Angiogenesis . Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality

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Angiogenesis


. 2021 Jan 15;1-13.
doi: 10.1007/s10456-020-09762-6. Online ahead of print.
Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality


Aur?lien Philippe ¹ , Richard Chocron ² , Nicolas Gendron ¹ , Olivier Bory ³ , Agathe Beauvais ³ , Nicolas Peron ⁴ , Lina Khider ⁵ , Coralie L Guerin ⁶ , Guillaume Goudot ⁵ , Fran?oise Levasseur ⁷ , Christophe Peronino ¹ , Jerome Duchemin ⁸ , Julie Brichet ¹ , Elise Sourdeau ⁹ , Florence Desvard ¹ , S?bastien Bertil ¹ , Fr?d?ric Pene ¹⁰ , Cherifa Cheurfa ¹¹ , Tali-Anne Szwebel ¹² , Benjamin Planquette ¹³ , Nadia Rivet ¹ , Georges Jourdi ¹⁴ , Caroline Hauw-Berlemont ⁴ , Bertrand Hermann ⁴ , Pascale Gaussem ¹ , Tristan Mirault ¹⁵ , Benjamin Terrier ¹⁶ , Olivier Sanchez ¹³ , Jean-Luc Diehl ¹⁷ , Michaela Fontenay ¹⁸ , David M Smadja ¹⁹



Affiliations

• PMID: 33449299
• PMCID: PMC7809553
• DOI: 10.1007/s10456-020-09762-6

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a respiratory disease associated with endotheliitis and microthrombosis.
Objectives: To correlate endothelial dysfunction to in-hospital mortality in a bi-centric cohort of COVID-19 adult patients.
Methods: Consecutive ambulatory and hospitalized patients with laboratory-confirmed COVID-19 were enrolled. A panel of endothelial biomarkers and von Willebrand factor (VWF) multimers were measured in each patient ≤ 48 h following admission.
Results: Study enrolled 208 COVID-19 patients of whom 23 were mild outpatients and 189 patients hospitalized after admission. Most of endothelial biomarkers tested were found increased in the 89 critical patients transferred to intensive care unit. However, only von Willebrand factor antigen (VWF:Ag) scaled according to clinical severity, with levels significantly higher in critical patients (median 507%, IQR 428-596) compared to non-critical patients (288%, 230-350, p < 0.0001) or COVID-19 outpatients (144%, 133-198, p = 0.007). Moreover, VWF high molecular weight multimers (HMWM) were significantly higher in critical patients (median ratio 1.18, IQR 0.86-1.09) compared to non-critical patients (0.96, 1.04-1.39, p < 0.001). Among all endothelial biomarkers measured, ROC curve analysis identified a VWF:Ag cut-off of 423% as the best predictor for in-hospital mortality. The accuracy of VWF:Ag was further confirmed in a Kaplan-Meier estimator analysis and a Cox proportional Hazard model adjusted on age, BMI, C-reactive protein and D-dimer levels.
Conclusion: VWF:Ag is a relevant predictive factor for in-hospital mortality in COVID-19 patients. More than a biomarker, we hypothesize that VWF, including excess of HMWM forms, drives microthrombosis in COVID-19.

Keywords: COVID-19; Endothelial activation; Microthrombosis; Mortality; Multimers; Von Willebrand factor.