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Vassiliou AG, Keskinidou C, Jahaj E, Gallos P, Zacharis A, Athanasiou N, Tsipilis S, Mastora Z, Dimopoulou I, Kotanidou A, Orfanos SE. Could Soluble Endothelial Protein C Receptor Levels Recognize SARS-CoV2-Positive Patients Requiring Hospitalization? Shock 2021; 56:733-736. [PMID: 33756504 PMCID: PMC8518207 DOI: 10.1097/shk.0000000000001780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The endothelial protein C receptor (EPCR) is a protein that regulates the protein C anticoagulant and anti-inflammatory pathways. A soluble form of EPCR (sEPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in COVID-19 has not been explored. In this study, we investigated whether sEPCR levels were related to COVID-19 patients' requirement for hospitalization. METHODS Plasma sEPCR levels were measured on hospital admission in 84 COVID-19 patients, and in 11 non-hospitalized SARS-CoV2-positive patients approximately 6 days after reported manifestation of their symptoms. Multiple logistic regression analysis was performed to identify potential risk factors for hospitalization and receiver operating characteristic (ROC) curves were generated to assess their value. RESULTS In our cohort, hospitalized patients had considerably higher sEPCR levels upon admission compared with outpatients [107.5 (76.7-156.3) vs. 44.6 (12.1-84.4) ng/mL; P < 0.0001)]. The ROC curve using hospitalization as the classification variable and sEPCR levels as the prognostic variable generated an area under the curve at 0.845 (95% CI = 0.710-0.981, P < 0.001). Additionally, we investigated the predictive value of sEPCR combined with BMI, age, or D-dimers. CONCLUSIONS In our cohort, sEPCR levels in COVID-19 patients upon hospital admission appear considerably elevated compared with outpatients; this could lead to impaired APC activities and might contribute to the pro-coagulant phenotype reported in such patients. sEPCR measurement might be useful as a point-of-care test in SARS-CoV2-positive patients.
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Affiliation(s)
- Alice G. Vassiliou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Chrysi Keskinidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Edison Jahaj
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Parisis Gallos
- Health Informatics Laboratory, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Zacharis
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Nikolaos Athanasiou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Stamatios Tsipilis
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Zafeiria Mastora
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Stylianos E. Orfanos
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Second Department of Critical Care, School of Medicine, National and Kapodistrian University of Athens, “Attikon” Hospital, Haidari Athens, Greece
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Chapelet A, Foucher Y, Gérard N, Rousseau C, Zambon O, Bretonnière C, Mira JP, Charreau B, Guitton C. An early increase in endothelial protein C receptor is associated with excess mortality in pneumococcal pneumonia with septic shock in the ICU. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:251. [PMID: 30290852 PMCID: PMC6173894 DOI: 10.1186/s13054-018-2179-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/05/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study investigated changes in plasma level of soluble endothelial protein C receptor (sEPCR) in association with outcome in patients with septic shock. We explored sEPCR for early sepsis prognosis assessment and constructed a scoring system based on clinical and biological data, in order to discriminate between surviving at hospital discharge and non-surviving patients. METHODS Clinical data and samples were extracted from the prospective "STREPTOGENE" cohort. We enrolled 278 patients, from 50 intensive care units (ICUs), with septic shock caused by pneumococcal pneumonia. Patients were divided into survivors (n = 194) and non-survivors (n = 84) based on in-hospital mortality. Soluble EPCR plasma levels were quantified at day 1 (D1) and day 2 (D2) by ELISA. The EPCR gene A3 haplotype was determined. Patients were followed up until hospital discharge. Univariate and multivariate analyses were performed. A scoring system was constructed using least absolute shrinkage and selection operator (lasso) logistic regression for selecting predictive variables. RESULTS In-hospital mortality was 30.2% (n = 84). Plasma sEPCR level was significantly higher at D1 and D2 in non-surviving patients compared to patients surviving to hospital discharge (p = 0.0447 and 0.0047, respectively). Early increase in sEPCR at D2 was found in non-survivors while a decrease was observed in the survival group (p = 0.0268). EPCR A3 polymorphism was not associated with mortality. Baseline sEPCR level and its variation from D1 to D2 were independent predictors of in-hospital mortality. The scoring system including sEPCR predicted mortality with an AUC of 0.75. CONCLUSIONS Our findings confirm that high plasma sEPCR and its increase at D2 are associated with poor outcome in sepsis and thus we propose sEPCR as a key player in the pathogenesis of sepsis and as a potential biomarker of sepsis outcome.
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Affiliation(s)
- Agnès Chapelet
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France.,Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France.,Institute of Transplantation Urology Nephrology (ITUN), Nantes University Hospital, Nantes, France
| | - Yohann Foucher
- INSERM, UMR 1246 - SPHERE, Nantes University, Nantes University Hospital, Nantes, France
| | - Nathalie Gérard
- Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France
| | | | - Olivier Zambon
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Jean-Paul Mira
- Institut Cochin, INSERM U1016, Paris, France.,Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Béatrice Charreau
- Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France.,Institute of Transplantation Urology Nephrology (ITUN), Nantes University Hospital, Nantes, France
| | - Christophe Guitton
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France. .,Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France. .,Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
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Vassiliou AG, Kotanidou A, Mastora Z, Tascini C, Cardinali G, Orfanos SE. The H3 Haplotype of the EPCR Gene Determines High sEPCR Levels in Critically Ill Septic Patients. Infect Dis Ther 2018; 7:3-14. [PMID: 29549653 PMCID: PMC5856733 DOI: 10.1007/s40121-018-0193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction A soluble (s) form of the endothelial protein C receptor (EPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in the septic process is under investigation. This study determined the frequencies of EPCR haplotypes H1 and H3 to investigate possible associations with plasma admission levels of sEPCR in an intensive care unit (ICU) cohort of septic patients. Methods Three polymorphisms in the EPCR gene were genotyped in 239 Caucasian critically ill patients, and their plasma sEPCR levels were also measured at the time of admission to the ICU. Multivariate logistic regression analysis controlling for sepsis severity, age, acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores, lactate level, sex, diagnostic category, length of ICU stay and hospital mortality was performed to determine the effect of EPCR haplotypes H1 and H3 on the levels of sEPCR. Results Individuals carrying at least one H3 allele had significantly higher levels of sEPCR than individuals with no H3 alleles (p < 0.001). No differences were found in the distribution of the H3 allele in the patient groups categorized using the pre-existing and current sepsis-3 definitions. Conclusion Using the preceding and current sepsis definitions, sEPCR levels and the H3 haplotype were not associated with sepsis severity and the risk of poor outcomes in septic patients; however, the EPCR H3 allele contributed to higher levels of sEPCR.
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Affiliation(s)
- Alice G Vassiliou
- First Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Evangelismos Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Evangelismos Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.,First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Zafeiria Mastora
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Gianluigi Cardinali
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Stylianos E Orfanos
- First Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Evangelismos Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Critical Care, Attikon Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
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Liang Y, Huang X, Jiang Y, Qin Y, Peng D, Huang Y, Li J, Sooranna SR, Pinhu L. Endothelial protein C receptor polymorphisms and risk of sepsis in a Chinese population. J Int Med Res 2017; 45:504-513. [PMID: 28415941 PMCID: PMC5536666 DOI: 10.1177/0300060516686496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective To examine the potential relationship of EPCR polymorphisms and the risk of sepsis in a Chinese population. Methods Snapshot SNP genotyping assays and DNA sequencing methods were used to detect polymorphisms of the EPCR gene, rs2069948C/T (2532C/T) and rs867186A/G (6936A/G), in 64 patients with sepsis and in 113 controls. Soluble EPCR (sEPCR) was measured by ELISA. Results There were significant differences in the allele and genotype frequencies of EPCR gene rs2069948C/T and allele frequencies of rs867186A/G between male and female patients and controls. Females carrying rs2069948 C/T genotype or T allele and males carrying rs867186 A allele were associated with a significantly increased risk of sepsis. Plasma sEPCR levels of sepsis patients were higher than controls and showed no correlation with EPCR gene polymorphisms. Conclusions EPCR polymorphisms may be associated with increased risk of sepsis, but this has no effect on the release of sEPCR in patients with sepsis.
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Affiliation(s)
- Yanbing Liang
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Xia Huang
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Yujie Jiang
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Yueqiu Qin
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Dingwei Peng
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Yuqing Huang
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Jin Li
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
| | - Suren R Sooranna
- 2 Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Liao Pinhu
- 1 Affiliated Hospital of Youjiang Medical University, Baise, Guangxi, PR China
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The endothelial protein C receptor rs867186-GG genotype is associated with increased soluble EPCR and could mediate protection against severe malaria. Sci Rep 2016; 6:27084. [PMID: 27255786 PMCID: PMC4891778 DOI: 10.1038/srep27084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/29/2016] [Indexed: 11/23/2022] Open
Abstract
The endothelial protein C receptor (EPCR) appears to play an important role in Plasmodium falciparum endothelial cell binding in severe malaria (SM). Despite consistent findings of elevated soluble EPCR (sEPCR) in other infectious diseases, field studies to date have provided conflicting data about the role of EPCR in SM. To better define this role, we performed genotyping for the rs867186-G variant, associated with increased sEPCR levels, and measured sEPCR levels in two prospective studies of Ugandan children designed to understand immunologic and genetic factors associated with neurocognitive deficits in SM including 551 SM children, 71 uncomplicated malaria (UM) and 172 healthy community children (CC). The rs867186-GG genotype was more frequent in CC (4.1%) than SM (0.6%, P = 0.002). The rs867186-G variant was associated with increased sEPCR levels and sEPCR was lower in children with SM than CC (P < 0.001). Among SM children, those who had a second SM episode showed a trend toward lower plasma sEPCR both at initial admission and at 6-month follow-up compared to those without repeated SM (P = 0.06 for both). The study findings support a role for sEPCR in severe malaria pathogenesis and emphasize a distinct role of sEPCR in malaria as compared to other infectious diseases.
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Timsit JF, Citerio G, Bakker J, Bassetti M, Benoit D, Cecconi M, Curtis JR, Hernandez G, Herridge M, Jaber S, Joannidis M, Papazian L, Peters M, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E. Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics. Intensive Care Med 2014; 40:471-83. [PMID: 24519574 PMCID: PMC7095429 DOI: 10.1007/s00134-014-3235-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Jean-Francois Timsit
- Medical and Infectious Diseases ICU, Bichat Hospital, Paris Diderot University, Paris, France,
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