Von Willebrand factor propeptide in severe coronavirus disease 2019 (COVID-19): evidence of acute and sustained endothelial cell activation
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2021Author:
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Ward, S.E. and Curley, G.F. and Lavin, M. and Fogarty, H. and Karampini, E. and McEvoy, N.L. and Clarke, J. and Boylan, M. and Alalqam, R. and Worrall, A.P. and Kelly, C. and de Barra, E. and Glavey, S. and Ni Cheallaigh, C. and Bergin, C. and Martin-Loeches, I. and Townsend, L. and Mallon, P.W. and O'Sullivan, J.M. and O'Donnell, J.S. and O'Connell, N. and Ryan, K. and Byrne, M. and Preston, R. and Kenny, D., Von Willebrand factor propeptide in severe coronavirus disease 2019 (COVID-19): evidence of acute and sustained endothelial cell activation, British Journal of Haematology, 192, 4, 2021, 714-719Download Item:
Abstract:
Endothelial cell (EC) activation plays a key role in the pathogenesis of pulmonarymicrovascular occlusion, which is a hallmark of severe coronavirus disease 2019(COVID-19). Consistent with EC activation, increased plasma von Willebrand factorantigen (VWF:Ag) levels have been reported in COVID-19. Importantly however,studies in other microangiopathies have shown that plasma VWF propeptide(VWFpp) is a more sensitive and specific measure of acute EC activation. In the pre-sent study, we further investigated the nature of EC activation in severe COVID-19.Markedly increased plasma VWF:Ag [median (interquatile range, IQR) 608 8 (531–830)iu/dl] and pro-coagulant factor VIII (FVIII) levels [median (IQR) 261 9 (170–315) iu/dl] were seen in patients with severe severe acute respiratory syndrome coro-navirus-2 (SARS-CoV-2) infection. Sequential testing showed that these elevatedVWF–FVIII complex levels remained high for up to 3 weeks. Similarly, plasmaVWFpp levels were also markedly elevated [median (IQR) 324 6 (267–524) iu/dl].Interestingly however, the VWFpp/VWF:Ag ratio was reduced, demonstrating thatdecreased VWF clearance contributes to the elevated plasma VWF:Ag levels in severeCOVID-19. Importantly, plasma VWFpp levels also correlated with clinical severityindices including the Sequential Organ Failure Assessment (SOFA) score, Sepsis-Induced Coagulopathy (SIC) score and the ratio of arterial oxygen partial pressure tofractional inspired oxygen (P/F ratio). Collectively, these findings support thehypothesis that sustained fulminant EC activation is occurring in severe COVID-19,and further suggest that VWFpp may have a role as a biomarker in this setting
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Author: Ni Cheallaigh, Cliona
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British Journal of Haematology192
4
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Endothelial cell (EC), von Willebrand factorantigen (VWF:Ag), Sequential Organ Failure Assessment (SOFA) scoreDOI:
http://dx.doi.org/10.1111/bjh.17273Metadata
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