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Clinical features and prognostic factors in Covid-19: A prospective cohort study.
de Bruin, Sanne; Bos, Lieuwe D; van Roon, Marian A; Tuip-de Boer, Anita M; Schuurman, Alex R; Koel-Simmelinck, Marleen J A; Bogaard, Harm Jan; Tuinman, Pieter Roel; van Agtmael, Michiel A; Hamann, Jörg; Teunissen, Charlotte E; Wiersinga, W Joost; Koos Zwinderman, A H; Brouwer, Matthijs C; van de Beek, Diederik; Vlaar, Alexander P J.
  • de Bruin S; From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
  • Bos LD; From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
  • van Roon MA; Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands.
  • Tuip-de Boer AM; From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
  • Schuurman AR; Department of Infectious Diseases, University of Amsterdam, Amsterdam UMC, Amsterdam Infection and Immunity, Amsterdam, The Netherlands.
  • Koel-Simmelinck MJA; Neurochemistry Laboratory, Department of Clinical Chemistry, Free University, Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands.
  • Bogaard HJ; Department of Pulmonary Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
  • Tuinman PR; Department of Intensive Care, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
  • van Agtmael MA; Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
  • Hamann J; Biobank Core Facility, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Teunissen CE; Neurochemistry Laboratory, Department of Clinical Chemistry, Free University, Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands.
  • Wiersinga WJ; Department of Infectious Diseases, University of Amsterdam, Amsterdam UMC, Amsterdam Infection and Immunity, Amsterdam, The Netherlands.
  • Koos Zwinderman AH; Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.
  • Brouwer MC; Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands.
  • van de Beek D; Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands. Electronic address: d.vandebeek@amsterdamumc.nl.
  • Vlaar APJ; From the Department of Intensive Care, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
EBioMedicine ; 67: 103378, 2021 May.
Article in English | MEDLINE | ID: covidwho-1230442
ABSTRACT

BACKGROUND:

Mortality rates are high among hospitalized patients with COVID-19, especially in those intubated on the ICU. Insight in pathways associated with unfavourable outcome may lead to new treatment strategies.

METHODS:

We performed a prospective cohort study of patients with COVID-19 admitted to general ward or ICU who underwent serial blood sampling. To provide insight in the pathways involved in disease progression, associations were estimated between outcome risk and serial measurements of 64 biomarkers in potential important pathways of COVID-19 infection (inflammation, tissue damage, complement system, coagulation and fibrinolysis) using joint models combining Cox regression and linear mixed-effects models. For patients admitted to the general ward, the primary outcome was admission to the ICU or mortality (unfavourable outcome). For patients admitted to the ICU, the primary outcome was 12-week mortality.

FINDINGS:

A total of 219 patients were included 136 (62%) on the ward and 119 patients (54%) on the ICU; 36 patients (26%) were included in both cohorts because they were transferred from general ward to ICU. On the general ward, 54 of 136 patients (40%) had an unfavourable outcome and 31 (23%) patients died. On the ICU, 54 out of 119 patients (45%) died. Unfavourable outcome on the general ward was associated with changes in concentrations of IL-6, IL-8, IL-10, soluble Receptor for Advanced Glycation End Products (sRAGE), vascular cell adhesion molecule 1 (VCAM-1) and Pentraxin-3. Death on the ICU was associated with changes in IL-6, IL-8, IL-10, sRAGE, VCAM-1, Pentraxin-3, urokinase-type plasminogen activator receptor, IL-1-receptor antagonist, CD14, procalcitonin, tumor necrosis factor alfa, tissue factor, complement component 5a, Growth arrest-specific 6, angiopoietin 2, and lactoferrin. Pathway analysis showed that unfavourable outcome on the ward was mainly driven by chemotaxis and interleukin production, whereas death on ICU was associated with a variety of pathways including chemotaxis, cell-cell adhesion, innate host response mechanisms, including the complement system, viral life cycle regulation, angiogenesis, wound healing and response to corticosteroids.

INTERPRETATION:

Clinical deterioration in patients with severe COVID-19 involves multiple pathways, including chemotaxis and interleukin production, but also endothelial dysfunction, the complement system, and immunothrombosis. Prognostic markers showed considerable overlap between general ward and ICU patients, but we identified distinct differences between groups that should be considered in the development and timing of interventional therapies in COVID-19.

FUNDING:

Amsterdam UMC, Amsterdam UMC Corona Fund, and Dr. C.J. Vaillant Fonds.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Biomarkers / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: EBioMedicine Year: 2021 Document Type: Article Affiliation country: J.ebiom.2021.103378

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Biomarkers / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: EBioMedicine Year: 2021 Document Type: Article Affiliation country: J.ebiom.2021.103378