Lupus Anticoagulant, Von Willerbrand Factor and Interleukin-6 as a reliable predictor of the need for mechanical ventilation in Covid-19

Abstract

Background: Coronavirus disease 2019 is characterized by causing thromboembolic events due to a procoagulant state. The possible relationship between lupus anticoagulant and patient's procoagulant state is controversial and no study has specifically evaluated the impact of lupus anticoagulant on noninvasive mechanical ventilation.

Objectives: The aim of our study was to analyze the association between lupus anticoagulant and the need for noninvasive mechanical ventilation in 44 consecutive patients hospitalized for Severe acute respiratory syndrome Coronavirus 2 pneumonia.

Methods: This was a prospective, multicenter, observational study conducted between January 1 and March 31, 2022, which included a total of 44 consecutive patients, > 18 years old and admitted for severe Severe acute respiratory syndrome Coronavirus 2 pneumonia. The following characteristics were determined: age, gender, blood group and Rh factor, plasma levels of Interleukin-6, Von Willerbrand Factor, lupus anticoagulant at admission, presence of venous thromboembolic disease, need for noninvasive mechanical ventilation, and intensive care unit admission. The relationship between the need for noninvasive mechanical ventilation and the levels of Von Willerbrand Factor and lupus anticoagulant was performed by T-student and its cutoff point was defined by ROC curve. Multivariate analysis was performed to establish worse prognosis factors. SPSS 27.0 statistical software was used, and an alpha error of 0.05 was established.

Results: 44 patients hospitalized with severe Severe acute respiratory syndrome Coronavirus 2 pneumonia (56.8% male, 68.5±17.9 years). 88.6% showed elevated Von Willerbrand Factor. Lupus anticoagulant levels were higher in patients requiring mechanical ventilation versus oxygen therapy (1.32±0.27 vs 1.12±0.17, p=0.011). The cutoff point for lupus anticoagulant levels that were associated with mechanical ventilation was 0.792 AUC (p=0.01). The predictors of noninvasive mechanical ventilation in the multivariate analysis were intensive care unit admission (p=0.02).

Conclusions: Plasma levels of Von Willerbrand Factor, lupus anticoagulant and Interleukin-6 can be a very useful prognostic tool for assessing the need for hospital admission to the critical care unit and the need for noninvasive mechanical ventilation. It would be interesting to include these determinations as routine assessments in patients with severe pneumonia.