| Title: |
Is COVID-19 Coagulopathy a Thrombotic Microangiopathy? A Prospective, Observational Study |
| Authors: |
Mauro Silingardi; Fulvia Zappulo; Ada Dormi; Attilia Maria Pizzini; Chiara Donadei; Maria Cappuccilli; Chiara Fantoni; Stefania Zaccaroni; Valeria Pizzuti; Nicola Cilloni; Simona Tantillo; Antonella Guidi; Rita Mancini; Gaetano La Manna; Giorgia Comai |
| Contributors: |
Silingardi, Mauro; Zappulo, Fulvia; Dormi, Ada; Maria Pizzini, Attilia; Donadei, Chiara; Cappuccilli, Maria; Fantoni, Chiara; Zaccaroni, Stefania; Pizzuti, Valeria; Cilloni, Nicola; Tantillo, Simona; Guidi, Antonella; Mancini, Rita; La Manna, Gaetano; Comai, Giorgia |
| Publication Year: |
2025 |
| Collection: |
IRIS Università degli Studi di Bologna (CRIS - Current Research Information System) |
| Subject Terms: |
ADAMTS13; complement activation; COVID-19-associated coagulopathy; inflammatory cytokine; von Willebrand factor |
| Description: |
Severe COVID-19 is often associated with coagulopathy and thrombotic complications. The underlying mechanisms are complex and multifactorial, involving platelet activation, dysregulation of the complement cascade, fibrinolytic imbalance, release of pro-inflammatory cytokines, immunothrombosis, antiphospholipid antibodies, and alterations in the von Willebrand factor (vWF)/ADAMTS13 axis. These pathways are also implicated in thrombotic microangiopathies (TMAs), characterized by endothelial injury and widespread microvascular thrombosis. In this prospective monocentric observational study, we investigated whether COVID-19-associated coagulopathy meets the criteria for TMA and evaluated the roles of complement activation and vWF/ADAMTS13 imbalance in disease severity. Forty-three hospitalized COVID-19 patients were enrolled and stratified by disease severity. Blood samples collected at admission were analyzed for hematologic, coagulation, inflammatory, and complement parameters. A 30-day follow-up recorded survival and thrombotic events. All patients showed elevated vWF and factor VIII levels; however, only vWF collagen-binding activity (vWF-CBA) significantly correlated with disease severity. ADAMTS13 activity remained above 60% in all cases, and no schistocytes were detected, arguing against a diagnosis of classical TMA. Nevertheless, the vWF-CBA/ADAMTS13 ratio was significantly higher in severe cases, particularly in unvaccinated individuals, suggesting endothelial dysregulation. Complement analysis revealed increased C5a levels and decreased C3b/iC3b ratios in severe disease, consistent with complement activation and consumption. C2 levels were also lower in these patients. Although complement activation and vWF/ADAMTS13 imbalance did not directly correlate, both pathways showed a similar trend according to disease severity. Overall, our findings indicate that COVID-19-related coagulopathy does not fulfill the criteria for classical TMA but shows features of complement-mediated endothelial injury and vWF ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
ELETTRONICO |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40508203; info:eu-repo/semantics/altIdentifier/wos/WOS:001505959600001; volume:26; issue:11; firstpage:1; lastpage:14; numberofpages:14; journal:INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES; https://hdl.handle.net/11585/1018006 |
| DOI: |
10.3390/ijms26115395 |
| Availability: |
https://hdl.handle.net/11585/1018006; https://doi.org/10.3390/ijms26115395; https://www.mdpi.com/1422-0067/26/11/5395 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.9CC69890 |
| Database: |
BASE |