Capillary Leukocytes, Microaggregates, and the Response to Hypoxemia in the Microcirculation of Coronavirus Disease 2019 Patients

Favaron, Emanuele; İnce, Can; Hilty, Matthias P.; Ergin, Bülent; Zee, Philip van der; Uz, Zühre; Wendel‐Garcia, Pedro David; Hofmaenner, Daniel A.; Acevedo, Claudio; Boven, Wim Jan van; Akın, Şakir; Gommers, Diederik; Endeman, Henrik

doi:10.1097/ccm.0000000000004862

Cited by 48 publications

(68 citation statements)

References 32 publications

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“…Further, the younger age of patients admitted during the third wave does not solely explain per se the decrease in physiological risk scores such as SAPS II and APACHE II. Whereas the need for circulatory support was indeed reduced during the third wave, which may suggest better compensation mechanisms, as was found in previous research [21], we have observed an unexpected trend towards more severe lung failure. A recent study reported an increase in mortality in patients infected with the B1.1.7 variant of the SARS-CoV-2 virus [10], demonstrating a relationship between changes in viral epidemiology and disease course.…”

Section: Discussionsupporting

confidence: 86%

Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland

et al. 2021

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AIMS OF THE STUDY: During the ongoing COVID-19 pandemic, the launch of a large-scale vaccination campaign and virus mutations have hinted at possible changes in transmissibility and the virulence affecting disease progression up to critical illness, and carry potential for future vaccination failure. To monitor disease development over time with respect to critically ill COVID-19 patients, we report near real-time prospective observational data from the RISC-19-ICU registry that indicate changed characteristics of critically ill patients admitted to Swiss intensive care units (ICUs) at the onset of a third pandemic wave. METHODS: 1829 of 3344 critically ill COVID-19 patients enrolled in the international RISC-19-ICU registry as of 31 May 2021 were treated in Switzerland and were included in the present study. Of these, 1690 patients were admitted to the ICU before 1 February 2021 and were compared with 139 patients admitted during the emerging third pandemic wave RESULTS: Third wave patients were a mean of 5.2 years (95% confidence interval [CI] 3.2-7.1) younger (median 66.0 years, interquartile range [IQR] 57.0-73.0 vs 62.0 years, IQR 54.5-68.0; p <0.0001) and had a higher body mass index than patients admitted in the previous pandemic period. They presented with lower SAPS II and APACHE II scores, less need for circulatory support and lower white blood cell counts at ICU admission. P/F ratio was similar, but a 14% increase in ventilatory ratio was observed over time (p = 0.03) CONCLUSION: Near real-time registry data show that the latest COVID-19 patients admitted to ICUs in Switzerland at the onset of the third wave were on average 5 years younger, had a higher body mass index, and presented with lower physiological risk scores but a trend towards more severe lung failure. These differences may primarily be related to the ongoing nationwide vaccination campaign, but the possibility that changes in virus-host interactions may be a co-factor in the age shift and change in disease characteristics is cause for concern, and should be taken into account in the public health and vaccination strategy during the ongoing pandemic. (ClinicalTrials.gov Identifier: NCT04357275)

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Section: Discussionsupporting

confidence: 86%

Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland

et al. 2021

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“…Hypoxia, hyperinflammation, and hypercoagulability during the disease course may stimulate neoangiogenesis in the nail bed capillaries and as in our cohort, this may demonstrate why neoangiogenesis is significantly more pronounced in patients with MIS-C. Similarly, Emanule et al, who examined sublingual microcirculation by a hand-held vital microscope based on incident dark field microscopy imaging in COVID-19 patients in the ICU, reported that as a response to hypoxemia, hyperinflammation, and hypercoagulation the number of vessels and functional capillary density in COVID-19 patients were increased in comparison to healthy volunteers ( Favaron et al, 2021 ). In our cohort, even though the capillary density was lower with respect to controls, neoangiogenesis was significantly noticeable in patients diagnosed with COVID-19, chiefly MIS-C.…”

Section: Discussionsupporting

confidence: 80%

“…In April 2020, COVID-19 reports of children with clinical and laboratory features similar to Kawasaki disease and toxic shock syndrome begin to come out ( Verdoni et al, 2020 ; Cook et al, 2020 ) Afterwards, a unique syndrome with fever and hyperinflammation affecting not only the skin and heart but also the gastrointestinal, neurological, and respiratory systems were defined and then currently named as multisystem inflammatory syndrome in children (MIS-C) ( Henderson and Yeung, 2021 ). While evaluating patients attentively, alterations of the microcirculation and endothelial structures were demonstrated in adult studies, however evidence of microvascular dysfunction in children with COVID-19 or MIS-C is scarce ( Rovas et al, 2021 ; Favaron et al, 2021 ; Goshua et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Nailfold capillaroscopy: A sensitive method for evaluating microvascular involvement in children with SARS-CoV-2 infection

Çakmak

Demirbuğa

Demirkol

et al. 2021

Microvascular Research

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Objectives The hyperinflammatory state and the viral invasion may result in endothelial dysfunction in SARS-CoV-2 infection. Although a method foreseeing microvascular dysfunction has not been defined yet, studies conducted in patients diagnosed with COVID-19 have demonstrated the presence of endotheliitis. With this study, we aimed to investigate the microvascular circulation in patients diagnosed with COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by nailfold videocapillaroscopy (NVC). Methods Thirty-one patients with SARS-CoV-2 infection, 25 of whom were diagnosed with COVID-19 and 6 with MIS-C and 58 healthy peers were included in the study. NVC was performed in eight fingers with 2 images per finger and 16 images were examined for the morphology of capillaries, presence of pericapillary edema, microhemorrhage, avascular area, and neoangiogenesis. Capillary length, capillary width, apical loop, arterial and venous width, and intercapillary distance were measured from three consecutive capillaries from the ring finger of the non-dominant hand. Results COVID-19 patients showed significantly more capillary ramification ( p < 0.001), capillary meandering ( p = 0.04), microhemorrhage (p < 0.001), neoangiogenesis (p < 0.001), capillary tortuosity ( p = 0.003). Capillary density ( p = 0.002) and capillary length (p = 0.002) were significantly lower in the patient group while intercapillary distance ( p = 0.01) was significantly longer compared with healthy volunteers. Morphologically, patients with MIS-C had a higher frequency of capillary ramification and neoangiogenesis compared with COVID-19 patients (p = 0.04). Conclusion Abnormal capillary alterations seen in COVID-19 and MIS-C patients indicate both similar and different aspects of these two spectra of SARS-CoV-2 infection and NVC appears to be a simple and non-invasive method for evaluation of microvascular involvement.

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“…These processes have been found to occur in the lungs in ARDS ( 35 ), in the heart in ischemia-reperfusion injury ( 36 ), and in the kidney in AKI ( 37 ). Thus, RVD (and extrapulmonary organ) may mirror the enormous burden of pulmonary cell stress and systemic microvascular dysfunction in COVID-19 ( 38 , 39 ) but also where the dysfunctional RV further contributes to remote organ dysfunction through harmful reductions in organ blood flow.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome*

Chotalia

Ali

Alderman

et al. 2021

Critical Care Medicine

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Capillary Leukocytes, Microaggregates, and the Response to Hypoxemia in the Microcirculation of Coronavirus Disease 2019 Patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 48 publications

References 32 publications

Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland

Near real-time observation reveals increased prevalence of young patients in the ICU during the emerging third SARS-CoV-2 wave in Switzerland

Nailfold capillaroscopy: A sensitive method for evaluating microvascular involvement in children with SARS-CoV-2 infection

Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome*

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