Heart Failure and Respiratory Distress Clinic, Cardiology Service, Ciudad de México, Mexico.
Subdivision of Clinical Research, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México, 14080, Mexico.
BMC Pulm Med. 2024 Jul 4;24(1):325. doi: 10.1186/s12890-024-03136-0.
SARS-CoV-2 is a systemic disease that affects endothelial function and leads to coagulation disorders, increasing the risk of mortality. Blood levels of endothelial biomarkers such as Von Willebrand Factor (VWF), Thrombomodulin or Blood Dendritic Cell Antigen-3 (BDCA3), and uUokinase (uPA) increase in patients with severe disease and can be prognostic indicators for mortality. Therefore, the aim of this study was to determine the effect of VWF, BDCA3, and uPA levels on mortality.
From May 2020 to January 2021, we studied a prospective cohort of hospitalized adult patients with polymerase chain reaction (PCR)-confirmed COVID-19 with a SaO2 ≤ 93% and a PaO/FiO ratio < 300. In-hospital survival was evaluated from admission to death or to a maximum of 60 days of follow-up with Kaplan-Meier survival curves and Cox proportional hazard models as independent predictor measures of endothelial dysfunction.
We recruited a total of 165 subjects (73% men) with a median age of 57.3 ± 12.9 years. The most common comorbidities were obesity (39.7%), hypertension (35.4%) and diabetes (30.3%). Endothelial biomarkers were increased in non-survivors compared to survivors. According to the multivariate Cox proportional hazard model, those with an elevated VWF concentration ≥ 4870 pg/ml had a hazard ratio (HR) of 4.06 (95% CI: 1.32-12.5) compared to those with a lower VWF concentration adjusted for age, cerebrovascular events, enoxaparin dose, lactate dehydrogenase (LDH) level, and bilirubin level. uPA and BDCA3 also increased mortality in patients with levels ≥ 460 pg/ml and ≥ 3600 pg/ml, respectively.
The risk of mortality in those with elevated levels of endothelial biomarkers was observable in this study.
SARS-CoV-2 是一种全身性疾病，会影响内皮功能并导致凝血障碍，增加死亡率。严重疾病患者的内皮生物标志物（如血管性血友病因子（VWF）、血栓调节蛋白或血液树突状细胞抗原-3（BDCA3）和尿激酶（uPA））的血液水平会升高，并且这些标志物可以作为死亡率的预后指标。因此，本研究旨在确定 VWF、BDCA3 和 uPA 水平对死亡率的影响。
2020 年 5 月至 2021 年 1 月，我们对聚合酶链反应（PCR）确诊的 COVID-19 住院成年患者进行了前瞻性队列研究，这些患者的 SaO2≤93%，PaO/FiO 比值<300。从入院到死亡或最长 60 天的随访，通过 Kaplan-Meier 生存曲线和 Cox 比例风险模型评估住院生存率，并将其作为内皮功能障碍的独立预测指标。
我们共招募了 165 名受试者（73%为男性），中位年龄为 57.3±12.9 岁。最常见的合并症是肥胖症（39.7%）、高血压（35.4%）和糖尿病（30.3%）。与幸存者相比，非幸存者的内皮生物标志物水平升高。根据多变量 Cox 比例风险模型，与 VWF 浓度较低的患者相比，VWF 浓度≥4870pg/ml 的患者危险比（HR）为 4.06（95%可信区间：1.32-12.5），校正年龄、脑血管事件、依诺肝素剂量、乳酸脱氢酶（LDH）水平和胆红素水平。uPA 和 BDCA3 的水平分别≥460pg/ml 和≥3600pg/ml 也会增加患者的死亡率。
本研究观察到内皮生物标志物水平升高的患者死亡率风险增加。
Zotero 插件