Department of Biostatistics and Methodology, University Hospital of Angers, Angers, France.
Shock. 2024 Nov 1;62(5):673-681. doi: 10.1097/SHK.0000000000002451. Epub 2024 Aug 12.
Aim: To identify and describe microcirculatory dysfunction (MD) in severe COVID-19 cases. Methods: This prospective, cohort study evaluated microvascular function in COVID-19 patients with acute respiratory failure not requiring mechanical ventilation and compared it with that of non-COVID-19 intensive care unit (ICU)-matched controls. A validation cohort included healthy, comorbidity-free patients. The primary outcome compared tissue oxygen resaturation slope (rStO 2 ) in COVID-19 patients and non-COVID ICU controls. rStO 2 was measured post a 3-min vaso-occlusive test during post-occlusive reactive hyperemia (PORH). Additionally, microvascular reactivity was assessed using perfusion index (PI) during PORH and laser speckle contrast imaging post iontophoresis with acetylcholine (ACH), sodium nitroprusside (SNP), and sublingual microcirculation. Results: Overall, 75 patients (25 per cohort) were included. COVID-19 patients exhibited greater severity than ICU controls, as indicated by their SOFA scores (4.0 [3.0; 4.0] vs. 1.0 [0; 1.0], P < 0.001) and PaO 2 /FiO 2 ratios (113 [82; 150] vs. 443 [348; 533], P < 0.001). No significant difference was observed in rStO 2 between the groups. COVID-19 patients showed longer time in reaching peak PI ( P = 0.025), reduced vasodilation with ACH and SNP ( P = 0.010 and P = 0.018, respectively), and increased microvascular density ( P = 0.019) compared to non-COVID-19 ICU controls. Conclusion: We observed evidence of MD in COVID-19 patients through various microcirculatory parameters. This study's reproducible multimodal approach facilitates acute MD detection across multiple clinical applications. Limitations included the observational design, limited statistical power, single-time microvascular measurements, varying illness severity among groups, and possible influences of treatments and vaccinations on MD. Trial registration : Clinical-Trials.gov (NCT04773899).
识别和描述严重 COVID-19 病例中的微循环功能障碍（MD）。方法：本前瞻性队列研究评估了急性呼吸衰竭但无需机械通气的 COVID-19 患者的微血管功能，并将其与非 COVID-19 重症监护病房（ICU）匹配的对照组进行比较。验证队列纳入了健康、无合并症的患者。主要结局比较 COVID-19 患者和非 COVID-ICU 对照组的组织氧再饱和斜率（rStO 2 ）。rStO 2 在阻塞后反应性充血（PORH）期间测量 3 分钟血管阻塞试验后。此外，使用 PORH 期间的灌注指数（PI）和乙酰胆碱（ACH）、硝普钠（SNP）离子电渗和舌下微循环后激光散斑对比成像评估微血管反应性。结果：共有 75 名患者（每组 25 名）入组。COVID-19 患者的严重程度高于 ICU 对照组，其 SOFA 评分（4.0[3.0；4.0] vs. 1.0[0；1.0]，P<0.001）和 PaO 2 /FiO 2 比值（113[82；150] vs. 443[348；533]，P<0.001）差异有统计学意义。两组间 rStO 2 无显著差异。与非 COVID-19 ICU 对照组相比，COVID-19 患者达到峰值 PI 的时间更长（P=0.025），ACH 和 SNP 时血管扩张减少（P=0.010 和 P=0.018），微血管密度增加（P=0.019）。结论：我们通过多种微循环参数观察到 COVID-19 患者存在 MD 的证据。本研究的可重复多模态方法便于在多个临床应用中检测急性 MD。局限性包括观察性设计、统计能力有限、单次微血管测量、组间疾病严重程度不同以及治疗和疫苗接种对 MD 的可能影响。试验注册：Clinical-Trials.gov（NCT04773899）。
