Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has been linked to thrombotic complications and endothelial dysfunction. We assessed the prognostic implications of endothelial activation through measurement of endothelin-I precursor peptide (proET-1), the stable precursor protein of Endothelin-1, in a well-defined cohort of patients hospitalized with COVID-19. Methods We measured proET-1 in 74 consecutively admitted adult patients with confirmed COVID-19 and compared its prognostic accuracy to that of patients with community-acquired pneumonia (n = 876) and viral bronchitis (n = 371) from a previous study by means of logistic regression analysis. The primary endpoint was all-cause 30-day mortality. Results Overall, median admission proET-1 levels were lower in COVID-19 patients compared to those with pneumonia and exacerbated bronchitis, respectively (57.0 pmol/l vs. 113.0 pmol/l vs. 96.0 pmol/l, p < 0.01). Although COVID-19 non-survivors had 1.5-fold higher admission proET-1 levels compared to survivors (81.8 pmol/l [IQR: 76 to 118] vs. 53.6 [IQR: 37 to 69]), no significant association of proET-1 levels and mortality was found in a regression model adjusted for age, gender, creatinine level, diastolic blood pressure as well as cancer and coronary artery disease (adjusted OR 0.1, 95% CI 0.0009 to 14.7). In patients with pneumonia (adjusted OR 25.4, 95% CI 5.1 to 127.4) and exacerbated bronchitis (adjusted OR 120.1, 95% CI 1.9 to 7499) we found significant associations of proET-1 and mortality. Conclusions Compared to other types of pulmonary infection, COVID-19 shows only a mild activation of the endothelium as assessed through measurement of proET-1. Therefore, the high mortality associated with COVID-19 may not be attributed to endothelial dysfunction by the surrogate marker proET-1.
【저자키워드】 COVID-19, SARS-CoV-2, Risk assessment, Endothelin-1, All-cause 30-day mortality, ProET-1, Prognostic marker, 【초록키워드】 severe acute respiratory syndrome coronavirus 2, coronavirus, Hospitalized, Mortality, Pneumonia, Thrombotic complications, Cancer, peptide, Gender, severe acute respiratory syndrome Coronavirus, Endothelial dysfunction, Endothelium, Coronary artery disease, Protein, Viral, Accuracy, Regression model, Patient, Endothelin-1, Mild, age, prognostic, respiratory, disease, Admission, community-acquired pneumonia, Pulmonary infection, association, 30-Day mortality, marker, creatinine, primary endpoint, COVID-19 patient, Coronary artery, Diastolic blood pressure, Non-survivors, endothelial, acute respiratory syndrome, Activation, Logistic regression analysis, 95% CI, acute respiratory syndrome coronavirus, bronchitis, high mortality, previous study, precursor, survivor, implication, non-survivor, thrombotic complication, Result, exacerbated, median, adjusted, cohort of patient, patients with pneumonia, with COVID-19, 【제목키워드】 Mortality, Analysis, endothelial, Activation, precursor,