IDENTIFICATION OF LABORATORY CRITERIA FOR RISK STRATIFICATION OF THROMBOSIS IN PATIENTS WITH COVID-19

Arterial and venous thrombotic events are a common complication of COVID infection, often complicating the course and prognosis of the primary disease. This study presents laboratory criteria for stratifying the high risk of deep vein thrombosis (DVT) in patients with COVID-19, which can be used for early prediction of DVT in order to prescribe or timely adjust anticoagulant therapy.

The aim of the study was to develop prognostic laboratory criteria for the degree of risk of COVID-associated thrombosis.

Material and methods. We determined the dynamics of biomarker levels of inflammation, endothelial dysfunction, and antiphospholipid antibodies in three groups of patients: COVID-19positive (COV), with COVID-associated thrombosis (COV-DVT), and with DVT without SARS-CoV2 infection (DVT). Peripheral blood samples were collected and analyzed from 143 patients: 13 patients with COV-DVT, 85 patients with COV, and 36 patients with DVT. The levels of markers of endothelial dysfunction, von Willebrand factor (VWF) and tissue plasminogen activator (t-PA) were analyzed using enzyme immunoassay, antibodies to phospholipids – lupus anticoagulant (SSB) and mannose-binding protein (MBL). The levels of antibodies to phospholipids (to β2-glycoprotein I IgM/IgG, to cardiolipin IgM/IgG) was determined. A comparative analysis of the levels of proinflammatory cytokines (interleukin 1-beta [IL-1β], interleukin 6 [IL-6], interleukin 10 [IL-10]) and anti-inflammatory cytokine (tumor necrosis factor-alpha [TNF-α]) was performed.

Results. In the patient groups studied, it was found that at the onset of the disease, COVID-positive patients had significantly higher levels of SSB, VWF, MBL, TNF-α, and IL-10 compared to patients with DVT. When comparing these same indicators in the COV group with patients with COV-DVT, only the levels of VWF and MBL were significantly higher. Analysis of phospholipid antibody levels showed that COVID-positive patients had significantly higher levels of antibodies to β2-glycoprotein I IgM and cardiolipin IgG at admission compared to patients with DVT, and when comparing the indicators in the group of COVID-positive patients with patients with COV-DVT, a significant difference was found only in the level of antibodies to cardiolipin IgG.

Conclusion. For stratifying the risk of DVT in patients with COVID-19 infection, interleukin-6, the marker of endothelial dysfunction VWF, and IgG antibodies to cardiolipin are of highest prognostic significance.

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