Elevated von Willebrand Factor Antigen Is an Early Predictor of Mortality and Prolonged Length of Stay for Coronavirus Disease 2019 (COVID-19) Inpatients

Coagulation factor and endothelial injury marker, von Willebrand factor antigen (vWF:Ag), is elevated in coronavirus disease 2019 (COVID-19). To assess the prognostic value of vWF:Ag for COVID-19 inpatients. Citrated plasma samples collected from COVID-19 inpatients for D-dimer measurement were tested for vWF:Ag. Measurements of vWF:Ag and common acute-phase reactants were correlated with clinical outcomes and length of stay (LOS). We included 333 samples from a diverse group of 120 COVID-19 inpatients. There was a clear association of higher peak measurements of vWF:Ag and other acute-phase reactants with adverse clinical outcomes. Peak vWF:Ag >300% was associated with a 5-fold increased risk of death (odds ratio [OR], 5.08; P < .001) and a 30-fold increased risk of prolonged (>4 days) LOS (OR, 29.65; P = .001). Peak D-dimer >3.8 fibrinogen equivalent units (FEUs) mg/L was associated with a 15-fold increase in risk of death (OR, 14.73; P < .001) and a 5-fold increased risk of prolonged LOS (OR, 4.55; P = .02). Using the earliest paired measurements of vWF:Ag and D-dimer from each patient and the same cutoffs, vWF:Ag was associated with a 3.5-fold increase in risk of death (OR, 3.54; P = .004) and a 20-fold risk of prolonged LOS (OR, 20.19; P = .004). Yet D-dimer was not significantly associated with either death (OR, 1.9; P = .29) or prolonged LOS (OR, 1.02; P = .98). Both peak and early postadmission vWF:Ag >300% were highly predictive of death and prolonged LOS among COVID-19 inpatients. Measurement of vWF:Ag may prove a valuable tool to guide escalation of COVID-19 treatment, particularly anticoagulation.