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Updated: May 20, 2025
Monitoring Changes in Human Umbilical Vein Endothelial Cells upon Viral Infection Using Impedance-Based Real-Time Cell Analysis
Published on: May 5, 2023
Effects of COVID-19 Infection on Endothelial Vascular Function
Andreea Mara Munteanu1, Daniel Florin Lighezan2, Violeta Ariana Nicoras3
1Department V, Internal Medicine I-Discipline of Internal Medicine IV, Center of Advanced Research in Cardiology and Hemostasology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania.
Insights
COVID-19 infection causes endothelial dysfunction, characterized by reduced flow-mediated dilatation (FMD). Inflammatory markers like erythrocyte sedimentation rate (ESR) and neutrophil-to-lymphocyte ratio (NLR) significantly correlate with this dysfunction.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Infectious Diseases
Background:
- COVID-19 complications are linked to inflammation and neutrophil activity.
- Neutrophils release interleukin-6 (IL-6), contributing to oxidative stress and vascular endothelial dysfunction.
- Higher neutrophil counts and neutrophil-to-lymphocyte ratio (NLR) correlate with increased COVID-19 mortality.
Purpose of the Study:
- To assess endothelial dysfunction in post-COVID-19 patients using flow-mediated dilatation (FMD).
- To evaluate the correlation between FMD and inflammatory markers (ESR, fibrinogen, NLR, IL-6) in moderate COVID-19 survivors.
Main Methods:
- Retrospective study comparing 99 post-COVID-19 patients with 99 controls.
- Flow-mediated dilatation (FMD) of the brachial artery was used to measure endothelial function.
- Analysis included inflammatory markers: erythrocyte sedimentation rate (ESR), fibrinogen, C-reactive protein (CRP), leukocyte count, granulocyte count, NLR, and IL-6.
Main Results:
- FMD values were significantly reduced in post-COVID-19 patients (p < 0.0001).
- Reduced FMD inversely correlated with ESR, fibrinogen, CRP, leukocyte count, and granulocyte count (p < 0.0001).
- ESR showed the strongest association with FMD, explaining 63% of the dependency. ANOVA confirmed inverse associations between NLR quartiles/IL-6 levels and FMD.
Conclusions:
- Endothelial dysfunction is present in patients recovering from moderate COVID-19.
- Significant inverse correlations exist between FMD, IL-6 levels, and NLR in post-COVID-19 patients.
- Inflammatory markers play a crucial role in the development of COVID-19-related endothelial dysfunction.
Abstract:
Most studies analyzing data from patients who experienced at least one episode of acute COVID-19 infection have attributed the cascade of immediate and late complications to disruption of the inflammatory system and neutrophil activity in particular. Among the various functions of neutrophils is the release of pro-inflammatory mediators, including interleukin-6 (IL-6). Oxidative stress induced by pro-inflammatory mediators secreted by neutrophils leads to vascular endothelial dysfunction. Neutrophil counts and the neutrophil-to-lymphocyte ratio (NLR) are directly associated with COVID-19 patient survival, with higher values correlating with increased mortality. To assess endothelial dysfunction secondary to COVID-19 infection, we conducted a retrospective study involving two patient cohorts, each comprising 99 participants: one group with a history of COVID-19 infection and another without. The study aimed to demonstrate the presence of endothelial dysfunction in patients with moderate COVID-19 infection using flow-mediated dilatation (FMD) of the brachial artery and to evaluate its correlation with key inflammatory markers (erythrocyte sedimentation rate-ESR, fibrinogen, NLR, IL-6). FMD values were significantly reduced (p < 0.0001) in post-COVID-19 patients compared to those without prior infection. ESR (p < 0.0001), fibrinogen (p < 0.0001), C-reactive protein (CRP) (p < 0.0001), leukocyte count (p < 0.0001), and granulocyte count (p < 0.0001) were inversely correlated with FMD values. Among post-COVID-19 patients, all analyzed parameters demonstrated a statistically significant impact on FMD, with ESR showing the strongest effect, accounting for nearly 63% of the dependency. ANOVA testing confirmed an inverse association between NLR quartiles and FMD, as well as between IL-6 levels and FMD. In conclusion, this study highlights the presence of endothelial dysfunction in post-COVID-19 patients, as assessed by FMD, and demonstrates statistically significant inverse correlations between FMD values, IL-6 levels, and the neutrophil-to-lymphocyte ratio.
