Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is characterized by a procoagulant state that can lead to fatal thromboembolic events. Several studies have documented a high prevalence of lupus anticoagulant that may at least partially explain the procoagulant profile of COVID-19. However, the association between lupus anticoagulant and thrombotic complications in COVID-19 is controversial and no study has specifically evaluated the impact of lupus anticoagulant on mortality. The aim of our study was to investigate the association between lupus anticoagulant and mortality in a large group of 192 consecutive patients hospitalized for COVID-19. Lupus anticoagulant was found in 95 patients (49.5%). No difference in the percentage of patients with lupus anticoagulant was observed between 130 survivors and 62 non-survivors (47.7 versus 53,2%; p = 0.4745). When the combined outcome of death or need for mechanical ventilation in survivors was taken into account, the difference in the prevalence of patients with lupus anticoagulant between the patients with the combined outcome (n = 76) and survivors who did not require mechanical ventilation (n = 116) was not significant (52.6% versus 47.4%; p = 0.4806). In multivariate analysis predictors of mortality or need for mechanical ventilation in survivors were obesity, low oxygen saturation and elevated troponin levels measured on admission. In conclusion, our study did not show any association of lupus anticoagulant with mortality and with need for mechanical ventilation in survivors. The role of obesity, low SaO2 and elevated troponin levels as predictors of a worse prognosis in patients hospitalized for COVID-19 was confirmed.

Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity

“… [61] 192 M: 69.4 58.3 Italy No association was found between lupus anticoagulant and mortality as well as mechanical ventilation. [62] Healthy: 20 Non-severe: 37 Severe: 64 Non-Survivors: 18 M: 41.40 M: 44.52 M: 55.53 M: 63.77 40 62.16 60.9 50 Mexico Concentrations of D-dimer and plasminogen activator inhibitor-1 were significantly elevated in severe COVID-19 patients. A significant difference was found in PAI-1 in non-severe and healthy donors when compared to severe and deceased COVID- 19 patients.…”

Is Lupus Anticoagulant a Significant Feature of COVID-19? A Critical Appraisal of the Literature

“…53,71,72 It is important to note that CRP is also highly elevated in patients with COVID-19, including those with reported LA. 51,55,56,58,59,61,62,[64][65][66][67] Interestingly, however, most researchers reporting on LA in COVID-19 did not mention CRP, nor report data on this biomarker. In some cases, these data may have possibly been reported elsewhere, and in other casesmaynothavebeengatheredorevenconsidered.Offurther interest, even when investigated or reported, CRP was not always contemplated by the researchers as a potential confounder for LA identification.…”

COVID-19 Convalescent Plasma Is More than Neutralizing Antibodies: A Narrative Review of Potential Beneficial and Detrimental Co-Factors

“…The aPLs in COVID-19 patients are mainly directed against β 2 -GPI but display an epitope specificity different from antibodies in aPL syndrome [ 62 ]. L upus anticoagulant (LA) , a misnomer for prothrombotic antibody, was found in 46.6% of hospitalized COVID-19 patients, but no association was found with mortality or the need for mechanical ventilation in survivors [ 63 ]. Most importantly, LA is transient, but other aPLs are persistent [ 64 ] and potentially found in CCP donors.…”