Markers of endothelial and epithelial pulmonary injury in mechanically ventilated COVID-19 ICU patients

Critical Care

Gianluca Campo¹  Roberto Ferrari¹  Rita Pavasini¹  Ottavio Zucchetti¹  Tanushree Tunstall²  Salvatore Grasso³  Francesca Fortini³  Francesco Murgolo³  Francesco Vieceli Dalla Sega³  Marco Verri⁴  Valentina Scaramuzzo⁴  Carlo Alberto Volta⁴  Elisabetta Marangoni⁴  Savino Spadaro⁴  Irene Ottaviani⁴  Alberto Fogagnolo⁴  Paola Rizzo⁵  Alberto Papi⁶  Marco Contoli⁶ 

[1] Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara;Department of Infection Biology, School of Hygiene and Tropical Medicine;Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari “Aldo Moro”;Intensive Care Unit, Department of Translational medicine and for Romagna, University of Ferrara;Maria Cecilia Hospital, GVM Care and Research;Respiratory Section, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara;

关键词: COVID-19;    Acute respiratory distress syndrome;    Biomarkers;    Angiopoietin-2;    Intercellular adhesion molecule-1;    Vascular cell adhesion protein 1;   

DOI  :  10.1186/s13054-021-03499-4

来源: DOAJ

【 摘 要 】

Abstract Background Biomarkers can be used to detect the presence of endothelial and/or alveolar epithelial injuries in case of ARDS. Angiopoietin-2 (Ang-2), soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1), P-selectin and E-selectin are biomarkers of endothelial injury, whereas the receptor for advanced glycation end-products (RAGE) reflects alveolar epithelial injury. The aims of this study were to evaluate whether the plasma concentration of the above-mentioned biomarkers was different 1) in survivors and non-survivors of COVID-19-related ARDS and 2) in COVID-19-related and classical ARDS. Methods This prospective study was performed in two COVID-19-dedicated Intensive Care Units (ICU) and one non-COVID-19 ICU at Ferrara University Hospital. A cohort of 31 mechanically ventilated patients with COVID-19 ARDS and a cohort of 11 patients with classical ARDS were enrolled. Ang-2, ICAM-1, VCAM-1, P-selectin, E-selectin and RAGE were determined with a bead-based multiplex immunoassay at three time points: inclusion in the study (T1), after 7 ± 2 days (T2) and 14 ± 2 days (T3). The primary outcome was to evaluate the plasma trend of the biomarker levels in survivors and non-survivors. The secondary outcome was to evaluate the differences in respiratory mechanics variables and gas exchanges between survivors and non-survivors. Furthermore, we compared the plasma levels of the biomarkers at T1 in patients with COVID-19-related ARDS and classical ARDS. Results In COVID-19-related ARDS, the plasma levels of Ang-2 and ICAM-1 at T1 were statistically higher in non-survivors than survivors, (p = 0.04 and p = 0.03, respectively), whereas those of P-selectin, E-selectin and RAGE did not differ. Ang-2 and ICAM-1 at T1 were predictors of mortality (AUROC 0.650 and 0.717, respectively). At T1, RAGE and P-selectin levels were higher in classical ARDS than in COVID-19-related ARDS. Ang-2, ICAM-1 and E-selectin were lower in classical ARDS than in COVID-19-related ARDS (all p < 0.001). Conclusions COVID-19 ARDS is characterized by an early pulmonary endothelial injury, as detected by Ang-2 and ICAM-1. COVID-19 ARDS and classical ARDS exhibited a different expression of biomarkers, suggesting different pathological pathways. Trial registration NCT04343053 , Date of registration: April 13, 2020

【 授权许可】

Unknown