Frontiers in Medicine (Nov 2020)
Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload
- Guillaume Goudot,
- Richard Chocron,
- Richard Chocron,
- Jean-Loup Augy,
- Nicolas Gendron,
- Nicolas Gendron,
- Lina Khider,
- Benjamin Debuc,
- Benjamin Debuc,
- Nadia Aissaoui,
- Nicolas Peron,
- Caroline Hauw-Berlemont,
- Benoit Vedie,
- Charles Cheng,
- Nassim Mohamedi,
- Daphné Krzisch,
- Aurélien Philippe,
- Aurélien Philippe,
- Tania Puscas,
- Bertrand Hermann,
- Julie Brichet,
- Philippe Juvin,
- Benjamin Planquette,
- Benjamin Planquette,
- Emmanuel Messas,
- Emmanuel Messas,
- Hélène Pere,
- Hélène Pere,
- David Veyer,
- David Veyer,
- Pascale Gaussem,
- Pascale Gaussem,
- Olivier Sanchez,
- Olivier Sanchez,
- Jean-Luc Diehl,
- Jean-Luc Diehl,
- Tristan Mirault,
- Tristan Mirault,
- David M. Smadja,
- David M. Smadja
Affiliations
- Guillaume Goudot
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Richard Chocron
- PARCC, INSERM, Université de Paris, Paris, France
- Richard Chocron
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Jean-Loup Augy
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Nicolas Gendron
- Haematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Lina Khider
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Benjamin Debuc
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Benjamin Debuc
- Plastic Surgery Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Nadia Aissaoui
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Nicolas Peron
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Caroline Hauw-Berlemont
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Benoit Vedie
- Biochemistry Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Charles Cheng
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Nassim Mohamedi
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Daphné Krzisch
- Haematology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Aurélien Philippe
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Aurélien Philippe
- Haematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Tania Puscas
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Bertrand Hermann
- Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Julie Brichet
- Haematology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Philippe Juvin
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Benjamin Planquette
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Benjamin Planquette
- 0Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Emmanuel Messas
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Emmanuel Messas
- PARCC, INSERM, Université de Paris, Paris, France
- Hélène Pere
- PARCC, INSERM, Université de Paris, Paris, France
- Hélène Pere
- 1Virology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- David Veyer
- 1Virology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- David Veyer
- 2Centre de Recherche des Cordeliers, Functional Genomics of Solid Tumors, INSERM, Université de Paris, Paris, France
- Pascale Gaussem
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Pascale Gaussem
- Haematology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Olivier Sanchez
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Olivier Sanchez
- 0Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Jean-Luc Diehl
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Jean-Luc Diehl
- 3Intensive Care Unit and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Tristan Mirault
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- Tristan Mirault
- PARCC, INSERM, Université de Paris, Paris, France
- David M. Smadja
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- David M. Smadja
- Haematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
- DOI
- https://doi.org/10.3389/fmed.2020.586307
- Journal volume & issue
-
Vol. 7
Abstract
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 SpO2, 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.
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