Key result
A 3-day angiopoietin-2 increase of at least twofold from baseline was significantly associated with in-hospital mortality (HR 6.69; 95% CI 1.85-24.19; P=.004) in hospitalized COVID-19 patients.
Why the study?
The study was designed to examine the association between dynamic angiopoietin-2 assessment and short- and long-term clinical course in COVID-19.
Does dynamic angiopoietin-2 assessment predict in-hospital mortality and nonresolving pulmonary condition in hospitalized patients with COVID-19?
Cohort (n=249)
Yes
Does dynamic angiopoietin-2 assessment predict in-hospital mortality and nonresolving pulmonary condition in hospitalized patients with COVID-19?
Dynamic angiopoietin-2 assessment is a strong predictor of in-hospital mortality and nonresolving pulmonary condition in hospitalized COVID-19 patients.
Answers are grounded in this paper and cite their sources.
Serial angiopoietin-2 monitoring may refine mortality risk stratification in COVID-19; leaves open prospective validation and therapeutic implications.
This study examined the association between dynamic angiopoietin-2 assessment and COVID-19 short- and long-term clinical course. We included consecutive hospitalized patients from 1 February to 31 May 2020 with laboratory-confirmed COVID-19 from 2 Italian tertiary referral centers (derivation cohort, n = 187 patients; validation cohort, n = 62 patients). Serum biomarker levels were measured by sandwich enzyme-linked immunosorbent assay. Lung tissue from 9 patients was stained for angiopoietin-2, Tie2, CD68, and CD34. Cox model was used to identify risk factors for mortality and nonresolving pulmonary condition. Area under the receiver operating characteristic curve (AUROC) was used to assess the accuracy of 3- and 10-day angiopoietin-2 for in-hospital mortality and nonresolving pulmonary condition, respectively. Three-day angiopoietin-2 increase of at least twofold from baseline was significantly associated with in-hospital mortality by multivariate analysis (hazard ratio [HR], 6.69; 95% confidence interval [CI], 1.85-24.19; P = .004) with AUROC = 0.845 (95% CI, 0.725-0.940). Ten-day angiopoietin-2 of at least twofold from baseline was instead significantly associated with nonresolving pulmonary condition by multivariate analysis (HR, 5.33; 95% CI, 1.34-11.77; P ≤ .0001) with AUROC = 0.969 (95% CI, 0.919-1.000). Patients with persistent elevation of 10-day angiopoietin-2 levels showed severe reticular interstitial thickening and fibrous changes on follow-up computed tomography scans. Angiopoietin-2 and Tie2 were diffusely colocalized in small-vessel endothelia and alveolar new vessels and macrophages. Angiopoietin-2 course is strongly associated with COVID-19 in-hospital mortality and nonresolving pulmonary condition. Angiopoietin-2 may be an early and useful predictor of COVID-19 clinical course, and it could be a relevant part of disease pathogenesis. Angiopoietin-2 blockade may be a COVID-19 treatment option.
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Villa et al. (2021) conducted a cohort in COVID-19 (n=249). Angiopoietin-2 increase of at least twofold from baseline vs. No twofold increase from baseline was evaluated on In-hospital mortality (HR 6.69, 95% CI 1.85-24.19, p=.004). A 3-day angiopoietin-2 increase of at least twofold from baseline was significantly associated with in-hospital mortality (HR 6.69; 95% CI 1.85-24.19; P=.004) in hospitalized COVID-19 patients.
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