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Smadja DM, Fellous BA, Bonnet G, Hauw-Berlemont C, Sutter W, Beauvais A, Fauvel C, Philippe A, Weizman O, Mika D, Juvin P, Waldmann V, Diehl JL, Cohen A, Chocron R. D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak. Front Cardiovasc Med 2022; 9:935333. [PMID: 36148049 PMCID: PMC9485619 DOI: 10.3389/fcvm.2022.935333] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- David M. Smadja
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
- *Correspondence: David M. Smadja
| | - Benjamin A. Fellous
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, France
| | | | - Willy Sutter
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Vascular Surgery Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Agathe Beauvais
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | | | - Aurélien Philippe
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Orianne Weizman
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, Chatenay-Malabry, France
| | - Philippe Juvin
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Cardiology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Jean-Luc Diehl
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Medical Intensive Care Department AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Ariel Cohen
- Cardiology Department, AP-HP, Saint Antoine Hospital, Paris, France
| | - Richard Chocron
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
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