BackgroundThe coronavirus disease 2019 (COVID-19) is caused by severe here acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has evoked a pandemic that challenges public health-care systems worldwide.Endothelial cell dysfunction plays a key role in pathophysiology, and simple prognosticators may help to optimize allocation of limited resources.Endothelial activation and stress index (EASIX) is a validated predictor of endothelial complications and outcome after allogeneic stem cell transplantation.
Aim of this study was to test if EASIX could predict life-threatening complications in patients with COVID-19.MethodsSARS-CoV-2-positive, hospitalized patients were enrolled onto a prospective non-interventional register study (n=100).Biomarkers were assessed at hospital admission.
Primary endpoint was severe course of disease (mechanical ventilation and/or death, V/D).Results were validated in 126 patients treated in two independent institutions.ResultsEASIX at admission was a strong predictor of severe course of the disease (odds ratio for a two-fold change 3.
4, 95%CI 1.8-6.3, p<0.
001), time to V/D (hazard ratio (HR) for a two-fold change 2.0, 95%CI 1.5-2.
6, p<0.001) as well as survival (HR for a two-fold change 1.7, 95%CI 1.
2-2.5, p=0.006).
The effect was retained in multivariable analysis adjusting for age, gender, and comorbidities and could be validated in the independent cohort.At hospital admission EASIX correlated with increased suppressor of tumorigenicity-2, soluble thrombomodulin, angiopoietin-2, CXCL8, CXCL9 and interleukin-18, but not interferon-alpha.ConclusionEASIX is a validated predictor of COVID19 outcome and an easy-to-access tool to segregate patients in need for read more intensive surveillance.