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Antiphospholipid Antibodies in Critically Ill Patients With COVID‐19
Author(s) -
Xiao Meng,
Zhang Yan,
Zhang Shulan,
Qin Xuzhen,
Xia Peng,
Cao Wei,
Jiang Wei,
Chen Huan,
Ding Xin,
Zhao Hua,
Zhang Hongmin,
Wang Chunyao,
Zhao Jing,
Sun Xuefeng,
Tian Ran,
Wu Wei,
Wu Dong,
Ma Jie,
Chen Yu,
Zhang Dong,
Xie Jing,
Yan Xiaowei,
Zhou Xiang,
Liu Zhengyin,
Wang Jinglan,
Du Bin,
Qin Yan,
Gao Peng,
Lu Minya,
Hou Xin,
Wu Xian,
Zhu Huadong,
Xu Yingchun,
Zhang Wen,
Li Taisheng,
Zhang Fengchun,
Zhao Yongqiang,
Li Yongzhe,
Zhang Shuyang
Publication year - 2020
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41425
Subject(s) - antibody , medicine , coagulopathy , immunology , covid-19 , critically ill , immunoassay , disease , infectious disease (medical specialty)
Objective Coagulopathy is one of the characteristics observed in critically ill patients with coronavirus disease 2019 (COVID‐19). Antiphospholipid antibodies (aPLs) contribute to coagulopathy, though their role in COVID‐19 remains unclear. This study was undertaken to determine the prevalence and characteristics of aPLs in patients with COVID‐19. Methods Sera collected from 66 COVID‐19 patients who were critically ill and 13 COVID‐19 patients who were not critically ill were tested by chemiluminescence immunoassay for anticardiolipin antibodies (aCLs), anti–β 2 ‐glycoprotein I (anti‐β 2 GPI) (IgG, IgM, and IgA), and IgG anti‐β 2 GPI–domain 1 (anti‐β 2 GPI–D1) and IgM and IgG anti–phosphatidylserine/prothrombin (anti‐PS/PT) antibodies were detected in the serum by enzyme‐linked immunosorbent assay. Results Of the 66 COVID‐19 patients in critical condition, aPLs were detected in 31 (47% ). Antiphospholipid antibodies were not present among COVID‐19 patients who were not in critical condition. The IgA anti‐β 2 GPI antibody was the most commonly observed aPL in patients with COVID‐19 and was present in 28.8% (19 of 66) of the critically ill patients, followed by IgA aCLs (17 of 66, or 25.8%) and IgG anti‐β 2 GPI (12 of 66, or 18.2%). For multiple aPLs, IgA anti‐β 2 GPI + IgA aCLs was the most common antibody profile observed (15 of 66, or 22.7%), followed by IgA anti‐β 2 GPI + IgA aCL + IgG anti‐β 2 GPI (10 of 66, or 15.2%). Antiphospholipid antibodies emerge ~35–39 days after disease onset. A dynamic analysis of aPLs revealed 4 patterns based on the persistence or transient appearance of the aPLs. Patients with multiple aPLs had a significantly higher incidence of cerebral infarction compared to patients who were negative for aPLs ( P = 0.023). Conclusion Antiphospholipid antibodies were common in critically ill patients with COVID‐19. Repeated testing demonstrating medium to high titers of aPLs and the number of aPL types a patient is positive for may help in identifying patients who are at risk of developing cerebral infarction. Antiphospholipid antibodies may be transient and disappear within a few weeks, but in genetically predisposed patients, COVID‐19 may trigger the development of an autoimmune condition similar to the antiphospholipid syndrome (APS), referred to as “COVID‐19–induced APS‐like syndrome.” Long‐term follow‐up of COVID‐19 patients who are positive for aPLs would be of great importance in understanding the pathogenesis of this novel coronavirus.