Abstract Number: PB0298
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background:
COVID-19 is associated with an intense inflammatory response and an increased risk of thrombosis. High levels of D-dimer (DD), fibrinogen (Fg), von Willebrand factor (vWF) and factor VIII (FVIII) was reported among patients with severe disease.
Aims: We aimed to characterize the relationship between vWF and other coagulation factors and clinical outcome among inpatients with severe COVID-19.
Methods:
We conducted a cross-sectional study of COVID-19 inpatients admitted in Mexico National Institute of Cardiology between April and December 2020. Patients with severe COVID-19 diagnosis who were admitted to the Intensive Care Unit were included. Blood samples were collected and processed according to the standardized institutional procedures. For patients who had anticoagulation therapy with heparin, anti-Xa level was determined. Patient’s demographic and clinical characteristics, inflammatory and coagulation markers, and clinical outcome (thrombosis, mechanical ventilation, and death) were retrieved from the electronic medical records. Descriptive statistics and multivariate models were performed to assess associations between coagulation factors and clinical outcome.
Results:
A total of 58 patients were included during the study period. The mean age was 53.7 +14 years and 75.9% were men. Overall, 84.2% required mechanical ventilation, 25% had thrombosis (pulmonary embolism and/or deep vein thrombosis).
Both vWFAg and vWFRCo were increased; the median value was 362.2% and 297.3% respectively. Among patients who died, a significantly increase in VWF measured by both methods was found. Of the 58 patients, 38 (65.5%) had mechanical ventilation and 22 (57.9%) died. Mortality was significantly higher among patients with mechanical ventilation (57.9% vs 42.1%; p <0.001.
| Total 58 (%) |
Alive 36 (%) |
Death 22 (%) |
OR (CI 95%) | P-value | |
| Male | 44 (75.9) | 24 (66.7) | 20 (90.9) | 5 (0.99-25.02) | 0.057 |
| Age > 60 years | 18 (31) | 11 (30.6) | 7 (31.8) | 1.06 (0.34-3.33) | 0.920 |
| Biochemical markers*, mean (SD) or median (RIQ) | |||||
| C-reactive protein | 124.4 (53.2-201.9) | 100.7 (40-140.6) | 151.1 (95-359.8) | – | 0.011 |
| Fibrinogen | 5.9 (2.1) | 5.9 (2) | 6.2 (2.5) | – | 0.513 |
| D-dimer | 1.3 (0.63-2) | 1.3 (0.6-2.5) | 1.4 (0.8-1.9) | – | 0.694 |
| Factor VIII (%) | 296.5 (113.1) | 262.6 (115.3) | 305.8 (112) | – | 0.853 |
| Factor von Wilebrand Ag (%) | 362.2 (261.4-481.6) | 299.5 (235.1-400.5) | 421.8 (299.6-521.6) | – | 0.023 |
| Factor von Wilebrand CoRi (%) | 297.3 (203.3-487.1) | 247 (191.9-383) | 364.9 (247.3-539) | – | 0.023 |
Clinical characteristics and factors associated with death among COVID-19 patients. *The measure of central tendency and dispersion was chosen based on the distribution of the data according to the Kolmogorov-Smirnov test.
| Without mechanical ventilation (%) |
With mechanical ventilation (%) |
OR (CI 95%) | P-value | |
| Biochemical markers*, mean (SD) or median (RIQ) | ||||
| Factor von Wilebrand Ag (%) | 266.5 (220.5-299.5) | 421.8 (334.4-517.5) | – | <0.001 |
| Factor von Wilebrand CoRi (%) | 202.5 (187-241) | 364.9 (283.4-540.5) | – | <0.001 |
| Outcomes, n (%) | ||||
| Days from admission to discharge or death, median (IQR) | 11 (7-15) | 44 (22-55) | – | <0.001 |
| Thrombosis | 5 (25) | 7 (18.4) | 0.68 (0.18-2.49) | 0.734 |
| Deep vein thrombosis | 3 (15) | 6 (15.8) | 1.06 (0.24-4.79) | 1 |
| Pulmonary embolism | 3 (15) | 1 (2.6) | 0.15 (0.02-1.58) | 0.114 |
Clinical characteristics and factors associated with mechanical ventilation among COVID-19 patients. *The measure of central tendency and dispersion was chosen based on the distribution of the data according to the Kolmogorov-Smirnov test.
Conclusions:
In this study, we determined the levels of antigenic and RCo vWF in 58 patients with moderate-severe COVID-19. The vWF was markedly increased among patients with severe clinical presentation. Both antigenic and functional vWF were significantly associated with mechanical ventilation and death.
To cite this abstract in AMA style:
Rivera-Buendia F, Garcia-Chavez LE, Cortina-de la Rosa E, Grimaldo-Gomez FA, Altamirano-Solorzano GA, Anguiano-Alvarez VM, Romero-Arroyo MO, Izaguirre-Avila R. Relationship between von Willebrand Factor and Clinical Outcome in Patients with Severe COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/relationship-between-von-willebrand-factor-and-clinical-outcome-in-patients-with-severe-covid-19/. Accessed December 6, 2023.« Back to ISTH 2021 Congress
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