Table 2.
Prevalence of antiphospholipid autoantibodies in COVID-19 disease.
| Study | Reference number | Country | Patients | Mean/median age (years) | Proportion of males | Prevalence of aPL | Findings |
|---|---|---|---|---|---|---|---|
| Amezcua-Guerra et al. | 39 | Mexico | 21 ICU patients | 62 (IQR 54–67) | 43% | Anti-annexin V IgG (5%), anti-annexin V IgM (19%), ACA IgG (10%), ACA IgM (14%), AB2GPI IgG (5%), AB2GPI IgM (0%), aPT IgG (0%), aPT IgM (5%), aPS IgG (10%), aPS IgM (14%), aPI IgG (0%), and aPI IgM (0%)* | Elevated levels of interleukin-6/ferritin/C-reactive protein only in patients with aPL; pulmonary embolism in two aPL+ patients but in no aPL- patients |
| Bertin et al. | 40 | France | 56 patients with moderate and severe disease | 67 | 59% | ACA IgG (29%), ACA IgM (5%), AB2GPI IgG (2%), and AB2GPI IgM (7%)* | ACA IgG was associated with severe disease |
| Borghi et al. | 41 | Italy | 122 patients with severe disease | 69 (SD 16) | 63% | ACA IgG (6%), ACA IgM (7%), AB2GPI IgG (16%), AB2GPI IgG domain I (5%), AB2GPI IgM (9%), AB2GPI IgA (7%), aPS/PT IgG (3%), and aPS/PT IgM (10%)* | No association between aPL and thrombotic events, even for AB2GPI domain I IgG |
| Bowles et al. | 42 | UK | 35 patients with a prolonged aPTT | 57 (95%CI 19–83) | 69% | LA (53%)** | |
| Cuenca Saez et al. | 43 | Spain | 11 patients with perniosis | (range 2–40) | N.A. | LA (0%), ACA IgG (0%), ACA IgM (0%), and low titer ACA IgA (100%) | |
| Devreese et al. | 44 | Belgium | 31 ICU patients | 63 (range 38–82) | 90% | LA (68%), ACA IgG (0%), ACA IgM (3%), ACA IgA (10%), AB2GPI IgG (3%), AB2GPI IgM (3%), AB2GPI IgA (10%), aPS/PT IgG (10%), and aPS/PT IgM (13%) | No association between aPL and thrombotic events |
| Galeano-Valle et al. | 45 | Spain | 24 patients with venous thromboembolism | 64 (SD 14) | 58% | ACA IgG (0%), low titer ACA IgM (8.3%), AB2GPI IgG (0%), and low titer AB2GPI IgM (8.3%) | |
| Gatto et al. | 46 | Italy | 122 patients with mild to severe disease | 54 (SD 19) | 49% | LA (22%)**, ACA IgG (13%), ACA IgM (3%), ACA IgA (2%), AB2GPI IgG (6%), AB2GPI IgM (7%), and AB2GPI IgA (3%) | A trend toward an association between aPL and thrombotic events |
| Gutierrez López de Ocáriz et al. | 47 | Spain | 27 hospitalized patients | 58 (range 20–90) | 44% | LA (22%)**, ACA IgG (0%), ACA IgM (0%), AB2GPI IgG (0%), AB2GPI IgM (0%) and AB2GPI IgA (4%)* | No association between aPL and thrombotic events |
| Harzallah et al. | 48 | France | 56 patients | N.A. | N.A. | LA (45%)** and ACA IgG/M/AB2GPI IgG/M (10%) | |
| Pascolini et al. | 18 | Italy | 33 hospitalized patients | 70 (range 22–90) | 52% | ACA IgG (9%), ACA IgM (15%), AB2GPI IgG (6%), and AB2GPI IgM (6%)* | None of the patients had thrombotic events |
| Pineton de Chambrun et al. | 49 | France | 25 ICU patients | 48 (range 35–64), | 68% | LA (92%), ACA IgG (12%), ACA IgM (0%), ACA IgA (8%), AB2GPI IgG (0%), AB2GPI IgM (0%), and AB2GPI IgA (8%) | Massive pulmonary embolism in 6 patients, all aPL+ |
| Previtali et al. | 50 | Italy | 35 deceased patients | 73 (range 52–82) | 74% | Low titer ACA IgG (3%), low titer ACA IgM (6%), ACA IgA (0%), AB2GPI IgG (0%), AB2GPI IgM (0%), low titer aPS/PT IgG (3%), and low titer aPS/PT IgM (6%) | Catastrophic APS was less likely despite multiple thrombosis at autopsies |
| Reyes Gil et al. | 51 | USA | 68 patients | 57 | 50% | LA (60%)**, ACA IgG (0%), ACA IgM (1%), AB2GPI IgG (0%), and AB2GPI IgM (1%)* | LA associated with thrombotic events |
| Schiaffino et al. | 19 | Spain | 53 hospitalized patients | 64 (range 24–91) | 58% | ACA IgG (2%), ACA IgM (9%), AB2GPI IgG (2%), and AB2GPI IgM (6%)* | No association between aPL and thrombotic events |
| Siguret et al. | 52 | France | 74 mechanically ventilated patients | 64 | N.A. | LA (85%) and ACA IgG/IgM/AB2GPI IgG (12%)* | No association between aPL and thrombotic events |
| Tvito et al. | 53 | Israel | 43 patients with mild to severe disease | N.A. | 63% | LA (37%)**, ACA IgG (0%), ACA IgM (0%), AB2GPI IgG (0%), and AB2GPI IgM (0%) | No association between aPL and thrombotic events |
| Vlachoyiannopoulos et al. | 20 | Greece | 29 ICU patients | 64 (range 43–85) | 72% | ACA IgG (24%), ACA IgM (10%), ABGPI IgG (17%), and ABGPI IgM (28%)* | |
| Xiao et al. | 54 | China | 66 ICU patients | 65 | 59% | LA (3%), ACA IgG (6%), ACA IgM (3%), ACA IgA (26%), AB2GPI IgG (18%), AB2GPI IgM (2%), AB2GPI IgA (29%), aPS/PT IgG (0%), and aPS/PT IgM (11%)* | Patients with multiple aPLs had a significantly higher incidence of cerebral infarction |
| Zhang et al. | 55 | China | 19 ICU patients | 65 (IQR 60–70) | 53% | LA (5%), ACA IgG (11%), ACA IgM (5%), ACA IgA (32%), AB2GPI IgG (32%), AB2GPI IgM (0%), and AB2GPI IgA (37%)* | All 4 patients with cerebral infarction had aPL with multiple isotypes whereas no thrombotic events developed in aPL-patients. |
*
Probably including low titer aPL as positive.
**
Determined by two tests based on different principles per the International Society of Thrombosis and Haemostasis criteria.
AB2GPI, anti-β2glycoprotein I; ACA, anticardiolipin antibody; aPI, antiphosphatidylinositol antibody; aPL, antiphospholipid antibodies; aPS, anti-phosphotidylserine antibody; aPT, antiprothrombin antibody; aPTT, activated partial-thromboplastin time; CI, confidence interval; COVID-19, the coronavirus disease 2019; ICU, intensive care unit; IQR, interquartile range; LA, lupus anticoagulant; N.A., not available; SD, standard deviation.