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Endothelial glycocalyx damage in patients with severe COVID-19 on mechanical ventilation - A prospective observational pilot study

D. Astapenko, A. Tomasova, A. Ticha, R. Hyspler, HS. Chua, M. Manzoor, R. Skulec, C. Lehmann, RG. Hahn, ML. Malbrain, V. Cerny

. 2022 ; 81 (3) : 205-219. [pub] -

Language English Country Netherlands

Document type Journal Article, Observational Study

Persistent link   https://www.medvik.cz/link/bmc22019505

BACKGROUND: Coronavirus disease (COVID-19) associated endotheliopathy and microvascular dysfunction are of concern. OBJECTIVE: The objective of the present single-center observational pilot study was to compare endothelial glycocalyx (EG) damage and endotheliopathy in patients with severe COVID-19 (COVID-19 group) with patients with bacterial pneumonia with septic shock (non-COVID group). METHODS: Biomarkers of EG damage (syndecan-1), endothelial cells (EC) damage (thrombomodulin), and activation (P-selectin) were measured in blood on three consecutive days from admission to the intensive care unit (ICU). The sublingual microcirculation was studied by Side-stream Dark Field (SDF) imaging with automatic assessment. RESULTS: We enrolled 13 patients in the non-COVID group (mean age 70 years, 6 women), and 15 in the COVID-19 group (64 years old, 3 women). The plasma concentrations of syndecan-1 were significantly higher in the COVID-19 group during all three days. Differences regarding other biomarkers were not statistically significant. The assessment of the sublingual microcirculation showed improvement on Day 2 in the COVID-19 group. Plasma levels of C-reactive protein (CRP) were significantly higher on the first two days in the COVID-19 group. Plasma syndecan-1 and CRP were higher in patients suffering from severe COVID-19 pneumonia compared to bacterial pneumonia patients. CONCLUSIONS: These findings support the role of EG injury in the microvascular dysfunction in COVID-19 patients who require ICU.

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$a BACKGROUND: Coronavirus disease (COVID-19) associated endotheliopathy and microvascular dysfunction are of concern. OBJECTIVE: The objective of the present single-center observational pilot study was to compare endothelial glycocalyx (EG) damage and endotheliopathy in patients with severe COVID-19 (COVID-19 group) with patients with bacterial pneumonia with septic shock (non-COVID group). METHODS: Biomarkers of EG damage (syndecan-1), endothelial cells (EC) damage (thrombomodulin), and activation (P-selectin) were measured in blood on three consecutive days from admission to the intensive care unit (ICU). The sublingual microcirculation was studied by Side-stream Dark Field (SDF) imaging with automatic assessment. RESULTS: We enrolled 13 patients in the non-COVID group (mean age 70 years, 6 women), and 15 in the COVID-19 group (64 years old, 3 women). The plasma concentrations of syndecan-1 were significantly higher in the COVID-19 group during all three days. Differences regarding other biomarkers were not statistically significant. The assessment of the sublingual microcirculation showed improvement on Day 2 in the COVID-19 group. Plasma levels of C-reactive protein (CRP) were significantly higher on the first two days in the COVID-19 group. Plasma syndecan-1 and CRP were higher in patients suffering from severe COVID-19 pneumonia compared to bacterial pneumonia patients. CONCLUSIONS: These findings support the role of EG injury in the microvascular dysfunction in COVID-19 patients who require ICU.
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$a Tomasova, Adela $u Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic $u Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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$a Ticha, Alena $u Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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$a Hyspler, Radomir $u Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic $u Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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$a Chua, Huey Shin $u Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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$a Skulec, Roman $u Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic $u Department of Anesthesiology, Perioperative Medicine, and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic
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$a Lehmann, Christian $u Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada $u Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada $u Department of Pharmacology, Dalhousie University, Halifax, NS, Canada $u Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
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$a Hahn, Robert G $u Research Unit, Södertälje Hospital, Södertälje, Sweden $u Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
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$a Cerny, Vladimir $u Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic $u Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic $u Center for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic $u Department of Anesthesiology, Perioperative Medicine, and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic $u Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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