Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Abstract

Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients. Methods: Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses. Results: Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs (p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155–2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death. Conclusions: Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.

COVID-19 and thrombosis: The role of hemodynamics

“…Indirectly, measurement of parameters such as blood viscosity and vWF have been used to understand whether there is an impact on hemodynamics [24] , [78] , [79] . It has also been shown that low brachial artery flow-mediated dilation, a marker of endothelial dysfunction, predicts an unfavorable in-hospital prognosis in COVID-19 patients [80] , [81] .…”

Lower brachial artery flow-mediated dilation is associated with a worse prognosis and more lung parenchymal involvement in Covid-19: Prospective observational study

“…Similarly, it was reported that lower FMD values were found in patients who had radiographic signs of pneumonia compared with those who did not. [ 14 ] This is another important finding showing that there is a relationship between the severity of the Covid-19 and low FMD values.…”

“…It is also the first study in which patients were objectively grouped according to lung parenchyma involvement and compared in terms of FMD%. Indeed, in some recent studies in which FMD was evaluated in patients with recent or ongoing Covid-19, [ 14 , 15 ] however, the correlation between FMD% and biochemical parameters of the patients such as d-dimer, troponin, ferritin, LDH, and WBC has not been directly evaluated.…”

Thyroid-Stimulating Hormone Predicts Total Cholesterol and Low-Density Lipoprotein Cholesterol Reduction during the Acute Phase of COVID-19

“…Third, since liver dysfunction may be a clinical feature of severe COVID-19, lower TC and LDL-C levels have been hypothesized to result from reduced lipoprotein synthesis by dysfunctional hepatocytes in the most severe clinical forms of COVID-19 [ 29 ]. Fourth, as microcirculation is damaged and vascular permeability increases with increasing COVID-19 severity [ 36 ], it has been suggested that an abnormal distribution of lipoproteins from the intravascular to the extravascular space may contribute to reduce circulating TC and LDL-C in severe COVID-19 [ 19 , 29 ]. Of note, all these mechanisms are intriguing and biologically well-founded.…”