Department of Cardiology, Medicana International Hospital, İstanbul, Turkey.
Department of Anesthesiology and Reanimation, University of Health Sciences, Bagcilar Training Research Hospital, İstanbul, Turkey.
Medicine (Baltimore). 2022 Aug 19;101(33):e30001. doi: 10.1097/MD.0000000000030001.
Severe acute respiratory syndrome coronavirus-2 is a highly infectious pathogenic coronavirus, which has appeared toward the end of 2019. The virus seen all over the world caused a pandemic of an acute respiratory disease named coronavirus disease 2019 (Covid-19). It has been shown that the virus that uses angiotensin-converting enzyme 2 receptors is causing endothelial dysfunction resulting in vascular inflammation and coagulopathy. It is possible to assess endothelial dysfunction by the flow-mediated dilatation (FMD) technique. Our study aimed to demonstrate the effect of endothelial dysfunction assessed using the FMD on prognosis and mortality in the patients hospitalized with the diagnosis of Covid-19. In this prospective observational study, endothelial functions of 94 patients hospitalized due to the Covid-19 in the ward or intensive care unit (ICU) were evaluated by FMD. The relationship among endothelial dysfunction and prognosis of disease, biochemical parameters, lung involvement, and mortality was investigated. We found that the FMD% values of the Covid-19 ICU patients compared to those followed up in the ward (2.66 ± 0.62 vs. 5.23 ± 1.46/P < .001) and those who died due to Covid-19 compared to those who were discharged alive (2.57 ± 0.22 vs. 4.66 ± 1.7/P < .001) were significantly lower. There were moderate negative correlation between FMD% and peak values of D-dimer (r = -0.52, P < .001), troponin (r = -0.45, P < .001), ferritin (r = -0.47, P < .001), lactate dehydrogenase (r = -0.49, P < .001), and white blood cells count (r = -0.23, P = .024). Lower FMD% was associated with higher lung parenchymal involvement (P < .001). The optimum cutoff point of FMD in predicting mortality was found to be 3.135% (sensitivity: 1, selectivity: 0.70). According to our results, lower FMD% was associated with higher lung parenchyma involvement, ICU admission, and mortality rate in Covid-19 patients. The best cutoff point for predicting mortality of FMD was 3.135%. Nevertheless, largescale, multicenter studies are needed to evaluate lower FMD values as a risk factor for mortality in Covid-19.
严重急性呼吸系统综合征冠状病毒 2 是一种高度传染性的致病冠状病毒，于 2019 年末出现。在全球范围内发现的这种病毒引发了一种名为 2019 年冠状病毒病（Covid-19）的急性呼吸道疾病大流行。已经表明，使用血管紧张素转换酶 2 受体的病毒会导致内皮功能障碍，从而导致血管炎症和凝血功能障碍。可以通过血流介导的扩张（FMD）技术评估内皮功能障碍。我们的研究旨在证明使用 FMD 评估的内皮功能障碍对因 Covid-19 住院患者的预后和死亡率的影响。在这项前瞻性观察性研究中，通过 FMD 评估了因 Covid-19 住院的 94 名患者的内皮功能。研究了内皮功能障碍与疾病预后、生化参数、肺受累和死亡率之间的关系。我们发现，与在病房接受随访的患者（2.66±0.62 比 5.23±1.46，P<0.001）和因 Covid-19 死亡的患者（2.57±0.22 比 4.66±1.7，P<0.001）相比，Covid-19 ICU 患者的 FMD%值明显更低。FMD%与 D-二聚体峰值（r=-0.52，P<0.001）、肌钙蛋白（r=-0.45，P<0.001）、铁蛋白（r=-0.47，P<0.001）、乳酸脱氢酶（r=-0.49，P<0.001）和白细胞计数（r=-0.23，P=0.024）之间呈中度负相关。较低的 FMD%与较高的肺实质受累有关（P<0.001）。预测死亡率的 FMD 的最佳截断点被发现为 3.135%（敏感性：1，特异性：0.70）。根据我们的结果，较低的 FMD%与较高的肺实质受累、入住 ICU 和 Covid-19 患者的死亡率有关。FMD 预测死亡率的最佳截断点为 3.135%。然而，需要进行大规模、多中心研究，以评估 FMD 低值是否为 Covid-19 患者死亡的危险因素。
