Evaluating the potential mediating role of ADAMTS13 activity in the relationship between obesity and the severity of COVID-19: A retrospective cohort study

Author:

Hafez Wael12ORCID,Rashid Asrar1,Abuelsaoud Hesham Mohamed1,Jose Mohan1,Kishk Samy1,Gador Muneir1,Emoshe Tesfalidet1,Abdulaal Fatema1,Nair Nivedita1,Ahmad Muhammad1,Rashid Vanya Jalal1,Faheem Youmna1,John Steffi1,Ahmed Sabah1,Daraghmi Ahmed1,Soliman Rami13,Abdelrahman Ahmed14,Mohamed Ahmed Ali15,Ghanem Mirvat1

Affiliation:

1. NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates

2. Internal Medicine Department, Medical Research and Clinical Studies Institute; The National Research Centre, Cairo, Egypt

3. National Institute of Chest and Allergy, Egypt

4. Internal Medicine Department, Zagazig Faculty of Medicine, Zagazig, Egypt

5. Intensive Care Department, Theodor Bilharz Research Institute, AL Warak, Giza Governorate, Egypt.

Abstract

Obesity and low enzyme A disintegrin and metalloproteinase with thrombospondin type-1 motif-13 (ADAMTS13) activity have been linked to poor coronavirus disease 2019 (COVID-19). Given that obesity may influence ADAMTS13 activity, it is feasible; however, it remains unclear whether ADAMTS13 activity acts as a mediator between obesity and COVID-19 outcomes. We investigated the link between body mass index (BMI) and COVID-19 outcomes, using ADAMTS13 activity as a mediator. ADAMTS13 activity was measured in 86 hospitalized COVID-19 patients. BMI, ADAMTS13 activity, and COVID-19 outcomes were assessed. Obese patients had a high odds ratio for low ADAMTS13 levels. When different levels of ADAMTS13 activity were considered, the severity of COVID-19 in obese patients was 4.5 times that in the normal BMI group. Furthermore, increased coagulopathy indicators correlated with low ADAMTS13 activity. Patients with elevated ALT and AST levels showed a 3 to 4-fold increase in the chances of low ADAMTS13 activity (OR:3.19, 95% CI:1.22–8.90, P = .021; OR:2.17, 95% CI:0.91–5.27, P = .082, respectively). When ADAMTS13 activity was considered, obese patients had greater COVID-19 severity and slower viral clearance than those with normal BMI. Low ADAMTS13 activity and impaired liver function are associated with poor COVID-19 outcomes. These findings encourage researchers to use molecular component identification to study the effects of obesity on the von Willebrand factor (VWF)/ADAMTS13 axis, COVID-19 pathogenesis, and outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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