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Endotheliopathy ID'd in COVID-19, Tied to Higher Mortality Risk

Soluble thrombomodulin concentration >3.26 ng/mL linked to lower rates of hospital discharge, survival

MONDAY, July 6, 2020 (HealthDay News) -- Endotheliopathy is present in COVID-19 and is associated with critical illness and death, according to a study published online June 30 in The Lancet Haematology.

George Goshua, M.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a single-center study involving hospitalized adult patients with laboratory-confirmed COVID-19 from the medical intensive care unit (ICU) or a specialized non-ICU COVID-19 floor (48 and 20 patients, respectively); 13 asymptomatic nonhospitalized controls were recruited as a comparator group. Markers of endothelial cell and platelet activations were assessed and the levels were compared for ICU patients, non-ICU patients, and controls.

The researchers found that compared with non-ICU patients, in ICU patients, markers of endothelial cell and platelet activation were significantly elevated, including von Willebrand Factor (VWF) antigen (mean, 565 percent in ICU patients versus 278 percent in non-ICU patients) and soluble P-selectin (15.9 versus 11.2 ng/mL). In 16 of 20 non-ICU patients, VWF antigen concentrations were also elevated above the normal range. Among all patients, there was a significant association between mortality and VWF antigen and soluble thrombomodulin. Soluble thrombomodulin concentrations greater than 3.26 ng/mL were associated with lower rates of hospital discharge (88 versus 52 percent) and a lower likelihood of survival (hazard ratio, 5.9).

"Additional studies are required to elucidate the factors that drive endotheliopathy in critical illness and to explore the possible therapeutic effects of adding antiplatelet or endothelial cell-modifying therapy," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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