COVID-19-associated coagulopathy is one of the essential features of severe acute respiratory syndrome coronavirus-2 pathogenesis. 

Previous studies suggest the association of endothelial cell injury with COVID-19 related coagulopathy. This study aims to determine the role of endothelial cell injury in COVID-19-associated coagulopathy.

This is a single-center, cross-sectional study conducted on 68 patients (48 ICU and 20 non-ICU). All patients had laboratory-confirmed COVID-19. The researchers assessed markers of endothelial cell and platelet activation and compared them with control participants. The associations between laboratory results and clinical outcomes, including mortality and hospital discharge, were also assessed. The primary outcome was the presence of endothelial injury in COVID-19-related mortality.

The markers of endothelial cell and platelet activation were substantially elevated in ICU and non-ICU patients, including soluble P-selectin and VWF antigen. The concentrations of VWF antigen were also elevated in 80% of non-ICU patients. Mortality was significantly correlated with soluble thrombomodulin and VWF antigen. Patients with higher soluble thrombomodulin concentrations were associated with lower rates of hospital discharge.

The research concluded that COVID-19 illness was associated with increased levels of soluble thrombomodulin and VWF antigen, thereby indicating endotheliopathy. It was also discovered that endotheliopathy in COVID-19 patients was linked to critical illness and increased risk of mortality.