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Published on: August 14, 2017
Plasma Von Willebrand Factor Levels Predict Survival in COVID-19 Patients Across the Entire Spectrum of Disease
Vineeth Varghese Thomas1, Santhosh E Kumar2, Vijay Alexander2
1Departments of Medicine, Christian Medical College, Vellore, Tamil Nadu India.
Insights
Reticulo-endothelial activation, particularly endothelial marker von Willebrand factor (VWF), increases with COVID-19 severity. Elevated VWF independently predicts disease severity and in-hospital death.
Area of Science:
- Immunology
- Virology
- Critical Care Medicine
Background:
- Reticulo-endothelial system activation is implicated in COVID-19 pathogenesis.
- Understanding this activation may inform therapeutic strategies for COVID-19.
Purpose of the Study:
- To evaluate reticulo-endothelial activation markers in hospitalized COVID-19 patients.
- To correlate these markers with COVID-19 disease severity and patient survival.
- To investigate the role of macrophage and endothelial activation markers.
Main Methods:
- Consecutive hospitalized COVID-19 patients were categorized by disease severity.
- Baseline serum ferritin, sCD163 (macrophage activation), and plasma von Willebrand factor (VWF) antigen (endothelial activation) were measured.
- Clinical parameters, D-dimer, and survival data were analyzed for correlations.
Main Results:
- Ferritin, sCD163, VWF, and D-dimer levels increased with COVID-19 severity.
- Elevated VWF levels (>332.6 units/dl) significantly correlated with increased COVID-19 severity (OR: 2.77) and in-hospital death (OR: 29.28).
- Most patients (139) had normal sCD163 levels, suggesting limited macrophage activation.
Conclusions:
- Reticulo-endothelial activation markers, including VWF, rise with worsening COVID-19.
- Baseline VWF, an endothelial activation marker, independently predicts COVID-19 severity and mortality.
- Macrophage activation markers (sCD163) did not show independent correlation with outcomes.
Background:
Characterization of reticulo-endothelial activation in COVID-19 may guide treatment.
Objectives:
To assess reticulo-endothelial activation and its correlation with disease severity and death in patients across the entire spectrum of COVID-19 severity.
Methods:
Consecutive hospitalized COVID-19 patients were studied, with similar number of patients in each disease severity category. Baseline serum ferritin, sCD163 (macrophage activation markers) and plasma von Willebrand factor (VWF) antigen (endothelial activation marker) levels were studied. Clinical parameters and plasma D-dimer levels were also studied. The study parameters were correlated with COVID-19 severity and survival.
Results:
The 143 patients (104 males [80%], age 54 [42 - 65] years, median [inter-quartile range]) presented 4 (3-7) days after symptom onset. Thirty-four patients had mild disease, 36 had moderate disease, 36 had severe disease and 37 had critical disease at baseline. With increasing COVID-19 severity, ferritin, sCD163, VWF and D-dimer levels significantly increased at baseline, however, 139 patients had normal sCD163 levels. Of the reticulo-endothelial markers, VWF level independently correlated with COVID-19 severity and with survival. VWF level > 332.6 units/dl correlated with COVID-19 severity (odds ratio [OR]: 2.77 [95% confidence interval (C.I): 1.1 - 6.99], p value: 0.031) and in-hospital death (OR [95% CI]: 29.28 [5.2 - 165], p value < 0.001).
Conclusions:
Reticulo-endothelial activation markers increased incrementally with worsening COVID-19 severity. Baseline endothelial activation marker (VWF), and not macrophage activation markers, independently correlated with COVID-19 severity and death.
