Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study



Benjamin, Laura A ORCID: 0000-0002-9685-1664, Paterson, Ross W, Moll, Rachel, Pericleous, Charis, Brown, Rachel, Mehta, Puja R, Athauda, Dilan, Ziff, Oliver J, Heaney, Judith, Checkley, Anna M
et al (show 26 more authors) (2021) Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study. ECLINICALMEDICINE, 39. 101070-.

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Abstract

<h4>Background</h4>A high prevalence of antiphospholipid antibodies has been reported in case series of patients with neurological manifestations and COVID-19; however, the pathogenicity of antiphospholipid antibodies in COVID-19 neurology remains unclear.<h4>Methods</h4>This single-centre cross-sectional study included 106 adult patients: 30 hospitalised COVID-neurological cases, 47 non-neurological COVID-hospitalised controls, and 29 COVID-non-hospitalised controls, recruited between March and July 2020. We evaluated nine antiphospholipid antibodies: anticardiolipin antibodies [aCL] IgA, IgM, IgG; anti-beta-2 glycoprotein-1 [aβ<sub>2</sub>GPI] IgA, IgM, IgG; anti-phosphatidylserine/prothrombin [aPS/PT] IgM, IgG; and anti-domain I β<sub>2</sub>GPI (aD1β2GPI) IgG.<h4>Findings</h4>There was a high prevalence of antiphospholipid antibodies in the COVID-neurological (73.3%) and non-neurological COVID-hospitalised controls (76.6%) in contrast to the COVID-non-hospitalised controls (48.2%). aPS/PT IgG titres were significantly higher in the COVID-neurological group compared to both control groups (<i>p</i> < 0.001). Moderate-high titre of aPS/PT IgG was found in 2 out of 3 (67%) patients with acute disseminated encephalomyelitis [ADEM]. aPS/PT IgG titres negatively correlated with oxygen requirement (FiO<sub>2</sub> <i>R</i>=-0.15 <i>p</i> = 0.040) and was associated with venous thromboembolism (<i>p</i> = 0.043). In contrast, aCL IgA (<i>p</i> < 0.001) and IgG (<i>p</i> < 0.001) was associated with non-neurological COVID-hospitalised controls compared to the other groups and correlated positively with d-dimer and creatinine but negatively with FiO<sub>2</sub>.<h4>Interpretation</h4>Our findings show that aPS/PT IgG is associated with COVID-19-associated ADEM. In contrast, aCL IgA and IgG are seen much more frequently in non-neurological hospitalised patients with COVID-19. Characterisation of antiphospholipid antibody persistence and potential longitudinal clinical impact are required to guide appropriate management.<h4>Funding</h4>This work is supported by UCL Queen Square Biomedical Research Centre (BRC) and Moorfields BRC grants (#560441 and #557595). LB is supported by a Wellcome Trust Fellowship (222102/Z/20/Z). RWP is supported by an Alzheimer's Association Clinician Scientist Fellowship (AACSF-20-685780) and the UK Dementia Research Institute. KB is supported by the Swedish Research Council (#2017-00915) and the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986). HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG-720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), and theUK Dementia Research Institute at UCL. BDM is supported by grants from the MRC/UKRI (MR/V007181/1), MRC (MR/T028750/1) and Wellcome (ISSF201902/3). MSZ, MH and RS are supported by the UCL/UCLH NIHR Biomedical Research Centre and MSZ is supported by Queen Square National Brain Appeal.

Item Type: Article
Uncontrolled Keywords: UCLH Queen Square COVID-19 Biomarker Study group
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 10 Nov 2021 10:05
Last Modified: 18 Jan 2023 21:25
DOI: 10.1016/j.eclinm.2021.101070
Open Access URL: https://www.thelancet.com/journals/eclinm/article/...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3142998