The COMPASS-COVID-19-ICU Study: Identification of Factors to Predict the Risk of Intubation and Mortality in Patients with Severe COVID-19
Grigoris T. Gerotziafas,
Patrick Van Dreden,
Douglas D. Fraser,
Guillaume Voiriot,
Maitray A. Patel,
Mark Daley,
Alexandre Elabbadi,
Aurélie Rousseau,
Yannis Prassas,
Matthieu Turpin,
Marina Marchetti,
Loula Papageorgiou,
Evangelos Terpos,
Meletios A. Dimopoulos,
Anna Falanga,
Jawed Fareed,
Muriel Fartoukh,
Ismail Elalamy
Affiliations
Grigoris T. Gerotziafas
Research Team “Cancer-Hemostasis-Angiogenesis”, Research Group “Cancer Biology and Therapeutics”, Centre de Recherche Saint Antoine (CRSA), Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, 75012 Paris, France
Patrick Van Dreden
Thrombosis and Haemostasis Centre, Biological Hematology Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012 Paris, France
Douglas D. Fraser
Lawson Health Research Institute, London, ON N6C 2R5, Canada
Guillaume Voiriot
Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, 75020 Paris, France
Maitray A. Patel
Department of Computer Science, Western University, London, ON N6A 3K7, Canada
Mark Daley
Department of Computer Science, Western University, London, ON N6A 3K7, Canada
Alexandre Elabbadi
Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, 75020 Paris, France
Aurélie Rousseau
Research Team “Cancer-Hemostasis-Angiogenesis”, Research Group “Cancer Biology and Therapeutics”, Centre de Recherche Saint Antoine (CRSA), Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, 75012 Paris, France
Yannis Prassas
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
Matthieu Turpin
Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, 75020 Paris, France
Marina Marchetti
Immunohematology and Transfusion Medicine Department, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Loula Papageorgiou
Research Team “Cancer-Hemostasis-Angiogenesis”, Research Group “Cancer Biology and Therapeutics”, Centre de Recherche Saint Antoine (CRSA), Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, 75012 Paris, France
Evangelos Terpos
Department of Clinical Therapeutics, Alexandra General Hospital, 11528 Athens, Greece
Meletios A. Dimopoulos
Department of Clinical Therapeutics, Alexandra General Hospital, 11528 Athens, Greece
Anna Falanga
Immunohematology and Transfusion Medicine Department, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Jawed Fareed
Cardiovascular Research Institute, Loyola University Chicago Health Sciences Campus, Maywood, IL 60153, USA
Muriel Fartoukh
Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, 75020 Paris, France
Ismail Elalamy
Research Team “Cancer-Hemostasis-Angiogenesis”, Research Group “Cancer Biology and Therapeutics”, Centre de Recherche Saint Antoine (CRSA), Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, 75012 Paris, France
In some patients, SARS-CoV-2 infection induces cytokine storm, hypercoagulability and endothelial cell activation leading to worsening of COVID-19, intubation and death. Prompt identification of patients at risk of intubation is an urgent need. Objectives. To derive a prognostic score for the risk of intubation or death in patients with COVID-19 admitted in intensive care unit (ICU), by assessing biomarkers of hypercoagulability, endothelial cell activation and inflammation and a large panel of clinical analytes. Design, Setting and Participants. A prospective, observational study enrolled 118 patients with COVID-19 admitted in the ICU. On the first day of ICU admission, all patients were assessed for biomarkers (protein C, protein S, antithrombin, D-Dimer, fibrin monomers, FVIIa, FV, FXII, FXII, FVIII, FvW antigen, fibrinogen, procoagulant phospholipid dependent clotting time, TFPI, thrombomodulin, P-selectin, heparinase, microparticles exposing TF, IL-6, complement C3a, C5a, thrombin generation, PT, aPTT, hemogram, platelet count) and clinical predictors. Main Outcomes and Measures. The clinical outcomes were intubation and mortality during hospitalization in ICU. Results: The intubation and mortality rates were 70% and 18%, respectively. The COMPASS-COVID-19-ICU score composed of P-Selectin, D-Dimer, free TFPI, TF activity, IL-6 and FXII, age and duration of hospitalization predicted the risk of intubation or death with high sensitivity and specificity (0.90 and 0.92, respectively). Conclusions and Relevance. COVID-19 is related to severe endothelial cell activation and hypercoagulability orchestrated in the context of inflammation. The COMPASS-COVID-19-ICU risk assessment model is accurate for the evaluation of the risk of mechanical ventilation and death in patients with critical COVID-19. The COMPASS-COVID-19-ICU score is feasible in tertiary hospitals and could be placed in the diagnostic procedure of personalized medical management and prompt therapeutic intervention.
