Mannose-Binding Lectin is Associated with Thrombosis and Coagulopathy in Critically Ill COVID-19 Patients

Thromb Haemost. 2020 Dec;120(12):1720-1724. doi: 10.1055/s-0040-1715835. Epub 2020 Sep 1.


The ongoing COVID-19 pandemic has caused significant morbidity and mortality worldwide, as well as profound effects on society. COVID-19 patients have an increased risk of thromboembolic (TE) complications, which develop despite pharmacological thromboprophylaxis. The mechanism behind COVID-19-associated coagulopathy remains unclear. Mannose-binding lectin (MBL), a pattern recognition molecule that initiates the lectin pathway of complement activation, has been suggested as a potential amplifier of blood coagulation during thromboinflammation. Here we describe data from a cohort of critically ill COVID-19 patients (n = 65) treated at a tertiary hospital center intensive care unit (ICU). A subset of patients had strongly elevated MBL plasma levels, and activity upon ICU admission, and patients who developed symptomatic TE (14%) had significantly higher MBL levels than patients without TE. MBL was strongly correlated to plasma D-dimer levels, a marker of COVID-19 coagulopathy, but showed no relationship to degree of inflammation or other organ dysfunction. In conclusion, we have identified complement activation through the MBL pathway as a novel amplification mechanism that contributes to pathological thrombosis in critically ill COVID-19 patients. Pharmacological targeting of the MBL pathway could be a novel treatment option for thrombosis in COVID-19. Laboratory testing of MBL levels could be of value for identifying COVID-19 patients at risk for TE events.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood*
  • Blood Coagulation Disorders / diagnostic imaging*
  • COVID-19 / diagnosis*
  • Complement Activation
  • Critical Illness*
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Humans
  • Intensive Care Units
  • Male
  • Mannose-Binding Lectin / blood*
  • Middle Aged
  • Pandemics
  • Risk
  • SARS-CoV-2 / physiology*
  • Sweden
  • Tertiary Care Centers
  • Up-Regulation
  • Venous Thromboembolism / diagnosis*
  • Young Adult


  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Mannose-Binding Lectin
  • fibrin fragment D