ABSTRACT
BACKGROUND: SARS-CoV-2 uses Angiotensin-Converting Enzyme 2 as a viral gateway to the cell and could interact with the renin-angiotensin-aldosterone system. Other studies have shown kalemia abnormalities in patients with severe forms of coronavirus disease 2019. Our goal was to assess the prognosis value of kalemia within ten days of symptom offset in the COVID-19 hospitalized population. METHODS: We analyzed data from a prospective cohort that included 65 patients with COVID-19, admitted between March 15, 2020, and March 21, 2020. The study aimed at determining the relationship between baseline kalemia and the admission to an intensive care unit (ICU) or death. RESULTS: The median age of the patients was 65 [54-79] years old, and 66.2% of the patients were men. Baseline kalemia under 3.8mmol/l occurred in 31 patients (48%), including 11 patients (35.5%) who were admitted to an ICU and one patient (3.2%) who died before ICU admission. In the primary end-point analysis, the adjusted hazard ratios for admission to an ICU or death were 3.52 [95% confidence interval (CI), 1.12 to 11.04] among patients with low baseline kalemia. CONCLUSION: Our study suggests that low kalemia levels within ten days of the first symptom onset might be associated with an increased risk of intensive care unit admission or death. The future perspective should be to better understand this relationship.
Subject(s)
COVID-19 , Aged , Cohort Studies , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , SARS-CoV-2ABSTRACT
Background : D-dimer is a safe tool to exclude pulmonary embolism (PE) but its specificity is decreased in COVID-19. Aims : Our aim was to derive a new algorithm with D-dimer threshold adjusted to CT extent of lung damage. Methods : We conducted a multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to CT extent of lung damage was derived in a patient set ( n = 337), and its safety assessed in an independent validation set ( n = 337). Results : According to ROC curves, D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm's sensitivity was 98.2% (95% CI: 94.7-100.0), and its specificity 28.4% (95% CI: 24.1-32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01-0.44) and the AUC was 0.63 (95% CI: 0.60-0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7-99.6) and 39.2% (95% CI: 32.2-46.1), respectively. The NLR was 0.08 (95% CI: 0.02-0.33), and the AUC did not differ from that of the derivation set (0.68 (95% CI: 0.64-0.72), P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA). Conclusions : The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA in COVID-19 patients. Prospective management studies are necessary to validate this strategy.
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) use Angiotensin-Converting Enzyme 2 (ACE-2) as a viral gateway and could have interactions with the RAA system. Other studies have found kalemia abnormalities associated with severe forms of COVID-19.Our goal was to assess the prognosis value of kalemia in severe COVID-19 hospitalized population. Methods: We analyzed data from a monocentric prospective observational cohort that included 65 patients PCR-confirmed positive for COVID-19 who were admitted at HEGP in Paris, between 15 to 21 March, 2020. The study aimed to determine the relationship between baseline kalemia and the primary composite outcome defined as admission to an intensive care unit (ICU) or death. Baseline kalemia was defined as the presence of a kalemia under 3.8 mmol/L within 10 days of the first symptom onset. Results: We included 65 patients with PCR COVID-19 positive test. Median age was 65 years old and 66.2% were male. Baseline kalemia under 3.8 mmol/l occurred in 31 patients (48%) including 11 patients (35.5%) who were hospitalized in ICU and 1 patient (3.2%) who died before ICU admission. In the primary end-point analysis based on multiple imputations for missing data, the adjusted hazard ratios for admission to ICU or death were 3.52 [95%(CI), 1.12 to 11.04] among patients who presented a kalemia under 3.8 mmol/L within 10 days of the first symptom onset. Moreover, we did find an adjusted association between baseline kalemia and the minimum hemoglobin level presented by the patients during the hospital stay (odds ratio, 0.80;95% CI, 0.64 to 0.99) (Fig. 1). Conclusion: Our study suggests that the presence of a kalemia under 3.8 mmol/L within 10 days of the first symptom onset might be associated with an increased risk of intensive care unit or death, and the minimum hemoglobin level presented by the patients during the hospital stay. Future intervention studies aimed for correcting this hypokalemia with ARBs to improve prognosis are ongoing.
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Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2020
ABSTRACT
RATIONALE: COVID-19 ARDS could differ from typical forms of the syndrome. OBJECTIVE: Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. METHODS: Between March 22 and March 30, 2020 respiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 [1-4] day after intubation (median [IQR]). MEASUREMENTS AND MAIN RESULTS: Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. We observed moderately decreased respiratory system compliance: 39.5 [33.1-44.7] mL/cmH2O and end-expiratory lung volume: 2100 [1721-2434] mL. Gas exchanges were characterized by hypercapnia 55 [44-62] mmHg, high physiological dead-space (VD/VT): 75 [69-85.5] % and ventilatory ratio (VR): 2.9 [2.2-3.4]. VD/VT and VR were significantly correlated: r2 = 0.24, p = 0.014. No pulmonary embolism was suspected at the time of measurements. CECs and D-dimers were elevated as compared to normal values: 24 [12-46] cells per mL and 1483 [999-2217] ng/mL, respectively. CONCLUSIONS: We observed early in the course of COVID-19 ARDS high VD/VT in association with biological markers of endothelial damage and thrombosis. High VD/VT can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process.