ADAMTS-13 Behavior in Thrombocytopenia of Infectious Origin in ICU Patients.

Abstract

Introduction: Thrombocytopenia is a common hematological abnormality in intensive care unit (ICU) patients, with varying incidence across populations. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 (ADAMTS-13), a plasma serine protease, plays a crucial role in modulating von Willebrand factor (vWF) activity by cleaving its ultra-large (UL) multimers and preventing excess platelet aggregation. This study aimed to evaluate the association between ADAMTS-13 levels, viral and non-viral (NV) infections, and thrombocytopenia severity.

Materials and methods: This Prospective observational study included adult ICU patients with thrombocytopenia, categorized into viral and non-viral groups. Thrombocytopenia severity was assessed by absolute platelet count on diagnosis day. Statistical analyses evaluated correlations between ADAMTS-13 levels, thrombocytopenia severity, and clinical outcomes, including bleeding episodes, transfusion needs, and overall patient outcomes.

Results: Among 72 patients (30 viral, 42 non-viral), lower ADAMTS-13 activity correlated significantly with thrombocytopenia severity in both groups (p < 0.05), with a greater deficiency observed in NV cases. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 levels were associated with bleeding episodes, transfusion requirements, and thrombocytopenia progression in both groups but did not predict increased transfusion needs despite lower platelet counts.

Conclusion: This study highlights an association between reduced ADAMTS-13 activity, infection type, and thrombocytopenia severity, especially in NV infections. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 (ADAMTS-13) depletion and increased vWF activity may contribute to infection-related thrombocytopenia pathogenesis. These findings suggest that ADAMTS-13 levels could aid in assessing thrombocytopenia severity and prognosis, informing early management strategies and transfusion guidelines.

Clinical significance: This study found that low ADAMTS-13 activity is associated with higher disease severity in both viral and non-viral infections, particularly in NV cases. While thrombocytopenia correlated with reduced ADAMTS-13 activity, it did not lead to increased platelet transfusions.

How to cite this article: Gontla VDK, Samavedam S, Aluru N, Rudravarapu R, Pabba S, Shaik MN. ADAMTS-13 Behavior in Thrombocytopenia of Infectious Origin in ICU Patients. Indian J Crit Care Med 2025;29(2):143-147.