Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study

Abstract

Background A high prevalence of antiphospholipid antibodies has been reported in case series of patients with neurological manifestations and COVID-19; however, the pathogenicity of antiphospholipid antibodies in COVID-19 neurology remains unclear. Methods This single-centre cross-sectional study included 106 adult patients: 30 hospitalised COVID-neurological cases, 47 non-neurological COVID-hospitalised controls, and 29 COVID-non-hospitalised controls, recruited between March and July 2020. We evaluated nine antiphospholipid antibodies: anticardiolipin antibodies [aCL] IgA, IgM, IgG; anti-beta-2 glycoprotein-1 [aβ 2 GPI] IgA, IgM, IgG; anti-phosphatidylserine/prothrombin [aPS/PT] IgM, IgG; and anti-domain I β 2 GPI (aD1β2GPI) IgG. Findings There was a high prevalence of antiphospholipid antibodies in the COVID-neurological (73.3%) and non-neurological COVID-hospitalised controls (76.6%) in contrast to the COVID-non-hospitalised controls (48.2%). aPS/PT IgG titres were significantly higher in the COVID-neurological group compared to both control groups ( p < 0.001). Moderate-high titre of aPS/PT IgG was found in 2 out of 3 (67%) patients with acute disseminated encephalomyelitis [ADEM]. aPS/PT IgG titres negatively correlated with oxygen requirement (FiO 2 R =-0.15 p = 0.040) and was associated with venous thromboembolism ( p = 0.043). In contrast, aCL IgA ( p < 0.001) and IgG ( p < 0.001) was associated with non-neurological COVID-hospitalised controls compared to the other groups and correlated positively with d -dimer and creatinine but negatively with FiO 2 . Interpretation Our findings show that aPS/PT IgG is associated with COVID-19-associated ADEM. In contrast, aCL IgA and IgG are seen much more frequently in non-neurological hospitalised patients with COVID-19. Characterisation of antiphospholipid antibody persistence and potential longitudinal clinical impact are required to guide appropriate management.

Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

“…Antiphospholipid antibodies (i.e., anti-phosphatidylserine/prothrombin) were higher in COVID-19 patients, particularly those with neurological manifestations, than in controls. In contrast, anticardiolipin antibodies were not associated with neurologic involvement in COVID-19 ( 96 ).…”

The Presence of Antineutrophil Cytoplasmic Antibodies and Antiphospholipid Antibodies in Patients with Severe Acute Respiratory Syndrome Coronavirus 2: A Case-Control Study among Sudanese Patients

“…Following the fnding of Bahramnezhad et al, which describes a case of an antiphospholipid-like condition caused by COVID-19 [31], another piece of evidence from the literature is the fnding of Moon et al [32], who presented a hypothetical model to elucidate the pathophysiology of APS in COVID-19 and described clinicopathological similarities between CAPS and severe COVID-19 [32]. In light of this evidence and our fndings, COVID-19 may induce an antiphospholipid-like condition that plays a role in increasing the severity of disease manifestation; this hypothesis is strongly supported by the fndings of Laura et al, who examined 106 COVID-19 patients for the presence of aPL antibodies, including 30 hospitalized cases, 47 hospitalized nonneurological COVID-19 controls, and 29 COVID-19 nonhospitalized controls, and reported a high prevalence of antiphospholipid antibodies in 72 (67.9%) of all cases and 22 (73.3%) of the 30 hospitalized neurological cases [33]. An important note in our study is to mention that the positive case of aPL is also positive for the ANCA, indicating that a range of autoantibodies could be induced in COVID-19 infection.…”

Characterizing Covid-19–related Retinal Vascular Occlusions

“…4,5 Among different factors identified, thrombotic complications might be specifically induced by the presence of lupus anticoagulant and other antiphospholipid antibodies or by the development of an autoimmune vasculitis elicited by the virus. 3,5,39 In this regard, primary and secondary causes of isolated retinal vasculitis, including virus-induced vasculitis, have been previously described. 40 Our study showed that retinal vascular occlusions were not accompanied by thrombotic or occlusive lesions in other territories in most of the patients.…”