Impaired Microvascular Function in Patients With Critical COVID-19
Patrik Gille-Johnson1, Irene Kessler1, Sara Tehrani1
1All authors: Department of Clinical Sciences, Division of Internal Medicine and Infectious Diseases, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
Insights
Critical COVID-19 impairs microvascular function, showing persistent changes in skin circulation and vasodilation even after recovery. This suggests long-term systemic microvascular damage from the infection.
Area of Science:
- Cardiovascular Research
- Infectious Diseases
- Microcirculation Studies
Background:
- Severe coronavirus disease 2019 (COVID-19) is linked to microvascular endothelial cell infection.
- Understanding microvascular function is crucial for managing critical COVID-19.
Purpose of the Study:
- To investigate microvascular function in patients with critical and severe COVID-19.
- To assess changes during the acute phase and at least 3 months post-infection.
Main Methods:
- Prospective observational study at a single center.
- Laser speckle contrast imaging used to assess skin perfusion and vasodilation (endothelial-dependent and -independent) via iontophoresis.
- Comparison between critical COVID-19, severe COVID-19, and non-COVID-19 control groups.
Main Results:
- Critical COVID-19 patients exhibited higher basal skin perfusion acutely and post-infection compared to controls.
- Reduced endothelial-dependent and -independent vasodilation observed in critical COVID-19 during the acute phase.
- Severe COVID-19 patients showed reduced endothelial-independent vasodilation, but other parameters were not significantly different from controls.
Conclusions:
- COVID-19 infection induces systemic microvascular impairment in critical cases.
- These microvascular changes demonstrate persisting long-term effects on function.
- Findings highlight the significant impact of COVID-19 on the microvasculature.
Abstract:
Severe coronavirus disease 2019 is characterized by infected microvascular endothelial cells. The primary aim of this study was to investigate microvascular function in patients with critical coronavirus disease 2019.
Design:
A prospective observational study was conducted in which patients with critical and severe COVID-19 were investigated during acute disease phase and at least 3 months after disease onset.
Setting:
Single-center study at Danderyd University Hospital.
Patients:
Twenty-three patients with critical coronavirus disease 2019 treated with noninvasive or invasive mechanical ventilation, seven patients with severe COVID-19 with dyspnea or need of oxygen supply up to 8 L/min, and 15 noncoronavirus disease controls.
Interventions:
None.
Measurements:
Skin perfusion was investigated through laser speckle contrast imaging before and after iontophoresis of acetylcholine and sodium nitroprusside for determination of the endothelial-dependent and the endothelial-independent vasodilation, respectively.
Main Results:
Patients with critical COVID-19 had higher basal skin perfusion during both the acute (34 ± 9 perfusion unit; p = 0.0003) and the postinfectious phase (29 ± 8 perfusion unit; p = 0.04), compared with noncoronavirus disease controls (23 ± 7 perfusion unit). In addition, endothelial-dependent and endothelial-independent vasodilation were reduced in patients with critical COVID-19 during the acute disease phase (p < 0.001 for both), whereas no significant differences between patients and controls were found during the postinfectious phase. In patients with severe COVID-19, basal skin perfusion and endothelial-dependent vasodilatation were not significantly changed, whereas endothelial-independent vasodilatation was reduced (p = 0.02) compared with controls.
Conclusions:
Changes in skin microcirculation in patients with critical COVID-19 indicate that the infection induces a systemic microvascular impairment with persisting long-term effects on the microvascular function.
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