Abstract Number: PB0149
Meeting: ISTH 2021 Congress
Background: Endotheliopathy is a key element in COVID-19 pathophysiology, contributing to both morbidity and mortality. Biomarkers distinguishing different COVID-19 phenotypes from sepsis syndromes remain poorly understood.
Aims: We aimed to characterize circulating biomarkers of endothelial damage in different COVID-19 clinical disease stages in comparison to sepsis syndromes and normal volunteers.
Patients with COVID-19 pneumonia (n=49) were included and classified into moderate, severe or critical (life-threatening). Patients with other septic syndromes: sepsis (S, n=7), septic shock (SS, n=14) and patients with non-infectious systemic inflammatory response syndrome (NI-SIRS, n=7) were also included. Plasma samples were collected within 48-72h of hospitalization to analyze endothelial activation markers, including sVCAM-1, VWF, ADAMTS-13 activity, thrombomodulin (TM) and soluble TNF receptor I (sTNFRI); heparan sulfate (HS) for endothelial glycocalyx degradation; C5b9 deposits on endothelial cells in culture and soluble C5b9 for complement activation; circulating dsDNA for neutrophil extracellular traps (NETs) presence, and α2-antiplasmin and PAI-1 as parameters of fibrinolysis. Results were compared to healthy donors as controls (n=45); all three COVID-19 groups and septic shock patients.
All analyzed biomarkers were increased in COVID-19 patients vs. controls (p<0.001), except for ADAMTS-13 activity which was normal in both groups. Correlation with disease severity was observed for sVCAM-1, VWF, sTNFRI and HS (p<0.05). SS patients showed significantly higher levels of VWF, TM, sTNFRI and NETS, with reduced ADAMTS-13 activity (p<0.05). Importantly, α2-antiplasmin activity was higher in critical COVID-19 (p<0.001) vs. SS.
Conclusions: COVID-19 patients present increased circulating endothelial stress products, complement activation and fibrinolytic dysregulation, associated with disease severity. COVID-19 endotheliopathy differs from SS, in which endothelial damage is also a critical feature of pathobiology. These biomarker profiles may inform therapeutic intervention in COVID-19.
This study was supported by Fundació Clínic, Barcelona (HCB/2020/0401) and Jazz Pharmaceuticals (IST-16-10355).
To cite this abstract in AMA style:Moreno-Castaño AB, Fernandez S, Palomo M, Martinez-Sanchez J, Torramade-Moix S, Tellez A, Ventosa H, Segui F, Escolar G, Carreras E, Nicolas JM, Richardson E, Garcia-Bernal D, Carlo-Stella C, Moraleda JM, Richardson P, Diaz-Ricart M, Castro P. Distinctive Biomarker Features in the Endotheliopathy of Covid-19 and Septic Syndromes [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/distinctive-biomarker-features-in-the-endotheliopathy-of-covid-19-and-septic-syndromes/. Accessed September 24, 2021.
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