背景:2019年冠状病毒病(COVID-19)感染与动脉血栓栓塞事件(ATE)和静脉血栓栓塞事件(VTE)的风险增加相关。与COVID-19感染相关的高凝状态是多因素的,潜在导致血栓形成的潜在致病机制包括导致内皮损伤的炎症,血小板活化和抗磷脂抗体(APAs)的存在。抗磷脂抗体综合征是与静脉和动脉血栓栓塞事件相关的极少数原因之一。COVID-19患者的APA以及ATE和VTE的患病率很高,但其在COVID-19患者中的临床意义尚不完全清楚。
目的:在本研究中,我们打算在确诊时发现住院COVID-19患者中APA的患病率,并确定其存在是否具有任何临床意义.
方法:这是一项回顾性的单机构研究,涉及托莱多大学医学中心因COVID-19感染而住院的患者。在获得托莱多大学生物医学机构审查委员会的批准后,对这些患者预先储存的血液样本进行抗磷脂抗体(APA)检测,并在COVID-19检测结果为阳性后6个月内回顾医院病历.根据患者的APA检测结果(APA阳性和APA阴性)创建两组,并进行统计比较。任何狼疮抗凝剂(LA)阳性或APA抗体滴度异常的患者均标记为阳性。人口统计数据,采用连续变量的Mann-WhitneyU检验或分类变量的Fisher精确检验比较预后结局和实验室值.
结果:本研究确诊时住院COVID-19患者中APA的患病率为39.3%。APA阳性和APA阴性组之间的人口统计学变量没有差异。吸烟者的APA患病率较高,其中91%的APA阳性患者是吸烟者。APA阳性和APA阴性患者的预后结果(包括6个月死亡率)无统计学差异。两组的合并症特征相同。发现APA阳性患者在住院期间绝对淋巴细胞计数的最低点较低,C反应蛋白的最低点较高。
结论:在我们的研究中,住院COVID-19患者的APA阳性患病率高于涉及非COVID-19住院患者的历史研究,尤其是吸烟者。然而,APA阳性与包括6个月死亡率在内的预后结局无相关性.在这一点上,目前尚不清楚APA是否只是旁观者或具有致病作用。不需要对COVID-19患者进行APA常规检测。需要进一步的前瞻性研究来阐明APA的持久性和临床意义。
BACKGROUND: Coronavirus disease 2019 (COVID-19) infection is associated with an increased risk of arterial thromboembolic events (ATE) and venous thromboembolic events (VTE). Hypercoagulability associated with COVID-19 infection is multifactorial, and underlying pathogenic mechanisms potentially responsible for thrombosis include inflammation resulting in endothelial damage, platelet activation and the presence of antiphospholipid antibodies (APAs). Antiphospholipid antibody syndrome is one of the very few causes which is associated with venous and arterial thromboembolic events. COVID-19 patients have a high prevalence of APAs as well as both ATE and VTE, but their clinical significance in COVID-19 patients is not fully understood yet.
OBJECTIVE: In this study, we intend to find the prevalence of APAs in hospitalized COVID-19 patients at the time of diagnosis and determine whether their presence has any clinical significance.
METHODS: This is a retrospective single-institution study involving patients hospitalized for the management of COVID-19 infection at The University of Toledo Medical Center. After obtaining approval from the biomedical institutional review board at The University of Toledo, antiphospholipid antibody (APA) testing was done on pre-stored blood samples of these patients and hospital charts were reviewed till six months from the positive COVID-19 test result. Two groups were created based on the patients\' APA testing results (APA positive and APA negative) and used for statistical comparison. Any patients with positive lupus anticoagulant (LA) or abnormal titers APA antibodies were labeled as positive. Demographic data, prognostic outcomes and laboratory values were compared either using Mann-Whitney U-test for continuous variables or Fisher\'s exact test for categorical variables.
RESULTS: The prevalence of APAs in hospitalized COVID-19 patients at the time of diagnosis was 39.3% in this study. There was no difference in demographic variables between the APA-positive and APA-negative groups. The prevalence of APAs was higher in smokers, where 91% of the APA-positive patients were smokers. There was no statistically significant difference in prognostic outcomes including six-month mortality between APA-positive and APA-negative patients. The comorbidity profile was the same in the two groups. APA-positive patients were found to have lower nadir of absolute lymphocyte count and higher nadir levels of C-reactive protein during hospitalization.
CONCLUSIONS: The prevalence of APA positivity in hospitalized COVID-19 patients is higher in our study than in historical studies involving non-COVID-19 hospitalized patients, particularly in smokers. However, there is no correlation between APA positivity and prognostic outcomes including six-month mortality. At this point, it is unclear whether APAs are just bystanders or have a pathogenic role. Routine testing of APA in COVID-19 patients is not indicated. Further prospective studies to elucidate the persistence and clinical implications of APAs are needed.