Comparison of D-dimer level measured on the third day of hospitalization with D-dimer level in predicting in-hospital mortality in COVID-19 patients

Abstract Objective The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0–500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00–1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836–0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

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Comparison of D-dimer Level Measured on Third Day of Hospitalization with Admission D-dimer Level in Predicting In-hospital Mortality in COVID-19 Patients

Medeniyet Medical Journal ◽

10.5222/mmj.2021.07348 ◽

2021 ◽

Author(s):

Murat Selçuk ◽

Tufan Çınar ◽

Nuran Günay ◽

Muhammed Keskin ◽

Vedat Çiçek ◽

...

Keyword(s):

Hospital Mortality ◽

Primary Outcome ◽

Multivariable Analysis ◽

Hospital Death ◽

Normal Range ◽

Auc Value ◽

Wbc Count ◽

D Dimer ◽

Higher Sensitivity ◽

The Ideal

Objective: The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. Method: In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0-500 μg/mL. In the current research, the primary outcome was the in-hospital mortality. Results: In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00-1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836-0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). Conclusion: The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

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Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0866 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Selcuk ◽

M Keskin ◽

T Cinar ◽

N Gunay ◽

S Dogan ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Troponin I ◽

Prognostic Significance ◽

Multivariable Analysis ◽

Previous History ◽

Hospital Death ◽

Funding Sources ◽

Elevated Glucose ◽

Artery Disease

Abstract Introduction The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97). Conclusion The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa198 ◽

2020 ◽

Vol 22 (Supplement_N) ◽

pp. N65-N79

Author(s):

Luca Arcari ◽

Michelangelo Luciano ◽

Luca Cacciotti ◽

Maria Beatrice Musumeci ◽

Valerio Spuntarelli ◽

...

Keyword(s):

Hospital Mortality ◽

Natriuretic Peptides ◽

Multivariable Analysis ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Good Ability ◽

Myocardial Involvement ◽

D Dimer

Abstract Aims myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results in this multicenter observational study, we analyzed data from n = 111 COVID-19 patients admitted to dedicated “COVID-19” medical units. Hs-Troponin was assessed in n = 103 patients and NP in n = 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP only (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B=-0.212, p = 0.013 and B = 0.179, p = 0.037 respectively), and of NP with age and previous CVD (B = 0.480, p < 0.001 and B = 0.253, p = 0.001 respectively). In patients with in-hospital mortality (n = 23, 21%) hs-Troponin and NP were both higher (p = 0.001 and p = 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p = 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p = 0.025) and OR 4.67 (95% CI 2-10.8), p < 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p = 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC = 0.869 p < 0.001 and AUC = 0.810, p < 0.001 respectively). Conclusion myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting.

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Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02078-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying-Wen Lin ◽

Mei Jiang ◽

Xue-biao Wei ◽

Jie-leng Huang ◽

Zedazhong Su ◽

...

Keyword(s):

Regression Analysis ◽

Infective Endocarditis ◽

Adverse Events ◽

Prognostic Value ◽

Multivariable Analysis ◽

Adverse Outcomes ◽

Hospital Death ◽

Large Sample Size ◽

Cox Regression Analysis ◽

D Dimer

Abstract Background Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). Methods 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. Results In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03–1.19, P = 0.005). In addition, the Kaplan–Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05–1.18, P < 0.001). Conclusions D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.

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Predictive Value of Lactate Dehydrogenase to Albumin Ratio (LAR) in Patients With Coronavirus Disease 2019 (COVID-19)

10.21203/rs.3.rs-143788/v1 ◽

2021 ◽

Author(s):

Mingqing Liu ◽

Luping Zhang ◽

Yingli Zhang ◽

Xiaoming Xu ◽

Tantan Ma ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Hospital Mortality ◽

Disease Severity ◽

Predictive Value ◽

Hospital Death ◽

Albumin Ratio ◽

Acute Infectious Disease ◽

Critical Patients ◽

Wbc Count

Abstract BackgroundCoronavirus Disease-2019 (COVID-19) is an emerging acute infectious disease that was first discovered in Wuhan, Hubei Province, China. Since then, it has quickly spread to over one hundred cities around the world. Therefore, it is crucial to identify the risk factors of in-hospital mortality and disease severity for COVID-19 patients. MethodsWe firstly proposed a biomarker ratio, lactate dehydrogenase(LDH) to albumin ratio (LAR) may be more reliable to assess the predictive value of LAR for in-hospital mortality and early identification of critical COVID-19 patients. A retrospective study was conducted including patients (≥18 years old) with laboratory-confirmed COVID-19 infection who had been discharged or had died from 1 February to 29 February, 2020. ResultsThe study included 321 patients with COVID-19. The median age of the 321 patients was 63.0 (IQR 51.0-70.0), ranging from 19 to 95 years old and 180 (56.1%) patients were male. 142 (44.2%) patients had 1 or more coexisting comorbidity. The most common symptoms on admission were fever(289[90%]) and cough(258[80.4%]). In multivariable logistic regression, only older age (OR, 1.11; 95% CI, 1.05-1.16), WBC count (OR, 1.26; 95% CI, 1.11-1.44), lymphocyte count (OR, 0.78; 95% CI, 0.62-0.99) and LAR (OR, 1.29; 95% CI, 1.18-1.40) were found to be significantly associated with in-hospital death. ROC analysis showed that LAR had a higher AUC (0.917) and the highest specificity(84.0%) and sensitivity(84.6%). Furthermore, the results showed that LAR had a higher AUC (0.931) to differentiate critical from mild patients and had a sensitivity of 87.7% and a specificity of 82.1%. Besides, LAR had an AUC (0.861) to differentiate critical from severe patients and had a sensitivity of 86.0% and a specificity of 73.8% and the role of LAR to distinguish severe from mild patients was the worst. ConclusionsTo the best of our knowledge, this study is the first for us to explore the predictive value of LAR for in-hospital mortality and disease severity. A high LAR appears to predict higher odds of mortality and differentiate critical patients from mild or severe COVID-19 patients.

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Predictive determinants of overall survival among re-infected COVID-19 patients using the elastic-net regularized Cox proportional hazards model: a machine-learning algorithm

BMC Public Health ◽

10.1186/s12889-021-12383-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Vahid Ebrahimi ◽

Mehrdad Sharifi ◽

Razieh Sadat Mousavi-Roknabadi ◽

Robab Sadegh ◽

Mohammad Hossein Khademian ◽

...

Keyword(s):

Machine Learning ◽

Overall Survival ◽

Mortality Rate ◽

Serum Creatinine ◽

Hospital Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Elastic Net ◽

Hospital Death ◽

Wbc Count

Abstract Background Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning algorithms. Methods The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. The model was further reduced to its core features to maximize simplicity and generalizability. Results The empirical in-hospital mortality rate among the re-infected COVID-19 patients was 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients. Conclusion The results of the machine-learning analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients. We recommend that future machine-learning studies should further investigate these relationships and the associated factors in these patients for a better prediction of OS.

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Development and validation of a predictive model of in-hospital mortality in COVID-19 patients

PLoS ONE ◽

10.1371/journal.pone.0247676 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247676

Author(s):

Diego Velasco-Rodríguez ◽

Juan-Manuel Alonso-Dominguez ◽

Rosa Vidal Laso ◽

Daniel Lainez-González ◽

Aránzazu García-Raso ◽

...

Keyword(s):

Hospital Mortality ◽

Predictive Model ◽

Predictive Value ◽

Demographic Data ◽

Smoking Habit ◽

Fatal Outcome ◽

Multivariable Analysis ◽

Male Gender ◽

Correlated Factors ◽

D Dimer

We retrospectively evaluated 2879 hospitalized COVID-19 patients from four hospitals to evaluate the ability of demographic data, medical history, and on-admission laboratory parameters to predict in-hospital mortality. Association of previously published risk factors (age, gender, arterial hypertension, diabetes mellitus, smoking habit, obesity, renal failure, cardiovascular/ pulmonary diseases, serum ferritin, lymphocyte count, APTT, PT, fibrinogen, D-dimer, and platelet count) with death was tested by a multivariate logistic regression, and a predictive model was created, with further validation in an independent sample. A total of 2070 hospitalized COVID-19 patients were finally included in the multivariable analysis. Age 61–70 years (p<0.001; OR: 7.69; 95%CI: 2.93 to 20.14), age 71–80 years (p<0.001; OR: 14.99; 95%CI: 5.88 to 38.22), age >80 years (p<0.001; OR: 36.78; 95%CI: 14.42 to 93.85), male gender (p<0.001; OR: 1.84; 95%CI: 1.31 to 2.58), D-dimer levels >2 ULN (p = 0.003; OR: 1.79; 95%CI: 1.22 to 2.62), and prolonged PT (p<0.001; OR: 2.18; 95%CI: 1.49 to 3.18) were independently associated with increased in-hospital mortality. A predictive model performed with these parameters showed an AUC of 0.81 in the development cohort (n = 1270) [sensitivity of 95.83%, specificity of 41.46%, negative predictive value of 98.01%, and positive predictive value of 24.85%]. These results were then validated in an independent data sample (n = 800). Our predictive model of in-hospital mortality of COVID-19 patients has been developed, calibrated and validated. The model (MRS-COVID) included age, male gender, and on-admission coagulopathy markers as positively correlated factors with fatal outcome.

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Abstract P161: Drug-Eluting Stent Utilization and Post-Coronary Revascularization Procedure Mortality: Do Racial Disparities Matter?

Circulation ◽

10.1161/circ.129.suppl_1.p161 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Alexander V Sergeev

Keyword(s):

Native American ◽

Hospital Mortality ◽

Racial Disparities ◽

Coronary Revascularization ◽

Multivariable Analysis ◽

Drug Eluting Stents ◽

Drug Eluting Stent ◽

Hospital Death ◽

Drug Eluting ◽

To Receive

Background: Besides being a major risk factor for coronary artery disease (CAD), diabetes mellitus (DM) also worsens CAD patients’ prognosis. Percutaneous coronary intervention (PCI) with stenting is an effective treatment procedure for certain categories of CAD patients with DM (CAD-DM). Newer drug-eluting stents (DES) were developed to minimize the occurrence of restenosis known to hinder PCI with older non-drug-eluting stents (non-DES). We hypothesized that disparities in DES utilization and post-procedure mortality would exist in CAD-DM patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 132,934 CAD-DM patients [mean+SD age: 65.3+11.4 years; 62.7% (83,409 of 132,934) males] after PCI with DES and non-DES in the years 2007,2009. Patient race was classified as white, black, or other Asian, Pacific Islander, Native American). Due to short length of stay, in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for in-hospital death after DES and non-DES PCI in relation to patients’ race, adjusting for confounders: age, gender, comorbidities, number of stents inserted, number of vessels treated, socio-economic status, emergency department (ED) admission, rural/urban area status. Results: Blacks were less likely to receive newer DES stent than any other racial group: 75.7% blacks, 76.9% whites, 79.0% other (p<0.04). Blacks were more likely to undergo an emergency rather than planned procedure: 45.7% blacks, 39.8% whites, and 42.7% other were ED-admitted (p<0.01). In adjusted multivariable analysis, controlling for the type of stent and confounding factors, post-PCI mortality in blacks was similar to whites (adjusted OR 0.824, 95% CI: 0.672-1.010, p=0.06), but in other was higher than in whites (adjusted OR 1.284, 95% CI: 1.151-1.434, p<0.001). Conclusions: Racial disparities exist in DES utilization by CAD-DM patients and in post-PCI in-hospital mortality: blacks are least likely to receive DES, but patients of other racial groups are more likely to die after PCI. Further studies investigating the mechanisms responsible for these disparities are warranted.

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Cardiogenic shock without hypotension in acute myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.039 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

R Caldeira Da Rocha ◽

B Picarra ◽

R Fernandes ◽

F Dias Claudio ◽

M Carrington ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Hospital Death ◽

Lv Function ◽

Vessel Occlusion ◽

Funding Sources ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiogenic Shock(CS)complicates 10%of Acute Myocardial Infarction(AMI), being the main cause for intra-hospital death in these patients.Although early revascularization has contributed to increase survival,mortality still presents high, being 40-50%.CS usually presents with inadequate cardiac output and persistent hypotension.However,after large AMI,peripheral hypoperfusion can occur with sustained or borderline systolic blood pressure(SBP). Purpose Characterize patients(pts)with CS after AMI in the absence of hypotension(defined as SBP < 90mmHg),and assess impact in mortality. Methods We evaluated 528pts presenting with CS in context of AMI.We considered 2groups:Group 1-Pts who had SBP ≥90mmHg,without any inotropic drug or assist device and 2-Pts with SBP < 90mmHg.We registered age,gender,co-morbidities,presentation,coronary anatomy and treatment strategies.We evaluated in-hospital mortality and complications:re-infarction,mechanical complications,high-grade atrioventricular block(AVB),sustained ventricular tachycardia,atrial fibrillation,resuscitated cardiac arrest and stroke. Results AMI presenting as Cardiogenic Shock without hypotension(CSWH)was found in 51%of pts(n = 272),of whom 69%were male.They were younger(between age of 45-64years old in 34%of cases vs 25%,p = 0.040)and had higher body mass index (27.3 ± 4.5vs 26 ± 4.1,p = 0.001).Hypertension was a similarly distributed comorbidity.In group 1,pts were previously more frequently under beta blocker medication (25.2%vs 17.7%,p = 0.047).In this group,mean left ventricular (LV)ejection fraction was 39 ± 13%,a quarter having severely depressed LV function(<30%).Although STEMI was the most common presentation in both sets(73.5% vs 87.1%,p < 0.001),NSTEMI was more prevalent in CSWH(23.9%vs12.1%,p < 0.001).Those pts presented more,at admission,with dyspnea(14.9%vs5.5%,p < 0.001)and in sinus rhythm(81.9%vs69%,p < 0.001).In this group,ICU admission was less frequent(19.4%vs27.2%,p = 0.036),and only about half of pts were medicated with inotropic drugs(vs 78.1%,p < 0.001).However,difference in intra-aortic balloon use wasn’t found.CSWH presented with multivessel disease in 63.8%of pts,being LAD more frequently the culprit vessel(42.4% vs 30.7%,p = 0.030),but fewer left main artery(LM)(4.2%vs14.0%,p = 0.003).Group 1 had fewer prevalence of vessel occlusion,which was particularly true for LM(3.8%vs11.5%,p = 0.015) and circumflex(12.4%vs20.7%,p = 0.047),and were less often submitted to revascularization.Group 1 had fewer AVB(9.8%vs22.4%,p < 0.001).Rates of other complications were similar.In-hospital mortality was higher in classic CS(33.1% vs 43.8%, p= 0.012). Conclusion Cardiogenic Shock without hypotension was found in about half of pts with CS due to AMI.A majority of these were younger and globally had a less severe event and complications.Even though CSWH was associated with one third of in-hospital mortality,it was lower than in pts with hypotension.

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Endothelium Activation Markers in Severe Hospitalized COVID-19 Patients: Role in Mortality Risk Prediction

TH Open ◽

10.1055/s-0041-1731711 ◽

2021 ◽

Vol 05 (03) ◽

pp. e253-e263

Author(s):

Marina Marchetti ◽

Patricia Gomez-Rosas ◽

Eleonora Sanga ◽

Sara Gamba ◽

Cristina Verzeroli ◽

...

Keyword(s):

Hospital Mortality ◽

Multivariable Analysis ◽

Risk Groups ◽

Endothelial Activation ◽

Endothelial Damage ◽

High Risk Group ◽

Activation Markers ◽

Soluble Thrombomodulin ◽

Inflammatory Status ◽

D Dimer

Abstract Introduction Endothelial damage and hypercoagulability are major players behind the hemostatic derangement of SARS-CoV-2 infection. Aim In this prospective study we assessed endothelial and inflammatory biomarkers in a cohort of COVID-19 patients, aiming to identify predictive factors of in-hospital mortality. Methods COVID-19 patients hospitalized in intensive care (ICU) and non-ICU units at 2 Bergamo (Italy) hospitals from March 23 to May 30, 2020, were enrolled. Markers of endothelium activation including von-Willebrand factor (vWF), soluble thrombomodulin (sTM), and fibrinolytic proteins (t-PA and PAI-1) were measured. Additionally, D-dimer, Fibrinogen, FVIII, nucleosomes, C reactive protein (CRP) and procalcitonin were assessed. Results Sixty-three (45 ICU, and 18 non-ICU) patients, with a median age of 62 years were analyzed. Increased plasma levels of D-dimer, FVIII, fibrinogen, nucleosomes, CRP, and procalcitonin were observed in the whole cohort. Extremely elevated vWF levels characterized all patients (highest values in ICU-subjects). After a median time of 30 days, death occurred in 13 (21%) patients. By multivariable analysis, vWF-activity, neutrophil-count and PaO2/FiO2 were significantly associated with death. Using these variables, a linear score with 3-risk groups was generated that provided a cumulative incidence of death of 0% in the low-, 32% in the intermediate-, and 78% in the high-risk group. Conclusions COVID-19-induced hemostatic abnormalities are exacerbated by the severity of the disease and strongly correlate with the inflammatory status, underlying the link between coagulation, endothelial activation, and inflammation. Our study provides evidence for a role of vWF, together with neutrophils and PaO2/FiO2, as a significant predictor of in-hospital mortality by SARSCoV-2 infection.

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