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Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement.
Natalello, Gerlando; De Luca, Giacomo; Gigante, Laura; Campochiaro, Corrado; De Lorenzis, Enrico; Verardi, Lucrezia; Paglionico, Annamaria; Petricca, Luca; Martone, Anna Maria; Calvisi, Stefania; Ripa, Marco; Cavalli, Giulio; Della-Torre, Emanuel; Tresoldi, Moreno; Landi, Francesco; Bosello, Silvia Laura; Gremese, Elisa; Dagna, Lorenzo.
  • Natalello G; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gerlando.natalello01@icatt.it.
  • De Luca G; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • Gigante L; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Campochiaro C; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • De Lorenzis E; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy; PhD program in Biomolecular Medicine - cycle XXXV, University of Verona, Italy.
  • Verardi L; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Paglionico A; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Petricca L; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Martone AM; Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Calvisi S; General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Ripa M; Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Cavalli G; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • Della-Torre E; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • Tresoldi M; General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Landi F; Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Bosello SL; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Gremese E; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Dagna L; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Microvasc Res ; 133: 104071, 2021 01.
Article in English | MEDLINE | ID: covidwho-850352
ABSTRACT

OBJECTIVE:

Increasing evidence points to endothelial dysfunction as a key pathophysiological factor in coronavirus disease-2019 (COVID-19). No specific methods have been identified to predict, detect and quantify the microvascular alterations during COVID-19. Our aim was to assess microvasculature through nailfold videocapillaroscopy (NVC) in COVID-19 patients.

METHODS:

We performed NVC in patients with a confirmed diagnosis of COVID-19 pneumonia. Elementary alterations were reported for each finger according to a semi-quantitative score. Capillary density, number of enlarged and giant capillaries, number of micro-hemorrhages and micro-thrombosis (NEMO score) were registered.

RESULTS:

We enrolled 82 patients (mean age 58.8 ± 13.2 years, male 68.3%) of whom 28 during the hospitalization and 54 after recovery and hospital discharge. At NVC examination we found abnormalities classifiable as non-specific pattern in 53 patients (64.6%). Common abnormalities were pericapillary edema (80.5%), enlarged capillaries (61.0%), sludge flow (53.7%), meandering capillaries and reduced capillary density (50.0%). No pictures suggestive of scleroderma pattern have been observed. Acute COVID-19 patients, compared to recovered patients, showed a higher prevalence of hemosiderin deposits as a result of micro-hemorrhages (P = .027) and micro-thrombosis (P < .016), sludge flow (P = .001), and pericapillary edema (P < .001), while recovered patients showed a higher prevalence of enlarged capillaries (P < .001), loss of capillaries (P = .002), meandering capillaries (P < .001), and empty dermal papillae (P = .006).

CONCLUSION:

COVID-19 patients present microvascular abnormalities at NVC. Currently ill and recovered subjects are characterized by a different distribution of elementary capillaroscopic alterations, resembling acute and post-acute microvascular damage. Further studies are needed to assess the clinical relevance of NVC in COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vascular Diseases / Capillaries / Microscopic Angioscopy / COVID-19 / Nails Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Microvasc Res Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vascular Diseases / Capillaries / Microscopic Angioscopy / COVID-19 / Nails Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Microvasc Res Year: 2021 Document Type: Article