Abstract
Background: In a pilot study, we found a significant reduction in mean daily sequential organ failure assessment score in mechanically ventilated patients with COVID-19 who received prostacyclin, compared to placebo. We here investigate the effect on biomarkers of endothelial activation and damage.
Methods: Post-hoc study of a randomized controlled trial in adult patients with confirmed SARS-CoV-2 infection, mechanically ventilated, with soluble thrombomodulin (sTM) plasma levels >4 ng/mL. Patients received prostacyclin infusion (1 ng/kg/min) or placebo. Blood samples were collected at baseline and 24 h.
Results: Eighty patients were randomized (41 prostacyclin, 39 placebo). The median changes in syndecan-1 plasma levels at 24 h were -3.95 (IQR: -21.1 to 2.71) ng/mL in the prostacyclin group vs. 3.06 (IQR: -8.73 to 20.5) ng/mL in the placebo group (difference of the medians: -7.01 [95% CI: -22.3 to -0.231] ng/mL, corresponding to -3% [95% CI: -11% to 0%], p = 0.04). Changes in plasma levels of sTM, PECAM-1, p-selectin, and CD40L did not differ significantly between groups.
Conclusions: Prostacyclin infusion, compared to placebo, resulted in a measurable decrease in endothelial glycocalyx shedding (syndecan-1) at 24 h, suggesting a protective effect on the endothelium, which may be related to the observed reduction in organ failure.
Keywords: COVID-19; Endothelium; Glycocalyx; SARS-CoV-2; Syndecan-1; Thrombomodulin.
【저자키워드】 COVID-19, SARS-CoV-2, Endothelium, glycocalyx, Syndecan-1, Thrombomodulin., 【초록키워드】 Randomized controlled trial, Biomarker, Biomarkers, thrombomodulin, prostacyclin, SARS-COV-2 infection, CD40L, mechanically ventilated patients, P-selectin, Endothelium, Randomized, glycocalyx, Patient, plasma, Placebo, syndecan, Syndecan-1, change, protective effect, Plasma levels, Organ failure, endothelial, Activation, Blood samples, pilot study, placebo group, Adult patients, damage, medians, blood sample, mechanically ventilated, selectin, decrease, not differ, collected, significantly, median, changes in, groups, reduction in, baseline, mechanically ventilated patient, the placebo group, with COVID-19, 【제목키워드】 marker, endothelial, Activation, mechanically ventilated patient,