The ADAMTS13-von Willebrand factor axis in COVID-19 patients
The ADAMTS13-von Willebrand factor axis in COVID-19 patients
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DOI：
10.1111/jth.15191
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发表时间：
2020-12-18
影响因子：
10.4
通讯作者：
Peyvandi, Flora
中科院分区：
文献类型：
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作者：
Mancini, Ilaria;Baronciani, Luciano;Peyvandi, Flora
背景2019年严重冠状病毒病目的研究微血栓形成在COVID-19进展中的机制。患者/方法我们评估了血管性血友病因子（VWF）抗原（VWF：Ag）、VWF瑞斯托菌素辅因子（VWF：Ag）、血管性血友病因子（VWF：Ristocetin-cofactor，VWF：Ristocetin-cofactor，VWF：Ag）、血管性血友病因子（VWF：Ristocetin-cofactor，VWF：Ag）和血管性血友病因子（VWF：Ristocetin-cofactor，VWF：Ag）。RCo），VWF多聚体，VWF前肽（VWFpp），和ADAMTS 13活性在50例患者的横断面研究中，根据他们进入三种不同强度的护理单位进行分层：低（需要高流量鼻插管氧合，n = 14），中度（需要持续气道正压通气装置，n = 17），结果COVID-19患者中位VWF：Ag、VWF：RCo和VWFpp水平显著升高，并随着护理强度的增加而升高，VWF：Ag分别为268、386和476 IU/dL; VWF：RCo分别为216、334和388 IU/dL;在低、中和高护理强度的患者中，VWFpp分别为156、172和192 IU/dL。相反，随着护理强度的增加，高分子量与低分子量VWF多聚体的比率以及ADAMTS 13活性水平的中位数逐渐降低，其范围从低强度护理患者的82 IU/dL到中等和高强度护理患者的62和55 IU/dL。VWF：Ag与ADAMTS 13活性比值升高，与疾病严重程度密切相关。这种不平衡增强了COVID-19患者的高凝状态及其微血栓形成的风险。
Background Severe coronavirus disease 2019 (COVID-19) is characterized by an increased risk of thromboembolic events, with evidence of microthrombosis in the lungs of deceased patients.Objectives To investigate the mechanism of microthrombosis in COVID-19 progression.Patients/Methods We assessed von Willebrand factor (VWF) antigen (VWF:Ag), VWF ristocetin-cofactor (VWF:RCo), VWF multimers, VWF propeptide (VWFpp), and ADAMTS13 activity in a cross-sectional study of 50 patients stratified according to their admission to three different intensity of care units: low (requiring high-flow nasal cannula oxygenation, n = 14), intermediate (requiring continuous positive airway pressure devices, n = 17), and high (requiring mechanical ventilation, n = 19).Results Median VWF:Ag, VWF:RCo, and VWFpp levels were markedly elevated in COVID-19 patients and increased with intensity of care, with VWF:Ag being 268, 386, and 476 IU/dL; VWF:RCo 216, 334, and 388 IU/dL; and VWFpp 156, 172, and 192 IU/dL in patients at low, intermediate, and high intensity of care, respectively. Conversely, the high-to-low molecular-weight VWF multimers ratios progressively decreased with increasing intensity of care, as well as median ADAMTS13 activity levels, which ranged from 82 IU/dL for patients at low intensity of care to 62 and 55 IU/dL for those at intermediate and high intensity of care.Conclusions We found a significant alteration of the VWF-ADAMTS13 axis in COVID-19 patients, with an elevated VWF:Ag to ADAMTS13 activity ratio that was strongly associated with disease severity. Such an imbalance enhances the hypercoagulable state of COVID-19 patients and their risk of microthrombosis.