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Is endocan correlated to ARDS severity or an epiphenomenon of thrombo-embolic disease in COVID

With great interest, we read the recently published paper by Pascreau et al. concluding that a high blood endocan profile during COVID‑19 distinguishes moderate from severe acute respiratory distress syndrome (ARDS) [1]. In a recent study including 46 patients with a diagnosis of pulmonary thromboembolism (PTE) and a control group of 25 healthy individuals [2], there was a significant difference in the serum endocan levels between the patients and the control group (321.93 ng/l and 192.77 ng/l, respectively; p < 0.030) [2]. Endocan is likely a good marker for PTE, a frequent phenomenon in COVID-19 [3]. In a prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated deaths, on autopsy (n = 283) it was found that the majority died of pneumonia and/or diffuse alveolar damage (73.6%) but thromboses were found in 39.2% and PTE in 22.1% [3]. Another study demonstrated significant associations between PTE and not only mechanical ventilation (OR = 3.71, 95% CI 2.57–5.36), but also intensive care unit admission (OR = 2.99, 95% CI 2.11–4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67–6.42) and c-reactive protein (CRP) (MD = 1.97 mg/dL, 95% CI 0.58–3.35) [4]. Those characteristics are similar to those found in the Pascreau study (high CRP, high D-dimers and mechanical ventilation in ARDS COVID patients) [1]. As there is no indication they excluded PTE in their patient cohort, it seems plausible that Pascreau et al. are describing the consequences of thromboses and PTE in ARDS COVID patients [1]. The explanation for endocan levels is therefore more likely to be found here than as a marker of ARDS severity.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

PTE:

Pulmonary thromboembolism

References

  1. 1.

    Pascreau T, Tcherakian C, Zuber B, et al. A high blood endocan profile during COVID-19 distinguishes moderate from severe acute respiratory distress syndrome. Crit Care. 2021;25(1):166. https://doi.org/10.1186/s13054-021-03589-3.

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PMH, SM, SR and DDB designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

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Correspondence to Patrick M. Honore.

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Honore, P.M., Redant, S., Preseau, T. et al. Is endocan correlated to ARDS severity or an epiphenomenon of thrombo-embolic disease in COVID. Crit Care 25, 425 (2021). https://doi.org/10.1186/s13054-021-03850-9

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  • DOI: https://doi.org/10.1186/s13054-021-03850-9

Keywords

  • Endocan
  • ARDS severity
  • Pulmonary embolism