Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilians University (LMU), Munich, Germany.
Front Immunol. 2021 Jun 23;12:634416. doi: 10.3389/fimmu.2021.634416. eCollection 2021.
The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has evoked a pandemic that challenges public health-care systems worldwide. Endothelial cell dysfunction plays a key role in pathophysiology, and simple prognosticators may help to optimize allocation of limited resources. Endothelial activation and stress index (EASIX) is a validated predictor of endothelial complications and outcome after allogeneic stem cell transplantation. Aim of this study was to test if EASIX could predict life-threatening complications in patients with COVID-19.
SARS-CoV-2-positive, hospitalized patients were enrolled onto a prospective non-interventional register study (n=100). Biomarkers were assessed at hospital admission. Primary endpoint was severe course of disease (mechanical ventilation and/or death, V/D). Results were validated in 126 patients treated in two independent institutions.
EASIX at admission was a strong predictor of severe course of the disease (odds ratio for a two-fold change 3.4, 95%CI 1.8-6.3, p<0.001), time to V/D (hazard ratio (HR) for a two-fold change 2.0, 95%CI 1.5-2.6, p<0.001) as well as survival (HR for a two-fold change 1.7, 95%CI 1.2-2.5, p=0.006). The effect was retained in multivariable analysis adjusting for age, gender, and comorbidities and could be validated in the independent cohort. At hospital admission EASIX correlated with increased suppressor of tumorigenicity-2, soluble thrombomodulin, angiopoietin-2, CXCL8, CXCL9 and interleukin-18, but not interferon-alpha.
EASIX is a validated predictor of COVID19 outcome and an easy-to-access tool to segregate patients in need for intensive surveillance.
2019 年冠状病毒病（COVID-19）由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起，引发了一场对全球公共卫生保健系统构成挑战的大流行。内皮细胞功能障碍在病理生理学中起着关键作用，简单的预后指标可能有助于优化有限资源的分配。内皮激活和应激指数（EASIX）是同种异体干细胞移植后内皮并发症和结局的有效预测指标。本研究旨在测试 EASIX 是否可以预测 COVID-19 患者的危及生命的并发症。
对 SARS-CoV-2 阳性、住院的患者进行前瞻性非干预性登记研究（n=100）。入院时评估生物标志物。主要终点是严重疾病（机械通气和/或死亡，V/D）。结果在两个独立机构治疗的 126 名患者中得到验证。
入院时的 EASIX 是严重疾病病程的强预测指标（两倍变化的优势比为 3.4，95%CI 1.8-6.3，p<0.001），V/D 的时间（两倍变化的风险比为 2.0，95%CI 1.5-2.6，p<0.001）以及存活率（两倍变化的风险比为 1.7，95%CI 1.2-2.5，p=0.006）。在调整年龄、性别和合并症的多变量分析中保留了该效果，并在独立队列中得到验证。入院时，EASIX 与肿瘤抑制素 2、可溶性血栓调节蛋白、血管生成素 2、CXCL8、CXCL9 和白细胞介素 18 的增加相关，但与干扰素-α无关。
EASIX 是 COVID19 结局的有效预测指标，是一种易于获得的工具，可将需要密切监测的患者分开。
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