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Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory disease associated with endotheliitis and microthrombosis. OBJECTIVES: To correlate endothelial dysfunction to in-hospital mortality in a bi-centric cohort of COVID-19 adult patients. METHODS: Consecutive ambulatory and hospitalized pa...

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Autores principales: Philippe, Aurélien, Chocron, Richard, Gendron, Nicolas, Bory, Olivier, Beauvais, Agathe, Peron, Nicolas, Khider, Lina, Guerin, Coralie L., Goudot, Guillaume, Levasseur, Françoise, Peronino, Christophe, Duchemin, Jerome, Brichet, Julie, Sourdeau, Elise, Desvard, Florence, Bertil, Sébastien, Pene, Frédéric, Cheurfa, Cherifa, Szwebel, Tali-Anne, Planquette, Benjamin, Rivet, Nadia, Jourdi, Georges, Hauw-Berlemont, Caroline, Hermann, Bertrand, Gaussem, Pascale, Mirault, Tristan, Terrier, Benjamin, Sanchez, Olivier, Diehl, Jean-Luc, Fontenay, Michaela, Smadja, David M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809553/
https://www.ncbi.nlm.nih.gov/pubmed/33449299
http://dx.doi.org/10.1007/s10456-020-09762-6
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author Philippe, Aurélien
Chocron, Richard
Gendron, Nicolas
Bory, Olivier
Beauvais, Agathe
Peron, Nicolas
Khider, Lina
Guerin, Coralie L.
Goudot, Guillaume
Levasseur, Françoise
Peronino, Christophe
Duchemin, Jerome
Brichet, Julie
Sourdeau, Elise
Desvard, Florence
Bertil, Sébastien
Pene, Frédéric
Cheurfa, Cherifa
Szwebel, Tali-Anne
Planquette, Benjamin
Rivet, Nadia
Jourdi, Georges
Hauw-Berlemont, Caroline
Hermann, Bertrand
Gaussem, Pascale
Mirault, Tristan
Terrier, Benjamin
Sanchez, Olivier
Diehl, Jean-Luc
Fontenay, Michaela
Smadja, David M.
author_facet Philippe, Aurélien
Chocron, Richard
Gendron, Nicolas
Bory, Olivier
Beauvais, Agathe
Peron, Nicolas
Khider, Lina
Guerin, Coralie L.
Goudot, Guillaume
Levasseur, Françoise
Peronino, Christophe
Duchemin, Jerome
Brichet, Julie
Sourdeau, Elise
Desvard, Florence
Bertil, Sébastien
Pene, Frédéric
Cheurfa, Cherifa
Szwebel, Tali-Anne
Planquette, Benjamin
Rivet, Nadia
Jourdi, Georges
Hauw-Berlemont, Caroline
Hermann, Bertrand
Gaussem, Pascale
Mirault, Tristan
Terrier, Benjamin
Sanchez, Olivier
Diehl, Jean-Luc
Fontenay, Michaela
Smadja, David M.
author_sort Philippe, Aurélien
collection PubMed
description BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory disease associated with endotheliitis and microthrombosis. OBJECTIVES: To correlate endothelial dysfunction to in-hospital mortality in a bi-centric cohort of COVID-19 adult patients. METHODS: Consecutive ambulatory and hospitalized patients with laboratory-confirmed COVID-19 were enrolled. A panel of endothelial biomarkers and von Willebrand factor (VWF) multimers were measured in each patient ≤ 48 h following admission. RESULTS: Study enrolled 208 COVID-19 patients of whom 23 were mild outpatients and 189 patients hospitalized after admission. Most of endothelial biomarkers tested were found increased in the 89 critical patients transferred to intensive care unit. However, only von Willebrand factor antigen (VWF:Ag) scaled according to clinical severity, with levels significantly higher in critical patients (median 507%, IQR 428–596) compared to non-critical patients (288%, 230–350, p < 0.0001) or COVID-19 outpatients (144%, 133–198, p = 0.007). Moreover, VWF high molecular weight multimers (HMWM) were significantly higher in critical patients (median ratio 1.18, IQR 0.86–1.09) compared to non-critical patients (0.96, 1.04–1.39, p < 0.001). Among all endothelial biomarkers measured, ROC curve analysis identified a VWF:Ag cut-off of 423% as the best predictor for in-hospital mortality. The accuracy of VWF:Ag was further confirmed in a Kaplan–Meier estimator analysis and a Cox proportional Hazard model adjusted on age, BMI, C-reactive protein and d-dimer levels. CONCLUSION: VWF:Ag is a relevant predictive factor for in-hospital mortality in COVID-19 patients. More than a biomarker, we hypothesize that VWF, including excess of HMWM forms, drives microthrombosis in COVID-19.
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spelling pubmed-78095532021-01-15 Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality Philippe, Aurélien Chocron, Richard Gendron, Nicolas Bory, Olivier Beauvais, Agathe Peron, Nicolas Khider, Lina Guerin, Coralie L. Goudot, Guillaume Levasseur, Françoise Peronino, Christophe Duchemin, Jerome Brichet, Julie Sourdeau, Elise Desvard, Florence Bertil, Sébastien Pene, Frédéric Cheurfa, Cherifa Szwebel, Tali-Anne Planquette, Benjamin Rivet, Nadia Jourdi, Georges Hauw-Berlemont, Caroline Hermann, Bertrand Gaussem, Pascale Mirault, Tristan Terrier, Benjamin Sanchez, Olivier Diehl, Jean-Luc Fontenay, Michaela Smadja, David M. Angiogenesis Original Paper BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory disease associated with endotheliitis and microthrombosis. OBJECTIVES: To correlate endothelial dysfunction to in-hospital mortality in a bi-centric cohort of COVID-19 adult patients. METHODS: Consecutive ambulatory and hospitalized patients with laboratory-confirmed COVID-19 were enrolled. A panel of endothelial biomarkers and von Willebrand factor (VWF) multimers were measured in each patient ≤ 48 h following admission. RESULTS: Study enrolled 208 COVID-19 patients of whom 23 were mild outpatients and 189 patients hospitalized after admission. Most of endothelial biomarkers tested were found increased in the 89 critical patients transferred to intensive care unit. However, only von Willebrand factor antigen (VWF:Ag) scaled according to clinical severity, with levels significantly higher in critical patients (median 507%, IQR 428–596) compared to non-critical patients (288%, 230–350, p < 0.0001) or COVID-19 outpatients (144%, 133–198, p = 0.007). Moreover, VWF high molecular weight multimers (HMWM) were significantly higher in critical patients (median ratio 1.18, IQR 0.86–1.09) compared to non-critical patients (0.96, 1.04–1.39, p < 0.001). Among all endothelial biomarkers measured, ROC curve analysis identified a VWF:Ag cut-off of 423% as the best predictor for in-hospital mortality. The accuracy of VWF:Ag was further confirmed in a Kaplan–Meier estimator analysis and a Cox proportional Hazard model adjusted on age, BMI, C-reactive protein and d-dimer levels. CONCLUSION: VWF:Ag is a relevant predictive factor for in-hospital mortality in COVID-19 patients. More than a biomarker, we hypothesize that VWF, including excess of HMWM forms, drives microthrombosis in COVID-19. Springer Netherlands 2021-01-15 2021 /pmc/articles/PMC7809553/ /pubmed/33449299 http://dx.doi.org/10.1007/s10456-020-09762-6 Text en © The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Paper
Philippe, Aurélien
Chocron, Richard
Gendron, Nicolas
Bory, Olivier
Beauvais, Agathe
Peron, Nicolas
Khider, Lina
Guerin, Coralie L.
Goudot, Guillaume
Levasseur, Françoise
Peronino, Christophe
Duchemin, Jerome
Brichet, Julie
Sourdeau, Elise
Desvard, Florence
Bertil, Sébastien
Pene, Frédéric
Cheurfa, Cherifa
Szwebel, Tali-Anne
Planquette, Benjamin
Rivet, Nadia
Jourdi, Georges
Hauw-Berlemont, Caroline
Hermann, Bertrand
Gaussem, Pascale
Mirault, Tristan
Terrier, Benjamin
Sanchez, Olivier
Diehl, Jean-Luc
Fontenay, Michaela
Smadja, David M.
Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality
title Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality
title_full Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality
title_fullStr Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality
title_full_unstemmed Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality
title_short Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality
title_sort circulating von willebrand factor and high molecular weight multimers as markers of endothelial injury predict covid-19 in-hospital mortality
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809553/
https://www.ncbi.nlm.nih.gov/pubmed/33449299
http://dx.doi.org/10.1007/s10456-020-09762-6
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