Abstract Details

Title Decreased ADAMTS13 Activity During COVID-19 Infection Predicts Future Major Cerebrovascular and Cardiovascular Adverse Events

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-010

Objective To examine whether ADAMTS13 activity levels measured at the time of acute SARS-CoV-2 infection predict major cerebrovascular and cardiovascular adverse events (MACE) at 42 months.

Background The critical role of ADAMTS13 in thrombosis is exemplified by its importance in pathogenesis of thrombotic thrombocytopenic purpura (TTP). Lower ADAMTS13 activity has been linked to increased risk of incident stroke, myocardial infarction and cardiovascular death in populational studies. COVID-19 patients are at increased risk of thrombotic events during both acute infection and after convalescence.

Design/Methods After consent, patients hospitalized with SARS-CoV-2 infection were enrolled. ADAMTS13 activity levels were measured upon admission, then twice weekly during hospitalization. Post-COVID-recovery MACE, defined as occurrence of stroke, myocardial infarction, acute coronary syndrome, pulmonary embolism, DVT or sudden cardiac death were identified by chart review. The distribution of MACE was compared among patients categorized into tertiles of ADAMTS13 activity. Receiver Operator Characteristic (ROC) and survival analyses assessed the predictive value of ADAMTS13 activity at enrollment for future MACE. Significance was set at 0.05.

Results We recruited 39 patients with COVID-19, mean age 68 years (range 37-88 years), followed for an average of 42 (2-48) months. Initial ADAMTS13 levels were 68% (range 12-94%). MACE occurred in 15/39 patients (38.4%): 9 in the lowest (69%), 3 in the middle (21%) and 3 in the highest tertile (25%) of initial ADAMTS13 activity levels (p=0.02). ADAMTS13 activity was associated with MACE (AUC 0.690, 95% CI: 0.503-0.877, p=0.046). Levels <55% were significantly associated with time to earliest MACE (Log-rank test p=0.002), with a HR of 4.30 (95% CI: 1.55-11.92), PPV of 0.778 and NPV of 0.733.

Conclusions Lower ADAMTS13 activity during SARS-CoV-2 infection is associated with increased risk for MACE 42 months after recovery. Future work is needed to investigate the link between ADAMTS13 activity and the long-term risk of major cerebrovascular and cardiovascular events.

Authors/Disclosures
Philion Gatchoff, MD (OU Health) PRESENTER	Dr. Gatchoff has nothing to disclose.
Claire E. Delpirou Nouh, MD (University of Oklahoma Health Science Center, Department of Neurology)	The institution of Dr. Delpirou Nouh has received research support from Oklahomas Nathan Shock Center. Dr. Delpirou Nouh has a non-compensated relationship as a Volunteer/Board member with Oklahoma Alzheimer Association that is relevant to AAN interests or activities.
Chao Xu	Chao Xu has nothing to disclose.
Andrea Vincent	Andrea Vincent has received personal compensation for serving as an employee of Vista LifeSciences. The institution of Andrea Vincent has received research support from Medical Technology Enterprise Consortium (MTEC).
Leslie Guthery	Leslie Guthery has nothing to disclose.
Jason Sharps	Jason Sharps has nothing to disclose.
Fabiola Donna-Ferreira, MD	Dr. Donna-Ferreira has nothing to disclose.
James George (Home)	James George has nothing to disclose.
Angelia Kirkpatrick	Angelia Kirkpatrick has nothing to disclose.
Calin I. Prodan, MD (Univ of Oklahoma - Neurology Dept)	The institution of Dr. Prodan has received research support from US Department of Veterans Affairs (Merit award CX000340).

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