Envolvimento de biomarcadores endoteliais na chikungunya crônica

Abstract

Introduction: Chikungunya is an arboviral disease responsible for triggering an intense inflammatory response, associated with long-lasting clinical manifestations in chronic cases. In the last decade, it has affected millions of people in the Americas, Africa, Asia, and Europe, becoming a major public health problem due to its significant impact on quality of life. In this context, the study of endothelial biomarkers can contribute to clarifying the prognosis of the disease and its clinical repercussions. Objective: To investigate biomarkers of endothelial injury in chronic chikungunya. Materials and methods: Cross-sectional study with 34 chronic cases, selected from the cohort of the Oliveira Pombo Basic Health Unit, linked to the “Study of the natural history and therapeutic response of Chikungunya focusing on acute and chronic musculoskeletal manifestations in Fortaleza-CE”. Venous blood samples were

collected for the measurement of endothelial biomarkers (ANG-2, VCAM-1, and SYN- 1), in addition to clinical data, such as comorbidities and symptoms, extracted from the

cohort questionnaires. Results: The mean age of chronic cases was 45.11 ± 15.86 years, with 28 (76.47%) being female. Twenty (58.82%) participants belonged to the group with 360 days of disease duration. The most prevalent symptoms were morning stiffness (28; 82.35%), arthralgia (22; 64.71%), and edema (16; 47.06%). In the comparison between the three groups of chronic patients with different disease durations (180, 360, and 720 days) and the control group, the biomarkers ANG-2, VCAM-1, and SYN-1 showed statistically significant differences (p = 0.007; p = 0.004; p < 0.001, respectively). Increased levels of ANG-2 (p = 0.037) were observed in patients with and without depression, as well as reductions in VCAM-1 (p = 0.047) and SYN-1 (p = 0.036) in cases with and without memory impairment. SYN-1 levels were increased in patients with fever (p = 0.041) and reduced in those with blurred vision (p = 0.019) and alopecia (p = 0.009), compared to those without these symptoms. Only the biomarkers ANG-2 and VCAM-1 showed a correlation with disease duration, with a moderate and positive correlation for ANG-2 (Rho = 0.456; p = 0.006) and a weak and negative correlation for VCAM-1 (Rho = -0.369; p = 0.034). ANG-2 was the only biomarker with good predictive performance in the AUC-ROC curve = 0.864 and 95% CI (0.725 - 1000), while VCAM-1 and SYN-1 presented, respectively, AUC-ROC = 0.605 and 95% CI (0.338 – 0.872); AUC-ROC = 0.519 and 95% CI (0.148 – 0.890). Conclusion: Increased levels of ANG-2 and reduced levels of VCAM-1 were associated with disease duration in the evaluated cases. SYN-1 may be related to the presence of symptoms such as fever, memory impairment, blurred vision, and alopecia in patients with chronic chikungunya.