PB0074 - Severe COVID-19 disease presentation is associated with significantly decreased levels of coagulation factor XIII

Background: Coronavirus disease 2019 (COVID-19) can be associated with severe hemostatic disorders due to profound changes in coagulation and fibrinolytic systems.

Aims: To investigate activities of coagulation factors II (FII), V (FV), VIII (FVIII), X (FX) and XIII (FXIII) in COVID-19 patients with mild and severe disease presentation.

Methods: Activities of FII, FV and FX were measured using PT-based coagulometric method (Innovin/factor deficient plasmas), FVIII using APTT-based coagulometric method (Actin FS/FVIII deficient plasma) whereas FXIII was determined by chromogenic method (Berichrom FXIII Assay), all performed on BCSXP analyzer (Siemens Healthineers, Germany). The differences between groups were tested with Man-Whitney test (statistically significant P-values < 0.05).

Results: The study included 80 consecutive patients: 40 with mild disease admitted at general wards and 40 patients with severe disease admitted at intensive care units. Clinical data of the groups are presented in Table1. In contrast to other coagulation factors studied, acitivities of XIII were significantly decreased in severe COVID-19 patients compared to patients with mild disease in which FXIII levels were within reference range (Table 2). Among patients with severe COVID-19 disease, lower acitivites of FXIII in non-survivors (n =25) compared to survivors (n=15) were observed, although without statistically significant difference (P=0.056, Table 2).

Conclusion(s): Our results indicate an acquired FXIII deficiency in COVID-19 patients with severe disease. Significant differences of FXIII levels between patients with mild and severe disease suggest that FXIII levels are related to disease severity and mortality. Simultaneously measurable differences with slight decrease of FII and FX acitivites in severe ill patients compared to those with mild desease suggest that consumption, as the consequence of previous coagulation activation, could be the cause of marked decrease of FXIII in severely ill patients. Further studies are required for elucidating the cause(s) of FXIII deficiency and its association with profound hemostatic disorders in critically ill COVID-19 patients.