دراسة عامل von Willebrand و ADAMTS-13 وبعض المتغيرات البايوكيميائية كمؤشرات تنبؤية لشدة Covid-19 لدى المرضى العراقيين

Study of von Willebrand Factor, ADAMTS-13 and some biochemical parameter as Predictor Markers for Severity of Covid-19 in Iraqi Patients

Abstract

Coronavirus disease 2019 (Covid-19) is a respiratory disease with heterogeneous manifestations ranging from asymptomatic illness in some, to systemic inflammation, multiorgan failure, and a rapid death in others.
The first stage of disease manifests as an upper respiratory infection followed by pneumonia when the virus invades the respiratory epithelium via binding to reseptors. And a second, more severe, phase may be manifested as multiorgan damage, including respiratory, cardiac, hepatic, and renal injury. At this stage, the receptors on the endothelium can also be involved, causing direct damage to blood vessels and inducing a coagulopathy.
Systemic inflammation and coagulopathy are characteristic hallmarks of this phase. “Covid-19 coagulopathy” manifests mainly as a prothrombotic state affecting both large and small blood vessels, and presenting as arterial, venous, and microangiopathic thrombotic events. The causes of coagulopathy associated with coronavirus disease 2019 (Covid-19) are poorly understood.
Therefore, the aimed of this study to investigate levels of von Willebrand factor (VWF), and adisintegrin and metalloproteinase with a thrombospondin type 1 motif, member-13 (ADAMTS-13) biomarkers, intravascular hemolysis, coagulation, and organ damage in Covid-19 patients and study their association with disease severity and mortality and to a decisive role in identifying patients at risk of developing fatal complications of this case, thus helping to save the lives of many patients.
The case-control study design included collecting the sera of 90 samples from patients and healthy people during the period from January 2021 to May 2021, where the patients were divided into two groups:
The first group: patients with the Corona virus, whose samples were collected from Al-Amal hospital, Al-Shifaa Center in Najaf city, and from Al- Hussein Teaching Hospital in Karbala and it consisted of three groups, the first group mild symptoms, the second group were used mechanical ventilation (adverse clinical outcome) as sever group symptoms . The results were compared with 30 samples apparently healthy people as a control group.
The serum level of vWF, ADAMTS-13, and vitamin K were determined by ELISA technique, and the level of lipid profiles were determined by enzymatic and colorimetric methods. Ferritin, and D- dimer were determined, by ichroma, CBC automated by auto Hematology Analyzer. Levels of LDL-C, and VLDL- C, data of Atherogenic index (AIP), Catelli’s risk index-I (CRI-I), CRI-II, and body mass index (BMI) were calculated by especial equations.
The results of this study found a high significant increase (p≤0.000) in the levels of D-dimer, ferritin, neutrophils, high sensitivity CRP, TG, VLDL-C, and data of atherogenic index in Covid-19 patients group when compared with healthy group. While, the results showed a significant decrease in the levels of HDL-C, TC, and platelet levels when compared with the healthy group.
These results illustrated that the patients who died had significantly lower ADAMTS-13 activity and vitamin K levels, significantly elevated D-dimer, and ferritin. Significantly elevated vWF levels compared with patients discharged alive.
Linear regression analysis for ADAMTS-13, vWF and Vit. K levels pointed out significant correlation with age, BMI, ferritin, D-dimer, CRP, and NLR in Covid-19 patients groups. Level of serum vWF revealed significant negative correlations with ADAMTS-13, Vit. K, LYMP%, HDL-C , and TC levels. However ADAMTS-13 demonstrated significant positive correlations with TG,NLR,D-dimer,VLDL-C and levels in patients group.
This study concluded that improve prevention strategies, including those for the mild and sever case by uses of vWF, ADAMTS-13 and Vit. K as predicator markers for Covid-19 severity and their complications.
Thus, in addition to elevated vWF may warrant further work-up including ADAMTS-13 activity and vWF and activity levels since these patients may be at increased risk of mortality and might serve as a simple prognostic measure of thrombotic risk in Covid-19 and potentially a significant contributor to disease pathogenesis and may benefit from more aggressive therapy .Also, that vitamin K deficiency could support cytokine storm by increasing pro-inflammatory cytokines which is involved in the building up of the inflammatory response recruiting both cellular and humoral components. Vitamin K is well-known to play an essential role in the coagulation system. Highlighting a role of vitamin K, probably via coagulation modulation. Altogether, potential mechanisms linking Covid-19 with coagulopathy in which vitamin K may exert its modulating role in coagulation related with disease pathogenesis Besides, it can also contribute to those events involved in vascular calcification leading to thrombosis and disseminate intravascular coagulation (DIC), which feature the microvascular damage observed in Covid-19 patients.