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Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19
Vanessa Bianconi1, Massimo Raffaele Mannarino1, Filippo Figorilli1
1Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy.
Insights
Low brachial artery flow-mediated dilation (bFMD) indicates a poor prognosis for hospitalized COVID-19 patients. This non-invasive measure can help predict severe outcomes like ICU admission or death.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Clinical Prognostics
Background:
- Endothelial injury is implicated in severe COVID-19.
- Brachial artery flow-mediated dilation (bFMD) is a non-invasive marker of endothelial function.
- The prognostic value of bFMD in COVID-19 patients requires investigation.
Purpose of the Study:
- To assess the association between bFMD and in-hospital prognosis in COVID-19 patients.
- To determine if bFMD can predict severe clinical outcomes.
- To evaluate bFMD as a prognostic tool for COVID-19.
Main Methods:
- Brachial artery flow-mediated dilation (bFMD) was measured in 408 hospitalized COVID-19 patients within 48 hours of admission.
- Associations between bFMD and ICU admission or in-hospital death were analyzed.
- Univariable and multivariable Cox regression models were employed.
Main Results:
- Lower bFMD values were significantly associated with pneumonia, respiratory distress, and need for ventilation.
- Low bFMD (<4.4%) was linked to a higher risk of ICU admission or death (HR 1.675).
- Multivariable analysis confirmed low bFMD as an independent predictor of adverse outcomes (1.519- to 1.658-fold increased risk).
Conclusions:
- Reduced bFMD is a significant predictor of unfavorable in-hospital prognosis in COVID-19.
- bFMD measurement offers clinical utility for prognostic stratification of COVID-19 patients.
- Non-invasive endothelial function assessment can aid in managing COVID-19 severity.
Background:
Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients.
Methods:
Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses.
Results:
Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs (p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155-2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death.
Conclusions:
Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.
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