Evaluation of Coronavirus Disease-2019 Patients with Nailfold Capillaroscopy

Abstract

Aim: Microvasculopathy is one of the suspected complications in Coronavirus disease-2019 . Nailfold capillaroscopy is a noninvasive method used to evaluate microvascularity. It can be a guide in detecting endothelial dysfunction and microvasculopathy in COVID-19 patients. Materials and Methods:Severe acute respiratory syndrome-CoV-2 polymerase chain reaction positive 54 patients were evaluated. The 2 nd -5 th digits of both hands were investigated by nailfold capillaroscopy. Capillary density, capillary architecture and capillary morphology were recorded. Patients with abnormal and normal nailfold capillaroscopy findings were compared in terms of COVID-19 clinical symptoms. Results:Of the patients included in the study, 72% were male and the mean age was 35.6±11.6 years. In total, 22 patients (41%) had at least 1 abnormal capillaroscopy change. Diffuse capillaroscopic abnormalities were as follows: pericapillary edema 43%, enlarged and dilated capillaries 24%, and tortiosteal capillaries 22%. Hyperinflammatory response was observed in 17% of the patients and intensive care was required in only 1 patient. The frequency of hyperinflammatory response, anticytokine use and thrombosis increased in patients with abnormal capillaroscopy. Conclusion:Abnormal capillaroscopy findings were found to be frequent in COVID-19 patients. Higher rates of the hyperinflammatory response and anticytokine drug use in patients with abnormal nailfold findings suggest that there may be a relationship between hyperinflammation and microvasculopathy in COVID-19. Further studies are needed to evaluate the clinical relevance of nailfold abnormalities with clinical manifestations of COVID-19 disease.

Baseline capillaroscopy provides no evidence of microvascular changes to predict long-COVID syndrome

“…Nailfold capillaroscopy is a simple method of detecting microvascular changes in capillaries. In nailfold capillaroscopy examinations performed in patients with COVID-19 in the acute and post-acute phases, abnormal capillaroscopy findings were found in patients with COVID-19 compared to healthy controls (14,15,31,32). In one of these studies, 41% of 54 patients hospitalized for COVID-19 had abnormal capillaroscopic findings.…”

“…In one of these studies, 41% of 54 patients hospitalized for COVID-19 had abnormal capillaroscopic findings. Patients with abnormal capillaroscopic findings were found to have an increased frequency of hyperinflammatory response and use anti-cytokine drugs (15). In pediatric patients, capillaroscopic abnormalities have also been shown in COVID-19 infection, and during the long follow-up period, especially in patients who developed an inflammatory response (33,34).…”

“…In patients with COVID-19, capillaroscopic changes representing microvascular damage were observed in the acute and follow-up periods (14,15). Furthermore, hyperinflammatory response was more frequently observed in patients with capillaroscopic changes (15).…”

“…Capillaroscopy is a widely used non-invasive method to evaluate microvasculopathy by examining the nail capillary bed (12). Capillaroscopy as a bedside, easily applicable method may help detect dysfunctional endothelial activation and microvasculopathy in patients with COVID-19 (13,14,15). In patients with COVID-19, capillaroscopic changes representing microvascular damage were observed in the acute and follow-up periods (14,15).…”

“…Capillaroscopy as a bedside, easily applicable method may help detect dysfunctional endothelial activation and microvasculopathy in patients with COVID-19 (13,14,15). In patients with COVID-19, capillaroscopic changes representing microvascular damage were observed in the acute and follow-up periods (14,15). Furthermore, hyperinflammatory response was more frequently observed in patients with capillaroscopic changes (15).…”