Podzolkov VI, Bragina AE, Tarzimanova AI, Ogibenina ES, Shvedov II, Ivannikov AA, Megeneishvili NК, Sutulova AV. Association between cardio-ankle vascular index and markers of thrombosis in hospitalized patients COVID-19. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(7):548–553. DOI: 10.26442/00403660.2023.07.202292
Взаимосвязь сердечно-лодыжечного сосудистого индекса с маркерами тромбообразования у госпитализированных больных COVID-19
Podzolkov VI, Bragina AE, Tarzimanova AI, Ogibenina ES, Shvedov II, Ivannikov AA, Megeneishvili NК, Sutulova AV. Association between cardio-ankle vascular index and markers of thrombosis in hospitalized patients COVID-19. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(7):548–553. DOI: 10.26442/00403660.2023.07.202292
Цель. Целью исследования являлась оценка взаимосвязи сердечно-лодыжечного сосудистого индекса (CAVI) с маркером прокоагулянтного состояния – D-димером у госпитализированных пациентов с новой коронавирусной инфекцией (COVID-19). Материалы и методы. В данное одномоментное обсервационное исследование включались взрослые пациенты, госпитализированные в университетскую клинику с верифицированным диагнозом COVID-19. Проведено сравнение групп пациентов с нормальным и повышенным CAVI. Однофакторный и многофакторный регрессионные анализы использовались для оценки связи между факторами риска и повышением уровня D-димера, отношения шансов с 95% доверительными интервалами рассчитаны для установления силы связи. За уровень статистической значимости принято p<0,05. Результаты. В исследование включены 152 пациента: 64 (42,1%) мужчины и 88 (57,9%) женщин; средний возраст 59,10±12,74 года. У 45 (29,6%) выявлен повышенный уровень CAVI (более 9,5). Пациенты с повышенным уровнем CAVI оказались старше, в этой группе отмечено значимо больше пациентов с коморбидными заболеваниями, выше индекс коморбидности Чарлсона и уровень D-димера. По результатам проведенного анализа возраст, индекс коморбидности и уровень CAVI выше 9,5 связаны с повышенным уровнем D-димера у пациентов с COVID-19. В многофакторном регрессионном анализе CAVI более 9,5 оказался достоверным предиктором повышения D-димера у пациентов с COVID-19 (отношение шансов 2,513, 95% доверительный интервал 1,050–6,012; p=0,038). Заключение. Впервые выявлена взаимосвязь маркера сосудистой жесткости – повышенного CAVI – с ростом уровня D-димера у больных COVID-19. Данная взаимосвязь может являться следствием эндотелиальной дисфункции и использоваться как дополнительный маркер коагулопатии, развивающейся в рамках коронавирусной инфекции SARS-CoV-2.
Aim. To evaluate the relationship between the cardio-ankle vascular index (CAVI) and the marker of procoagulant state – D-dimer in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and methods. This cross-sectional study involved adult patients admitted to the University hospital with clinically diagnosed or laboratory-confirmed COVID-19. We compared groups of patients with normal and elevated CAVI. Univariate and multivariate logistic regression analyses were performed to assess the association between risk factors and elevated D-dimer levels; odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated to determine the strength of association. A p<0.05 was considered statistically significant. Results. The study included 152 patients [64 (42.1%) men and 88 (57.9%) women], mean age 59.10±12.74 years. 45 (29.6%) had elevated CAVI. Patients with elevated CAVI were older, had more comorbid diseases, a higher Charlson comorbidity index and D-dimer levels. Age, the comorbidity index, and CAVI above 9.5 were associated with elevated D-dimer levels in patients with COVID-19. In a multivariate logistic regression, CAVI above 9.5 was an independent predictor of increased D-dimer in patients with COVID-19 (OR 2.513, 95% CI 1.050–6.012; p=0.038). Conclusion. In this study, for the first time, the association between a vascular stiffness marker, elevated CAVI, and increased D-dimer levels in COVID-19 patients was shown. This relationship may be a consequence of endothelial dysfunction and can be used as an additional marker of coagulopathy developing as part of COVID-19.
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1. Alimohamadi Y, Tola HH, Abbasi-Ghahramanloo A, et al. Case fatality rate of COVID-19: A systematic review and meta-analysis. J Prev Med Hyg. 2021;62(2):E311-20. DOI:10.15167/2421-4248/jpmh2021.62.2.1627
2. Podzolkov VI, Tarzimanova AI, Bragina AE, et al. Damage to the Cardiovascular System in Patients with SARS-CoV-2 Coronavirus Infection. Part 1: Predictors of the Development of an Unfavorable Prognosis. Rational Pharmacotherapy in Cardiology. 2021;17(6):825-30 (in Russian). DOI:10.20996/1819-6446-2021-11-03
3. Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Investig. 2020;130(5):2620-9. DOI:10.1172/JCI137244
4. Kollias A, Kyriakoulis KG, Lagou S, et al. Venous thromboembolism in COVID-19: A systematic review and meta-analysis. Vasc Med (UK). 2021;26(4):415-25. DOI:10.1177/1358863X21995566
5. Mizurini DM, Hottz ED, Bozza PT, Monteiro RQ. Fundamentals in Covid-19-Associated Thrombosis: Molecular and Cellular Aspects. Front Cardiovasc Med. 2021;8. DOI:10.3389/fcvm.2021.785738
6. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. New Eng J Med. 2020;383(2):120-8. DOI:10.1056/nejmoa2015432
7. Ratchford SM, Stickford JL, Province VM, et al. Vascular alterations among young adults with SARS-CoV-2. Am J Physiol Heart Circ Physiol. 2021;320(1):H404-10. DOI:10.1152/AJPHEART.00897.2020
8. Schnaubelt S, Oppenauer J, Tihanyi D, et al. Arterial stiffness in acute COVID-19 and potential associations with clinical outcome. J Intern Med. 2021;290(2):437-43. DOI:10.1111/joim.13275
9. Vasyuk YA, Ivanova SV, Shkolnik EL, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovasc Ther Prev. 2016;15(2):4-19. DOI:10.15829/1728-8800-2016-2-4-19
10. Saiki A, Sato Y, Watanabe R, et al. The role of a novel arterial stiffness parameter, cardio-ankle vascular index (CAVI), as a surrogate marker for cardiovascular diseases. J Atheroscler Thromb. 2016;23(2):155-68. DOI:10.5551/jat.32797
11. Aydın E, Kant A, Yilmaz G. Evaluation of the cardio-ankle vascular index in COVID-19 patients. Revista da Associação Médica Brasileira. 2022;68(1):73-6.
DOI:10.1590/1806-9282.20210781
12. Palombo C, Kozakova M. Arterial stiffness, atherosclerosis and cardiovascular risk: Pathophysiologic mechanisms and emerging clinical indications. Vasc Pharmacol. 2016;77:1-7. DOI:10.1016/j.vph.2015.11.083
13. Gohbara M, Iwahashi N, Sano Y, et al. Clinical Impact of the Cardio-Ankle Vascular Index for Predicting Cardiovascular Events After Acute Coronary Syndrome. Circ J. 2016;80(6):1420-6. DOI:10.1253/circj.CJ-15-1257
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15. Namekata T, Suzuki K, Ishizuka N, Shirai K. Establishing baseline criteria of cardio-ankle vascular index as a new indicator of arteriosclerosis: A cross-sectional study. BMC Cardiovascr Dis. 2011;11. DOI:10.1186/1471-2261-11-51
16. McEniery CM, Wallace S, MacKenzie IS, et al. Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans. Hypertension. 2006;48(4):602-8. DOI:10.1161/01.HYP.0000239206.64270.5f
17. Wilkinson IB, Qasem A, McEniery CM, et al. Nitric Oxide Regulates Local Arterial Distensibility In Vivo. Circulation. 2002;105(2):213-7. DOI:10.1161/hc0202.101970
18. Miyoshi T, Ito H, Shirai K, et al. Predictive value of the cardio-ankle vascular index for cardiovascular events in patients at cardiovascular risk. J Am Heart Assoc. 2021;10(16). DOI:10.1161/JAHA.120.020103
19. Matsushita K, Ding N, Kim ED, et al. Cardio-ankle vascular index and cardiovascular disease: Systematic review and meta-analysis of prospective and cross-sectional studies. J Clin Hypertens. 2019;21(1):16‑24. DOI:10.1111/jch.13425
20. Aykan AÇ, Hatem E, Kalaycıoğlu E, et al. Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits? Phlebology. 2017;32(5):316-21. DOI:10.1177/0268355516652033
21. Hayashi S. Significance of plasma D-dimer in relation to the severity of atherosclerosis among patients evaluated by non-invasive indices of cardio-ankle vascular index and carotid intima-media thickness. Int J Hematol. 2010;92(1):76-82. DOI:10.1007/s12185-010-0622-9
22. Zairova AR, Rogoza AN, Dobrovolsky AB, et al. Arterial stiffness and vascular aging in relation to coalugogical CVD risk factors, parameters of lipid and carbohydrate metabolism in adult population of Tomsk in the framework of the project ESSE-RF. Kardiologicheskii vestnik. 2018;13(1):5 (in Russian).
DOI:10.17116/cardiobulletin20181315-15
23. Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res. 2020;19:23-6. DOI:10.1016/j.thromres.2020.05.018
24. Hasan HA, Almubarak N, Jeber MA. The Relationship Between Esr and C-Reactive Protein With Variable Level of D-Dimer in Covid-19. Wiadomosci lekarskie (Warsaw, Poland: 1960). 2021;74(12):3172-8. DOI:10.36740/wlek202112109
25. Bukhtiiarov IV, Izmerov NF, Kuz'mina LP, et al. Metod ob"iemnoi sfigmografii v meditsine truda. Metodicheskiie rekomendatsii. Moscow: Nauchno-issledovatel'skii institut meditsiny truda, 2015 (in Russian).
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*anna.bragina@mail.ru
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Valery I. Podzolkov, Anna E. Bragina*, Aida I. Tarzimanova, Ekaterina S. Ogibenina, Ilya I. Shvedov, Alexander A. Ivannikov, Nino К. Megeneishvili, Angelina V. Sutulova
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*anna.bragina@mail.ru