Background:Nailfold capillaroscopy is a relatively easy-to-access, low-cost clinical tool that could help identify early coagulopathy in subjects with SARS-CoV-2, but specific findings vs. controls and its possible prognostic role has not been studied.Objectives:To describe capillaroscopic findings and their usefulness in patients with COVID-19 compared to healthy controls.Methods:We designed a cross-sectional study, carried out in a single care center for critical patients with SARS-CoV-2 pneumonia at the ABC Medical Center, Mexico City, which included patients from an intensive care unit (ICU) and internal medicine ward from March to April 2020. Demographic, biochemical and clinical features were collected. All patients signed the informed consent and the study was approved by the hospital ethics committee. All patients underwent nail capillary imaging of the 3 central fingers of each hand with a portable microscope with 60-100x magnification coupled to a smartphone with 7 megapixel images in an immersion medium. Capillaroscopy was performed in patients who did not have fever or hypothermia, or need vasopressors at the time of evaluation. Control subjects are healthy subjects matched on age and sex from a database of healthy controls without rheumatic diseases. Image evaluation of COVID-19 patients was performed in a blinded way for their characteristics. Prior to the analysis of the images, a pilot test was obtained with 4 rheumatologists in random cases, obtaining an acceptable global agreement in the visualization of capillaries and specific alterations of the nail bed. (Kappa = 0.58, p = 0.0019). Obtained data from capillaroscopies were used to be compared between severe and moderate cases of SARS-CoV-2 pneumonia. Additionally, we compared the findings against a healthy population in order to establish a reference.Results:We included data from 27 patients and 32 controls with similar demographic features. Patients with COVID-19 patients had a mean age of 43 +/- 13.8 years, 63% female. Comorbidities were present in 44.4% with: type II Diabetes Mellitus 18.5%, systemic arterial hypertension 18.5%, and rheumatoid arthritis 3.7%. The mean length of stay time was 13 +/- 7.1 days, 48.1% were admitted to the ICU, and 40.7% required invasive mechanical ventilation. In the capillaroscopic review remarkable findings of patients vs. controls were hemosiderin deposits (33 vs 12.5%, p=0.05), less frequently observable capillaries (77 vs 100%, p=0.005), any abnormality in capillaries (25.9 vs. 6.3%, p=0.03). Of notice, specific findings in COVID-19 patients were capillary tortuosities in 19%, dilatation in 9.5%, serpentine pattern in 4.8%, bush pattern in 9.5% and decreased density in only 4.8% of the cases. No avascular areas or capillaries of neoformation were observed. Finally, the presence of hemosiderin was associated with worse presentation and risk factors for severe COVID-19: Male sex 66.7 vs. 27.8%, (p = 0.024); Admission to ICU 77% vs 33% (p = 0.029); BMI > 30 kg/m2 66.7 vs. 27.8% (p = 0.053). And risk for ICU admission OR = 7.0 (95% CI 1.098 - 44.6). No significant associations were found for abnormalities in capillary morphology.Conclusion:We present one of the first reports of nailfold capillaroscopic findings in patients with COVID-19 and the first to compare to healthy controls. Previous data on this regard suggests the presence of endothelial dysfunction and microvascular complications such as micro hemorrhage or micro thrombosis. Further studies may confirm these findings and prognostic value for worse outcomes in COVID-19 patients.References:[1]Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.[2]Cutolo M, Cortes S. capillaroscopic patterns in rheumatic diseases. Acta Reumatol Port. 2007 Jan-Mar;32(1):29-36.[3]Natalello G, De Luca G, Gigante L, et al. Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement. Microvasc Res. 2021;133:104071.Disclosure of Interests:None declared
Background:Atherosclerotic cardiovascular diseases (ASCVD), metabolic syndrome and hyperuricemia due to an increment in their incidence world-wide, but information regarding the 10-year estimated risk in gout vs. healthy subjects is scarce.Objectives:To assess baseline the 10-year cardiovascular risk and high-risk status in gout patients compared to healthy controls.Methods:Data from 494 gout paired to controls in a ratio of 1:1 matched with age, sex and body mass index (BMI) and stratified by normal (≤ 24.9 Kg/m2), overweight (25 - 29.9 Kg/m2) and obese (≥30 Kg/m2). Controls were asymptomatic subjects attending a preventive clinic in Mexico City. We used the Framingham Risk Score for Coronary Heart Disease (FRS-CHD) and the 2013 American College of Cardiology/American Heart Association (2013 ACC/AHA). Additionally, high risk status was defined according to pre-defined cutoff points for FRS-CHD (≥ 20%) and ACC/AHA 2013 (≥7.5%).Results:Data from 494 gout and 494 controls. Gout patients were male 97.4%, 47 (SD ± 13) years, mean BMI of 28.4 (SD ± 4.31) Kg/m2. Age, sex, and BMI and subgroups were equilibrated (p=NS). Gout patients had higher 10-year estimated risk vs. controls nevertheless, only FRS-CHD reached statistically significant difference with 9.38 vs. 7.5 ± 5.74 (p<0.001); For 2013 ACC/AHA 4.94 ± 6.16 vs. 5.23 ± 6.78, (p=0.49). Further stratification by BMI groups revealed that subjects with gout in normal and overweight categories were had higher risk vs. controls with FRS-CHD score of 8.86 ± 8.05 vs. 6.53 ± 6.41 (p=0.03) and 9.37 ± 7.72 vs. 7.89 ± 5.58 (p=0.01), respectively. No differences for 2013 ACC/AHA in global and BMI-stratified comparisons. Proportion of high-risk subjects were similar in both groups regardless of BMI category: for FRS-CHD 7.5 vs 4.7% (p=0.06) and 2013 ACC/AHA with 21.5 vs. 17.8% (p=0.14).Conclusion:Normal BMI or overweight Mexican patients with gout may be at higher 10-year estimated cardiovascular risk compared to matched age, gender and BMI healthy controls. Obese gout subjects are at high risk with non-statistical significance scores for FRS-CHD or 2013 ACC/AHA compared to controls.References:[1]Acosta-Cázares B, Escobedo-de la Peña J. High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?. American Heart Journal. 2010;160:230-6.[2]Sánchez Rodríguez A, Moreno-Del Castillo C, Prado Anaya CA et al. ESTIMATED 10-YEAR CARDIOVASCULAR RISK WITH FRAMINGHAM RISK AND 2013 ACC/AHA IN GOUT AND HEALTHY MEXICAN SUBJECTS: A CASE-CONTROL STUDY WITH A PROPENSITY SCORE-MATCHED ANALYSIS J Clin Rheumatol: 2019;25:S1–S96.[3]Bevis M, Blagojevic-Bucknall M, Mallen C, Hider S, Roddy E. Comorbidity cluster in people with gout: an observational cohort study with linked medial record review. Rheumatology (Oxford). 2018 Apr 17.[4]Andrés M, Bernal JA, Sivera F, Quilis N, Carmona L, Vela P, Pascual E. Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment. Ann Rheum Dis. 2017;76:1263-8.Disclosure of Interests:None declared.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.