tetano
Editor, Senior Moderator
ACR Open Rheumatol
. 2021 Mar 19.
doi: 10.1002/acr2.11245. Online ahead of print.
Beta-2-Glycoprotein-I Deficiency Could Precipitate an Antiphospholipid Syndrome-like Prothrombotic Situation in Patients With Coronavirus Disease 2019
Manuel Serrano[SUP] 1 [/SUP], Gerard Espinosa[SUP] 2 [/SUP], Antonio Lalueza[SUP] 3 [/SUP], Luz Yadira Bravo-Gallego[SUP] 2 [/SUP], Raquel Diaz-Sim?n[SUP] 3 [/SUP], Sara Garcinu?o[SUP] 3 [/SUP], Javier Gil-Etayo[SUP] 3 [/SUP], Jorge Moises[SUP] 2 [/SUP], Laura Naranjo[SUP] 3 [/SUP], Sergio Prieto-Gonz?lez[SUP] 2 [/SUP], Estibaliz Ruiz-Ortiz[SUP] 2 [/SUP], Beatriz S?nchez[SUP] 2 [/SUP], Ana Belen Moreno-Casta?o[SUP] 2 [/SUP], Carmen D?az-Pedroche[SUP] 3 [/SUP], Odette Vi?as-Gomis[SUP] 2 [/SUP], Ricard Cervera[SUP] 2 [/SUP], Antonio Serrano[SUP] 4 [/SUP], APS-COVID 19 Study Group/European Forum on Antiphospholipid Antibodies
Collaborators, Affiliations
Abstract
Objective: Patients with coronavirus disease 2019 (COVID-19) present coagulation abnormalities and thromboembolic events that resemble antiphospholipid syndrome (APS). This work has aimed to study the prevalence of APS-related antigens, antibodies, and immune complexes in patients with COVID-19 and their association with clinical events.
Methods: A prospective study was conducted on 474 adults with severe acute respiratory syndrome coronavirus 2 infection hospitalized in two Spanish university hospitals. Patients were evaluated for classic and extra-criteria antiphospholipid antibodies (aPLs), immunoglobulin G (IgG)/immunoglobulin M (IgM) anticardiolipin, IgG/IgM/immunoglobulin A (IgA) anti-?2-glicoprotein-I (a?2GPI), IgG/IgM antiphosphatidylserine/prothrombin (aPS/PT), the immune complex of IgA a?2GPI (IgA-a?2GPI), bounded to ?2-glicoprotein-1 (?2GPI) and ?2GPI levels soon after COVID-19 diagnosis and were followed-up until medical discharge or death.
Results: Prevalence of aPLs in patients with COVID-19 was as follows: classic aPLs, 5.8%; aPS/PT, 4.6%; IgA-a?2GPI, 15%; and any aPL, 21%. When patients were compared with individuals of a control group of a similar age, the only significant difference found was the higher prevalence of IgA-a?2GPI (odds ratio: 2.31; 95% confidence interval: 1.16-4.09). No significant differences were observed in survival, thrombosis, or ventilatory failure in aPL-positive versus aPL-negative patients. ?2GPI median levels were much lower in patients with COVID-19 (15.9 mg/l) than in blood donors (168.8 mg/l; P < 0.001). Only 3.5% of patients with COVID-19 had normal levels of ?2GPI (>85 mg/l). Low levels of ?2GPI were significantly associated with ventilatory failure (P = 0.026).
Conclusion: ?2GPI levels were much lower in patients with COVID-19 than in healthy people. Low ?2GPI-levels were associated with ventilatory failure. No differences were observed in the COVID-19 evolution between aPL-positive and aPL-negative patients. Functional ?2GPI deficiency could trigger a clinical process similar to that seen in APS but in the absence of aPLs.
. 2021 Mar 19.
doi: 10.1002/acr2.11245. Online ahead of print.
Beta-2-Glycoprotein-I Deficiency Could Precipitate an Antiphospholipid Syndrome-like Prothrombotic Situation in Patients With Coronavirus Disease 2019
Manuel Serrano[SUP] 1 [/SUP], Gerard Espinosa[SUP] 2 [/SUP], Antonio Lalueza[SUP] 3 [/SUP], Luz Yadira Bravo-Gallego[SUP] 2 [/SUP], Raquel Diaz-Sim?n[SUP] 3 [/SUP], Sara Garcinu?o[SUP] 3 [/SUP], Javier Gil-Etayo[SUP] 3 [/SUP], Jorge Moises[SUP] 2 [/SUP], Laura Naranjo[SUP] 3 [/SUP], Sergio Prieto-Gonz?lez[SUP] 2 [/SUP], Estibaliz Ruiz-Ortiz[SUP] 2 [/SUP], Beatriz S?nchez[SUP] 2 [/SUP], Ana Belen Moreno-Casta?o[SUP] 2 [/SUP], Carmen D?az-Pedroche[SUP] 3 [/SUP], Odette Vi?as-Gomis[SUP] 2 [/SUP], Ricard Cervera[SUP] 2 [/SUP], Antonio Serrano[SUP] 4 [/SUP], APS-COVID 19 Study Group/European Forum on Antiphospholipid Antibodies
Collaborators, Affiliations
- PMID: 33738987
- DOI: 10.1002/acr2.11245
Abstract
Objective: Patients with coronavirus disease 2019 (COVID-19) present coagulation abnormalities and thromboembolic events that resemble antiphospholipid syndrome (APS). This work has aimed to study the prevalence of APS-related antigens, antibodies, and immune complexes in patients with COVID-19 and their association with clinical events.
Methods: A prospective study was conducted on 474 adults with severe acute respiratory syndrome coronavirus 2 infection hospitalized in two Spanish university hospitals. Patients were evaluated for classic and extra-criteria antiphospholipid antibodies (aPLs), immunoglobulin G (IgG)/immunoglobulin M (IgM) anticardiolipin, IgG/IgM/immunoglobulin A (IgA) anti-?2-glicoprotein-I (a?2GPI), IgG/IgM antiphosphatidylserine/prothrombin (aPS/PT), the immune complex of IgA a?2GPI (IgA-a?2GPI), bounded to ?2-glicoprotein-1 (?2GPI) and ?2GPI levels soon after COVID-19 diagnosis and were followed-up until medical discharge or death.
Results: Prevalence of aPLs in patients with COVID-19 was as follows: classic aPLs, 5.8%; aPS/PT, 4.6%; IgA-a?2GPI, 15%; and any aPL, 21%. When patients were compared with individuals of a control group of a similar age, the only significant difference found was the higher prevalence of IgA-a?2GPI (odds ratio: 2.31; 95% confidence interval: 1.16-4.09). No significant differences were observed in survival, thrombosis, or ventilatory failure in aPL-positive versus aPL-negative patients. ?2GPI median levels were much lower in patients with COVID-19 (15.9 mg/l) than in blood donors (168.8 mg/l; P < 0.001). Only 3.5% of patients with COVID-19 had normal levels of ?2GPI (>85 mg/l). Low levels of ?2GPI were significantly associated with ventilatory failure (P = 0.026).
Conclusion: ?2GPI levels were much lower in patients with COVID-19 than in healthy people. Low ?2GPI-levels were associated with ventilatory failure. No differences were observed in the COVID-19 evolution between aPL-positive and aPL-negative patients. Functional ?2GPI deficiency could trigger a clinical process similar to that seen in APS but in the absence of aPLs.