MO175: Association between Thrombotic Microangiopathy, ADAMTS13 Activity and Development of AKI, ARDS, AND Poor Outcomes in COVID-19 Patients (Pilot Study). (3rd May 2022)

• Record Type: Journal Article
• Authors: Vorobyev, Eugene; Vorobyeva, Snezhana; Galkina, Olga; Zubina, Irina; Bogdanova, Evdokia; Levykina, Elena; Kulikov, Aleksander
• 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/gfac066.077
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: BACKGROUND AND AIMS: Cases of microangiopathy associated with COVID-19 are not fully understood. We aimed to clarify in these patients the presence of thrombotic microangiopathy (TMA) and decreased ADAMTS13 activity, the possible influence of these factors on kidney and lung damage, and outcomes. METHOD: The study involved 90 patients with COVID-19 and viral pneumonia, who were treated at the Pavlov First St. Petersburg State Medical University. Patients undergoing plasma transfusion were excluded. In addition to the standard examination, activity of ADAMTS13 was determined in admission (ELISA, normal range 30–160%). RESULTS: Median level ADAMTS13 was 92%, IQR 27.9%. The presence of TMA took place in 26.7% of patients, in 41.5% patients with TMA the level of activity of ADAMTS13 was less than 60%. In patients with respiratory failure, the ADAMTS13 level was significantly lower–78.4%, IQR 32.1% versus 108.6%, IQR 26.7%. In patients with respiratory failure ( P < .01), the incidence of TMA was significantly higher–34.2% versus 19.3%, respectively ( P < .01). The ADAMTS13 level neg. correlated with the risk of developing TMA (ρ = –0.486, P < .01), AKI of any stage (KDIGO2012 criteria) (ρ = –0.288, P < .01), acute respiratory distress syndrome (ARDS, 'Berlin definition') (ρ = –0.304, P < .01), the duration of hospitalization (ρ = –0.342, P < .01) and the probability of death (ρ =–0.278, P < .01). In the case of five patients, an extremely low level of ADAMTS13 (less than 30%) was noted, which in all cases was accompanied by laboratory signs of TMA and the development of ARDS; two patients had a fatal outcome. CONCLUSION: TMA and low ADAMTS13 activity are associated with progression to severe COVID-19 disease and development of AKI. Some of the cases of TMA in these patients may be due to low ADAMTS13 activity. Further research is needed to assess the potency of treating these patients with TMA associated with low ADAMTS activity.