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D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak

BACKGROUND: The decision for withholding and withdrawing of life-sustaining treatments (LSTs) in COVID-19 patients is currently based on a collegial and mainly clinical assessment. In the context of a global pandemic and overwhelmed health system, the question of LST decision support for COVID-19 pa...

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Autores principales: Smadja, David M., Fellous, Benjamin A., Bonnet, Guillaume, Hauw-Berlemont, Caroline, Sutter, Willy, Beauvais, Agathe, Fauvel, Charles, Philippe, Aurélien, Weizman, Orianne, Mika, Delphine, Juvin, Philippe, Waldmann, Victor, Diehl, Jean-Luc, Cohen, Ariel, Chocron, Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485619/
https://www.ncbi.nlm.nih.gov/pubmed/36148049
http://dx.doi.org/10.3389/fcvm.2022.935333
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author Smadja, David M.
Fellous, Benjamin A.
Bonnet, Guillaume
Hauw-Berlemont, Caroline
Sutter, Willy
Beauvais, Agathe
Fauvel, Charles
Philippe, Aurélien
Weizman, Orianne
Mika, Delphine
Juvin, Philippe
Waldmann, Victor
Diehl, Jean-Luc
Cohen, Ariel
Chocron, Richard
author_facet Smadja, David M.
Fellous, Benjamin A.
Bonnet, Guillaume
Hauw-Berlemont, Caroline
Sutter, Willy
Beauvais, Agathe
Fauvel, Charles
Philippe, Aurélien
Weizman, Orianne
Mika, Delphine
Juvin, Philippe
Waldmann, Victor
Diehl, Jean-Luc
Cohen, Ariel
Chocron, Richard
author_sort Smadja, David M.
collection PubMed
description BACKGROUND: The decision for withholding and withdrawing of life-sustaining treatments (LSTs) in COVID-19 patients is currently based on a collegial and mainly clinical assessment. In the context of a global pandemic and overwhelmed health system, the question of LST decision support for COVID-19 patients using prognostic biomarkers arises. METHODS: In a multicenter study in 24 French hospitals, 2878 COVID-19 patients hospitalized in medical departments from 26 February to 20 April 2020 were included. In a propensity-matched population, we compared the clinical, biological, and management characteristics and survival of patients with and without LST decision using Student's t-test, the chi-square test, and the Cox model, respectively. RESULTS: An LST was decided for 591 COVID-19 patients (20.5%). These 591 patients with LST decision were secondarily matched (1:1) based on age, sex, body mass index, and cancer history with 591 COVID-19 patients with no LST decision. The patients with LST decision had significantly more cardiovascular diseases, such as high blood pressure (72.9 vs. 66.7%, p = 0.02), stroke (19.3 vs. 11.1%, p < 0.001), renal failure (30.4 vs. 17.4%, p < 0.001), and heart disease (22.5 vs. 14.9%, p < 0.001). Upon admission, LST patients were more severely attested by a qSOFA score ≥2 (66.5 vs. 58.8%, p = 0.03). Biologically, LST patients had significantly higher values of D-dimer, markers of heart failure (BNP and NT-pro-BNP), and renal damage (creatinine) (p < 0.001). Their evolutions were more often unfavorable (in-hospital mortality) than patients with no LST decision (41.5 vs. 10.3%, p < 0.001). By combining the three biomarkers (D-dimer, BNP and/or NT-proBNP, and creatinine), the proportion of LST increased significantly with the number of abnormally high biomarkers (24, 41.3, 48.3, and 60%, respectively, for none, one, two, and three high values of biomarkers, trend p < 0.01). CONCLUSION: The concomitant increase in D-dimer, BNP/NT-proBNP, and creatinine during the admission of a COVID-19 patient could represent a reliable and helpful tool for LST decision. Circulating biomarker might potentially provide additional information for LST decision in COVID-19.
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spelling pubmed-94856192022-09-21 D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak Smadja, David M. Fellous, Benjamin A. Bonnet, Guillaume Hauw-Berlemont, Caroline Sutter, Willy Beauvais, Agathe Fauvel, Charles Philippe, Aurélien Weizman, Orianne Mika, Delphine Juvin, Philippe Waldmann, Victor Diehl, Jean-Luc Cohen, Ariel Chocron, Richard Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: The decision for withholding and withdrawing of life-sustaining treatments (LSTs) in COVID-19 patients is currently based on a collegial and mainly clinical assessment. In the context of a global pandemic and overwhelmed health system, the question of LST decision support for COVID-19 patients using prognostic biomarkers arises. METHODS: In a multicenter study in 24 French hospitals, 2878 COVID-19 patients hospitalized in medical departments from 26 February to 20 April 2020 were included. In a propensity-matched population, we compared the clinical, biological, and management characteristics and survival of patients with and without LST decision using Student's t-test, the chi-square test, and the Cox model, respectively. RESULTS: An LST was decided for 591 COVID-19 patients (20.5%). These 591 patients with LST decision were secondarily matched (1:1) based on age, sex, body mass index, and cancer history with 591 COVID-19 patients with no LST decision. The patients with LST decision had significantly more cardiovascular diseases, such as high blood pressure (72.9 vs. 66.7%, p = 0.02), stroke (19.3 vs. 11.1%, p < 0.001), renal failure (30.4 vs. 17.4%, p < 0.001), and heart disease (22.5 vs. 14.9%, p < 0.001). Upon admission, LST patients were more severely attested by a qSOFA score ≥2 (66.5 vs. 58.8%, p = 0.03). Biologically, LST patients had significantly higher values of D-dimer, markers of heart failure (BNP and NT-pro-BNP), and renal damage (creatinine) (p < 0.001). Their evolutions were more often unfavorable (in-hospital mortality) than patients with no LST decision (41.5 vs. 10.3%, p < 0.001). By combining the three biomarkers (D-dimer, BNP and/or NT-proBNP, and creatinine), the proportion of LST increased significantly with the number of abnormally high biomarkers (24, 41.3, 48.3, and 60%, respectively, for none, one, two, and three high values of biomarkers, trend p < 0.01). CONCLUSION: The concomitant increase in D-dimer, BNP/NT-proBNP, and creatinine during the admission of a COVID-19 patient could represent a reliable and helpful tool for LST decision. Circulating biomarker might potentially provide additional information for LST decision in COVID-19. Frontiers Media S.A. 2022-09-06 /pmc/articles/PMC9485619/ /pubmed/36148049 http://dx.doi.org/10.3389/fcvm.2022.935333 Text en Copyright © 2022 Smadja, Fellous, Bonnet, Hauw-Berlemont, Sutter, Beauvais, Fauvel, Philippe, Weizman, Mika, Juvin, Waldmann, Diehl, Cohen and Chocron. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Smadja, David M.
Fellous, Benjamin A.
Bonnet, Guillaume
Hauw-Berlemont, Caroline
Sutter, Willy
Beauvais, Agathe
Fauvel, Charles
Philippe, Aurélien
Weizman, Orianne
Mika, Delphine
Juvin, Philippe
Waldmann, Victor
Diehl, Jean-Luc
Cohen, Ariel
Chocron, Richard
D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak
title D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak
title_full D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak
title_fullStr D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak
title_full_unstemmed D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak
title_short D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak
title_sort d-dimer, bnp/nt-pro-bnp, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during covid-19 outbreak
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485619/
https://www.ncbi.nlm.nih.gov/pubmed/36148049
http://dx.doi.org/10.3389/fcvm.2022.935333
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