Thrombosis Journal (Nov 2021)

Low FXIII activity levels in intensive care unit hospitalized COVID-19 patients

  • Yael Lichter,
  • Tanya Badelbayov,
  • Irina Shalev,
  • Reut Schvartz,
  • Yishay Szekely,
  • Dan Benisty,
  • Ilana Goldiner,
  • Maxim Kagarlyk,
  • Keren Asraf,
  • Ram Doolman,
  • Efrat Luttwak,
  • Ilya Kirgner,
  • Irit Avivi,
  • Nimrod Adi,
  • Ben-Zion Katz

DOI
https://doi.org/10.1186/s12959-021-00333-3
Journal volume & issue
Vol. 19, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Background COVID-19 infection is associated with a hypercoagulable state. Severe COVID-19 patients present with high plasma fibrinogen levels, continuous deposition of fibrin and the presence of microthrombi in their lungs, accompanied by significant fibrinolysis, resulting in high D-dimer levels. Due to the role of FXIII in fibrin crosslinking and clot stabilization, we analyzed its activity levels and dynamics in COVID-19 patients hospitalized in the intensive care unit (ICU). Methods FXIII levels were measured in thirty four COVID-19 patients hospitalized in the ICU and in fourteen non-severe COVID-19 patients. FVIII levels were measured for comparison. Laboratory data and clinical variables were recorded. Results The average FXIII activity level in 34 ICU hospitalized COVID-19 patients was 69.9±33 %, significantly lower compared to an average of 120±20.9 % FXIII activity in 14 non-severe COVID-19 patients. FXIII activity levels were below the low normal value (< 79 % FXIII activity) in 74 % of the ICU hospitalized COVID-19 patients. In contrast, high FVIII activity was measured among all severe COVID-19 patients. Consecutive measurements, performed in fourteen ICU hospitalized COVID-19 patients, pointed to a significant decrease in FXIII activity from the average of 85.7±28.2 %, (which is in the normal range), to an average of 68.0±20.4 %, below the low normal range, within 6.4±3.4 days of ICU hospitalization. Liver functions did not differentiate between patients with low and normal FXIII activity. No inhibitor to FXIII activity was found in the plasma of severe COVID-19 patients. Levels of FXIII-A antigen correlated with FXIII activity, and were low in severe COVID-19 patients. Conclusions Low FXIII activity levels were found in COVID-19 patients hospitalized in the ICU, with gradual decline during their hospitalization. A mechanism of consumption may account for the low FXIII activity in these patients.

Keywords