Antiphospholipid antibodies in patients hospitalized with COVID-19 infection in conventional units

Document Type : Original Article

Authors

1 Clinical Research Development Unit of Shahid Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

2 Environmental Health Engineering Department, Saveh University of Medical Sciences, Saveh, Iran

3 Department of Biostatistics, School of public health, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract

Objectives: This study aimed to evaluate the status of antiphospholipid antibodies (APL) in hospitalized patients with COVID-19 infection.
Methods: This case-control study was conducted at Shahid Beheshti Hospital of Hamadan University of Medical Sciences from 2020 to 2022. Participants were divided into two groups: COVID-19 (n=35 recovered cases) and non-COVID-19 (n=34). The study assessed anti-cardiolipin antibodies (ACA) including IgM, IgG, and antibodies against β2-glycoprotein (anti-B2GPI). Additionally, the lupus anticoagulant (LAC) test was conducted on patients not using anticoagulant medications. Enzyme-linked immunosorbent assay (ELISA) was employed for ACA and anti-B2GPI testing, while the LAC test was conducted using a fully automated coagulometer.
Results: The mean LAC among participants was 33.8 ± 7.53s for females and 36.39 ± 5.54s for males. Results of antibody tests indicated that ACA IgM was positive in 2 out of 33 cases, with none in the non-recovered COVID-19 and COVID-19 patients (P value = 0.15). Furthermore, the LAC test showed positive results in 5 and 2 patients in the case and control groups, respectively (P value = 0.26). Correlation analyses of LAC with other antibodies revealed no significant associations for non-COVID-19 patients, while a significant association was observed between LAC and β2GPI IgG and ACA IgG (r = 0.52; P <0.001 and r = 0.51; P <0.001, respectively). Negative correlations were found between LAC and ACA IgM and hospitalization in the case group (r = -0.22 and r = -0.04, respectively). For the control group, negative correlations were observed between LAC and β2GPI IgM, ACA IgG, and ACA IgM (r = -0.25, r = -0.03, and r = -0.03, respectively). Additionally, Anti-β2GPI IgG and anti-β2GPI IgM tests were positive in both COVID-19 and non-COVID-19 groups (two positives in total) (P value = 0.98 vs P value = 0.31).
Conclusion: We recommend routine testing for aPL antibodies in recovered COVID-19 patients to assess their normal condition. Our findings suggest that APS antibodies in COVID-19 patients can serve as a negative prognostic indicator, guiding decisions on the need for intensive care based on antibody levels.

Keywords

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  1. Hoseinzadeh E, Javan S, Farzadkia M, Mohammadi F, Hossini H, Taghavi M. An updated min-review on environmental route of the SARS-CoV-2 transmission. Ecotoxicol Environ Saf 2020; 202: 111015. doi:10.1016/j.ecoenv.2020.111015 PMid:32800237 PMCid:PMC7346818
  2. Koksoy Vayisoglu S, Aydin Besen M, Oncu E. Perspectives of midwifery and nursing students on recommending the COVID-19 vaccine to women of reproductive age and factors influencing counseling competency: a cross-sectional study. Novel Clin Med 2024; 3(1): 1-11. doi: 10.22034/ncm.2023.418212.1133
  3. Jha NK, Ojha S, Jha SK, Dureja H, Singh SK, Shukla SD, et al. Evidence of coronavirus (CoV) pathogenesis and emerging pathogen SARS-CoV-2 in the nervous system: a review on neurological impairments and manifestations. Journal of molecular neuroscience 2021:1-18. doi:10.1007/s12031-020- 01767-6 PMid:33464535 PMCid:PMC7814864
  4. Godini H, Hoseinzadeh E, Hossini H. Water and wastewater as potential sources of SARS-CoV-2 transmission: a systematic review. Rev Environ Health 2021;36(3):309-17. doi:10.1515/reveh-2020-0148 PMid:33594845
  5. Riou M, Marcot C, Canuet M, Renaud-Picard B, Chatron E, Porzio M, et al. Clinical characteristics of and outcomes for patients with COVID-19 and comorbid lung diseases primarily hospitalized in a conventional pulmonology unit: A retrospective study. Respir Med Res 2021;79:100801 doi:10.1016/j.resmer.2020.100801 PMid:33259989 PMCid:PMC7659648
  6. Abdorrahim-Kashi E, Azadchehr MJ, Aminipour M, Talari H, Ghafoor L, Abedzadeh-Kalahroudi M, et al. General surgery admissions, operations, and patient outcomes during the COVID-19 pandemic. Arch Trauma Res 2022; 11(3): 118-122. doi: 10.4103/atr.atr_42_22
  7. Talotta R, Robertson ES. Antiphospholipid antibodies and risk of post-COVID-19 vaccination thrombophilia: The straw that breaks the camel's back? Cytokine Growth Factor Rev 2021; 60: 52-60. doi:10.1016/j.cytogfr.2021.05.001 PMid:34090785 PMCid:PMC8159713
  8. Damoiseaux J, Dotan A, Fritzler MJ, Bogdanos DP, Meroni PL, Roggenbuck D, et al. Autoantibodies and SARS-CoV2 infection: The spectrum from association to clinical implication: Report of the 15th Dresden Symposium on Autoantibodies. Autoimmun Rev 2022;21(3):103012. doi:10.1016/j.autrev.2021.103012 PMid:34896650 PMCid:PMC8656211
  9. Benjamin LA, Paterson RW, Moll R, Pericleous C, Brown R, Mehta PR, et al. Antiphospholipid antibodies and neurological manifestations in acute COVID-19: a single-centre cross-sectional study. E Clin Med 2021;39. doi:10.1016/j.eclinm.2021.101070 PMid:34401683 PMCid:PMC8358233
  10. Le Joncour A, Frere C, Martin-Toutain I, Gougis P, Ghillani-Dalbin P, Maalouf G, et al. Antiphospholipid antibodies and thrombotic events in COVID-19 patients hospitalized in medicine ward. Autoimmun Rev 2021;20(2):102729. doi:10.1016/j.autrev.2020.102729 PMid:33321245 PMCid:PMC7834187
  11. Chighizola CB, Andreoli L, Gerosa M, Tincani A, Ruffatti A, Meroni PL. The treatment of anti-phospholipid syndrome: a comprehensive clinical approach. J Autoimmun 2018;90:1-27. doi:10.1016/j.jaut.2018.02.003 PMid:29449131
  12. Ünlü O, Zuily S, Erkan D. The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus. Eur J Rheumatol 2016;3(2):75 doi:10.5152/eurjrheum.2015.0085 PMid:27708976 PMCid:PMC5042235
  13. Brusch A. The significance of anti-beta-2-glycoprotein I antibodies in antiphospholipid syndrome. Antibodies 2016; 5(2): 16. doi:10.3390/antib5020016 PMid:31557997 PMCid:PMC6698844
  14. Hu C, Li S, Xie Z, You H, Jiang H, Shi Y, et al. Evaluation of the diagnostic value of non-criteria antibodies for antiphospholipid syndrome patients in a Chinese cohort. Front Immunol 2021; 12: 741369. doi:10.3389/fimmu.2021.741369 PMid:34567005 PMCid:PMC8461188
  15. Serrano M, Espinosa G, Cervera R, Serrano A. COVID-19 coagulopathy and antiphospholipid syndrome. Revista Colombiana de Reumatología 2022;29:S25-S34 doi:10.1016/j.rcreu.2021.02.013 PMCid:PMC8390358
  16. Karahan S, Erol K, Yuksel RC, Artan C, Celik I. Antiphospholipid antibodies in COVID-19-associated pneumonia patients in intensive care unit. Mod Rheumatol 2022;32(1):163-8 doi:10.1080/14397595.2021.1892257 PMid:33620009 PMCid:PMC9383176
  17. Devreese KM, Linskens EA, Benoit D, Peperstraete H. Antiphospholipid antibodies in patients with COVID‐19: a relevant observation? J Thromb Haemost 2020;18(9):2191-201. doi:10.1111/jth.14994 PMid:32619328 PMCid:PMC7361253
  18. Nosrati A, Torabizadeh Z, Larijani LV, Alizade-Navaei R, Mobini M, Aliyali M, et al. Evaluation of Antiphospholipid Antibodies in COVID-19 Patients with Coagulopathy. Tanaffos 2022; 21(1):45.
  19. Taha M, Samavati L. Antiphospholipid antibodies in COVID-19: a meta-analysis and systematic review. RMD Open 2021;7(2): e001580. doi:10.1136/rmdopen-2021-001580 PMid:33958439 PMCid:PMC8103564
  20. Zuo Y, Estes SK, Ali RA, Gandhi AA, Yalavarthi S, Shi H, et al. Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19. Sci Transl Medicine 2020;12(570): eabd3876. doi:10.1126/scitranslmed.abd3876 PMid:33139519 PMCid:PMC7724273
  21. Borghi MO, Beltagy A, Garrafa E, Curreli D, Cecchini G, Bodio C, et al. Anti-phospholipid antibodies in COVID-19 are different from those detectable in the anti-phospholipid syndrome. Front Immunol 2020;11:584241. doi:10.3389/fimmu.2020.584241 PMid:33178218 PMCid:PMC7593765
  22. Sciascia S, Radin M, Bazzan M, Montaruli B, Cosseddu D, Norbiato C, et al. Antiphospholipid antibodies and infection: non nova sed nove. Front Immunol 2021;12:687534 doi:10.3389/fimmu.2021.687534 PMid:34220842 PMCid:PMC8242935
  23. Favaloro EJ, Henry BM, Lippi G, editors. COVID-19 and antiphospholipid antibodies: time for a reality check? Seminars in Thrombosis and Hemostasis; 2021: Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY doi:10.1055/s-0041-1728832 PMid:34130340
  24. Dima A, Popescu DN, Moroti R, Stoica E, State G, Negoi F, et al. Antiphospholipid antibodies occurrence in Acute SARS-CoV-2 infection without overt thrombosis. Biomedicines 2023; 11 (5):1241. doi:10.3390/biomedicines11051241 PMid:37238912 PMCid:PMC10215326
  25. Noordermeer T, Schutgens RE, Visser C, Rademaker E, de Maat MP, Jansen AG, et al. Lupus anticoagulant associates with thrombosis in patients with COVID‐19 admitted to intensive care units: A retrospective cohort study. Res Pract Thromb Haemost 2022;6(6):e12809.
  26. Pakzad B, Salehi M, Abbasi S, Salehi MM, Naeini MK, Salehi H. Evaluation of the association between antiphospholipid antibodies and ICU admission outcome in critically ill COVID-19 patients in Iranian population. Int J Prev Med 2022;13.