The Association between Protein C and Antithrombin III Levels with the Severity of Coronavirus Disease-2019 Symptoms

Jelita Siregar; Riyadh Ihsan

doi:10.3889/oamjms.2022.9409

Authors

Jelita Siregar Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
Riyadh Ihsan Department of Dermatovenereology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9409

Keywords:

Antithrombin III, Coagulation, COVID-19, Protein C, Symptom

Abstract

BACKGROUND: Coronavirus disease-2019 (COVID-19) has various symptoms ranging from mild to critical. Hypercoagulation state is often observed in severe and critical COVID-19. Both coagulation and inflammation are interrelated and amplifying each other, with protein C and antithrombin (AT) III as two important mediators.

OBJECTIVE: To determine the association between protein C and AT III levels with the severity of COVID-19 symptoms.

METHODS: This analytical study was conducted at Haji Adam Malik Hospital from April to July 2021. Subjects were obtained by consecutive sampling method. Inclusion criteria were patients with confirmed COVID-19 using RT-PCR and willing to participate. Subjects were divided into 2 groups: mild-moderate and severe-critical symptom groups. Demographic and blood sample were obtained from each subject. Blood samples underwent examination for leukocyte, thrombocyte, PT, aPTT, protein C, and AT III.

RESULTS: A total of 50 patients were obtained with female domination (58%) and mean age of 41.44 (SD 20.90) years. Most subjects (86%) were in mild-moderate symptom group. There were significant differences in the level of protein C and AT III in both group (p= 0.029 and 0.034, respectively). Using the cut-off values for protein C of 5.36 ng/mL and AT III of 45.6%, subjects who had mediators level below the value tend to develop severe and critical symptoms compared to their counterparts (OR= 5.769 and 6.458, respectively).

CONCLUSION: Protein C and AT III are associated with severity of COVID-19 symptoms. Lower protein C and AT III levels increase the risk for developing severe and critical symptoms.

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