The ADAMTS13-von Willebrand factor axis in COVID-19 patients.
BACKGROUND
Severe coronavirus disease 2019 (COVID-19) is characterized by an increased risk of thromboembolic events, with evidence of microthrombosis in the lungs of deceased patients.


OBJECTIVES
To investigate the mechanism of microthrombosis in COVID-19 progression.


PATIENTS/METHODS
We assessed von Willebrand factor (VWF) antigen (VWF:Ag), VWF ristocetin-cofactor (VWF:RCo), VWF multimers, VWF propeptide (VWFpp), and ADAMTS13 activity in a cross-sectional study of 50 patients stratified according to their admission to three different intensity of care units: low (requiring high-flow nasal cannula oxygenation, n = 14), intermediate (requiring continuous positive airway pressure devices, n = 17), and high (requiring mechanical ventilation, n = 19).


RESULTS
Median VWF:Ag, VWF:RCo, and VWFpp levels were markedly elevated in COVID-19 patients and increased with intensity of care, with VWF:Ag being 268, 386, and 476 IU/dL; VWF:RCo 216, 334, and 388 IU/dL; and VWFpp 156, 172, and 192 IU/dL in patients at low, intermediate, and high intensity of care, respectively. Conversely, the high-to-low molecular-weight VWF multimers ratios progressively decreased with increasing intensity of care, as well as median ADAMTS13 activity levels, which ranged from 82 IU/dL for patients at low intensity of care to 62 and 55 IU/dL for those at intermediate and high intensity of care.


CONCLUSIONS
We found a significant alteration of the VWF-ADAMTS13 axis in COVID-19 patients, with an elevated VWF:Ag to ADAMTS13 activity ratio that was strongly associated with disease severity. Such an imbalance enhances the hypercoagulable state of COVID-19 patients and their risk of microthrombosis.
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D000071120:ADAMTS13 Protein D000328:Adult D000368:Aged D000369:Aged, 80 and over D015415:Biomarkers D001777:Blood Coagulation D000086382:COVID-19 D003430:Cross-Sectional Studies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D012720:Severity of Illness Index D013927:Thrombosis D014841:von Willebrand Factor
COVID-19 von Willebrand factor ADAMTS13 Protein Microvasculature Severe acute respiratory syndrome coronavirus 2 Thrombosis