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Antiphospholipid Antibodies in Critically Ill Patients With COVID-19

Meng Xiao1, Yan Zhang1, Shulan Zhang1

  • 1Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Arthritis & Rheumatology (Hoboken, N.J.)
|July 1, 2020
PubMed

Insights

Antiphospholipid antibodies (aPLs) were found in 47% of critically ill COVID-19 patients, with IgA anti-β2 GPI being the most common. These antibodies may indicate a higher risk of cerebral infarction in severe COVID-19 cases.

Area of Science:

  • Immunology
  • Virology
  • Critical Care Medicine

Background:

  • Coagulopathy is a known complication in critically ill COVID-19 patients.
  • The role of antiphospholipid antibodies (aPLs) in COVID-19-associated coagulopathy is not fully understood.

Purpose of the Study:

  • To determine the prevalence and characteristics of aPLs in patients with COVID-19.
  • To investigate the association between aPLs and severe outcomes in COVID-19.

Main Methods:

  • Sera from 66 critically ill and 13 non-critically ill COVID-19 patients were tested for various aPLs using chemiluminescence immunoassay and ELISA.
  • Antibody detection included anticardiolipin antibodies (aCLs), anti-β2-glycoprotein I (anti-β2 GPI), and anti-phosphatidylserine/prothrombin (anti-PS/PT).

Main Results:

  • aPLs were detected in 47% of critically ill COVID-19 patients, but none in non-critically ill patients.
  • IgA anti-β2 GPI was the most prevalent aPL (28.8%), followed by IgA aCLs (25.8%) and IgG anti-β2 GPI (18.2%).
  • Patients with multiple aPLs had a significantly higher incidence of cerebral infarction (P=0.023).

Conclusions:

  • Antiphospholipid antibodies are common in critically ill COVID-19 patients and may be transient.
  • The presence of multiple aPLs or high titers could identify patients at risk for cerebral infarction.
  • COVID-19 may trigger an antiphospholipid syndrome-like condition in susceptible individuals.
Abstract

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