Endothelail and Stress Index as One of New Prognostic Determinants of COVID- 19 Severity

Abstract

Background and study aim: COVID-19 pandemic began in China in 2019. The disease course can be unnoticed, mild, aggressive or end by death. Several prognostic markers have been studied in order to minimize the severity of the disease or its danger. This study aims at investigating the prognostic value of Endothelial activation and stress index (EASIX) as a new predictor in addition to some haematological, biochemical, computerized tomography (CT), electrocardiogram (ECG) and echocardiography (Echo) findings as determinants of the COVID-19 severity. Patients and Methods: ‎‎‎ 105 non-vaccinated COVID-19 patients aged 17–89 admitted to a referral hospital in Alexandria, Egypt, from January to August 2022 with positive nasopharyngeal qualitative PCR swabs were included. Considerations include demographics, history, hospital stay, and intensive care unit (ICU) admission. Complete blood picture with differential count, C-reactive protein, ferritin, D-Dimer, liver and renal function tests, lactate dehydrogenase, cardiac markers, EASIX, chest CT, ECG, and Echo were done‎.‎ Results: EASIX along with D-Dimer and ferritin showed statistically significant sensitivity and specificity when analysed as predictors for COVID-19 mortality, need for ICU admission and mechanical ventilation, while lymphocyte/monocyte ratio (LMR) showed statistically significant sensitivity and specificity only for COVID-19 mortality and need for ICU admission. D-Dimer had the highest overall accuracy, followed by ferritin, EASIX, and the lowest accuracy appear in LMR‎. Conclusion and recommendation: Because of its strong correlation with COVID-19 mortality, ESAIX should be added as a new biomarker to the existing set of biomarkers linked to poor prognosis namely D-Dimer and ferritin ‎‎.