Age-Adjusted Endothelial Activation and Stress Index for Coronavirus Disease 2019 at Admission Is a Reliable Predictor for 28-Day Mortality in Hospitalized Patients With Coronavirus Disease 2019

Frontiers in Medicine

María Jiménez-González¹  Irene García-García¹  Pablo Ryan²  Juan Cuadros-González³  Rebeca Bailén⁴  Julen Cadiñanos⁶  Juan Torres-Macho⁷  Eva Jiménez⁸  Felipe Pérez-García⁹  Mario Pérez-Butragueño^1,10  Amanda Fernández-Rodríguez^1,11  Salvador Resino^1,11  Maria Ángeles Jiménez-Sousa^1,11 

[1] 0Servicio de Farmacología Clínica, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain;1Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain;Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá de Henares, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain;Servicio de Hematología y Hemoterapia, Hospital General Universitario Gregorio Marañón, Madrid, Spain;Servicio de Medicina Interna, Hospital General de Villalba, Collado Villalba, Spain;Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain;Servicio de Medicina Preventiva, Hospital Universitario Infanta Leonor, Madrid, Spain;Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain;Servicio de Pediatria, Hospital Universitario Infanta Leonor, Madrid, Spain;Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain;

关键词: COVID-19;    mortality;    clinical prediction rule;    blood coagulation disorders;    endothelium;   

DOI  :  10.3389/fmed.2021.736028

来源: DOAJ

【 摘 要 】

Background: Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients.Methods: We performed a retrospective study on COVID-19 patients from two different cohorts [derivation (n = 1,200 patients) and validation (n = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase * creatinine)/thrombocytes] and aEASIX-COVID (EASIX * age), which were log2-transformed for analysis.Results: Log2-EASIX and log2-aEASIX-COVID were independently associated with an increased risk of death in both cohorts (p < 0.001). Log2-aEASIX-COVID showed a good predictive performance for 28-day mortality both in the derivation cohort (area under the receiver-operating characteristic = 0.827) and in the validation cohort (area under the receiver-operating characteristic = 0.820), with better predictive performance than log2-EASIX (p < 0.001). For log2 aEASIX-COVID, patients with low/moderate risk (<6) had a 28-day mortality probability of 5.3% [95% confidence interval (95% CI) = 4–6.5%], high (6–7) of 17.2% (95% CI = 14.7–19.6%), and very high (>7) of 47.6% (95% CI = 44.2–50.9%). The cutoff of log2 aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log2 aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%.Conclusion: Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.

【 授权许可】

Unknown