MO149: Effect of Plasma Exchange on COVID-19 Associated Excess of Von Willebrand Factor and Inflammation in Critically Ill Patients. (3rd May 2022)

• Record Type: Journal Article
• Authors: Seibert, Felix S; Blazquez-Navarro, Arturo; Hölzer, Bodo; Doevelaar, Adrian; Nusshag, Christian; Merle, Uta; Morath, Christian; Zgoura, Panagiota; Dittmer, Rita; Schneppenheim, Sonja; Babel, Nina; Budde, Ulrich; Henning Westhoff, Timm
• Is Part Of: Nephrology dialysis transplantation. Volume 37(2022)Supplement 3
• Publication Date: 2022-05-03
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac066.051
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: BACKGROUND AND AIMS: Ubiquitous microthromboses in the pulmonary vasculature play a crucial role in the pathogenesis of COVID-19 associated acute respiratory distress syndrome (ARDS). Excess of von Willebrand factor (vWf) with intravascular multimer formation was identified as a key driver of this finding. Plasma exchange (PLEX) might be a therapeutic option to restore the disbalance between vWf and ADAMTS13. We report the effects of PLEX on vWf, ADAMTS13, inflammatory cytokines and parameters of ventilation. METHOD: We investigated 25 patients, who were on mechanical ventilation for COVID-19 pneumonia with ARDS at two German university hospitals. All patients received PLEX as an ultima ratio measure for refractory ARDS. VWf antigen (vWf: Ag), ADAMTS13 activity, a cytokine panel mirroring the inflammatory situation and clinical parameters were assessed before and after three to six PLEX therapies with fresh frozen plasma. RESULTS: Before the PLEX sequence, there was an excessive release of vWf: Ag (425.4 ± 167.5%) and mildly reduced ADAMTS13 activity (49.7 ± 23.3%). After the PLEX series, there was a significant increase of ADAMTS13 activity to 62.4 ± 17.7% ( P = .029) and a significant decrease of vWf: Ag to 336.1 ± 138.2% ( P = .041) resulting in a 63% improvement of the ADAMT13/vWf: Ag ratio from 14.5 ± 10.0 to 23.7 ± 14.6 ( P = .024). Comparison of parameters before and after individual PLEX sessions (n = 35) revealed a mean reduction of vWf from 387.8 ± 165.1% to 213.2 ± 62.3% ( P = .001) and an increase of ADAMTS13 activity from 60.4 ± 20.1% to 70.5 ± 14.0% ( P = .001). Parallelly, monocyte chemotactic protein-1 and interleukin-18 decreased significantly ( P = .034 each). Along the PLEX sequence lactate dehydrogenase ( P = .001), C-reactive protein ( P = .001), and positive end expiratory pressure ( P = .01) significantly decreased accompanied by an improvement of Horovitz index ( P = .001). CONCLUSION: PLEX restores the disbalance between ADAMTS13 and vWf: Ag, a driver of immunothrombosis. Moreover, it reduces the inflammatory state and is associated with a benefit of ventilation parameters. These findings render a further rationale to regard PLEX as a therapeutic option in severe COVID-19.