Abstract
Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders.Objectives: To explore clinical and biological parameters of COVID-19 patients with hospitalization criteria that could predict referral to intensive care unit (ICU).Methods: Analyzing the clinical and biological profiles of COVID-19 patients at admission.Results: Among 99 consecutive patients that fulfilled criteria for hospitalization, 48 were hospitalized in the medicine department, 21 were first admitted to the medicine ward department and referred later to ICU, and 30 were directly admitted to ICU from the emergency department. At admission, patients requiring ICU were more likely to have lymphopenia, decreased SpO2, a D-dimer level above 1,000 ng/mL, and a higher high-sensitivity cardiac troponin (Hs-cTnI) level. A receiver operating characteristic curve analysis identified Hs-cTnI above 9.75 pg/mL as the best predictive criteria for ICU referral [area under the curve (AUC), 86.4; 95% CI, 76.6–96.2]. This cutoff for Hs-cTnI was confirmed in univariate [odds ratio (OR), 22.8; 95% CI, 6.0–116.2] and multivariate analysis after adjustment for D-dimer level (adjusted OR, 20.85; 95% CI, 4.76–128.4). Transthoracic echocardiography parameters subsequently measured in 72 patients showed an increased right ventricular (RV) afterload correlated with Hs-cTnI (r = 0.42, p = 0.010) and D-dimer (r = 0.18, p = 0.047).Conclusion: Hs-cTnI appears to be the best relevant predictive factor for referring COVID-19 patients to ICU. This result associated with the correlation of D-dimer with RV dilatation probably reflects a myocardial injury due to an increased RV wall tension. This reinforces the hypothesis of a COVID-19-associated microvascular thrombosis inducing a higher RV afterload.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection can be asymptomatic or lead to the coronavirus disease 2019 (COVID-19), which has a very large pattern of respiratory manifestations and other nonspecific symptoms including fever, headache, hemoptysis, nausea, vomiting, and diarrhea previously described in other coronavirus infections [1, 2]
They were divided into three groups: patients hospitalized in the medical department (n = 48), patients first hospitalized in the medicine department referred to intensive care unit (ICU) due to respiratory degradation (n = 21), and patients admitted to ICU after admission to the emergency department (n = 30)
COVID-19 patients directly admitted to ICU had more often history of coronary heart disease and were more likely to have dyspnea at admission (p < 0.001), decreased SpO2 (p < 0.001), pneumonia on the computed tomography (CT) scan (p = 0.002), acute respiratory distress syndrome (ARDS) (p < 0.001), and increased respiratory rate–breath per minute (p < 0.001)
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection can be asymptomatic or lead to the coronavirus disease 2019 (COVID-19), which has a very large pattern of respiratory manifestations and other nonspecific symptoms including fever, headache, hemoptysis, nausea, vomiting, and diarrhea previously described in other coronavirus infections [1, 2]. In terms of respiratory symptoms, COVID-19 is characterized by a large spectrum of infectious signs from dry cough and pulmonary edema to acute respiratory distress syndrome (ARDS), requiring hospitalization in intensive care unit (ICU) and leading to death in the most severe cases [2]. We previously described the endothelial lesion in patients with hospitalization criteria as a marker of COVID19 severity at hospital admission [19]. Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders
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