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Frequency and clinical correlates of antiphospholipid antibodies arising in patients with SARS-CoV-2 infection: findings from a multicentre study on 122 cases

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15

 

  1. Rheumatology Unit, Department of Medicine, University of Padova, Italy.
  2. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  3. Rheumatology Unit, Department of Medicine, University of Padova, Italy.
  4. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  5. Infectious Disease Unit, University Hospital of Padova, Italy.
  6. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  7. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  8. Section of Anesthesia, Intensive Care and Pain, Department of Surgical and Biomedical Sciences, University of Perugia, Italy.
  9. Medical Microbiology Unit, Department of Medicine, University of Perugia, Italy.
  10. Medical Microbiology Unit, Department of Medicine, University of Perugia, Italy.
  11. Respiratory Pathophysiology Division, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Italy.
  12. Rheumatology Unit, Department of Medicine, University of Padova, Italy.
  13. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  14. Rheumatology Unit, Department of Medicine, University of Padova, Italy. adoria@unipd.it
  15. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.

CER13808
2020 Vol.38, N°4
PI 0754, PF 0759
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PMID: 32723434 [PubMed]

Received: 14/07/2020
Accepted : 20/07/2020
In Press: 28/07/2020
Published: 28/07/2020

Abstract

OBJECTIVES:
COVID-19 features include disseminated intravascular coagulation and thrombotic microangiopathy indicating a hypercoagulable state. We aimed to investigate antiphospholipid antibodies (aPL) prevalence and clinical relationships in a large cohort of COVID-19 patients.
METHODS:
We analysed the prevalence and titres of serum aPL in 122 patients with COVID-19 and 157 with primary antiphospholipid syndrome (PAPS) and 91 with other autoimmune rheumatic diseases (oARD) for comparison. IgG/IgM anticardiolipin (aCL) and IgG/IgM anti-beta2glycoprotein I (β2GPI) were assayed using homemade ELISA, IgA aCL and anti-β2GPI by commercial ELISA kits and lupus anticoagulant (LAC) by multiple coagulation tests following updated international guidelines.
RESULTS:
Prevalence of IgG and IgM aCL and of IgG and IgM anti-β2GPI across COVID-19 patients were 13.4%, 2.7%, 6.3% and 7.1%, being significantly lower than in PAPS (p<0.0001 for all). Frequency of IgG aCL and IgM anti-β2GPI was comparable to oARD (13.4% vs. 13.2% and 7.1% vs. 11%, respectively), while IgG anti-β2GPI and IgM aCL were lower (p<0.01). IgA aCL and IgA anti-β2GPI were retrieved in 1.7% and 3.3% of COVID-19 patients, respectively. Positive LAC was observed in 22.2% COVID-19 vs. 54.1% of PAPS (p<0.0001) and 14.6% of oARD (p=0.21). Venous or arterial thromboses occurred in 18/46 (39.1%) COVID-19 patients and were not associated with positive aPL (p=0.09).
CONCLUSIONS:
Thrombosis is a frequent manifestation during COVID-19 infection. However, prevalence and titres of aPL antibodies or LAC were neither consistently increased nor associated with thrombosis when measured at a single timepoint, therefore not representing a suitable screening tool in the acute stage of disease.

Rheumatology Article