Endothelial activation and haemostasis markers associate with post-COVID-19 physical function
Anna Kamdar, Catherine N Bagot, Andrew Morrow, Robert Sykes, Alasdair McIntosh, Hannah K Bayes, Kevin G Blyth, Colin Church, Lynsey Gillespie, Roditi Giles, David Stobo, Sarah Weeden, Paul Welsh, Kenneth Mangion, Alex McConnachie, Colin BerryObjectives
Endothelial activation and vascular injury influence systemic effects of acute COVID-19, but links to longer-term outcomes remain unclear. We hypothesised that endothelial activation and haemostatic dysfunction are associated with impaired quality of life and physical function after COVID-19 hospitalisation.
Design
Prospective, multicentre, observational study. Participants underwent blood sampling at enrolment and, for COVID-19 participants, again at 28–60 days.
Setting
West of Scotland.
Participants
Hospitalised COVID-19 survivors and seronegative controls.
Main outcome measures
Physical and psychological function were assessed using validated patient-reported outcome measures. Associations with haemostasis and endothelial activation biomarkers were assessed. Participants were followed for 3 years for healthcare utilisation.
Results
COVID-19 participants (n=252) and controls (n=25) were similar in age (56.0 ± 9.0 vs 54.6 ± 12.0 years), sex (40.0% vs 41.3% female) and body mass index (30.2 ± 5.1 vs 31.0 ± 7.0 kg/m²; all p>0.5). At enrolment, COVID-19 participants had higher fibrinogen (3.5 vs 3.0 g/L, p=0.006), factor VIII (167 vs 104 IU/dL, p<0.001), intercellular adhesion molecule-1 (594 vs 396 ng/mL, p<0.001) and vascular cell adhesion molecule-1 (VCAM-1) (1210 vs 667 ng/mL, p<0.001). Higher p-selectin (−0.28 per 10 ng/mL, p=0.014) and VCAM-1 (−0.02 per 10 ng/mL, p=0.007) were independently associated with lower functional capacity (Duke Activity Status Index) and greater psychological stress (Patient Health Questionnaire-4). Haemostasis biomarkers were not associated with rehospitalisation or mortality at 3-year follow-up.
Conclusions
Endothelial and haemostatic biomarkers are independently associated with impaired function and quality of life post-COVID-19 infection.
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