Bianconi Vanessa, Mannarino Massimo Raffaele, Figorilli Filippo, Schiaroli Elisabetta, Cosentini Elena, Batori Giuseppe, Marini Ettore, Sahebkar Amirhossein, Grignani Francesco, Gidari Anna, Francisci Daniela, Pirro Matteo
Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy.
Unit of Infectious Diseases, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy.
J Clin Med. 2021 Nov 22;10(22):5456. doi: 10.3390/jcm10225456.
Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients.
Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses.
Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs ( < 0.001, = 0.001, and < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155-2.428, = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death.
Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.
2019冠状病毒病（COVID-19）可导致内皮损伤，且似乎在其最严重的临床表现中发挥关键致病作用。我们旨在研究肱动脉血流介导的血管舒张（bFMD）（一种评估内皮功能的潜在临床非侵入性指标）与COVID-19患者住院预后之间的关联。
在住院的COVID-19患者入院后48小时内评估肱动脉血流介导的血管舒张。采用单变量和多变量分析探讨bFMD与入住重症监护病房（ICU）或院内死亡之间的关联。
共纳入408例患者。与无肺炎影像学表现、呼吸窘迫或无创通气需求的患者相比，有上述表现的COVID-19患者的bFMD值显著降低（分别为<0.001、=0.001和<0.001）。42例（10%）患者入住ICU，76例（19%）患者死亡，118例（29%）患者达到入住ICU/院内死亡的复合终点。未经调整的Cox回归分析显示，与高bFMD（≥4.4%，中位数）相比，低bFMD（<4.4%，中位数）与入住ICU/院内死亡复合终点的风险更高相关（HR 1.675，95%CI 1.155-2.428，=0.007）。多因素调整的Cox回归分析显示，低bFMD与入住ICU/院内死亡复合终点的风险增加1.519至1.658倍独立相关。
低bFMD预示COVID-19患者住院预后不良。bFMD测量可能对COVID-19患者入院时的预后分层具有临床意义。
