| Summary: | Background: Endocan, an endothelial dysfunction marker, recently emerged as a risk-stratification and prognostic marker in cardiovascular and respiratory diseases, but remains seldom explored in COVID-19. We evaluated endocan and other endothelial activation markers in hospitalized COVID-19 patients with different disease severity. The impact of hypertension on endothelial dysfunction and the association of endocan with inflammation, cardiovascular injury and outcomes were also assessed. Methods: Serum endocan, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin were measured in "severe" (n=27), "critically ill" (n=17) and "criticallly ill on veno-venous extracorporeal membrane oxygenation (VV-ECMO)" (n=17) COVID-19 patients at admission, days 3-4, 5-8 and weekly thereafter, and in controls (n=23) at a single time point. Inflammatory and cardiac biomarkers and outcomes were also evaluated. Results: At admission, endocan and VCAM-1 increased in all patients (p<0.001 vs controls), but "critically ill on VV-ECMO" patients had significantly higher endocan and E-Selectin. VCAM-1 was the only endothelial marker that decreased in all patient groups during hospitalization. "Severe" patients with hypertension showed higher endocan than normotensives, but in "critically ill on VV-ECMO" group endocan similarly increased in normotensives and hypertensives. Endocan positively correlated with endothelial markers, inflammation and hospitalization time among all patients and with cardiac injury biomarkers only in hypertensives. Conclusions: Endocan appears to be a major endothelial dysfunction marker in "critically ill on VV-ECMO" COVID-19 patients. Hypertension significantly augments endocan in "severe" patients, but in "critically ill on VV-ECMO" group other factors also increase endocan. Endocan is related to cardiac injury in COVID-19 hypertensives.
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