key: cord-0843411-iuyewzyo
authors: Levy, Clémentine; Dognon, Nicolas; Normandin, Sylvain; Duburcq, Thibault; Gaudet, Alexandre
title: Assessment of plasma endocan for the prediction of mortality in COVID-19 patients undergoing veno-venous ECMO: a pilot study
date: 2022-05-05
journal: Med Intensiva
DOI: 10.1016/j.medin.2022.04.003
sha: 795e92ae9feb2caa9aac57cff5cce2a9b113046a
doc_id: 843411
cord_uid: iuyewzyo

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Thus, we aimed in this study to assess whether plasma endocan measurements performed on the day of V-V ECMO implantation (D0) and repeated seven days later (D7) may be effective in predicting mortality on ICU discharge.

This study was conducted in a 50-bed mixed ICU, from October 2020 to June 2021. We included all consecutive Covid-19 patients undergoing V-V ECMO implantation and with available results of plasma endocan measured on day of ECMO implantation.

Endocan was measured weekly on EDTA plasma in the central laboratory of our hospital using the ENDOMARK H1 ELISA kit (Biothelis, France) in Covid-19 patients admitted in our ICU as part as the routine assessment of prognosis in ARDS 4 -6 , along with CRP and fibrinogen. This research was examined by our local IRB, and approved under the number HP 22/01. Because of the retrospective observational design, written informed consent was not required.

Patients' characteristics were obtained at D0. We also retrospectively collected values on D0 and D7 for plasma endocan (endocanD0 and endocanD7), CRP (CRPD0 and CRPD7) and fibrinogen (fibrinogenD0 and fibrinogenD7). Variations between D0 and D7 were respectively 4 calculated for endocan (endocanD0-D7), CRP (CRPD0-D7) and fibrinogen (fibrinogenD0-D7) as following: (value on D7 -value on D0) / value on D0.

Categorical variables were expressed as numbers (percentages) and compared using Fisher's exact test, given small sample sizes. Skewed continuous variables were presented as median (interquartile range) and compared using Mann-Whitney U test.

Decision tree based on CART algorithm was generated using the rpart R package with default settings, using endocanD0, endocanD7, endocanD0-D7, CRPD0, CRPD7, CRPD0-D7, fibrinogenD0, fibrinogenD7 and fibrinogenD0-D7 as covariates.

All statistical tests were two-tailed, and p values <0.05 were considered statistically significant. Statistical analysis was performed using R version 3.6 (R foundation for statistical analysis, Austria).

Eleven patients undergoing V-V ECMO implantation for Covid-19 related ARDS were included in this study, of whom 5 (45%) were discharged alive from ICU. All patients underwent invasive mechanical ventilation (MV) during their stay in ICU, although invasive MV was initiated right before ECMO implantation and maintained less than 24h for 2 patients from the survivors group. These results are in line with previous data regarding the biological role of endocan in critically ill subjects. Indeed, secretion of endocan is upregulated by pro-inflammatory cytokines 7 , and endocan has been widely reported as a marker of pulmonary endothelial stress 2 . Furthermore, endocan is known as an inhibitor of leukocyte recruitment, therefore regulating lung inflammation 8 . Consistent data suggest that low circulating levels of endocan at the early phase of lung aggression, followed by secondary rise in its plasmatic values, would reflect insufficient initial protection against lung inflammation, being thus associated with poor outcomes 5 , 9 -11 . Interestingly, both patients from our cohort who underwent ECMO implantation with a duration of invasive MV < 24h experienced marked decreases of plasma endocan on D7, respectively found at -69% and -47%. Further studies are needed to investigate the significance of these results. 

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

Endocan, sepsis, pneumonia, and acute respiratory distress syndrome

A high blood endocan profile during COVID-19 distinguishes moderate from severe acute respiratory distress syndrome

Endocan levels in peripheral blood predict outcomes of acute respiratory distress syndrome

Endocan as an early biomarker of severity in patients with acute respiratory distress syndrome

Angiopoietin-2 Levels as Predictors of Outcome in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome

ESM-1 is a novel human endothelial cell-specific molecule expressed in lung and regulated by cytokines

Endocan regulates acute lung inflammation through control of leukocyte diapedesis

Low endocan levels are predictive of Acute Respiratory Distress Syndrome in severe sepsis and septic shock

Increase of circulating endocan over sepsis follow-up is associated with progression into organ dysfunction

The complex kinetics of blood endocan during the time course of sepsis and acute respiratory distress syndrome

BMI Body Mass Index; COPD Chronic Obstructive Pulmonary Disease; D0 Day of ECMO implantation; D7 Day 7 following ECMO implantation; ECMO Extra Corporeal Membrane Oxygenation; ICU Intensive Care Unit; MV Mechanical Ventilation; RESP Respiratory Extracorporeal Membrane Oxygenation Survival Prediction; RPM Rounds Per Minute; SOFA Sequential Organ Failure Assessment