Anticoagulant protein S in COVID-19: low activity, and associated with outcome.
Introduction. COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.Aim. Assessment of protein S activity in patients with COVID-19 as a cause of this prothrombotic state, and of the association of protein S activity with worse outcome.Methods. All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, while secondary outcomes were clinical severity and lung damage.Results. 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p < 0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = -0.320, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = -0.290, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001). High neutrophil count was also independently associated with death (p = 0.002).Conclusion. Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.
['Stoichitoiu|Laura Elena|LE|', 'Pinte|Larisa|L|', 'Balea|Marius Ioan|MI|', 'Nedelcu|Valentin|V|', 'Badea|Camelia|C|', 'Baicus|Cristian|C|']
D000086382:COVID-19 D006801:Humans D007958:Leukocyte Count D008168:Lung D009504:Neutrophils D011446:Prospective Studies D017293:Protein S D000086402:SARS-CoV-2 D012720:Severity of Illness Index D016019:Survival Analysis D013923:Thromboembolism D014057:Tomography, X-Ray Computed
protein S COVID-19 neutrophilia thrombophilia thrombosis