Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload

Guillaume Goudot; Richard Chocron; Jean-Loup Augy; Nicolas Gendron; Lina Khider; Benjamin Debuc; Nadia Aissaoui; Nicolas Peron; Caroline Hauw-Berlemont; Benoit Vedie; Charles Cheng; Nassim Mohamedi; Daphné Krzisch; Aurélien Philippe; Tania Puscas; Bertrand Hermann; Julie Brichet; Philippe Juvin; Benjamin Planquette; Emmanuel Messas; Hélène Pere; David Veyer; Pascale Gaussem; Olivier Sanchez; Jean-Luc Diehl; Tristan Mirault; David M Smadja

doi:10.3389/fmed.2020.586307

Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload

Front Med (Lausanne). 2020 Nov 12:7:586307. doi: 10.3389/fmed.2020.586307. eCollection 2020.

Authors

Guillaume Goudot¹, Richard Chocron^{2

3}, Jean-Loup Augy⁴, Nicolas Gendron^{5

6}, Lina Khider¹, Benjamin Debuc^{5

7}, Nadia Aissaoui⁴, Nicolas Peron⁴, Caroline Hauw-Berlemont⁴, Benoit Vedie⁸, Charles Cheng¹, Nassim Mohamedi¹, Daphné Krzisch⁹, Aurélien Philippe^{5

6}, Tania Puscas⁴, Bertrand Hermann⁴, Julie Brichet⁹, Philippe Juvin³, Benjamin Planquette^{5

10}, Emmanuel Messas^{1

2}, Hélène Pere^{2

11}, David Veyer^{11

12}, Pascale Gaussem^{5

9}, Olivier Sanchez^{5

10}, Jean-Luc Diehl^{5

13}, Tristan Mirault^{1

2}, David M Smadja^{5

6}

Affiliations

¹ Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
² PARCC, INSERM, Université de Paris, Paris, France.
³ Emergency Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
⁴ Intensive Care Unit, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
⁵ Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France.
⁶ Haematology Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
⁷ Plastic Surgery Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
⁸ Biochemistry Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
⁹ Haematology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
¹⁰ Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
¹¹ Virology Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.
¹² Centre de Recherche des Cordeliers, Functional Genomics of Solid Tumors, INSERM, Université de Paris, Paris, France.
¹³ Intensive Care Unit and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France.

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.

Keywords: COVID-19; D-dimer (DD); echocardiograghy; right ventricle; thrombosis; troponin.

Copyright © 2020 Goudot, Chocron, Augy, Gendron, Khider, Debuc, Aissaoui, Peron, Hauw-Berlemont, Vedie, Cheng, Mohamedi, Krzisch, Philippe, Puscas, Hermann, Brichet, Juvin, Planquette, Messas, Pere, Veyer, Gaussem, Sanchez, Diehl, Mirault and Smadja.