Distinctive Biomarker Features in the Endotheliopathy of COVID-19 and Septic Syndromes.
Shock
; 57(1): 95-105, 2022 01 01.
Article
in English
| MEDLINE | ID: covidwho-1574295
ABSTRACT
BACKGROUND:
Endotheliopathy is a key element in COVID-19 pathophysiology, contributing to both morbidity and mortality. Biomarkers distinguishing different COVID-19 phenotypes from sepsis syndrome remain poorly understood.OBJECTIVE:
To characterize circulating biomarkers of endothelial damage in different COVID-19 clinical disease stages compared with sepsis syndrome and normal volunteers.METHODS:
Patients with COVID-19 pneumonia (nâ=â49) were classified into moderate, severe, or critical (life-threatening) disease. Plasma samples were collected within 48 to 72âh of hospitalization to analyze endothelial activation markers, including soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1), von Willebrand Factor (VWF), A disintegrin-like and metalloprotease with thrombospondin type 1 motif no. 13 (ADAMTS-13) activity, thrombomodulin (TM), and soluble TNF receptor I (sTNFRI); heparan sulfate (HS) for endothelial glycocalyx degradation; C5b9 deposits on endothelial cells in culture and soluble C5b9 for complement activation; circulating dsDNA for neutrophil extracellular traps (NETs) presence, and α2-antiplasmin and PAI-1 as parameters of fibrinolysis. We compared the level of each biomarker in all three COVID-19 groups and healthy donors as controls (nâ=â45). Results in critically ill COVID-19 patients were compared with other intensive care unit (ICU) patients with septic shock (SS, nâ=â14), sepsis (S, nâ=â7), and noninfectious systemic inflammatory response syndrome (NI-SIRS, nâ=â7).RESULTS:
All analyzed biomarkers were increased in COVID-19 patients versus controls (Pâ<â0.001), except for ADAMTS-13 activity that was normal in both groups. The increased expression of sVCAM-1, VWF, sTNFRI, and HS was related to COVID-19 disease severity (Pâ<â0.05). Several differences in these parameters were found between ICU groups SS patients showed significantly higher levels of VWF, TM, sTNFRI, and NETS compared with critical COVID-19 patients and ADAMTS-13 activity was significantly lover in SS, S, and NI-SIRS versus critical COVID-19 (Pâ<â0.001). Furthermore, α2-antiplasmin activity was higher in critical COVID-19 versus NI-SIRS (Pâ<â0.01) and SS (Pâ<â0.001), whereas PAI-1 levels were significantly lower in COVID-19 patients compared with NI-SIRS, S, and SS patients (Pâ<â0.01).CONCLUSIONS:
COVID-19 patients present with increased circulating endothelial stress products, complement activation, and fibrinolytic dysregulation, associated with disease severity. COVID-19 endotheliopathy differs from SS, in which endothelial damage is also a critical feature of pathobiology. These biomarkers could help to stratify the severity of COVID-19 disease and may also provide information to guide specific therapeutic strategies to mitigate endotheliopathy progression.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Shock
Journal subject:
Vascular Diseases
/
Cardiology
Year:
2022
Document Type:
Article
Affiliation country:
SHK.0000000000001823
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