ADAMTS-13 Behavior in Thrombocytopenia of Infectious Origin in ICU Patients

Thrombocytopenia is a common hematological abnormality in intensive care unit (ICU) patients, with varying incidence across populations. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 (ADAMTS-13), a plasma serine protease, plays a crucial role in modulating von Willebrand factor (vWF) activity by cleaving its ultra-large (UL) multimers and preventing excess platelet aggregation. This study aimed to evaluate the association between ADAMTS-13 levels, viral and non-viral (NV) infections, and thrombocytopenia severity.

This Prospective observational study included adult ICU patients with thrombocytopenia, categorized into viral and non-viral groups. Thrombocytopenia severity was assessed by absolute platelet count on diagnosis day. Statistical analyses evaluated correlations between ADAMTS-13 levels, thrombocytopenia severity, and clinical outcomes, including bleeding episodes, transfusion needs, and overall patient outcomes.

Among 72 patients (30 viral, 42 non-viral), lower ADAMTS-13 activity correlated significantly with thrombocytopenia severity in both groups (p < 0.05), with a greater deficiency observed in NV cases. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 levels were associated with bleeding episodes, transfusion requirements, and thrombocytopenia progression in both groups but did not predict increased transfusion needs despite lower platelet counts.

This study highlights an association between reduced ADAMTS-13 activity, infection type, and thrombocytopenia severity, especially in NV infections. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 (ADAMTS-13) depletion and increased vWF activity may contribute to infection-related thrombocytopenia pathogenesis. These findings suggest that ADAMTS-13 levels could aid in assessing thrombocytopenia severity and prognosis, informing early management strategies and transfusion guidelines.

This study found that low ADAMTS-13 activity is associated with higher disease severity in both viral and non-viral infections, particularly in NV cases. While thrombocytopenia correlated with reduced ADAMTS-13 activity, it did not lead to increased platelet transfusions.

Gontla VDK, Samavedam S, Aluru N, Rudravarapu R, Pabba S, Shaik MN. ADAMTS-13 Behavior in Thrombocytopenia of Infectious Origin in ICU Patients. Indian J Crit Care Med 2025;29(2):143-147.