravascular hemolysis, and outcome
We show a clear association of elevated VWF antigen and activity levels with high D-dimer and FM levels
Summary
At this stage, the ACE2 receptors on the endothelium can be involved, causing direct damage to blood vessels and inducing a coagulopathy.. Coagulopathy with D-dimer elevations is reported in most hospitalized COVID-19 patients.. A recent study showed that markers of endothelial damage such as von Willebrand factor (VWF) and soluble thrombomodulin were increased in COVID-19 hospitalized patients. All these markers were even higher in intensive care unit patients and correlated with mortality.. There have been some COVID19 data involving ADAMTS13 activity levels, the small sample size in these reports precluded any major conclusions.
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