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Observational Study
. 2021 Aug-Sep:185:106469.
doi: 10.1016/j.rmed.2021.106469. Epub 2021 May 23.

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study

Murilo Rezende Oliveira  1 , Guilherme Dionir Back  2 , Cássia da Luz Goulart  3 , Bianca Cristina Domingos  4 , Ross Arena  5 , Audrey Borghi-Silva  6
Affiliations
Observational Study

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study

Murilo Rezende Oliveira et al. Respir Med. 2021 Aug-Sep.

Abstract

Background: The prothrombotic phenotype and diffuse intravascular coagulation observed in COVID-19 reflect endothelial dysfunction, which is linked to blood flow delivery deficiencies and cardiovascular risk. Assessments of detect vascular deficiencies among newly diagnosed and hospitalized patients due to COVID-19 have yet to be determined.

Objective: To assess endothelial function characteristics in relation to length of hospitalization and mortality in patients diagnosed with COVID-19 and compare to patients without COVID-19.

Methods: A prospective observational study involving 180 patients with confirmed COVID-19 (COVID-19 group) or suspected and ruled out COVID-19 (Non-COVID-19 group). Clinical evaluation and flow mediated vasodilation (FMD) were performed between the first 24-48 h of hospitalization. Patients were followed until death or discharge.

Results: We evaluated 98 patients (COVID-19 group) and 82 (Non-COVID-19 group), COVID-19 group remained hospitalized longer and more deaths occurred compared to the Non-COVID-19 group (p = 0.01; and p < 0.01). Patients in COVID-19 group also had a significantly greater reduction in both FMDmm and FMD% (p < 0.01 in both). We found that absolute FMD≤0.26 mm and relative FMD≤3.43% were the ideal cutoff point to predict mortality and longer hospital stay. In Kaplan Meyer's analysis patients had a high probability of death within a period of up to 10 days of hospitalization.

Conclusion: Patients hospitalized for COVID-19 present endothelial vascular dysfunction early, remained hospitalized longer and had a higher number of deaths, when compared with patients without COVID-19.

Keywords: COVID-19; Endothelium; Flow-mediated dilation (FMD); Hospitalization.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Fig. 1
Fig. 1
Flow chart of study.
Fig. 2
Fig. 2
Comparison of FMD% and FMDmm between COVID-19 and Non-COVID-19 groups.
Fig. 3
Fig. 3
Illustration of the brachial artery diameter of Non-COVID-19 group and COVID-19 group on Baseline and post 3 min of ischemic stimulation. Legend: ' = minute.
Fig. 4
Fig. 4
ROC curves of patients with COVID-19.
Fig. 5
Fig. 5
Kaplan-Meyer's analysis for FMDmm in COVID-19 patients.
See this image and copyright information in PMC

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