Endothelial Activation and Stress Index (EASIX) as an Early Predictor for Mortality and Overall Survival in Hematological and Non-Hematological Patients with COVID-19: Multicenter Cohort Study.

Elżbieta Kalicińska,Monika Biernat,Justyna Janocha-Litwin,Justyna Rybka,Krzysztof Simon,Marcin Rymko,Anna Waszczuk-Gajda,Aleksander Zińczuk,Marta Rosiek-Biegus,Marta Morawska,Tomasz Wróbel,Łukasz Szukalski,Joanna Drozd-Sokołowska,Paula Jabłonowska

doi:10.3390/jcm10194373

Abstract

COVID-19, as a disease involving the endothelium of multiple organs, is characterized by high mortality rates among hospitalized patients. Patients with hematological malignancies are particularly at risk of an unfavorable course of COVID-19. The endothelial activation and stress index (EASIX) score has been used as a simple predictor of overall survival (OS) in specific groups of hematological cancer patients. EASIX, as a biomarker of endothelial dysfunction, might play a prognostic role in patients with COVID-19. Here, we performed a comprehensive retrospective analysis of the EASIX score in 523 hospitalized COVID-19 patients with or without coexisting hematological cancer. Hematological cancer COVID-19 patients had higher EASIX scores compared to the overall population with COVID-19. In hematological patients, EASIX was a strong predictor of the occurrence of sepsis during COVID-19. Our findings demonstrated EASIX as a strong predictor of intensive care unit admission, in-hospital mortality, the occurrence of acute renal failure and the need for hemodialysis, both in hematological and non-hematological COVID-19 patients. Patients with a high EASIX score on COVID-19 diagnosis had significantly inferior OS compared to patients with low EASIX. We showed for the first time that EASIX might serve as a simple, universal prognostic tool of OS in both hematological and non-hematological COVID-19 patients.

Highlights

The novel COVID-19 pandemic has paralyzed many health systems throughout the world and has contributed to significant mortality among the worldwide population
Our study has shown for the first time that endothelial activation and stress index (EASIX) is a universal, early and reliable predictor of the clinical outcome and overall survival in hematological and non-hematological patients diagnosed with COVID-19
In hematological cancer patients compared to non-hematological COVID-19 patients, EASIX is a strong predictor of the occurrence of sepsis during the course of SARS-CoV-2 infection

Summary

Introduction

The novel COVID-19 pandemic has paralyzed many health systems throughout the world and has contributed to significant mortality among the worldwide population. CoV-2 infection causes severe illness, in certain groups of patients. Patients with hematological cancer are vulnerable to an unfavorable course of COVID19 and poor outcome [1,2]. Finding a reliable and accurate predictor of the course of the SARS-CoV-2 infection might be beneficial during the early clinical evaluation and treatment of COVID-19 patients as well as in reducing mortality. Prognostic tools for COVID-19 outcome have been investigated recently. According to the meta-analyses, there are multiple risk factors associated with a poor clinical outcome of COVID-19 [3,4]. Little is known about the establishment of a universal prediction tool for COVID-19 prognosis that is accurate and reliable both in the general and hematological population of COVID-19 patients. The endothelial activation and stress index (EASIX), calculated by the formula

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Discussion

Conclusion