Article ; Online: Markers of endothelial and epithelial pulmonary injury in mechanically ventilated COVID-19 ICU patients.
Critical care (London, England)
2021 Volume 25, Issue 1, Page(s) 74
Abstract: ... mechanically ventilated patients with COVID-19 ARDS and a cohort of 11 patients with classical ARDS were ... of the biomarkers at T1 in patients with COVID-19-related ARDS and classical ARDS.: Results: In COVID-19-related ... Conclusions: COVID-19 ARDS is characterized by an early pulmonary endothelial injury, as detected by Ang-2 ...
| 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. |
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| MeSH term(s) | Aged ; Antigens, Neoplasm/analysis ; Antigens, Neoplasm/blood ; Area Under Curve ; Biomarkers/analysis ; COVID-19/blood ; COVID-19/prevention & control ; Cohort Studies ; E-Selectin/analysis ; E-Selectin/blood ; Female ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Intercellular Adhesion Molecule-1/analysis ; Intercellular Adhesion Molecule-1/blood ; Lung Injury/blood ; Lung Injury/diagnosis ; Lung Injury/physiopathology ; Male ; Middle Aged ; Mitogen-Activated Protein Kinases/analysis ; Mitogen-Activated Protein Kinases/blood ; P-Selectin/analysis ; P-Selectin/blood ; Prospective Studies ; ROC Curve ; Respiration, Artificial/adverse effects ; Respiration, Artificial/standards ; Respiration, Artificial/statistics & numerical data ; Respiratory Distress Syndrome/blood ; Respiratory Distress Syndrome/physiopathology ; Versicans/analysis ; Versicans/blood ; Vesicular Transport Proteins/analysis ; Vesicular Transport Proteins/blood | |||||
| Chemical Substances | Antigens, Neoplasm ; Biomarkers ; E-Selectin ; ICAM1 protein, human ; P-Selectin ; SELE protein, human ; VCAN protein, human ; VPS51 protein, human ; Vesicular Transport Proteins ; Intercellular Adhesion Molecule-1 (126547-89-5) ; Versicans (126968-45-4) ; MOK protein, human (EC 2.7.11.22) ; Mitogen-Activated Protein Kinases (EC 2.7.11.24) | |||||
| Language | English | |||||
| Publishing date | 2021-02-19 | |||||
| Publishing country | England | |||||
| Document type | Journal Article ; Research Support, Non-U.S. Gov't | |||||
| ZDB-ID | 2041406-7 | |||||
| ISSN | 1466-609X ; 1364-8535 | |||||
| ISSN (online) | 1466-609X | |||||
| ISSN | 1364-8535 | |||||
| DOI | 10.1186/s13054-021-03499-4 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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