Lambadiari Vaia, Korakas Emmanouil, Oikonomou Evangelos, Bletsa Evanthia, Kountouri Aikaterini, Goliopoulou Athina, Ikonomidis Ignatios, Siasos Gerasimos
2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece.
3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece.
Biomedicines. 2022 Sep 23;10(10):2379. doi: 10.3390/biomedicines10102379.
Capillary leak syndrome is an under-diagnosed condition leading to serious hypoalbuminemia with diffuse edema, pulmonary edema, severe hypotension, and possibly death. Sepsis leading to hemophagocytic lymphohistiocytosis (HLH) is a major risk factor; however, capillary hyper-permeability is the core underlying pathophysiological mechanism. Endothelial dysfunction plays a major role in cardiometabolic disease through insulin resistance, lipotoxicity, and, eventually, oxidative stress and chronic inflammation. We review the literature concerning the aforementioned mechanisms as well-established risk factors for adverse COVID-19 outcomes. We especially focus on data regarding the underlying endothelial effects of SARS-CoV-2 infection, including direct damage and increased vascular leakage through a hyper-inflammatory cascade and diminished nitric oxide bioavailability. Interestingly, an increased incidence of hypoalbuminemia has been observed in patients with severe COVID-19, especially those with underlying cardiometabolic disease. Importantly, low albumin levels present a strong, positive association with poor disease outcomes. Therefore, in this review article, we highlight the important role of cardiovascular risk factors on endothelium integrity and the possible link of endothelial damage in the hypoalbuminemia-associated adverse prognosis of COVID-19 patients.
毛细血管渗漏综合征是一种诊断不足的疾病，可导致严重的低白蛋白血症，并伴有弥漫性水肿、肺水肿、严重低血压，甚至可能导致死亡。导致噬血细胞性淋巴组织细胞增生症（HLH）的脓毒症是一个主要危险因素；然而，毛细血管高通透性是其核心的潜在病理生理机制。内皮功能障碍通过胰岛素抵抗、脂毒性以及最终的氧化应激和慢性炎症在心脏代谢疾病中起主要作用。我们回顾了有关上述机制作为COVID-19不良结局既定危险因素的文献。我们特别关注关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染潜在内皮效应的数据，包括通过过度炎症级联反应导致的直接损伤和血管渗漏增加以及一氧化氮生物利用度降低。有趣的是，在重症COVID-19患者中，尤其是那些患有潜在心脏代谢疾病的患者中，低白蛋白血症的发生率有所增加。重要的是，低白蛋白水平与不良疾病结局呈强烈正相关。因此，在这篇综述文章中，我们强调了心血管危险因素对内皮完整性的重要作用以及内皮损伤在COVID-19患者低白蛋白血症相关不良预后中的可能联系。
