Antiphospholipid antibodies in critically ill patients

Vassalo, Juliana; Spector, Nelson; Meis, Ernesto de; Soares, Márcio; Salluh, Jorge I.

doi:10.5935/0103-507x.20140026

Cited by 7 publications

(8 citation statements)

References 29 publications

(31 reference statements)

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“… 38 It was hypothesised that the damaged apoptotic cell surfaces expose these cellular components to the immune system, predisposing an individual to develop aPL. 38 Although aPL is associated with critical illness, this analysis as well as previous studies 36 39 did not find a significant association between aPL and disease outcomes like invasive ventilation and mortality. These findings suggest that aPL may be markers for disease severity or tissue injury but if aPL contribute to tissue damage and disease severity is questionable and require further investigations.…”

Section: Discussionsupporting

confidence: 44%

“…High prevalence of aPL in critically ill patients has been reported previously. 36 This can be partially explained by the extensive inflammation, cellular damage and apoptosis in critically ill patients that can induce aPL production. 37 38 aPL are antibodies targeting mainly phospholipid-binding proteins, such as β2-GPI and prothrombin, that expressed on cell membrane at high density.…”

Section: Discussionmentioning

confidence: 99%

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Antiphospholipid antibodies in COVID-19: a meta-analysis and systematic review

Taha

Samavati

2021

RMD Open

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BackgroundMany studies reported high prevalence of antiphospholipid antibodies (aPL) in patients with COVID-19 raising questions about its true prevalence and its clinical impact on the disease course.MethodsWe conducted a meta-analysis and a systematic review to examine the prevalence of aPL and its clinical impact in patients with COVID-19.Results21 studies with a total of 1159 patients were included in our meta-analysis. Among patients hospitalised with COVID-19, the pooled prevalence rate of one or more aPL (IgM or IgG or IgA of anticardiolipin (aCL) or anti-ß2 glycoprotein (anti-ß2 GPI) or antiphosphatidylserine/prothrombin, or lupus anticoagulant (LA)) was 46.8% (95% CI 36.1% to 57.8%). The most frequent type of aPL found was LA, with pooled prevalence rate of 50.7% (95% CI 34.8% to 66.5%). Critically ill patients with COVID-19 had significantly higher prevalence of aCL (IgM or IgG) (28.8% vs 7.10%, p<0.0001) and anti-ß2 GPI (IgM or IgG) (12.0% vs 5.8%, p<0.0001) as compared with non-critically ill patients. However, there was no association between aPL positivity and mean levels of C reactive protein (mean difference was 32 (95% CI −15 to 79), p=0.18), D-dimer (mean difference was 34 (95% CI −194 to 273), p=0.77), mortality (1.46 (95% CI 0.29 to 7.29), p=0.65), invasive ventilation (1.22 (95% CI 0.51 to 2.91), p=0.65) and venous thromboembolism (1.38 (95% CI 0.57 to 3.37), p=0.48).ConclusionsaPLs were detected in nearly half of patients with COVID-19, and higher prevalence of aPL was found in severe disease. However, there was no association between aPL positivity and disease outcomes including thrombosis, invasive ventilation and mortality. However, further studies are required to identify the clinical and pathological role of aPL in COVID-19.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Antiphospholipid antibodies in COVID-19: a meta-analysis and systematic review

Taha

Samavati

2021

RMD Open

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“…We found no significant differences in aPLs positivity between survived and dead patients, which is consistent with previous research [ 37 ], which found no significant link between aPLs positivity and mortality in COVID-19 patients with thrombotic complications. This could be explained by the associated severe pneumonia, which is the leading cause of death in COVID-19 patients.…”

Section: Discussionsupporting

confidence: 93%

Anti-phospholipid antibodies in the setting of thromboembolic events associated with severe COVID-19 pneumonia

Badr

Abu-Zaid

Elmedany

2022

Egypt Rheumatol Rehabil

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Background Thrombotic consequences have been reported in COVID-19-infected patients, especially those who are critically ill. Multiple studies have tested antiphospholipid antibodies (aPLs) among COVID-19 patients, but to date, the actual frequency of aPLs is still uncharted. In this cohort study, we analyzed the outcomes of 173 consecutive patients with confirmed COVID-19 infection. Anti-phospholipid antibodies, which include anti-cardiolipin antibodies [aCL (IgM), aCL (IgG)], and B2-glycoprotein I antibodies [aβ2GPI (IgM), aβ2GPI (IgG)] were detected by using immunoassays. In contrast, lupus anti-coagulant (LAC) antibodies are identified through a coagulation-based assay. Results The study demonstrated a high incidence of thrombotic consequences in severe COVID pneumonia cases and supported an increased risk of developing aPLs following COVID-19 infection. Pulmonary embolism had the most common prevalence of all thrombotic events. Among the various aPLs tested in thrombotic patients, lupus anti-coagulant (LAC) had the highest positivity (46.2%). Most patients with arterial thromboembolism (stroke, myocardial infarction, limb ischemia, bowel ischemia, and renal artery thrombosis) had triple positivity of anti-phospholipid antibodies. Testing aPLs antibodies after 12 weeks of recovery for survived patients only 2 out of 23 patients had aPLs positivity compared to 35 out of 65 tested during hospital admission. Furthermore, we found no significant changes in aPLs positivity between survived and non-survived patients with thrombotic event. Conclusions aPLs increased transiently as an inflammatory-mediated condition. Individuals with aPLs triple positivity (positive LAC, aCL, and aB2GPI) had a considerable risk of arterial thromboembolism (ATE).

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“…74 However, these antibodies commonly arise transiently in patients with critical illness and various infections. 75 If persistent, these antibodies may be associated with the thrombotic tendency of antiphospholipid syndrome. However, it is difficult to differentiate the role of these antibodies from other causes of thrombosis in critically ill patients with or without SARS-CoV-2 infection.…”

Section: Antiphospholipid Antibody Syndromementioning

confidence: 99%

The pathophysiology of the haematological manifestations of COVID-19 : a review

Abdullah

Chapanduka

2020

The Journal of Medical Laboratory Science and Technology of Sou

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the coronavirus disease 2019 (COVID-19) it causes, are associated with several haematological abnormalities which manifest as some of the clinical syndromes seen in COVID-19. The main organ affected by COVID-19 is the lung, where an intense inflammatory response occurs in the alveoli and the lung vasculature. This may result in severely compromised gaseous exchange consistent with acute respiratory disease syndrome (ARDS). Multiple organ failure and death may ensue. The extent to which SARS-CoV-2 directly affects erythroid, granulocytic and monocytic progenitors is unknown, however related Coronaviridae have previously been shown to infect megakaryocytes and their progenitors. Furthermore, SARS-CoV-2 may directly infect lymphocytes or monocytes causing the production of cytokines and chemokines, which then cause lymphocyte death and lymphopenia. The quantitative changes seen in monocytes and granulocytes are at least partly due to the marked increase in various cytokines also called the “cytokine storm” and the downstream effects of these cytokines. A COVID-19-associated coagulopathy (CAC) may occur, which ranges from a mild derangement of laboratory haemostatic tests, through to sepsis-induced coagulopathy (SIC), and later, frank disseminated intravascular coagulation (DIC). The most common and devastating haemostatic abnormality is widespread thrombosis, which is associated with severe lung inflammation, hypoxia and death. COVID-19 is associated with immune perturbation states namely, immune thrombocytopenia (ITP), Guillain-Barré syndrome, the anti-phospholipid syndrome and a Kawasaki-like syndrome in children. The pathophysiology of the haematological abnormalities seen in COVID-19 is briefly reviewed in this article.

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Antiphospholipid antibodies in critically ill patients

Cited by 7 publications

References 29 publications

Antiphospholipid antibodies in COVID-19: a meta-analysis and systematic review

Antiphospholipid antibodies in COVID-19: a meta-analysis and systematic review

Anti-phospholipid antibodies in the setting of thromboembolic events associated with severe COVID-19 pneumonia

The pathophysiology of the haematological manifestations of COVID-19 : a review

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