Prevalence and clinical significance of antiphospholipid antibodies in patients with coronavirus disease 2019 admitted to intensive care units: a prospective observational study

Najim, Mostafa; Rahhal, Alaa; Khir, Fadi; Aljundi, Amer; Yousef, Safae Abu; Ibrahim, Feryal; Amer, Aliaa; Mohamed, Ahmed S.; Saleh, Samira; Alfaridi, Dekra; Mahfouz, Ahmed; Alyafei, Sumaya; Howady, Faraj; Khatib, Mohamad; Al‐Emadi, Samar

doi:10.1007/s00296-021-04875-7

Cited by 17 publications

(18 citation statements)

References 34 publications

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“…Yet during COVID-19, some authors have suggested a pathological role to aPL to explain high number of thrombotic events. However some authors did not show any relationship of aPL and thromboses [ 18 , 54 , 55 ]. Differences of aPL prevalence could be observed in all types of aPL studied.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders?

et al. 2021

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Purpose of Review COVID-19 patients have a procoagulant state with a high prevalence of thrombotic events. The hypothesis of an involvement of antiphospholipid antibodies (aPL) has been suggested by several reports. Here, we reviewed 48 studies investigating aPL in COVID-19 patients. Recent Findings Prevalence of Lupus Anticoagulant (LA) ranged from 35% to 92% in ICU patients. Anti-cardiolipin (aCL) IgG and IgM were found in up to 52% and up to 40% of patients respectively. Anti-β 2 -glycoprotein I (aβ 2 -GPI) IgG and IgM were found in up to 39% and up to 34% of patients respectively. Between 1% and 12% of patients had a triple positive aPL profile. There was a high prevalence of aβ 2 -GPI and aCL IgA isotype. Two cohort studies found few persistent LA but more persistent solid phase assay aPL over time. Summary aPL determination and their potential role is a real challenge for the treatment of this disease.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders?

et al. 2021

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“…However, the LA test is functional assay, being influenced by multiple factors and should be interpreted with caution. The presence of aCL IgG is reported in 0–48%, and aCL IgM 0–21% ( 1 , 17 ). Anti-β2-GPI antibodies are less frequent, with anti-β2-GPI IgM reported in 0–16%, and anti-β2-GPI IgG in 2–18.2% ( 17 – 20 ).…”

Section: Discussionmentioning

confidence: 99%

Autoimmune and immunoserological markers of COVID-19 pneumonia: Can they help in the assessment of disease severity

et al. 2022

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BackgroundImmune dysregulation and associated inefficient anti-viral immunity during Coronavirus Disease 2019 (COVID-19) can cause tissue and organ damage which shares many similarities with pathogenetic processes in systemic autoimmune diseases. In this study, we investigate wide range autoimmune and immunoserological markers in hospitalized patients with COVID-19.MethodsStudy included 51 patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 infection and hospitalized due to COVID-19 pneumonia. Wide spectrum autoantibodies associated with different autoimmune inflammatory rheumatic diseases were analyzed and correlated with clinical and laboratory features and pneumonia severity.ResultsAntinuclear antibodies (ANA) positivity was found in 19.6%, anti-cardiolipin IgG antibodies (aCL IgG) in 15.7%, and anti-cardiolipin IgM antibodies (aCL IgM) in 7.8% of patients. Positive atypical x anti-neutrophil cytoplasmic antibodies (xANCA) were detected in 10.0% (all negative for Proteinase 3 and Myeloperoxidase) and rheumatoid factor was found in 8.2% of patients. None of tested autoantibodies were associated with disease or pneumonia severity, except for aCL IgG being significantly associated with higher pneumonia severity index (p = 0.036). Patients with reduced total serum IgG were more likely to require non-invasive mechanical ventilation (NIMV) (p < 0.0001). Serum concentrations of IgG (p = 0.003) and IgA (p = 0.032) were significantly lower in this group of patients. Higher total serum IgA (p = 0.009) was associated with mortality, with no difference in serum IgG (p = 0.115) or IgM (p = 0.175). Lethal outcome was associated with lower complement C4 (p = 0.013), while there was no difference in complement C3 concentration (p = 0.135).ConclusionIncreased autoimmune responses are present in moderate and severe COVID-19. Severe pneumonia is associated with the presence of aCL IgG, suggesting their role in disease pathogenesis. Evaluation of serum immunoglobulins and complement concentration could help assess the risk of non-invasive mechanical ventilation NIMV and poor outcome.

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“…A review of these studies, however, nevertheless lends itself to several key observations. Some have found no consistent association of antiphospholipid antibodies and thrombosis or disease severity [46,49,51,53,64,69,71]. Whether detected at the time of first patient presentation or shortly thereafter, such antibody status is time-accrued, maximizes in over 1 month after infection onset, and tends to be transient [49,68,70].…”

Section: Antiphospholipid Antibodies and Covid-19 Infectionmentioning

confidence: 99%

Untangling the Intricacies of Infection, Thrombosis, Vaccination, and Antiphospholipid Antibodies for COVID-19

Cimolai

2021

SN Compr. Clin. Med.

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Advanced SARS-CoV-2 infections not uncommonly associate with the occurrence of silent or manifest thrombotic events which may be found as focal or systemic disease. Given the potential complexity of COVID-19 illnesses, a multifactorial causation is likely, but several studies have focused on infection-induced coagulopathy. Procoagulant states are commonly found in association with the finding of antiphospholipid antibodies. The correlation of the latter with thrombosis and/or clinical severity remains controversial. Although measures of antiphospholipid antibodies most commonly include assessments for lupus anticoagulant, anticardiolipin, and anti-ß2-glycoprotein-I antibodies, lesser common antibodies have been detected, and there remains speculation that other yet undiscovered autoimmune thrombotic events may yet be found. The recent discovery of post-vaccination thromboses associated with platelet factor 4 antibody has created another level of concern. The pathogenesis of antiphospholipid antibodies and their role in COVID-19-related thrombosis deserves further attention. The multifactorial nature of thrombosis associated with both infection and vaccination should continue to be studied as new events unfold. Even if a cause-and-effect relationship is variable at best, such dedicated research is likely to generate other valuable insights that are applicable to medicine generally.

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Prevalence and clinical significance of antiphospholipid antibodies in patients with coronavirus disease 2019 admitted to intensive care units: a prospective observational study

Cited by 17 publications

References 34 publications

Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders?

Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders?

Autoimmune and immunoserological markers of COVID-19 pneumonia: Can they help in the assessment of disease severity

Untangling the Intricacies of Infection, Thrombosis, Vaccination, and Antiphospholipid Antibodies for COVID-19

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