ANGIOGENIC MARKERS AS PROGNOSTIC TOOLS IN PATIENTS WITH COVID-19: CRACOV-HHS STUDY

Abstract

Objective: The course of COVID-19 can be altered by different comorbidities and arterial hypertension (HT) is one of them. Angiogenic markers are already used to establish the prognosis of acute conditions related to HT. The aim of our study was to assess the prognostic impact of soluble fms-like tyrosine kinase 1 (sFLT1), angiopoietin 2 (Ang2) and vascular endothelial growth factor (VEGF) on the severity of COVID-19 course. The study was a part of CRACoV project. Design and method: It was a prospective cohort study including the patients hospitalized due to COVID-19. Patients were assigned to severe or non-severe COVID-19 group based on National Institutes of Health criteria on admission. The serum concentration of sFLT1, Ang2 and VEGF was measured 5 times: twice during hospitalization: on 1st and 7th day, and 3 times after hospitalization – 28 days, 180 days and a year after discharge. Results: The study included 229 patients – 120 (52.4%) in severe and 109 (47.6%) in non-severe COVID-19 group. The median age (Q1-Q3) was 59 (48-67) years and 81 (35.4%) of patients were female. There were 57 (52.8%) patients with HT in non-severe and 70 (58.3%) in severe group (p=0.399). The groups differed significantly in terms of median body mass index (kg/m2), waist circumference (cm) and the prevalence of diabetes mellitus which were higher in severe group (30.03 (26.77 - 33.22) vs. 28.65 (25.82 - 31.83), p=0.015; 105 (97 - 115) vs. 100 (89 - 108), p=0.001 and 24.4% vs. 13.3%, p=0.036; respectively). Area under the curve for COVID-19 severity prediction for VEGF concentration on 1st day was: 0.687 (p<0.001), while it was not significant for other angiogenetic factors. In both groups median VEGF concentration (pg/ml) was the highest on 7th day but significantly higher in the severe group (229.22 (128.02 – 334.62) vs. 160.63 (100.85 – 281.59), p=0.010). The sFLT1 and Ang2 concentrations did not differ significantly between the groups at any time point. Conclusions: Serum VEGF concentration might be considered as additional predictive factor for severe COVID-19 course while sFLT1 and Ang2 cannot be used to anticipate COVID-19 severity.