Abstract
BackgroundCOVID-19 infection is associated with a hypercoagulable state. Severe COVID-19 patients present with high plasma fibrinogen levels, continuous deposition of fibrin and the presence of microthrombi in their lungs, accompanied by significant fibrinolysis, resulting in high D-dimer levels. Due to the role of FXIII in fibrin crosslinking and clot stabilization, we analyzed its activity levels and dynamics in COVID-19 patients hospitalized in the intensive care unit (ICU).MethodsFXIII levels were measured in thirty four COVID-19 patients hospitalized in the ICU and in fourteen non-severe COVID-19 patients. FVIII levels were measured for comparison. Laboratory data and clinical variables were recorded.ResultsThe average FXIII activity level in 34 ICU hospitalized COVID-19 patients was 69.9±33 %, significantly lower compared to an average of 120±20.9 % FXIII activity in 14 non-severe COVID-19 patients. FXIII activity levels were below the low normal value (< 79 % FXIII activity) in 74 % of the ICU hospitalized COVID-19 patients. In contrast, high FVIII activity was measured among all severe COVID-19 patients. Consecutive measurements, performed in fourteen ICU hospitalized COVID-19 patients, pointed to a significant decrease in FXIII activity from the average of 85.7±28.2 %, (which is in the normal range), to an average of 68.0±20.4 %, below the low normal range, within 6.4±3.4 days of ICU hospitalization. Liver functions did not differentiate between patients with low and normal FXIII activity. No inhibitor to FXIII activity was found in the plasma of severe COVID-19 patients. Levels of FXIII-A antigen correlated with FXIII activity, and were low in severe COVID-19 patients.ConclusionsLow FXIII activity levels were found in COVID-19 patients hospitalized in the ICU, with gradual decline during their hospitalization. A mechanism of consumption may account for the low FXIII activity in these patients.
Highlights
COVID-19 infection is associated with a hypercoagulable state
coagulation factor 13 (FXIII) activity in intensive care unit (ICU) hospitalized COVID-19 patients The average FXIII activity level among COVID-19 patients hospitalized in the ICU was 69.9±33 %, median 62.7 %, range 29-180 % with 74 % of the patients (25/34)
Our data indicate that production difficulties may not account for the low FXIII we observed in severe COVID-19 patients, but rather a consumption-based mechanism
Summary
COVID-19 infection is associated with a hypercoagulable state. Severe COVID-19 patients present with high plasma fibrinogen levels, continuous deposition of fibrin and the presence of microthrombi in their lungs, accompanied by significant fibrinolysis, resulting in high D-dimer levels. Severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), causes coronavirus disease 2019 (COVID-19), Early observations revealed a hypercoagulable state in COVID-19 patients, accompanied by elevated D-dimer and fibrinogen levels [3, 7, 8]. Lichter et al Thrombosis Journal (2021) 19:79 with a higher rate of intensive care admissions, as well as mortality [2, 6, 7, 9]. Of the patients with VTE, deep vein thrombosis (DVT) was reported with an incidence of 23 % [12] (12.7 % in other non COVID-19 ICU patients [13]), and pulmonary embolism (PE) with an unusually high incidence of up to 81 % in some series. [10]
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