ANTIPHOSPHOLIPID ANTIBODY (aPL) PRESENCE IN COVID-19 PATIENTS

Öz

Objective: In our study, we aimed to show whether there is a relationship between antiphospholipid antibody (aPL) positivity and complications of COVID-19. Material and Methods: Eighty-three patients who were diagnosed with COVID-19 infection and hospitalized in the intensive care unit (ICU) of Bakirkoy Dr. Sadi Konuk Research and Training Hospital were included in our study as the case group and 79 healthy volunteers as the control group. Only patients with a positive polymerase chain reaction (PCR) test were included in the case group. Serum antiphospholipid antibodies (aPL IgM/G), C-Reactive Protein (CRP), ferritin, procalcitonin (PCT), plasma D-Dimer levels, prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were analyzed by routine laboratory methods. Results: Both groups were found statistically similar in terms of gender (χ2 test, p=0.236). The mean age of the case group and control group was 60.54±16.86 and 51.47±14.64 years, respec-tively. When aPL positivity was evaluated between the case and control groups, a statistically remarkable difference was found between the groups (p=0.046). The case group showed an aPL positivity of 7.5% and the control group 1%. The correlation be-tween D-Dimer, PT, INR, aPTT levels, and aPL IgM/G positivity in the case group was significant. Conclusion: Our results revealed that aPL positivity in patients with COVID-19 infection relate to the severity of the disease, in-dependent from age and gender. To confirm the result of this study further studies with participation of larger patient groups from national and international hospitals are required.

Anahtar Kelimeler

• COVID-19
• thromboembolism
• antiphospholipid antibody

COVID-19 HASTALARINDA ANTİFOSFOLİPİD ANTİKOR (AFA) VARLIĞI

Öz

Amaç: Çalışmamızda antifosfolipid antikor (AFA) pozitifliği ile COVID-19 komplikasyonları arasında bir ilişki olup olmadığını göstermeyi amaçladık.Gereç ve Yöntem: Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi yoğun bakım servisinde yatan COVID-19 enfeksiyonu tanısı almış 83 hasta olgu grubu olarak, 79 sağlıklı gönüllü de kontrol grubu olarak çalışmamıza dahil edildi. Olgu grubuna sadece polimeraz zincir reaksiyon (PZR) test sonucu pozitif olan hastalar alındı. Serum antifosfolipid antikorları (AFA IgM/G), C-Reaktif Protein (CRP), ferritin, prokalsitonin (PCT) ve plazma D-Dimer seviyeleri, protrombin zamanı (PT) ve uluslararası nor-malleştirilmiş oran (INR), aktive parsiyel tromboplastin zamanı (aPTT), rutin laboratuvar yöntemleriyle analiz edildi.Bulgular: Her iki grup cinsiyet açısından istatistiksel olarak ben-zer bulundu (χ2 testi, p=0,236). Olgu grubu ve kontrol grubunun yaş ortalaması sırasıyla 60,54±16,86 ve 51,47±14,64 yıl idi. Olgu ve kontrol grupları arasında AFA pozitifliği değerlendirildiğin-de, gruplar arasında istatistiksel olarak anlamlı fark bulundu (p=0,046). Olgu grubu %7,5 ve kontrol grubu %1 AFA pozitifliği gösterdi. Olgu grubunun D-Dimer, PT, INR, aPTT seviyeleri ile AFA IgM/G pozitifliği arasındaki korelasyon anlamlı bulundu. Sonuç: Sonuçlarımız, COVID-19 enfeksiyonu olan hastalarda AFA pozitifliğinin yaş ve cinsiyetten bağımsız olarak hastalığın şiddeti ile ilişkili olduğunu ortaya koydu. Bu çalışmanın sonucunu doğrulamak için ulusal ve uluslararası hastanelerden daha geniş hasta gruplarının katılımıyla daha ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• COVID-19
• tromboemboli
• antifosfolipid an-tikor

Kaynakça

1. 1. Civljak R, Markotic A, Kuzman I. The third coronavirus epidemic in the third millennium: what’s next? Croat Med J 2020;61(1):1-4. [CrossRef] google scholar
2. 2. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;16(24):91-8. [CrossRef] google scholar
3. 3. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up. JACC State-of-the Art Review. J Am Coll Cardiol 2020;75(23):2950-73. [CrossRef] google scholar
4. 4. Ginsberg JS, Wells PS, Brill-Edwards P, Donovan D, Moffatt K, Johnston M, et al: Antiphospholipid antibodies and venous thromboembolism. Blood 1995;86(10):3685-91. [CrossRef] google scholar
5. 5. Egiziano G, Widdifield J, Rahman A, Vinet E, Moura CS, Curtis JR, et al. Antiphospholipid Antibody Testing in a General Population Sample from the USA: An Administrative Database Study. Sci Rep 2020;10(1):3102. [CrossRef] google scholar
6. 6. Mustonen, P, Lehtonen KV, Javela K and Puurunen M. Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study. Lupus 2014;23(14):1468-76. [CrossRef] google scholar
7. 7. Asherson RA, Cervera R. Antiphospholipid antibodies and infections. Ann Rheum Dis 2003;62(5):388-93. [CrossRef] google scholar
8. 8. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020;58(7):1131-4. [CrossRef] google scholar

9. 9. Di Minno A, Ambrosino P, Calcaterra I, Di Minno MND. COVID-19 and venous thromboembolism: a meta-analysis of literature studies. Semin Thromb Hemost 2020;46(7):763-71. [CrossRef] google scholar
10. 10. Damiani S, Fiorentino M, De Palma A, Foschini MP, Lazzarotto T, Gabrielli L, et al. Pathological post-mortem findings in lungs infected with SARS-CoV-2. J Pathol 2021;253(1):31-40. [CrossRef] google scholar
11. 11. Kaul M, Erkan D, Sammaritano L, Lockshin MD. Assessment of the 2006 revised antiphospholipid syndrome classification criteria. Ann Rheum Dis 2007;66(7):927-30. [CrossRef] google scholar
12. 12. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Eng J Med 2002;346(10):752-63. [CrossRef] google scholar
13. 13. Hanly JG. Antiphospholipid syndrome: an overview. CMAJ 2003;168(13):1675-82. google scholar
14. 14. Martirosyan A, Aminov R, Manukyan G. Environmental Triggers of Autoreactive Responses: Induction of Antiphospholipid Antibody Formation. Front Immunol 2019;10:1609. [CrossRef] google scholar
15. 15. Lackner KJ, Calleja NM. Antiphospholipid Antibodies: Their Origin and Development. Antibodies (Basel) 2016;5(2):15. [CrossRef] google scholar
16. 16. Greaves M, Cohen H, Machin SJ, Mackie I: Guidelines on the investigation and management of the antiphospholipid syndrome. Br J Haematol 2000;109(4):704-15. [CrossRef] google scholar
17. 17. Gianfrancesco M, Yazdany J, Robinson PC. Epidemiology and outcomes of novel coronavirus 2019 in patients with immune-mediated inflammatory diseases. Curr Opin Rheumatol 2020;32(5):434-40. [CrossRef] google scholar
18. 18. Siguret V, Voicu S, Neuwirth M, Delrue M, Gayat E, Stepanian A, et al. Are antiphospholipid antibodies associated with thrombotic complications in critically ill COVID-19 patients? Thromb Res 2020;195:74-6. [CrossRef] google scholar
19. 19. Devreese MJ K, Linskens AE, Benoit D, Preperstraete H. Antiphospholipid antibodies in patients with COVID-19: A relevant observation? J Thromb Haemost 2020;18(9):2191-201. [CrossRef] google scholar
20. 20. Valle FG, Oblitas CM, Ferreiro-mazon MM, Munoz JA, Cervera JDT, Natale M, et al. Antiphospholipid antibodies are not elevated in patients with severe COVID-19 pneumonia and venous thromboembolism. Thromb Res 2020;192:113-5. [CrossRef] google scholar