Case Report: Endothelial Glycocalyx Damage in Critically ill Patients With SARS-CoV-2-Related Multisystem Inflammatory Syndrome (MIS-C)

Frontiers in Pediatrics

Steffanie Flórez¹  Lorena Acevedo¹  Laura C. Alarcón-Forero¹  Carolina Salamanca¹  Hernando Mulett¹  Jaime Fernández-Sarmiento²  Julio Garcia-Casallas³  Lina María Salazar-Peláez⁴ 

[1] Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia;Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de la Sabana, Bogotá, Colombia;Graduate School, Universidad CES, Medellín, Colombia;Department of Pharmacology and Internal Medicine, Universidad de la Sabana, Chia, Colombia;Graduate School, Universidad CES, Medellín, Colombia;

关键词: COVID-19;    PIMS-TS;    children;    inflammatory;    coronary aneurysm;   

DOI  :  10.3389/fped.2021.726949

来源: Frontiers

【 摘 要 】

Endothelial insult and damage is one of the reported consequences of SARS-CoV-2 infection. It has been associated with severe inflammation, thrombotic phenomena and profound hypoxemia in critically ill patients. Endothelial activation leads to a loss of the endothelium's antithrombotic properties which, under normal conditions, are maintained by the endothelial glycocalyx, a carbohydrate-rich layer that covers the luminal surface of endothelial cells. In children, one of the serious forms of SARS-CoV-2 virus disease (COVID-19) is multisystem inflammatory syndrome (MIS-C). This new disease is characterized by a large inflammatory response and frequent cardiovascular, cutaneous and gastrointestinal disorders. We describe the first two cases of critically ill children with MIS-C who evidenced a large inflammatory response associated with elevated plasma and imaging biomarkers of endothelial activation and endothelial glycocalyx degradation. This microcirculation involvement in MIS-C could, at least partially, explain some of the clinical manifestations and laboratory and imaging alterations found in these patients. These findings contribute to a better understanding of this disease and suggest that medications to modulate the inflammatory response and protect or restore the endothelial glycocalyx should be considered in future studies.

【 授权许可】

CC BY