The Prognostic Value of ADAMTS-13 and von Willebrand Factor in COVID-19 Patients: Prospective Evaluation by Care Setting

Abstract

Background: Endothelial dysfunction, coupled with inflammation, induces thrombo-inflammation. In COVID-19, this process is believed to be associated with clinical severity. Von Willebrand factor (VWF), and a disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS-13), are strong markers of endothelial dysfunction. We evaluated the impact of the VWF/ADAMTS-13 fraction on COVID-19 severity and prognosis. Materials and methods: A cohort study including 74 COVID-19 patients, with 22 admitted to the intensive care unit (ICU) and 52 to the medical ward (MW), was carried out. We also evaluated, in a group of 54 patients who were prospectively observed, whether variations in VWF/ADAMTS-13 correlated with the degree of severity and routine blood parameters. Results: A VWF:RCo/ADAMTS-13 fraction above 6.5 predicted in-hospital mortality in the entire cohort. At admission, a VWF:RCo/ADAMTS-13 fraction above 5.7 predicted admission to the ICU. Furthermore, the VWF:RCo/ADAMTS-13 fraction directly correlated with C-reactive protein (CRP) (Spearman r: 0.51, p < 0.0001) and D-dimer (Spearman r: 0.26, p = 0.03). In the prospective cohort, dynamic changes in VWF:RCo/ADAMTS-13 and the CRP concentration were directly correlated (Spearman r, p = 0.0014). This relationship was significant in both groups (ICU: p = 0.006; MW: p = 0.02).Conclusions: The present findings show that in COVID-19, the VWF/ADAMTS-13 fraction predicts in-hospital mortality. The VWF/ADAMTS-13 fraction may be a helpful tool to monitor COVID-19 patients throughout hospitalization.

Von Willebrand Factor and ADAMTS-13 Are Associated with the Severity of COVID-19 Disease

“…To calculate these ratios, the ADAMTS-13 concentration and vWF activity were measured in IU/mL (%/100). The literature contains data on the prognostic value of these ratios in terms of the severity of infection [ 13 ]. For example, a vWF:RCo/ADAMTS-13:activity level > 5.7 is associated with ICU admission, and a level > 6.5 was associated with increased patient mortality.…”

“…The diagnostic and prognostic value of vWF/ADAMTS-13 ratio has been studied in several studies [ 12 , 13 ]. In our study we found that, at the time of patient’s admission to a hospital, the vWF:RCo/ADAMTS-13:activity ratio has a greater diagnostic value than the vWF/ADAMTS-13 ratio.…”

“…A ratio above 5.7 (at the time of hospitalization) is associated with admission to the intensive care unit. Additionally, the vWF/ADAMTS-13 ratio correlates with C-reactive protein and D-dimer levels [ 13 ]. Thus, the analysis of the vWF/ADAMTS-13 ratio makes it possible to predict the course of COVID-19 when a patient is admitted to a hospital and can also be a useful tool for monitoring the severity of the disease.…”

Dynamic Assessment of Plasma von Willebrand Factor and ADAMTS13 Predicts Mortality in Hospitalized Patients with SARS-CoV-2 Infection

“…In a cohort of hospitalized patients with a suspected heparin-induced thrombocytopenia (HIT), high levels of plasma VWF antigen and low levels of ADAMTS13 activity were associated with increased mortality regardless of the HIT testing results by immunoassay or serotonin-releasing assay [76]. The prognostic value of the VWF/ADAMTS13 ratios in COVID-19 patients has also been reported by other groups [67,77]. Interestingly, plasma ADAMTS13 activity alone is not an independent predictor of all in-hospital mortality of COVID-19 patients after adjusting for other related factors in our study (not shown).…”

Prognostic value of von Willebrand factor and ADAMTS13 in patients with COVID-19: A systematic review and meta-analysis

“…The final full-text review included 163 reports, from which 123 studies did not meet the inclusion criteria and were excluded. A total of 40 studies comprising of 3764 patients met the including criteria and were included in this systematic review and meta-analysis [24] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] . Fig.…”