Int J Infect Dis. 2022 Feb 12:S1201-9712(22)00097-2. doi: 10.1016/j.ijid.2022.02.019. Online ahead of print.
BACKGROUND: Low ADAMTS 13 Activity has been suggested as an interplaying factor in the pathogenesis of COVID-19, considering that it is a thrombo-inflammatory disease with high risk of microthrombosis.
OBJECTIVES: The study aimed to explore the correlation between ADAMTS13 activity and the pathophysiological pathway of COVID-19.
PATIENTS/METHODS: We carried out a retrospective observational study of 87 COVID-19 patients in Nmc Royal Hospital, Abu Dhabi, UAE. ADAMTS13 activity was measured and compared with patients' characteristics and clinical outcomes.
RESULTS: Low ADAMTS13 level was associated with pneumonia (p=0.007), severity of COVID-19 (p<0.001), and mechanical ventilation rates (p=0.018). Death was more frequently observed among patients (5 patients) with low ADAMTS13 activity compared to normal activity (1 patient), as well as inflammatory markers. Decreased ADAMTS13 levels increased the risk of pneumonia, severity of COVID-19, need for mechanical ventilation, and use of anticoagulants ((OR= 4.75, 95%CI: [1.54-18.02], p=0.011), (OR= 6.50, 95%CI: [2.57-17.74], p<0.001), (OR= 4.10, 95%CI: [1.29-15.82], p=0.024), (OR=8.00, 95%CI: (3.13-22.16), p<0.001), respectively). The low ADAMTS13 activity group had a slightly longer time to viral clearance than the normal ADAMTS13 group, but it was not statistically significant. (20 days, 95% CI: [16-27] days, vs. 17 days, 95% CI: [13-22] days, p=0.08, Log rank= 3.1).
CONCLUSION: Low ADAMTS13 activity has been linked to pneumonia, COVID-19 severity, use of anticoagulants, and need for mechanical ventilation, but not to mortality. We propose rADAMTS13 as a novel treatment for severe COVID-19.