Abstract
Coronavirus disease 2019 (COVID-19) increases the risk of coagulopathy. Although the presence of antiphospholipid antibodies (aPLs) has been proposed as a possible mechanism of COVID-19-induced coagulopathy, its clinical significance remains uncertain. Therefore, this study aimed to evaluate the prevalence and clinical significance of aPLs among critically ill patients with COVID-19. This prospective observational study included 60 patients with COVID-19 admitted to intensive care units (ICU). The study outcomes included prevalence of aPLs, and a primary composite outcome of all-cause mortality and arterial or venous thrombosis between antiphospholipid-positive and antiphospholipid-negative patients during their ICU stay. Multiple logistic regression was used to assess the influence of aPLs on the primary composite outcome of mortality and thrombosis. A total of 60 critically ill patients were enrolled. Among them, 57 (95%) were men, with a mean age of 52.8 ± 12.2 years, and the majority were from Asia (68%). Twenty-two patients (37%) were found be antiphospholipid-positive; 21 of them were positive for lupus anticoagulant, whereas one patient was positive for anti-β2-glycoprotein IgG/IgM. The composite outcome of mortality and thrombosis during their ICU stay did not differ between antiphospholipid-positive and antiphospholipid-negative patients (4 [18%] vs. 6 [16%], adjusted odds ratio 0.98, 95% confidence interval 0.1–6.7; p value = 0.986). The presence of aPLs does not seem to affect the outcomes of critically ill patients with COVID-19 in terms of all-cause mortality and thrombosis. Therefore, clinicians may not screen critically ill patients with COVID-19 for aPLs unless deemed clinically appropriate.
Highlights
The novel coronavirus infection significantly contributes to the increased mortality in many countries, with a continuously increasing number of infected cases worldwide [1]
The International Society on Thrombosis and Homeostasis recently recommended that all hospitalized patients with COVID-19 receive a prophylactic-dose of low-molecularweight heparin (LMWH) unless they have contraindications defined as active bleeding and platelet count of < 25 × 1 09/L [4]
From June 26 to August 5, 2020, we identified a total of 117 patients with confirmed COVID-19 infection upon intensive care units (ICU) admission; 60 of them were found to be eligible for study enrollment
Summary
The novel coronavirus infection ( known as coronavirus disease 2019 [COVID-19]) significantly contributes to the increased mortality in many countries, with a continuously increasing number of infected cases worldwide [1]. One of the poor prognostic features in critically ill patients with COVID-19 is the development of coagulopathy [2]. Extended author information available on the last page of the article of developing coagulopathy, a condition associated with poor outcomes, as demonstrated by a retrospective analysis conducted in China [3]. The development of disseminated intravascular coagulation (DIC) on day 4 was observed in 71.4% of patients who died compared to 0.6% of patients who survived. A significantly increased D-dimer level and prothrombin time (PT) and decreased fibrinogen levels in non-survivors were observed. The International Society on Thrombosis and Homeostasis recently recommended that all hospitalized patients with COVID-19 receive a prophylactic-dose of low-molecularweight heparin (LMWH) unless they have contraindications defined as active bleeding and platelet count of < 25 × 1 09/L [4]
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