Antiphospholipid antibodies and COVID-۱۹ mortality and thrombotic events; A systematic review and meta-analysis

Introduction:Among various proposed pathologic mechanisms during the coronavirus disease ۲۰۱۹ (COVID-۱۹) pandemic, overproduction of autoantibodies is not widely studied. Antiphospholipid antibodies (aPLs) are target proteins that have affinity toward charged phospholipids. APLs are thought to have pro-thrombotic potentials that increase during thromboembolism. The present systematic review and meta-analysis aimed to evaluate the relationship between serum aPLs level and COVID-۱۹ mortality, severity, and thrombotic events.Methods: This systematic review and meta-analysis was conducted on all open access published articles in Medline, Scopus and Google Scholar. Studies evaluating individuals over the age of ۱۸ years who were diagnosed with COVID-۱۹ and had positive aPLs; and provided data on mortality or thrombotic events were included. Results: Of the initially identified ۵۱۲ articles, ۲۲ studies (overall ۱۴۶۲ patients) were finally included in the analysis. The prevalence of positive aPLs was ۴۸.۱%. Among the ۳۷۲ patients with positive aPLs, ۱۵۶ patients (۴۱.۹%) had severe COVID-۱۹ that indicated a significant relationship between COVID-۱۹ severity and aPLs positivity (p<۰.۰۵). The prevalence of thrombotic events in aPLs positive patients was ۲۶.۳% that indicated a significant relationship between aPLs positivity and the development of thrombotic events (p=۰.۰۳). APLs positivity was related to anytime mortality in COVID-۱۹ patients (p=۰.۰۱).Conclusion: The present review demonstrated that aPLs are linked to COVID-۱۹ severity and thrombotic events but not short-term mortality. Further studies with longer follow up periods are warranted.