Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19?
Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19?
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DOI：
10.7861/clinmed.2020-0346
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发表时间：
2020-09-01
影响因子：
4.4
通讯作者：
Chevassut, Timothy
中科院分区：
文献类型：
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作者：
Ladikou, Eleni E.;Sivaloganathan, Helena;Chevassut, Timothy
COVID-19感染的特征之一是血栓前状态，静脉血栓栓塞症(VTE)、D-二聚体和纤维蛋白原水平较高。方法连续选择24例新冠肺炎阳性患者，均来自布莱顿和苏塞克斯大学医院NHS信托基金的重症监护病房或高视力病房。纤维蛋白原和D-二聚体升高，分别为7.9(1.6)g/L和2.4(2.02)ug/ml。因子VIIIc和von vWF抗原水平均极高，分别为279(148)u/dL和350(131)%，与ICU合并严重脓毒症患者的水平相当。死亡患者的vWF水平显著升高(p=0.017)，且与年龄呈正相关。新冠肺炎病与非O型血显著相关(P=0.02)，80%(4/5)的新冠肺炎VTE患者为A型血。结论新冠肺炎患者vWF和VIIIc水平非常高，与严重脓毒症非冠状病毒感染的ICU患者相当。这可能导致新冠肺炎的高凝状态和室上性心动过速的发生率增加。还需要进一步的研究来评估vWF在新冠肺炎血栓形成风险分层中的应用，并确定vWF升高是否有助于疾病的发病机制。
BackgroundCOVID-19 infection is characterised, among other features, by a prothrombotic state with high rate of venous thromboembolism (VTE), D-dimer, and fibrinogen levels. Clinical observations have also highlighted that these patients have elevated von Willebrand factor (vWF) and factor VIIIc.Methods24 consecutive COVID-19 positive patients were selected from the intensive care unit (ICU) or the high acuity ward of Brighton and Sussex University Hospitals NHS Trust.ResultsThe rate of VTE was 25% and mortality rate was 16.7%. Fibrinogen and D-Dimers were elevated, 7.9 (1.6) g/L and 2.4 (2.02) ug/ml respectively. Factor VIIIc and von vWF antigen levels were both extremely elevated at 279 (148) u/dL and 350 (131) % respectively, which are comparable to levels seen in ICU patients with severe sepsis. vWF levels were significantly higher in patients that died (p=0.017) and showed a positive correlation with age. There was a statistically significant association between COVID-19 disease and non-O blood group (p=0.02); 80% (4/5) of COVID-19 patients with VTE were blood group A.ConclusionVery high levels of vWF and factor VIIIc are common in COVID-19 patients, comparable to levels in severely septic non-COVID ICU patients. This could contribute to the hypercoagulable state and increased VTE rate in COVID-19. Further studies are needed to evaluate the use of vWF for stratifying thrombotic risk in COVID-19 and to determine if elevated vWF is contributing to disease pathogenesis.