Relação entre biomarcadores endoteliais e choque séptico em pacientes críticos com COVID

Abstract

Septic shock due to COVID-19 impacts the mortality of critically ill patients admitted to Intensive Care Units (ICU). It is a hyperinflammatory response with consequent organ dysfunction. Such changes are mediated by glycocalyx desquamation, generation of reactive oxygen species, exposure of endothelial adhesion molecules, and tissue factor activation. Sepsis affects practically all endothelial cell functions and is considered a critical factor in the progression of the condition to multiple organ failure. Aim: To correlate vascular biomarkers with septic shock in critically ill patients with COVID-19. Methods: A prospective study was carried out with 86 patients with severe COVID-19 admitted to the ICU between June 2020 and April 2021. Patients were followed up until the 28th day of hospitalization. Laboratory tests and vascular biomarkers, such as VCAM-1, syndecan-1, angiopoietin-1, and angiopoietin-2, were quantified upon admission to the ICU and associated with the need or not for vasopressors in the first seven days of hospitalization. Methods: A prospective study was carried out with 86 patients with severe COVID-19 admitted to the ICU between June 2020 and April 2021. Patients were followed up until the 28th day of hospitalization. Laboratory tests and vascular biomarkers, such as VCAM-1, syndecan-1, angiopoietin-1, and angiopoietin-2, were quantified upon admission to the ICU and associated with the need or not for vasopressors in the first seven days of hospitalization. Results: The mean age of study participants was 60 ± 16 years, and most were male (59% of the sample). The mean time between the onset of symptoms and admission was 11.7 ± 7.4 days. On average, the participants remained in the ICU for 12 ± 7.5 days. Thirty-six (42%) patients died during hospitalization, and 50 (58%) survived. The most frequent comorbidities were hypertension (39%), obesity (31%), and diabetes mellitus (23%). Seventy-two percent (72%) of the sample were using mechanical ventilation in the first 24 hours of hospitalization, with a mean oxygenation index of 183.9 ± 115. Patients who used vasopressors were characterized by more tachycardia on admission (107 ± 22 versus 92 ± 20, p = 0.003); higher SAPS3 scores [68.66 (64.5-75.5) versus 41.5 (37 – 59.7), p < 0.001] and more frequent need for invasive mechanical ventilation (63% versus 37%, p < 0.001). The group using vasopressors had higher levels of D-dimer [2.46 (0.6 – 6.1) versus 1.01 (0.62 – 2.6), p = 0.019], and LDH (929 ± 382 versus 766 ± 312), compared to the group that did not use vasoactive drugs. The frequency of deaths during hospitalization was higher in the group that used vasoactive amines in the first 24 hours in the ICU compared to those that did not use them (70% versus 30%, p = 0.002). Sindecan-1 was independently associated with the need for vasoactive amines, and admission values above 269 ng/ml (95% CI 0.524 – 0.758, p = 0.024) were able to predict the need for vasopressors during the seven days following admission. Conclusion: Patients with septic shock due to COVID-19 are associated with greater use of mechanical ventilation, higher SAPS3 scores, and a higher risk of death during hospitalization. Furthermore, syndecan-1 has been shown to be a valuable biomarker for monitoring the progression of COVID-19 to septic shock. Data from this study show that severe COVID-19 results in vascular injury and endothelial glycocalyx degradation.