Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Link to article at PubMed

Rom J Intern Med. 2020 Aug 24:/j/rjim.ahead-of-print/rjim-2020-0024/rjim-2020-0024.xml. doi: 10.2478/rjim-2020-0024. Online ahead of print.


INTRODUCTION: COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.

AIM: Assessment of protein S activity in patients with COVID-19 as a cause this prothrombotic state, and of the association of protein S activity with worse outcome.

METHODS: All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, secondary outcomes were clinical severity and lung damage.

RESULTS: 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p<0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = -0.320, p < 0.001; Jonckheere-Terpstra for trend: p<0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = -0.290, p<0.001; Jonckheere-Terpstra for trend: p<0.001). High neutrophil count was also independently associated with death (p=0.002).

CONCLUSION: Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.

PMID:32841167 | DOI:10.2478/rjim-2020-0024

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