Lupus anticoagulant is an independent risk factor for non-thrombotic in-hospital mortality in COVID-19 patients

Constans, Mireia; Santiago, Raquel; Jimenez, Lidia; Motlló, Cristina; Lopez, Rosario; Trapé, Jaume; Reverter, Juan Carlos; Altés, Albert

doi:10.1016/j.thromres.2021.10.017

Cited by 6 publications

(7 citation statements)

References 26 publications

(53 reference statements)

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“…A total of 36 articles were included in the pooled analysis ( Table 1 ). 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 The majority (28; 78%) consisted of retrospective cohort studies whereas three (8%) were RCTs and five (14%) were prospective cohort studies ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

Candeloro

Schulman

2022

Semin Thromb Hemost

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It is well established that the risk of venous thromboembolism is high in coronavirus disease 19 (COVID-19). The frequency of arterial thromboembolic events (ATEs) in hospitalized patients with COVID-19 is unclear, as is the magnitude of these events in comparison with other infections. We searched MEDLINE from February 2020 to February 2022 for prospective or retrospective cohort studies and randomized clinical trials that reported the number of acute myocardial infarction (AMI), acute ischemic stroke (AIS), acute limb ischemia (ALI), or other ATE as defined by the original authors in hospitalized patients with COVID-19. The pooled frequencies were calculated through meta-analysis using random effects model with logit transformation and presented with relative 95% prediction intervals (95% PI). We retrieved a total of 4,547 studies, 36 of which (28 retrospective cohorts, five prospective cohorts and three randomized trials) were finally included in our analysis. The resulting cohort counted 100,949 patients, 2,641 (2.6%) of whom experienced ATE. The pooled ATE frequency was 2.0% (95% PI, 0.4–9.6%). The pooled ATE frequency for AMI, AIS, ALI, and other ATE was 0.8% (95% PI, 0.1–8.1%), 0.9% (95% PI, 0.3–2.9%), 0.2% (95% PI, 0.0–4.2%), and 0.5% (95% PI, 0.1–3.0%), respectively. In comparison with the ATE incidence reported in three studies on non-COVID viral pneumonia, we did not detect a significant difference from the results in our analysis. In conclusion, we found a non-negligible proportion of ATE in patients hospitalized for COVID-19. Our results are similar to those found in hospitalized patients with influenza or with non-COVID viral pneumonia.

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Section: Resultsmentioning

confidence: 99%

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

Candeloro

Schulman

2022

Semin Thromb Hemost

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“…Forty‐five of forty‐eight (94%) initially LA‐positive patients became LA‐negative. 31 Contrary to their study, we performed serial LA tests at relatively short intervals during hospitalization. Of the total 148 LA‐positive patients, most of the patients were confirmed as LA‐positive from the early stages of infection (128 patients (86.5%) within 10 days of SARS‐CoV‐2 positive, 87 patients (58.8%) within 5 days of SARS‐CoV‐2 positive), but 19 patients (12.8%) were negative in the early stages of infection and LA converted to be positive on median 13 days after SARS‐CoV‐2 positive.…”

Section: Discussionmentioning

confidence: 99%

Lupus anticoagulants as a prospective independent predictor in COVID‐19 patients

Kim

Chu

Kim

et al. 2022

Int J Lab Hematology

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Objective Lupus anticoagulant (LA) are commonly detected during SARS‐CoV‐2 infection. However, the relationship between LA and clinical significance is still unclear. Methods A retrospective chart analysis was performed on COVID‐19 patients who were tested for LA at our hospital from March 2020 to November 2021. We analyzed the patient's characteristics based on the result of the LA test. In addition, subgroup analysis performed the LA‐positive group who had undergone serial LA tests. Results A total of 219 COVID‐19 patients were enrolled in the study, 148 patients (67.6%) were positive for LA test. The LA‐positive group received more treatment of high flow nasal cannula (LA‐positive 73.0%, LA‐negative 57.7%, p = 0.024). The LA‐positive group showed prolonged aPTT, higher levels of CRP and fibrinogen (all p 's < 0.05). Among 148 LA‐positive patients, 127 patients (86.5%) were found to be LA‐positive within 10 days of SARS‐CoV‐2 positive, and LA‐positive group confirmed a median time to LA loss of 10 days. However, there was a group that was negative for LA in the early stages of infection and became positive about 13 days later. A subgroup analysis showed that these patients had different characteristics due to their longer hospital stays and higher D‐dimer levels. Conclusions In COVID‐19 patients, LA is expected to be associated to disease severity. Since the clinical significance of LA is different depending on the onset time of LA positivity, the LA test is suggested to be done at diagnosis of SARS‐CoV‐2 infection, even if LA is negative, follow‐up test should be considered within 10 days.

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“…Sin embargo, cabe destacar que bajos niveles de la proteína β2 glicoproteína 1, ya sea por déficit o por consumo, se han asociado previamente a mayor riesgo de insuficiencia respiratoria, sepsis y mortalidad en pacientes ingresados en unidad de cuidados intensivos 29 . También el anticoagulante lúpico fue reconocido como un factor de riesgo de muerte de causa no trombótica en pacientes con COVID-19 30 . En este contexto, nuestro hallazgo resulta de importancia, ya que en vez de medir anticuerpos antifosfolípidos que podrían constituir un epifenómeno, consideramos a los pacientes con SAF establecido.…”

Section: Discussionunclassified

Características clínicas y evolución de la infección por SARS-CoV-2 en pacientes con lupus eritematoso sistémico en Argentina: datos del registro nacional SAR-COVID

Isnardi¹,

Roberts²,

Tissera³

et al. 2023

Rev. Argent. Reumatol.

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Introducción: el lupus eritematoso sistémico (LES) es una enfermedad sistémica que se ha asociado a mayor severidad con la infección por SARS-CoV-2. Particularmente la alta actividad de la enfermedad y algunos inmunosupresores se han vinculado a peores desenlaces. Objetivos: describir las características por SARS-CoV-2 en pacientes con LES en Argentina del registro SAR-COVID y establecer los factores asociados a peor desenlace de la misma. Materiales y métodos: estudio observacional. Se incluyeron pacientes con diagnóstico de LES con infección confirmada por SARS-CoV-2 (RT-PCR y/o serología positiva) del registro SAR-COVID. Los datos se recolectaron desde agosto de 2020 hasta marzo de 2022. El desenlace de la infección se midió mediante la escala ordinal de la Organización Mundial de la Salud (EO-OMS). Se definió COVID-19 severo con un valor EO-OMS ≥5. Análisis descriptivo, test T de Student, U de Mann Whitney U, ANOVA, chi2 y Fisher. Regresión logística múltiple. Resultados: se incluyeron 399 pacientes, el 93% de sexo femenino, con una edad media de 40,9 años (DE 12,2). El 39,6% tenía al menos una comorbilidad. Al momento de la infección, el 54,9% recibía glucocorticoides, el 30,8% inmunosupresores y el 3,3% agentes biológicos. La infección por SARS-CoV-2 fue leve en la mayoría de los casos, mientras que un 4,6% tuvo curso severo y/o falleció. Estos últimos presentaban comorbilidades, usaban glucocorticoides y tenían síndrome antifosfolípido (SAF) con mayor frecuencia y mayor actividad de la enfermedad al momento de la infección. En el análisis multivariado, la hipertensión arterial, el diagnóstico de SAF y el uso de glucocorticoides se asociaron a hospitalización severa y/o muerte por COVID-19 (EO-OMS ≥5). Conclusiones: en esta cohorte de pacientes con LES con infección por SARS-CoV-2 confirmada, la mayoría cursó de manera sintomática, un 22,1% fue hospitalizado y un 5% requirió ventilación mecánica. La mortalidad fue cercana al 3%. El diagnóstico de SAF, tener hipertensión arterial y el uso de glucocorticoides se asociaron significativamente con COVID-19 severo.

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Lupus anticoagulant is an independent risk factor for non-thrombotic in-hospital mortality in COVID-19 patients

Cited by 6 publications

References 26 publications

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

Lupus anticoagulants as a prospective independent predictor in COVID‐19 patients

Características clínicas y evolución de la infección por SARS-CoV-2 en pacientes con lupus eritematoso sistémico en Argentina: datos del registro nacional SAR-COVID

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