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

Abstract

BackgroundThe 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.MethodsIn 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.ResultsAn 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).ConclusionThe 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.

Association of eosinopenia with worsening prognosis in hospitalized Azvudine-treated COVID-19 patients: a retrospective cohort study

“…However, decreased lymphocyte count was commonly observed in our cohort, which is consistent with previous studies (16). Our results indicated that COVID-19 patients with eosinopenia had higher levels of procalcitonin, which has recently been identified as a predictor of severity in hospitalized COVID-19 patients (21). A previous study suggested that high levels of B-type natriuretic peptide (BNP), a marker of heart failure, were significantly higher in the eosinopenia group, which is consistent with previous reports suggesting its importance in treatment decision-making for COVID-19 patients (22).…”

“…Additionally, high levels of B-type natriuretic peptide (BNP), a marker of heart failure, were significantly higher in the eosinopenia group, which is consistent with previous reports suggesting its importance in treatment decision-making for COVID-19 patients (21). Furthermore, we found that laboratory biomarkers associated with the diagnosis and prognosis of COVID-19 patients, including glutamic oxaloacetic transaminase, serum creatinine, blood urea nitrogen, lactate dehydrogenase, creatine kinase, creatine kinase MB, myoglobin, and troponin I, were significantly higher in the eosinopenia group compared to the normal eosinophil group (22).…”

Serum Pharmacochemistry Combined with Network Pharmacology-Based Mechanism Prediction and Pharmacological Validation of Zhenwu Decoction on Alleviating Isoprenaline-Induced Heart Failure Injury in Rats

“… 33 BNP and NT-pro BNP are well-known markers of heart failure for the detection of left ventricular hypertrophy and left ventricular systolic dysfunction. 34 , 35 The serum levels of BNP and NT-pro BNP will increase in chronic congestive heart failure. ISO treatment induces myocardial injury, which may ultimately lead to myocardial necrosis, left ventricular hypertrophy, and heart failure.…”

High Expression Levels of miR-21-5p in Younger Hospitalized COVID-19 Patients Are Associated with Mortality and Critical Disease

“…Clinical variables such as D-dimer [ 38 ], procalcitonin [ 39 ], glucose [ 40 ], creatinine [ 41 ], and urea [ 42 ] have demonstrated an association with coagulation pathways and lung, kidney, and liver damage, which could lead to more severe disease and death in COVID-19 patients. Upregulated miR-21-5p expression levels were statistically correlated with procalcitonin, creatinine, urea, and thromboplastin-D-dimer index in non-survivor patients; albumin, D-dimer, and ferritin levels were correlated in the whole population.…”