The Compass-COVID19-ICU Study: Identification of Factors to Predict the Risk of Intubation and Mortality in Patients with Severe COVID-19
Blood
; 138:2121, 2021.
Article
in English
| EMBASE | ID: covidwho-1582406
ABSTRACT
Background:
In some patients, SARS-CoV-2 infection induces cytokine storm, hypercoagulability and endothelial cell activation leading to worsening of COVID-19, intubation and death. Prompt identification of patients at risk of intubation or death is un unmet need.Objective:
To derive a prognostic score for the risk of intubation or death in patients with critical COVID-19 by assessing biomarkers of hypercoagulability, endothelial cell activation and inflammation and a large panel of clinical analytes.Methods:
We conducted a prospective, observational monocentric study enrolling 118 patients with COVID-19 admitted in the intensive care unit. At the 1st day of ICU admission all patients were assessed for the following biomarkers protein C, protein S, antithrombin, D-Dimer, fibrin monomers, factors VIIa, V, XII, XII, VIII, von Willebrand antigen, fibrinogen, procoagulant phospholipid dependent clotting time, TFPI, thrombomodulin, P-selectin, heparinase, microparticles exposing tissue factor, IL-6, complement C3a, C5a, thrombin generation, prothrombin time, activated partial thromboplastin time, hemogram, platelet count) and clinical predictors. The clinical outcomes were intubation and mortality during hospitalization in ICU.Results:
The intubation and mortality rate were 70 % and 18% respectively. Multivariate analysis led to the derivation of the COMPASS- COVID19-ICU score composed of P-Selectin, D-Dimer, free TFPI, TF activity, IL-6 and FXII, age and duration of hospitalization. The score predicted the risk of intubation or death with high sensitivity and specificity (0.90 and 0.92, respectively). Conclusions and Relevance Critical COVID-19 is related with severe endothelial cell activation and hypercoagulability orchestrated in the context of inflammation. The COMPASS-COVID19-ICU score is an accurate predictive model for the evaluation of the risk of mechanical ventilation and death in patients with critical COVID-19. The assessment with the COMPASS- COVID-19-ICU score is feasible in tertiary hospitals. In this context it could be placed in the diagnostic procedure of personalized medical management and prompt therapeutic intervention. Disclosures Terpos Novartis Honoraria;Janssen Consultancy, Honoraria, Research Funding;Genesis Consultancy, Honoraria, Research Funding;Celgene Consultancy, Honoraria, Research Funding;BMS Honoraria;Amgen Consultancy, Honoraria, Research Funding;Takeda Consultancy, Honoraria, Research Funding;Sanofi Consultancy, Honoraria, Research Funding;GSK Honoraria, Research Funding. Dimopoulos Amgen Honoraria;BMS Honoraria;Takeda Honoraria;Beigene Honoraria;Janssen Honoraria.
antithrombin; biological, marker; complement, component, C3a; complement, component, C5a; D, dimer; endogenous, compound; fibrin, monomer; fibrinogen; heparin, lyase; interleukin, 6; PADGEM, protein; phospholipid; procoagulant; protein, C; protein, S; thrombin; thrombomodulin; thromboplastin; tissue, factor, pathway, inhibitor; activated, partial, thromboplastin, time; adult; artificial, ventilation; cell, activation; clinical, assessment; clinical, outcome; conference, abstract; controlled, study; coronavirus, disease, 2019; endothelium, cell; enzyme, activity; female; funding; hospitalization; human; hypercoagulability; in-hospital, mortality; inflammation; intensive, care, unit; intubation; major, clinical, study; male; mortality, rate; outcome, assessment; platelet, count; prospective, study; prothrombin, time; risk, assessment; sensitivity, and, specificity; tertiary, care, center
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
Blood
Year:
2021
Document Type:
Article
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