Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload

被引：32

作者：

Goudot, Guillaume ^{[1
,2
]}

Chocron, Richard ^{[3
,4
]}

Augy, Jean-Loup ^{[5
]}

Gendron, Nicolas ^{[6
,7
,8
]}

Khider, Lina ^{[1
,2
]}

Debuc, Benjamin ^{[6
,9
]}

Aissaoui, Nadia ^{[5
]}

Peron, Nicolas ^{[5
]}

Hauw-Berlemont, Caroline ^{[5
]}

Vedie, Benoit ^{[10
]}

Cheng, Charles ^{[1
,2
]}

Mohamedi, Nassim ^{[1
,2
]}

Krzisch, Daphne ^{[11
]}

Philippe, Aurelien ^{[6
,7
,8
]}

Puscas, Tania ^{[5
]}

Hermann, Bertrand ^{[5
]}

Brichet, Julie ^{[11
]}

Juvin, Philippe ^{[4
]}

Planquette, Benjamin ^{[6
,12
,13
]}

Messas, Emmanuel ^{[1
,2
,3
]}

Pere, Helene ^{[3
,14
]}

Veyer, David ^{[14
,15
]}

Gaussem, Pascale ^{[6
,11
]}

Sanchez, Olivier ^{[6
,12
,13
]}

Diehl, Jean-Luc ^{[6
,16
,17
]}

Mirault, Tristan ^{[1
,2
,3
]}

Smadja, David M. ^{[6
,7
,8
]}

机构：

[1] Univ Paris, Vasc Med Dept, Georges Pompidou European Hosp, AP HP, Paris, France

[2] Univ Paris, Biosurg Res Lab, Georges Pompidou European Hosp, AP HP,Carpentier Fdn, Paris, France

[3] Univ Paris, PARCC, INSERM, Paris, France

[4] Univ Paris, Georges Pompidou European Hosp, AP HP, Emergency Dept, Paris, France

[5] Univ Paris, Georges Pompidou European Hosp, AP HP, Intens Care Unit, Paris, France

[6] Univ Paris, Innovat Therapies Haemostasis, INSERM, Paris, France

[7] Univ Paris, Georges Pompidou European Hosp, AP HP, Carpentier Fdn,Haematol Dept, Paris, France

[8] Univ Paris, Georges Pompidou European Hosp, AP HP, Carpentier Fdn,Biosurg Res Lab, Paris, France

[9] Univ Paris, Georges Pompidou European Hosp, AP HP, Plast Surg Dept, Paris, France

[10] Univ Paris, Georges Pompidou European Hosp, AP HP, Biochem Dept, Paris, France

[11] Univ Paris, Georges Pompidou European Hosp, AP HP, Haematol Dept, Paris, France

[12] Univ Paris, Georges Pompidou European Hosp, AP HP, Dept Resp Med, Paris, France

[13] Univ Paris, Georges Pompidou European Hosp, AP HP, Biosurg Res Lab,Carpentier Fdn, Paris, France

[14] Univ Paris, Georges Pompidou European Hosp, AP HP, Virol Dept, Paris, France

[15] Univ Paris, Ctr Rech Cordeliers, Funct Gen Solid Tumors, INSERM, Paris, France

[16] Univ Paris, Georges Pompidou European Hosp, AP HP, Intens Care Unit, Paris, France

[17] Univ Paris, Georges Pompidou European Hosp, AP HP, Biosurg Res Lab,Carpentier Fdn, Paris, France

来源：

FRONTIERS IN MEDICINE | 2020年 / 7卷

关键词：

COVID-19; troponin; D-dimer (DD); echocardiograghy; thrombosis; right ventricle; CHARACTERISTIC ROC CURVE; PNEUMONIA; OUTCOMES; INJURY; HEART;

D O I：

10.3389/fmed.2020.586307

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders. Objectives: To explore clinical and biological parameters of COVID-19 patients with hospitalization criteria that could predict referral to intensive care unit (ICU). Methods: Analyzing the clinical and biological profiles of COVID-19 patients at admission. Results: Among 99 consecutive patients that fulfilled criteria for hospitalization, 48 were hospitalized in the medicine department, 21 were first admitted to the medicine ward department and referred later to ICU, and 30 were directly admitted to ICU from the emergency department. At admission, patients requiring ICU were more likely to have lymphopenia, decreased SpO(2), a D-dimer level above 1,000 ng/mL, and a higher high-sensitivity cardiac troponin (Hs-cTnI) level. A receiver operating characteristic curve analysis identified Hs-cTnI above 9.75 pg/mL as the best predictive criteria for ICU referral [area under the curve (AUC), 86.4; 95% CI, 76.6-96.2]. This cutoff for Hs-cTnI was confirmed in univariate [odds ratio (OR), 22.8; 95% CI, 6.0-116.2] and multivariate analysis after adjustment for D-dimer level (adjusted OR, 20.85; 95% CI, 4.76-128.4). Transthoracic echocardiography parameters subsequently measured in 72 patients showed an increased right ventricular (RV) afterload correlated with Hs-cTnI (r = 0.42, p = 0.010) and D-dimer (r = 0.18, p = 0.047). Conclusion: Hs-cTnI appears to be the best relevant predictive factor for referring COVID-19 patients to ICU. This result associated with the correlation of D-dimer with RV dilatation probably reflects a myocardial injury due to an increased RV wall tension. This reinforces the hypothesis of a COVID-19-associated microvascular thrombosis inducing a higher RV afterload.

引用

页数：11

共 52 条

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