Time course of endothelial dysfunction markers and mortality in COVID-19 patients: A pilot study

This pilot study examined the correlation between endothelial dysfunction and mortality in patients with COVID-19. We measured the levels of various endothelial dysfunction biomarkers in 54 hospitalized patients with moderate-to-severe respiratory failure who tested positive for SARS-CoV-2, comparing them to 11 control patients with respiratory failure but negative for the virus. The measured biomarkers included endothelin-1, endoglin, sE-selectin, thrombomodulin, sVCAM-1, and vWF. The results showed that COVID-19 patients had significantly higher levels of sVCAM-1 and thrombomodulin compared to the controls. Additionally, in non-surviving patients, endoglin and sVCAM-1 were significantly higher at admission compared to survivors. Over time, thrombomodulin and vWF increased significantly in non-survivors, while endothelin-1 increased in survivors. Multivariate analysis revealed that only sVCAM-1 was independently associated with mortality. sVCAM-1 levels above the median at admission were correlated with higher mortality rates. This study suggests that endothelial dysfunction, particularly the increase in sVCAM-1, plays a crucial role in the pathogenesis of COVID-19 and prognosis. The findings may have clinical implications, considering that dexamethasone, which reduces sVCAM-1 expression, has been shown to be effective in reducing mortality in COVID-19 patients. The study needs validation in a larger cohort of patients.