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Comparative Study
. 2021 Jan:133:104071.
doi: 10.1016/j.mvr.2020.104071. Epub 2020 Sep 17.

Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement

Gerlando Natalello  1 , Giacomo De Luca  2 , Laura Gigante  3 , Corrado Campochiaro  2 , Enrico De Lorenzis  4 , Lucrezia Verardi  3 , Annamaria Paglionico  3 , Luca Petricca  3 , Anna Maria Martone  5 , Stefania Calvisi  6 , Marco Ripa  7 , Giulio Cavalli  2 , Emanuel Della-Torre  2 , Moreno Tresoldi  6 , Francesco Landi  5 , Silvia Laura Bosello  3 , Elisa Gremese  3 , Lorenzo Dagna  2
Affiliations
Comparative Study

Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement

Gerlando Natalello et al. Microvasc Res. 2021 Jan.

Abstract

Objective: Increasing evidence points to endothelial dysfunction as a key pathophysiological factor in coronavirus disease-2019 (COVID-19). No specific methods have been identified to predict, detect and quantify the microvascular alterations during COVID-19. Our aim was to assess microvasculature through nailfold videocapillaroscopy (NVC) in COVID-19 patients.

Methods: We performed NVC in patients with a confirmed diagnosis of COVID-19 pneumonia. Elementary alterations were reported for each finger according to a semi-quantitative score. Capillary density, number of enlarged and giant capillaries, number of micro-hemorrhages and micro-thrombosis (NEMO score) were registered.

Results: We enrolled 82 patients (mean age 58.8 ± 13.2 years, male 68.3%) of whom 28 during the hospitalization and 54 after recovery and hospital discharge. At NVC examination we found abnormalities classifiable as non-specific pattern in 53 patients (64.6%). Common abnormalities were pericapillary edema (80.5%), enlarged capillaries (61.0%), sludge flow (53.7%), meandering capillaries and reduced capillary density (50.0%). No pictures suggestive of scleroderma pattern have been observed. Acute COVID-19 patients, compared to recovered patients, showed a higher prevalence of hemosiderin deposits as a result of micro-hemorrhages (P = .027) and micro-thrombosis (P < .016), sludge flow (P = .001), and pericapillary edema (P < .001), while recovered patients showed a higher prevalence of enlarged capillaries (P < .001), loss of capillaries (P = .002), meandering capillaries (P < .001), and empty dermal papillae (P = .006).

Conclusion: COVID-19 patients present microvascular abnormalities at NVC. Currently ill and recovered subjects are characterized by a different distribution of elementary capillaroscopic alterations, resembling acute and post-acute microvascular damage. Further studies are needed to assess the clinical relevance of NVC in COVID-19.

Keywords: COVID-19; Micro-thrombosis; Microangiopathy; Nailfold videocapillaroscopy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Nailfold capillaroscopy abnormalities found in COVID-19 patients (200× magnification). A) Meandering capillaries and microvascular derangement; B) pericapillary edema; C) low capillary density; D) capillary ectasia; E) micro-thrombosis; F) micro-hemorrhage.
See this image and copyright information in PMC

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