82 - Oral Communication
Feb. 26, 2021, 1:45 p.m. - 3:15 p.m., Rome


Prothrombotic alterations of von Willebrand factor level and ADAMTS13 activity in hospitalized COVID-19 patients
G. Sinkovits, B. Mező, M. Réti, V. Müller, Z. Iványi, J. Gál, L. Gopcsa, P. Reményi, B. Szathmáry, B. Lakatos, J. Szlávik, I. Bobek, Z. Z. Prohászka, Z. Förhécz, D. Csuka, L. Hurler, E. Kajdácsi, L. Cervenak, P. Kiszel, T. Masszi, I. Vályi-Nagy, Z. Prohászka, Presenter: G. Sinkovits (Budapest)

Background and Objective
Based on our current knowledge, the severity of the COVID-19 disease is associated with the dysregulation of inflammation and haemostasis. Endothelial cells play a central role in regulating both processes. Our aim was to determine the VWF antigen (Ag) level, the ADAMTS13 activity (Ac) and their ratio in samples of COVID-19 patients, and to analyze their associations with disease severity, thromboembolic complications and laboratory parameters associated with COVID-19 severity.
Between 20th of April and 2nd of June 2020, 128 PCR-positive COVID-19 patients were included in our observational clinical study. Patients were stratified according to the severity at the time of sampling. The following groups were defined: (1) outpatient (n=26), (2) hospitalized, not requiring oxygen support (n=31), (3) hospitalized, receiving oxygen therapy (n=36), (4) critical, requiring intensive care (n=35). VWF:Ag level was determined by ELISA; ADAMTS13:Ac was determined by a FRET assay. Non-parametric statistical tests were used for statistical analysis.
VWF:Ag levels were significantly elevated in all groups of hospitalized patients (median values: 196%, 270% and 383% in groups 2, 3 and 4, respectively). ADAMTS13:Ac was decreased in patients requiring oxygen support or intensive therapy (median 75% and 50% in groups 3 and 4, respectively). Consequently, the VWF:Ag/ADAMTS13:Ac ratio was increased in all hospitalized patients, the rate of increase correlated with disease severity (median 1.97, 3.71 and 10.73 in groups 2, 3 and 4, respectively). The VWF:Ag level and VWF:Ag/ADAMTS13:Ac ratio were higher in patients with thromboembolic complications (median 390% vs. 213% and 6.0 vs. 2.3, respectively). We found a number of significant correlations between the above parameters and those related to the pathophysiology or severity of the COVID-19 disease: CRP, PCT, IL-6, neutrophil/lymphocyte ratio, RDW, D-dimer and markers of complement activation.
Our results show that VWF:Ag, ADAMTS13:Ac and their ratio correlate strongly with disease severity and are associated with an increased risk of thromboembolic complications. Moreover, they are associated with several markers of inflammation, coagulation and complement activation, which may indicate a potential key role of endothelial cells in the pathogenesis of immunothrombosis in COVID-19.
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