Goudot Guillaume, Chocron Richard, Augy Jean-Loup, Gendron Nicolas, Khider Lina, Debuc Benjamin, Aissaoui Nadia, Peron Nicolas, Hauw-Berlemont Caroline, Vedie Benoit, Cheng Charles, Mohamedi Nassim, Krzisch Daphné, Philippe Aurélien, Puscas Tania, Hermann Bertrand, Brichet Julie, Juvin Philippe, Planquette Benjamin, Messas Emmanuel, Pere Hélène, Veyer David, Gaussem Pascale, Sanchez Olivier, Diehl Jean-Luc, Mirault Tristan, Smadja David M
Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
PARCC, INSERM, Université de Paris, Paris, France.
Front Med (Lausanne). 2020 Nov 12;7:586307. doi: 10.3389/fmed.2020.586307. eCollection 2020.
Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders. To explore clinical and biological parameters of COVID-19 patients with hospitalization criteria that could predict referral to intensive care unit (ICU). Analyzing the clinical and biological profiles of COVID-19 patients at admission. 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, 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 ( = 0.42, = 0.010) and D-dimer ( = 0.18, = 0.047). 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.
2019冠状病毒病（COVID-19）与心血管并发症和凝血障碍有关。为了探索符合住院标准的COVID-19患者的临床和生物学参数，以预测其是否会被转诊至重症监护病房（ICU）。分析COVID-19患者入院时的临床和生物学特征。在99例符合住院标准的连续患者中，48例入住内科，21例先入住内科病房，随后转诊至ICU，30例从急诊科直接入住ICU。入院时，需要入住ICU的患者更易出现淋巴细胞减少、血氧饱和度降低、D-二聚体水平高于1000 ng/mL以及更高的高敏心肌肌钙蛋白（Hs-cTnI）水平。受试者工作特征曲线分析确定Hs-cTnI高于9.75 pg/mL是ICU转诊的最佳预测标准[曲线下面积（AUC），86.4；95%可信区间（CI），76.6 - 96.2]。在对D-二聚体水平进行校正后的单因素分析[比值比（OR），22.8；95% CI，6.0 - 116.2]和多因素分析中，均证实了Hs-cTnI的这一临界值（校正后OR，20.85；95% CI，4.76 - 128.4）。随后对72例患者进行的经胸超声心动图参数测量显示，右心室（RV）后负荷增加与Hs-cTnI（r = 0.42，P = 0.010）和D-二聚体（r = 0.18，P = 0.047）相关。Hs-cTnI似乎是将COVID-19患者转诊至ICU的最佳相关预测因素。这一结果与D-二聚体与RV扩张的相关性可能反映了由于RV壁张力增加导致的心肌损伤。这强化了COVID-19相关微血管血栓形成导致更高RV后负荷的假说。
