<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.<bold>Aim.</bold> Assessment of protein S activity in patients with COVID-19 as a cause of this prothrombotic state, and of the association of protein S activity with worse outcome.<bold>Methods.</bold> All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, while secondary outcomes were clinical severity and lung damage.<bold>Results.</bold> 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p &lt; 0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = –0.320, p &lt; 0.001; Jonckheere-Terpstra for trend: p &lt; 0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = –0.290, p &lt; 0.001; Jonckheere-Terpstra for trend: p &lt; 0.001). High neutrophil count was also independently associated with death (p = 0.002).<bold>Conclusion.</bold> Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.</abstract>

Introduction. COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies were found in some studies.Aim. Assessment of protein S activity in patients with COVID-19 as a cause of this prothrombotic state, and of the association of protein S activity with worse outcome.Methods. All patients admitted for COVID-19 disease in a university hospital between 15th of May and 15th of July 2020 were prospectively enrolled into this cohort study. Patients treated with antivitamin K anticoagulants and with liver disease were excluded. All patients had protein S activity determined at admission. The main outcome was survival, while secondary outcomes were clinical severity and lung damage.Results. 91 patients were included, of which 21 (23.3%) died. Protein S activity was decreased in 65% of the patients. Death was associated with lower activity of protein S (median 42% vs. 58%, p < 0.001), and the association remained after adjustment for age, inflammation markers and ALAT. There was a dose-response relationship between protein S activity and clinical severity (Kendall_tau coefficient = –0.320, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001) or pulmonary damage on CT scan (Kendall_tau coefficient = –0.290, p < 0.001; Jonckheere-Terpstra for trend: p < 0.001). High neutrophil count was also independently associated with death (p = 0.002).Conclusion. Protein S activity was lower in COVID-19 patients, and its level was associated with survival and disease severity, suggesting that it may have a role in the thrombotic manifestations of the disease.

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Carol Davila University of Medicine and Pharmacy Bucharest

Department of Internal Medicine Colentina

Romanian Journal of Internal Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

{"article-title":"Anticoagulant protein S in COVID-19: low activity, and associated with outcome"}

Introduction. COVID-19 disease was associated with both thrombo-embolic events and in-situ thrombi formation in small vessels. Antiphospholipidic antibodies...

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Published Online: Dec 17, 2020

Page range: 251 - 258

Received: Aug 01, 2020

DOI: https://doi.org/10.2478/rjim-2020-0024

Keywords
COVID-19, protein S, thrombophilia, thrombosis, neutrophilia

© 2020 Laura Elena Stoichitoiu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Anticoagulant protein S in COVID-19: low activity, and associated with outcome

Published Online: Dec 17, 2020

Page range: 251 - 258

Received: Aug 01, 2020

DOI: https://doi.org/10.2478/rjim-2020-0024

KeywordsCOVID-19, protein S, thrombophilia, thrombosis, neutrophilia

© 2020 Laura Elena Stoichitoiu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Keywords
COVID-19, protein S, thrombophilia, thrombosis, neutrophilia