Department of Internal Medicine, University of Patras Medical School, Patras, Greece;
School of Medicine, University of Crete, Heraklion, Greece.
In Vivo. 2021 Jul-Aug;35(4):2483-2488. doi: 10.21873/invivo.12528.
BACKGROUND/AIM: The present study was undertaken to investigate (i) whether hospitalized patients with COVID-19 pneumonia present intestinal barrier dysfunction with consequent translocation of endotoxin into the systemic circulation and (ii) whether intestinal barrier biomarkers have any prognostic role in terms of progression to severe respiratory failure.
In this prospective study, 22 patients with COVID-19-associated pneumonia and 19 patients with non-COVID-19-related community-acquired pneumonia (CAP group) were studied while 12 healthy persons comprised the control group. Blood samples were collected on admission and analysed for serum levels of endotoxin and zonula occludens-1 (ZO1). Clinical courses regarding progression to severe respiratory failure (SRF) requiring mechanical ventilation were recorded.
Patients with COVID-19-associated pneumonia and patients with CAP presented significantly higher serum endotoxin and ZO1 concentrations on admission as compared to healthy controls. There was no difference in endotoxin levels between patients with COVID-19-related pneumonia and patients with CAP. In patients with COVID-19-related pneumonia, serum endotoxin concentrations were positively correlated with C-reactive protein and ferritin values. There were no significant differences in serum endotoxin and ZO1 concentrations between patients with severe and not severe COVID-19-related pneumonia, nor between patients who developed SRF and those who did not Conclusion: Patients with COVID-19-related pneumonia present intestinal barrier dysfunction leading to systemic endotoxemia. Admission values of endotoxin and ZO1 do not have any prognostic role for progression to SRF.
背景/目的：本研究旨在探讨（i）COVID-19 肺炎住院患者是否存在肠道屏障功能障碍，继而导致内毒素向全身循环移位，以及（ii）肠道屏障生物标志物在向严重呼吸衰竭进展方面是否具有任何预后作用。
在这项前瞻性研究中，研究了 22 例 COVID-19 相关肺炎患者和 19 例非 COVID-19 相关社区获得性肺炎（CAP 组）患者，而 12 例健康人组成对照组。入院时采集血样，分析血清内毒素和闭合蛋白-1（ZO1）水平。记录了临床进展至需要机械通气的严重呼吸衰竭（SRF）的情况。
COVID-19 相关肺炎患者和 CAP 患者入院时血清内毒素和 ZO1 浓度明显高于健康对照组。COVID-19 相关肺炎患者和 CAP 患者之间内毒素水平无差异。COVID-19 相关肺炎患者血清内毒素浓度与 C 反应蛋白和铁蛋白值呈正相关。COVID-19 相关肺炎患者中严重和非严重肺炎之间、发生和未发生 SRF 的患者之间血清内毒素和 ZO1 浓度无显著差异。
COVID-19 相关肺炎患者存在肠道屏障功能障碍，导致全身内毒素血症。入院时内毒素和 ZO1 值对向 SRF 进展没有任何预后作用。
