Assessment of COVID -19 associated coagulopathy and multiple hemostatic markers: a single center study in Egypt

Abstract

Background Coagulopathy is still a serious pattern of coronavirus-19 disease. We aimed to evaluate COVID-19-associated coagulopathy and multiple hemostatic markers in Egyptian patients. In addition, to assess coagulation acute phase reactants and its effect on the outcome. Methods The study included 106 COVID-19 patients, and 51 controls. All patients were positive for COVID-19 infection by nasopharyngeal swab for detection of viral RNA by real-time PCR. In addition to baseline data and radiological findings, the coagulation profile was done with special attention to Fibrinogen, d-dimer, Factor VIII, von Willebrand factor (VWF), Protein C, Protein S, Antithrombin III (ATIII) and Lupus anticoagulant (LA)-1 and 2. Results The results showed significantly higher VWF, d-dimer, and LA1 (screening) and LA2 (confirmation) in patients than a control group. Significantly higher d-dimer FVIII, VWF and LA1-2 were detected in the severe group. ATIII had high diagnostic accuracy in severity prediction. We found a significantly higher international randomized ratio (INR) and VWF among patients with thrombotic events. For prediction of thrombosis; VWF at cutoff > 257.7 has 83.3% sensitivity and 83.3% specificity. Conclusion Patients with COVID-19 infection are vulnerable to different forms of coagulopathy. This could be associated with poor outcomes. d-Dimer is a chief tool in diagnosis, severity evaluation but not thrombosis prediction. Early screening for this complication and its proper management would improve the outcome.

Decreased protein C activity, lower ADAMTS13 antigen and free protein S levels accompanied by unchanged thrombin generation potential in hospitalized COVID-19 patients

“…Three factors are known to regulate ADAMTS13 activity: (1) shear stress in the microcirculation, which allows vWF to unfold and expose its A2 domain for ADAMTS13 binding; (2) factor VIII, which enhances the ADAMTS13 proteolytic activity; and (3) platelet glycoprotein 1bα (GP1bα) [40] . In our data, but also in other publications [23] , [39] , vWF was significantly increased in the COVID-19 group; and at least two first previously mentioned conditions were fulfilled, leading to the depletion of inhibitory mechanisms. Thus COVID-19 is related to the significantly higher vWF antigen/ADAMTS13 activity ratio, which recently has been found to predict mortality [41] or severe disease course [42] .…”

“…Thus, one can speculate that both those proteins might serve as biomarkers of thrombotic manifestations in COVID-19. However, other reports demonstrate similar protein C and S levels or activity in on-admission COVID-19 patients and controls [23] , [24] . It is worth highlighting that some studies evaluated free protein S levels, whereas others total protein S according to its activity or concentration.…”

Evaluating the potential mediating role of ADAMTS13 activity in the relationship between obesity and the severity of COVID-19: A retrospective cohort study

“…of pandemic-related deaths. [5][6][7] Furthermore, patients with COVID-19 frequently have pulmonary and extrapulmonary microthrombotic and thromboembolic indicators as well as significant pulmonary angiogenesis. [8,9] Endothelial cells and megakaryocytes produce Von Willebrand factor (VWF), which is a multimeric plasma glycoprotein., [10] which is required for both primary hemostasis via platelet and subendothelial collagen adhesion and the intrinsic coagulation cascade via factor VIII (FVIII) stabilization.…”

COVID-19 associated Mucormycosis among ICU patients: risk factors, control, and challenges

“…According to the latest report from World Health Organization (WHO), more than 760 million cases and 6.9 million deaths have been documented worldwide since December 2019, although the true figure is estimated to be higher (WHO 2023 ). Individuals with serious illnesses may experience respiratory distress and respiratory failure, requiring hospitalization to the intensive care unit (ICU) and mechanical respiratory support (Ranieri et al 2012 ; Khalaf et al 2022 ; Abdelaal et al 2023 ). The high rate of morbidity and mortality associated with long periods of ICU admission may be attributed mainly to the increased chance of secondary infections.…”