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ADAMTS13 activity to von Willebrand factor antigen ratio predicts acute kidney injury in patients with COVID‐19: Evidence of SARS‐CoV‐2 induced secondary thrombotic microangiopathy
Author(s) -
Henry Brandon Michael,
Benoit Stefanie W.,
Oliveira Maria Helena Santos,
Lippi Giuseppe,
Favaloro Emmanuel J.,
Benoit Justin L.
Publication year - 2021
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.13415
Subject(s) - adamts13 , medicine , thrombotic microangiopathy , von willebrand factor , odds ratio , acute kidney injury , gastroenterology , thrombotic thrombocytopenic purpura , disease , platelet
Severe COVID‐19 is often compounded by a prothrombotic state that is associated with poor outcomes. In this investigation, we aimed to evaluate ADAMTS13 activity, von Willebrand factor level (VWF:Ag), and the corresponding ADAMTS13 activity/VWF:Ag ratio, in patients with COVID‐19 and for associations with disease progression and acute kidney injury (AKI). Methods Patients presenting to the emergency department (ED) with COVID‐19 were enrolled in this prospective, observational study. ADAMTS13 activity and VWF:Ag were measured at index ED visit. The primary endpoint was severe AKI defined by KDIGO stage 2 + 3 criteria, while the secondary endpoint was peak 30‐day COVID‐19 severity. Results A total of 52 adult COVID‐19 patients were enrolled. Overall, we observed that 23.1% of the cohort had a relative deficiency in ADAMTS13 activity, while 80.8% had elevated VWF:Ag. The ADAMTS13 activity/VWF:Ag ratio was significantly lower in patients with severe AKI ( P = .002) and those who developed the severe form of COVID‐19 ( P = .020). The ADAMTS13 activity/VWF:Ag ratio was negatively correlated with age ( P < .001) and LDH ( P < .001), while positively correlated with hemoglobin ( P = .041). After controlling for confounders, a one‐unit increase in ADAMTS13/VWF:Ag ratio was associated with 20% decreased odds of severe AKI. Conclusion A low ADAMTS13 activity:VWF:Ag ratio at ED presentation is associated with progression to severe COVID‐19 disease and severe AKI, with a pattern suggestive of a secondary microangiopathy. Further interventional studies should be conducted to assess the restoration of ADAMTS13:VWF:Ag ratio in hospitalized patients with COVID‐19.