Lupus Anticoagulant is Associated With Critical Cases and High Mortality in COVID-19

Background: In severe COVID-19 cases, hypercoagulable state may occur. Antiphospholipid syndrome related auto-antibodies (APSRAs) contribute to coagulopathy, but their role in COVID-19 remains unclear. We aimed to investigate the prevalence of positive APSRAs and their effect on clinical outcomes in confirmed COVID-19 patients. Method In this cross-sectional study, severe hospitalized COVID-19 cases were enrolled. Demographic and clinical data were obtained from the day of admission. APSRAs including IgG and/or IgM anticardiolipin (aCL) and anti-β2-glycoprotein1 (anti-β2GP1) as well as lupus anticoagulant (LAC) were measured.  Finding: In this study, 54 severe COVID-19 cases with positive RT-PCR and/or chest CT scan were recruited. Positive APSRAs was found in 7 (12.9%) patients. Positive LAC was more prevalent marker as compared to other tests (11.1%). The prevalence of positive aCL (IgM or IgG) and anti-s2 GPI (IgM or IgG) was 1.8% (in an elderly woman). Lower oxygen saturation was found in positive APSRAs group as opposed to negative APSRAs group (70.3±9 vs 84.8±9.7%). Mortality rate in positive APSRAs group was significantly higher relative to negative APSRAs group (83.3% vs 27.1%; P-value: 0.01). Likewise, the mechanical ventilation requirement in the positive group was also higher (50% vs 27.1%, P-value: 0.28).  Conclusion: This study indicated that LAC directly is associated with critical cases and high mortality of COVID-19. Nonetheless the mortality was not related to macrothrombotic incidence. Funding Information: There is no funding. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study was confirmed by the Ethics in Medical Research Committee IR.SBMU.RETECH.REC.1399.1362. Signed informed consents were obtained from all the participants or their legally authorized representatives.