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Is endocan correlated to ARDS severity or an epiphenomenon of thrombo-embolic disease in COVID
Critical Care volume 25, Article number: 425 (2021)
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) . In a recent study including 46 patients with a diagnosis of pulmonary thromboembolism (PTE) and a control group of 25 healthy individuals , 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) . Endocan is likely a good marker for PTE, a frequent phenomenon in COVID-19 . 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% . 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) . Those characteristics are similar to those found in the Pascreau study (high CRP, high D-dimers and mechanical ventilation in ARDS COVID patients) . 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 . The explanation for endocan levels is therefore more likely to be found here than as a marker of ARDS severity.
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Acute respiratory distress syndrome
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.
Güzel A, Duran L, Köksal N, et al. Evaluation of serum endothelial cell specific molecule-1 (endocan) levels as a biomarker in patients with pulmonary thromboembolism. Blood Coagul Fibrinolysis. 2014;25(3):272–6. https://doi.org/10.1097/MBC.0000000000000071.
Fitzek A, Schädler J, Dietz E, et al. Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases. Sci Rep. 2021;11(1):19342. https://doi.org/10.1038/s41598-021-98499-3.
Gómez CA, Sun CK, Tsai IT, et al. Mortality and risk factors associated with pulmonary embolism in coronavirus disease 2019 patients: a systematic review and meta-analysis. Sci Rep. 2021;11(1):16025. https://doi.org/10.1038/s41598-021-95512-7.
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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
- ARDS severity
- Pulmonary embolism