First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece.
Health Informatics Laboratory, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Shock. 2021 Nov 1;56(5):733-736. doi: 10.1097/SHK.0000000000001780.
The endothelial protein C receptor (EPCR) is a protein that regulates the protein C anticoagulant and anti-inflammatory pathways. A soluble form of EPCR (sEPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in COVID-19 has not been explored. In this study, we investigated whether sEPCR levels were related to COVID-19 patients' requirement for hospitalization.
Plasma sEPCR levels were measured on hospital admission in 84 COVID-19 patients, and in 11 non-hospitalized SARS-CoV2-positive patients approximately 6 days after reported manifestation of their symptoms. Multiple logistic regression analysis was performed to identify potential risk factors for hospitalization and receiver operating characteristic (ROC) curves were generated to assess their value.
In our cohort, hospitalized patients had considerably higher sEPCR levels upon admission compared with outpatients [107.5 (76.7-156.3) vs. 44.6 (12.1-84.4) ng/mL; P < 0.0001)]. The ROC curve using hospitalization as the classification variable and sEPCR levels as the prognostic variable generated an area under the curve at 0.845 (95% CI = 0.710-0.981, P < 0.001). Additionally, we investigated the predictive value of sEPCR combined with BMI, age, or D-dimers.
In our cohort, sEPCR levels in COVID-19 patients upon hospital admission appear considerably elevated compared with outpatients; this could lead to impaired APC activities and might contribute to the pro-coagulant phenotype reported in such patients. sEPCR measurement might be useful as a point-of-care test in SARS-CoV2-positive patients.
内皮蛋白 C 受体（EPCR）是一种调节蛋白 C 抗凝和抗炎途径的蛋白质。EPCR 的可溶性形式（sEPCR）在血浆中循环，并抑制激活的蛋白 C（APC）活性。sEPCR 的临床影响及其在 COVID-19 中的作用尚未得到探索。在这项研究中，我们研究了 sEPCR 水平是否与 COVID-19 患者住院的需求有关。
在 84 名 COVID-19 患者入院时测量血浆 sEPCR 水平，并在大约 6 天后报告出现症状时测量 11 名非住院 SARS-CoV2 阳性患者的 sEPCR 水平。进行多因素逻辑回归分析以确定住院的潜在危险因素，并生成接受者操作特征（ROC）曲线以评估其价值。
在我们的队列中，住院患者入院时的 sEPCR 水平明显高于门诊患者[107.5（76.7-156.3）比 44.6（12.1-84.4）ng/mL；P<0.0001）]。使用住院作为分类变量，sEPCR 水平作为预后变量的 ROC 曲线生成曲线下面积为 0.845（95%CI=0.710-0.981，P<0.001）。此外，我们还研究了 sEPCR 与 BMI、年龄或 D-二聚体联合的预测价值。
在我们的队列中，COVID-19 患者入院时的 sEPCR 水平明显高于门诊患者；这可能导致 APC 活性受损，并可能导致此类患者报告的促凝表型。sEPCR 测量可能有助于 SARS-CoV2 阳性患者的即时护理测试。
