nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2024-4-445-458nid-737Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСнижение активности ADAMTS13 и тромбоцитопения как предикторы неблагоприятного исхода у пациентов с COVID-19, находящихся на гемодиализеReduced ADAMTS13 activity and thrombocytopenia as predictors of unfavorable outcome in patients with COVID-19 undergoing hemodialysishttps://orcid.org/0000-0001-7407-5695ИвановаЕ. С.IvanovaE. S.

Иванова Екатерина Сергеевна – канд. мед. наук, врач-нефролог нефрологического отделения №1

123182, г. Москва, ул. Пехотная, д.3

Еkaterina S. Ivanova

3, Pekhotnaya st., Moscow, 123182

katerineiv@mail.ruhttps://orcid.org/0000-0002-7701-772XАвдонинП. П.AvdoninP. P.

Авдонин Пётр Павлович – канд. биол. наук, старший научный сотрудник

119334, Москва, ул. Вавилова, 26

Piotr P. Avdonin

26, Vavilova st., Moscow, 119334

ppavdonin@gmail.comhttps://orcid.org/0000-0001-8264-7374КотенкоО. Н.KotenkoO. N.

Котенко Олег Николаевич – канд. мед. наук, главный внештатный специалист нефролог ДЗМ, руководитель Научно-практического центра нефрологии и патологии трансплантированной почки

123182, г. Москва, ул. Пехотная, д.3

Oleg N. Kotenko

3, Pekhotnaya st., Moscow, 123182

olkotenko@yandex.ruhttps://orcid.org/0000-0002-0402-8348СтоляревичЕ. С.StolyarevichE. S.

Столяревич Екатерина Сергеевна – доктор мед. наук, проф. кафедры нефрологии ФПДО ФГБОУ ВО «МГМСУ им. А.И. Евдокимова» МЗ РФ, врач-патологоанатом отделения патологической анатомии ГБУЗ «ГКБ № 52» ДЗМ

123182, г. Москва, ул. Пехотная, д.3

Ekaterina S. Stolyarevich

3, Pekhotnaya st., Moscow, 123182

Stolyarevich@yandex.ruhttps://orcid.org/0000-0002-6086-5220ФроловаН. Ф.FrolovaN. F.

Фролова Надия Фяатовна – канд. мед. наук, заместитель главного врача по нефрологической помощи

123182, г. Москва, ул. Пехотная, д.3

Nadiya F. Frolova

3, Pekhotnaya st., Moscow, 123182

nadiya.frolova@yandex.ruБлиноваМ. С.BlinovaM. S.

Блинова Мария Сергеевна – старший лаборант

119334, Москва, ул. Вавилова, 26

Maria S. Blinova

26, Vavilova st., Moscow, 119334

maria.s.blinova@gmail.comПопковаВ. С.PopkovaV. S.

Попкова Виктория Сергеевна – студентка Московской Ветеринарной Академии имени К.И. Скрябина

119334, Москва, ул. Вавилова, 26

Victoria S. Popkova

26, Vavilova st., Moscow, 119334

vipopkova2001@gmail.comРыбаковаЕ. Ю.RybakovaE. Y.

Рыбакова Елена Юрьевна – канд. биол. наук, научный сотрудник

119334, Москва, ул. Вавилова, 26

Elena Y. Rybakova

26, Vavilova st., Moscow, 119334

alenka3107@mail.ruhttps://orcid.org/0000-0002-5452-2125ГончаровН. В.GoncharovN. V.

Гончаров Николай Васильевич – доктор биол. наук, профессор, главный научный сотрудник, заведующий лабораторией сравнительной биохимии ферментов ИЭФБ РАН;

ведущий научный сотрудник НИИ гигиены, профпатологии и экологии человека ФМБА России

194223, Санкт-Петербург, пр. Тореза, 44

Nikolay V. Goncharov

44, Torez Avenue, St. Petersburg, 194223

ngoncharov@gmail.comhttps://orcid.org/0000-0002-4138-1589АвдонинП. В.AvdoninP. V.

Авдонин Павел Владимирович – доктор биол. наук, профессор. Зав. лабораторией физиологии рецепторов и сигнальных систем

119334, Москва, ул. Вавилова, 26

Pavel V. Avdonin

26, Vavilova st., Moscow, 119334

pvavdonin@yandex.ruГородская клиническая больница №52 Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital No.52 of the Moscow Healthcare DepartmentRussian FederationИнститут биологии развития им. Н.К. Кольцова РАНРоссияKoltsov Institute of Developmental Biology RASRussian FederationГородская клиническая больница № 52 Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital No.52 of the Moscow Healthcare DepartmentRussian FederationИнститут эволюционной физиологии и биохимии им. И.М. Сеченова РАНРоссияSechenov Institute of Evolutionary Physiology and Biochemistry RASRussian Federation202429122024264445458Copyright © Иванова Е.С., Авдонин П.П., Котенко О.Н., Столяревич Е.С., Фролова Н.Ф., Блинова М.С., Попкова В.С., Рыбакова Е.Ю., Гончаров Н.В., Авдонин П.В., 20242024Иванова Е.С., Авдонин П.П., Котенко О.Н., Столяревич Е.С., Фролова Н.Ф., Блинова М.С., Попкова В.С., Рыбакова Е.Ю., Гончаров Н.В., Авдонин П.В.Ivanova E.S., Avdonin P.P., Kotenko O.N., Stolyarevich E.S., Frolova N.F., Blinova M.S., Popkova V.S., Rybakova E.Y., Goncharov N.V., Avdonin P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/737

Целью работы было установить связь между нарушениями в системе ADAMTS13/фактор Виллебранда/тромбоциты и вероятностью летального исхода у больных COVID-19 (n=88) с нарушением функции почек и тромбоцитопенией. Объектами данного ретроспективного исследования были больные, проходившие лечение с мая 2020 г. по август 2022 г. в нефрологическом отделении ГКБ №52 г. Москвы. Показатели крови определяли при поступлении пациентов в стационар. Медиана активности ADAMTS13 у выписанных больных (n=62) составляла 91,0% от нормы (95% ДИ 75,0105%), а у умерших (n=26) была снижена до 74,0% (95% ДИ 42-84%; p< 001). В отличие от этого, содержание антигена фактора Виллебранда (фВ) и активность фВ у больных были значительно выше нормы, но в группах выживших и умерших не различались. Количество тромбо­цитов у выживших составляло 114×103/мкл (95% ДИ 103 до 128×103/мкл), у умерших 43,0×103/мкл (95% ДИ 25,7 до 59,9×103/мкл; p<0,001). Число тромбоцитов в плазме коррелировало с активностью ADAMTS13 (коэффициент Спирмена rho = 0,514; p<0,001) и не зависело от содержания и активности фВ. В группе больных, которым проводился гемодиализ (ГД), снижение активности ADAMTS13 и количества тромбоцитов достоверно коррелировало с летальным исходом. Анализ ROC-кривых для активности ADAMTS13 и количества тромбоцитов как предикторов смертности показал, что при значениях активности ADAMTS13 ≤79% и ≤53% отношение шансов (odds ratio – OR) для леталь­ного исхода у пациентов на ГД (n=58) составило 8,53 (95% ДИ 2,12‑34,3; p=0,0025) и 27,6 (95% ДИ 3,11‑245; p=0,0029), при количестве тромбоцитов ≤75×103/мкл OR было равно 10,9 (95% ДИ 3,00‑39,2; р=0,0003). У пациентов на ГД с острым поражением почек, развившемся на фоне хронической бо­лезни почек (n=10) при активности ADAMTS13 ≤79% OR для летального исхода было равно 117 (95% ДИ 19‑7960; p=0,023). У пациентов без ГД и у пациентов с трансплантированной почкой не было значимой корреляции между снижением активности ADAMTS13 и летальностью. Вероятность вы­живания у пациентов с COVID-19 на ГД через 35 дней после поступления в клинику при активности ADAMTS13 ≤53% была в 3,22±0,92 (p<0,01) раза ниже, чем у пациентов с активностью ADAMTS13 >53%. Полученные данные указывают, что у пациентов с COVID-19, находящихся на гемодиализе, сниженные показатели активности ADAMTS13 и количества тромбоцитов могут быть использованы в качестве предикторов неблагоприятного исхода.

Aim. The study aimed to explore the relationship between disturbances in the ADAMTS13/von Willebrand factor (vWF)/platelet system and the risk of mortality in COVID-19 patients (n=90) with impaired renal function and thrombocytopenia. The retrospective analysis included patients treated between May 2020 and August 2022 at the nephrology department of the 52nd city Hospital in Moscow. Blood counts were assessed upon hospital admission.Results. Median ADAMTS13 activity in discharged patients (n=62) was 91.0% of normal (95% CI 75.0‑105%), and in deceased patients (n=26) it was significantly reduced to 74.0% (95% CI 42‑84%; p<0.001). Conversely, vWF antigen level and its activity were significantly elevated in all patients but showed no difference between survivors and non-survivors. Platelet counts were 114×103/μl (95% CI 103 to 128×103/μl) in survivors and 43.0×103/μl (95% CI 25.7 to 59.9×103/μl) in deceased patients (p<0.001). Platelets counts correlated positively with ADAMTS13 activity (Spearman coefficient rho = 0.514; p<0.001) were independ of vWF level or activity. Among patients undergoing hemodialysis (HD), lower ADAMTS13 activity and platelet counts were significantly associated with mortality. ROC curve analysis revealed that ADAMTS13 ≤79% and ≤53% increased the odds ratio (OR) for mortality in HD patients (n=58) to 8.53 (95% CI 2.12‑34.3; p=0.0025) and 27.6 (95% CI 3.11‑245; p=0.0029) respectively. A platelet count ≤75×103/μl rised the OR to 10.9 (95% CI 3.00‑39.2; p=0.0003). In HD patients with acute kidney injury superimposed on chronic kidney disease (n=10), ADAMTS13 activity ≤79% increased the OR for mortalirty to 117 (95% CI 1.9‑7960; p=0.023). In contrast, no significant association between ADAMTS13 activity and mortality was observed in patients not undergoing HD or kidney transplant recipients. Survival probability in COVID-19 patients on HD with ADAMTS13 activity ≤53% was 3.22±0.92 times lower (p<0.01) after 35 days of hospital admission compared to patients with ADAMTS13 activity >53%.Conclusion. These findings suggest that reduced ADAMTS13 activity and platelet counts are strong predictors of poor outcomes in COVID-19 patients undergoing hemodialysis.

хроническая болезнь почекCOVID-19гемодиализADAMTS13тромбоцитыфактор Вилле-брандасмертностьchronic kidney diseaseCOVID-19hemodialysisADAMTS13plateletsvon Willebrand factormortalitИсследование выполнено при финансовой поддержке Российского научного фонда (грант 22 15 00409) и финансировалось также в рамках Государственной программы фундаментальных исследований №0088 2024 0009.The study was carried out with the financial support of the Russian Science Foundation (grant 22 15 00409) and was also financed within the framework of the State Program for Fundamental Research No.0088 2024 0009.ReferencesDiamond MS, Kanneganti TD. Innate immunity: the first line of defense against SARS-CoV-2. Nat Immunol. 2022;23 (2):165-176. DOI: 10.1038/s41590-021-01091-0Diamond MS, Kanneganti TD. Innate immunity: the first line of defense against SARS-CoV-2. Nat Immunol. 2022;23 (2):165-176. DOI: 10.1038/s41590-021-01091-0Amann K, Boor P, Wiech T et al. COVID-19 effects on the kidney. Der Pathologe. 2021;42(Suppl 1):76-80. DOI: 10.1007/s00292-020-00900-xAmann K, Boor P, Wiech T et al. COVID-19 effects on the kidney. Der Pathologe. 2021;42(Suppl 1):76-80. DOI: 10.1007/s00292-020-00900-xSabaghian T, Kharazmi AB, Ansari A et al. COVID19 and Acute Kidney Injury: A Systematic Review. Frontiers in medicine. 2022;9:705908. DOI: 10.3389/fmed.2022.705908Sabaghian T, Kharazmi AB, Ansari A et al. COVID19 and Acute Kidney Injury: A Systematic Review. Frontiers in medicine. 2022;9:705908. DOI: 10.3389/fmed.2022.705908Zhang J, Pang Q, Zhou T et al. Risk factors for acute kidney injury in COVID-19 patients: an updated systematic review and meta-analysis. Ren Fail. 2023;45(1):2170809. DOI: 10.1080/0886022X.2023.2170809Zhang J, Pang Q, Zhou T et al. Risk factors for acute kidney injury in COVID-19 patients: an updated systematic review and meta-analysis. Ren Fail. 2023;45(1):2170809. DOI: 10.1080/0886022X.2023.2170809Mittal R, Chourasia N, Bharti VK et al. Blood-based biomarkers for diagnosis, prognosis, and severity prediction of COVID-19: Opportunities and challenges. Journal of family medicine and primary care. 2022;11(8):4330-4341. DOI: 10.4103/jfmpc.jfmpc_2283_21Mittal R, Chourasia N, Bharti VK et al. Blood-based biomarkers for diagnosis, prognosis, and severity prediction of COVID-19: Opportunities and challenges. Journal of family medicine and primary care. 2022;11(8):4330-4341. DOI: 10.4103/jfmpc.jfmpc_2283_21Mayne ES, George JA, Louw S. Assessing Biomarkers in Viral Infection. Adv Exp Med Biol. 2023;1412:159-173. DOI: 10.1007/978-3-031-28012-2_8Mayne ES, George JA, Louw S. Assessing Biomarkers in Viral Infection. Adv Exp Med Biol. 2023;1412:159-173. DOI: 10.1007/978-3-031-28012-2_8Henry BM, Benoit SW, de Oliveira MHS et al. ADAMTS13 activity to von Willebrand factor antigen ratio predicts acute kidney injury in patients with COVID-19: Evidence of SARS-CoV-2 induced secondary thrombotic microangiopathy. Int J Lab Hematol. 2021;43(Suppl 1):129-136. DOI: 10.1111/ijlh.13415Henry BM, Benoit SW, de Oliveira MHS et al. ADAMTS13 activity to von Willebrand factor antigen ratio predicts acute kidney injury in patients with COVID-19: Evidence of SARS-CoV-2 induced secondary thrombotic microangiopathy. Int J Lab Hematol. 2021;43(Suppl 1):129-136. DOI: 10.1111/ijlh.13415Iba T, Levy JH, Levi M et al. Coagulopathy in COVID19. J Thromb Haemost. 2020;18 (9):2103-2109. DOI: 10.1111/jth.14975Iba T, Levy JH, Levi M et al. Coagulopathy in COVID19. J Thromb Haemost. 2020;18 (9):2103-2109. DOI: 10.1111/jth.14975Bahraini M, Dorgalaleh A. The Impact of SARS-CoV-2 Infection on Blood Coagulation and Fibrinolytic Pathways: A Review of Prothrombotic Changes Caused by COVID-19. Semin Thromb Hemost. 2022;48 (1):19-30. DOI: 10.1055/s-0041-1736166Bahraini M, Dorgalaleh A. The Impact of SARS-CoV-2 Infection on Blood Coagulation and Fibrinolytic Pathways: A Review of Prothrombotic Changes Caused by COVID-19. Semin Thromb Hemost. 2022;48 (1):19-30. DOI: 10.1055/s-0041-1736166Al Otair H, AlSaleh K, AlQahtany FS et al. The Level of vWF Antigen and Coagulation Markers in Hospitalized Patients with Covid-19. Journal of blood medicine. 2021;12:809-817. DOI: 10.2147/JBM.S318940Al Otair H, AlSaleh K, AlQahtany FS et al. The Level of vWF Antigen and Coagulation Markers in Hospitalized Patients with Covid-19. Journal of blood medicine. 2021;12:809-817. DOI: 10.2147/JBM.S318940Bray M, Guzel MA, Lam F et al. High levels of von Willebrand factor with reduced specific activities in hospitalized patients with or without COVID-19. J Thromb Thrombolysis. 2022;54(2):211-216. DOI: 10.1007/s11239-022-02679-5Bray M, Guzel MA, Lam F et al. High levels of von Willebrand factor with reduced specific activities in hospitalized patients with or without COVID-19. J Thromb Thrombolysis. 2022;54(2):211-216. DOI: 10.1007/s11239-022-02679-5Ladikou EE, Sivaloganathan H, Milne KM et al. Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19? Clinical medicine. 2020;20(5):e178-e182. DOI: 10.7861/clinmed.2020-0346Ladikou EE, Sivaloganathan H, Milne KM et al. Von Willebrand factor (vWF): marker of endothelial damage and thrombotic risk in COVID-19? Clinical medicine. 2020;20(5):e178-e182. DOI: 10.7861/clinmed.2020-0346Zachariah U, Nair SC, Goel A et al. Targeting raised von Willebrand factor levels and macrophage activation in severe COVID-19: Consider low volume plasma exchange and low dose steroid. Thromb Res. 2020;192:2. DOI: 10.1016/j.thromres.2020.05.001Zachariah U, Nair SC, Goel A et al. Targeting raised von Willebrand factor levels and macrophage activation in severe COVID-19: Consider low volume plasma exchange and low dose steroid. Thromb Res. 2020;192:2. DOI: 10.1016/j.thromres.2020.05.001De Cristofaro R, Liuzzo G, Sacco M et al. Marked von Willebrand factor and factor VIII elevations in severe acute respiratory syndrome coronavirus-2-positive, but not severe acute respiratory syndrome coronavirus-2-negative, pneumonia: a casecontrol study. Blood Coagul Fibrinolysis. 2021;32(4):285-289. DOI: 10.1097/MBC.0000000000000998De Cristofaro R, Liuzzo G, Sacco M et al. Marked von Willebrand factor and factor VIII elevations in severe acute respiratory syndrome coronavirus-2-positive, but not severe acute respiratory syndrome coronavirus-2-negative, pneumonia: a casecontrol study. Blood Coagul Fibrinolysis. 2021;32(4):285-289. DOI: 10.1097/MBC.0000000000000998Dolgushina N, Gorodnova E, Beznoshenco O et al. Von Willebrand Factor and ADAMTS-13 Are Associated with the Severity of COVID-19 Disease. Journal of clinical medicine. 2022;11(14). DOI: 10.3390/jcm11144006Dolgushina N, Gorodnova E, Beznoshenco O et al. Von Willebrand Factor and ADAMTS-13 Are Associated with the Severity of COVID-19 Disease. Journal of clinical medicine. 2022;11(14). DOI: 10.3390/jcm11144006Babkina AS, Ostrova IV, Yadgarov MY et al. The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19. Viruses. 2022;14(2). DOI: 10.3390/v14020211Babkina AS, Ostrova IV, Yadgarov MY et al. The Role of Von Willebrand Factor in the Pathogenesis of Pulmonary Vascular Thrombosis in COVID-19. Viruses. 2022;14(2). DOI: 10.3390/v14020211Favaloro EJ, Henry BM, Lippi G. Increased VWF and Decreased ADAMTS-13 in COVID-19: Creating a Milieu for (Micro)Thrombosis. SeminThrombHemost. 2021;47(4):400-418. DOI: 10.1055/s-0041-1727282Favaloro EJ, Henry BM, Lippi G. Increased VWF and Decreased ADAMTS-13 in COVID-19: Creating a Milieu for (Micro)Thrombosis. SeminThrombHemost. 2021;47(4):400-418. DOI: 10.1055/s-0041-1727282Emirova KM, Orlova OM, Chichuga EM et al. A Moderate Decrease in ADAMTS13 Activity Correlates with the Severity of STEC-HUS. Biomolecules. 2023;13(11). DOI: 10.3390/biom13111671Emirova KM, Orlova OM, Chichuga EM et al. A Moderate Decrease in ADAMTS13 Activity Correlates with the Severity of STEC-HUS. Biomolecules. 2023;13(11). DOI: 10.3390/biom13111671Kremer Hovinga JA, Zeerleder S, Kessler P et al. ADAMTS-13, von Willebrand factor and related parameters in severe sepsis and septic shock. J Thromb Haemost. 2007;5(11):2284-2290. DOI: 10.1111/j.1538-7836.2007.02743.xKremer Hovinga JA, Zeerleder S, Kessler P et al. ADAMTS-13, von Willebrand factor and related parameters in severe sepsis and septic shock. J Thromb Haemost. 2007;5(11):2284-2290. DOI: 10.1111/j.1538-7836.2007.02743.xVan den Born BJ, Van der Hoeven NV, Groot E et al. Association between thrombotic microangiopathy and reduced ADAMTS13 activity in malignant hypertension. Hypertension. 2008;51(4):862-866. DOI: 10.1161/HYPERTENSIONAHA.107.103127Van den Born BJ, Van der Hoeven NV, Groot E et al. Association between thrombotic microangiopathy and reduced ADAMTS13 activity in malignant hypertension. Hypertension. 2008;51(4):862-866. DOI: 10.1161/HYPERTENSIONAHA.107.103127Martin K, Borgel D, Lerolle N et al. Decreased ADAMTS-13 (A disintegrin-like and metalloprotease with thrombospondin type 1 repeats) is associated with a poor prognosis in sepsis-induced organ failure. Crit Care Med. 2007;35(10):2375-2382Martin K, Borgel D, Lerolle N et al. Decreased ADAMTS-13 (A disintegrin-like and metalloprotease with thrombospondin type 1 repeats) is associated with a poor prognosis in sepsis-induced organ failure. Crit Care Med. 2007;35(10):2375-2382Bazzan M, Montaruli B, Sciascia S et al. Low ADAMTS 13 plasma levels are predictors of mortality in COVID-19 patients. Internal and emergency medicine. 2020;15(5):861-863. DOI: 10.1007/s11739-020-02394-0Bazzan M, Montaruli B, Sciascia S et al. Low ADAMTS 13 plasma levels are predictors of mortality in COVID-19 patients. Internal and emergency medicine. 2020;15(5):861-863. DOI: 10.1007/s11739-020-02394-0De Jongh R, Ninivaggi M, Mesotten D et al. Vascular activation is a strong predictor of mortality in coronavirus disease 2019 patients on the ICU. Blood Coagul Fibrinolysis. 2021;32(4):290-293. DOI: 10.1097/MBC.0000000000001007De Jongh R, Ninivaggi M, Mesotten D et al. Vascular activation is a strong predictor of mortality in coronavirus disease 2019 patients on the ICU. Blood Coagul Fibrinolysis. 2021;32(4):290-293. DOI: 10.1097/MBC.0000000000001007Rodriguez Rodriguez M, Castro Quismondo N, Zafra Torres D et al. Increased von Willebrand factor antigen and low ADAMTS13 activity are related to poor prognosis in covid-19 patients. Int J Lab Hematol. 2021;43(4):O152-O155. DOI: 10.1111/ijlh.13476Rodriguez Rodriguez M, Castro Quismondo N, Zafra Torres D et al. Increased von Willebrand factor antigen and low ADAMTS13 activity are related to poor prognosis in covid-19 patients. Int J Lab Hematol. 2021;43(4):O152-O155. DOI: 10.1111/ijlh.13476Sweeney JM, Barouqa M, Krause GJ et al. Low ADAMTS13 Activity Correlates with Increased Mortality in COVID19 Patients. TH open : companion journal to thrombosis and haemostasis. 2021;5(1):e89-e103. DOI: 10.1055/s-0041-1723784Sweeney JM, Barouqa M, Krause GJ et al. Low ADAMTS13 Activity Correlates with Increased Mortality in COVID19 Patients. TH open : companion journal to thrombosis and haemostasis. 2021;5(1):e89-e103. DOI: 10.1055/s-0041-1723784Xu X, Feng Y, Jia Y et al. Prognostic value of von Willebrand factor and ADAMTS13 in patients with COVID-19: A systematic review and meta-analysis. Thromb Res. 2022;218:83-98. DOI: 10.1016/j.thromres.2022.08.017Xu X, Feng Y, Jia Y et al. Prognostic value of von Willebrand factor and ADAMTS13 in patients with COVID-19: A systematic review and meta-analysis. Thromb Res. 2022;218:83-98. DOI: 10.1016/j.thromres.2022.08.017Tiscia G, Favuzzi G, De Laurenzo A et al. The Prognostic Value of ADAMTS-13 and von Willebrand Factor in COVID19 Patients: Prospective Evaluation by Care Setting. Diagnostics. 2021;11(9). DOI: 10.3390/diagnostics11091648Tiscia G, Favuzzi G, De Laurenzo A et al. The Prognostic Value of ADAMTS-13 and von Willebrand Factor in COVID19 Patients: Prospective Evaluation by Care Setting. Diagnostics. 2021;11(9). DOI: 10.3390/diagnostics11091648Ward SE, Fogarty H, Karampini E et al. ADAMTS13 regulation of VWF multimer distribution in severe COVID19. J ThrombHaemost. 2021;19(8):1914-1921. DOI: 10.1111/jth.15409Ward SE, Fogarty H, Karampini E et al. ADAMTS13 regulation of VWF multimer distribution in severe COVID19. J ThrombHaemost. 2021;19(8):1914-1921. DOI: 10.1111/jth.15409Mancini I, Baronciani L, Artoni A et al. The ADAMTS13-von Willebrand factor axis in COVID-19 patients. J ThrombHaemost. 2021;19(2):513-521. DOI: 10.1111/jth.15191Mancini I, Baronciani L, Artoni A et al. The ADAMTS13-von Willebrand factor axis in COVID-19 patients. J ThrombHaemost. 2021;19(2):513-521. DOI: 10.1111/jth.15191Remuzzi G, Galbusera M, Noris M et al. von Willebrand factor cleaving protease (ADAMTS13) is deficient in recurrent and familial thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Blood. 2002;100(3):778-785. DOI: 10.1182/blood-2001-12-0166Remuzzi G, Galbusera M, Noris M et al. von Willebrand factor cleaving protease (ADAMTS13) is deficient in recurrent and familial thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Blood. 2002;100(3):778-785. DOI: 10.1182/blood-2001-12-0166Veyradier A, Obert B, Houllier A et al. Specific von Willebrand factor-cleaving protease in thrombotic microangiopathies: a study of 111 cases. Blood. 2001;98(6):1765-1772.Veyradier A, Obert B, Houllier A et al. Specific von Willebrand factor-cleaving protease in thrombotic microangiopathies: a study of 111 cases. Blood. 2001;98(6):1765-1772.Karabag Yilmaz E., Cebi M. N., Karahan I. et al. COVID-19 associated thrombotic microangiopathy. Nephrology. 2023;28(10):557-560. DOI: 10.1111/nep.14225Karabag Yilmaz E., Cebi M. N., Karahan I. et al. COVID-19 associated thrombotic microangiopathy. Nephrology. 2023;28(10):557-560. DOI: 10.1111/nep.14225Warnecke B, Kapoor V, Wehbe A et al. COVID-19-induced thrombotic microangiopathy: A great mimicker of thrombotic thrombocytopenic purpura (TTP). Clinical case reports. 2023;11(1):e6463. DOI: 10.1002/ccr3.6463Warnecke B, Kapoor V, Wehbe A et al. COVID-19-induced thrombotic microangiopathy: A great mimicker of thrombotic thrombocytopenic purpura (TTP). Clinical case reports. 2023;11(1):e6463. DOI: 10.1002/ccr3.6463Masuda E, Fukushima K, Hebisawa Y et al. Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review. Medicine. 2023;102(41):e35469. DOI: 10.1097/MD.0000000000035469Masuda E, Fukushima K, Hebisawa Y et al. Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review. Medicine. 2023;102(41):e35469. DOI: 10.1097/MD.0000000000035469Ardalan M, Moslemi M, Pakmehr A et al. TTP-like syndrome and its relationship with complement activation in critically ill patients with COVID-19: A cross-sectional study. Heliyon. 2023;9(6):e17370. DOI: 10.1016/j.heliyon.2023.e17370Ardalan M, Moslemi M, Pakmehr A et al. TTP-like syndrome and its relationship with complement activation in critically ill patients with COVID-19: A cross-sectional study. Heliyon. 2023;9(6):e17370. DOI: 10.1016/j.heliyon.2023.e17370Samaan F, Freitas RAP, Viana R et al. Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in Sao Paulo, Brazil. PLoS One. 2023;18(11):e0293846. DOI: 10.1371/journal.pone.0293846Samaan F, Freitas RAP, Viana R et al. Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in Sao Paulo, Brazil. PLoS One. 2023;18(11):e0293846. DOI: 10.1371/journal.pone.0293846Chen H, Yang G, Long Y et al. Lymphocyte and Platelet Counts, as well as Interleukin-6 Levels, Predict Mortality of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine: eCAM. 2021;2021:5582908. DOI: 10.1155/2021/5582908Chen H, Yang G, Long Y et al. Lymphocyte and Platelet Counts, as well as Interleukin-6 Levels, Predict Mortality of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine: eCAM. 2021;2021:5582908. DOI: 10.1155/2021/5582908

The authors declare that there are no conflicts of interest present.