Skip to main content
ISTH 2023 Main banner
Back

    Poster Networking

    COVID

    Poster Networking Session

    PB0604 - The VWF-ADAMTS13 axis as biomarkers of disease progression in severe COVID-19

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition
    Background: Von Willebrand factor (VWF), when secreted from activated endothelial cells (EC), regulates platelet recruitment and protects coagulation factor VIII (FVIII). As such, VWF is an indicator of acute EC activation and is elevated in severe COVID-19. ADAMTS13, the protease that processes VWF, is also reduced in severe COVID-19. These observations explain how EC injury may result in COVID-19-associated coagulopathy. However, the role of these biomarkers throughout disease progression and after acute SARS-CoV-2 infection requires further investigation.

    Aims: To assess biomarkers of the VWF-ADAMTS13 axis throughout disease progression in severe COVID-19 and further validate their association with clinical outcomes.

    Methods: Plasma samples were collected from 51 COVID-19 patients admitted to ICU. Two samples were analyzed, one at admission and another between days 5 and 15. An additional sample was collected at day 21/22 for patients confirmed COVID-19 negative via qRT-PCR. Clinical outcomes related to coagulopathy were recorded. VWF antigen (VWF:Ag), activity (VWF:GPIbM), propeptide (VWFpp), FVIII, ADAMTS13 activity (ADAMTS13:Ac) and antigen (ADAMTS13:Ag) were measured in all samples.

    Results: Clinical outcomes included deep vein thrombosis, pulmonary embolism, stroke, and death (Table 1). VWF:Ag and VWF:GPIbM were markedly elevated with mean values peaking at days 11 to 15 (Figure 1A, 1B). FVIII and VWFpp values were moderately elevated and displayed similar patterns throughout disease progression. Mean ADAMTS13:Ac and ADAMTS13:Ag values were below normal range, with some patients experiencing an ADAMTS13:Ac reduction to ≤10% (Figure 1C). There was significant association (P≤0.05) between VWF:Ag, VWF:GPIbM, VWFpp, and ADAMTS13:Ag levels at days 5 to 15 and death. VWF:GPIbM and VWFpp levels during days 5 to 15 were also associated with stroke.

    Conclusion(s): This study has confirmed the association of VWF-ADAMTS13 axis biomarkers with significant clinical outcomes and highlights their value during active infection. Severe COVID-19 may also induce acquired thrombotic thrombocytopenic purpura-like symptoms and EC activation that persist beyond acute infection.