Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients. Methods: Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses. Results: Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs ( p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155–2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death. Conclusions: Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.
【저자키워드】 COVID-19, SARS-CoV-2, Pneumonia, Endothelial dysfunction, bFMD, 【초록키워드】 coronavirus disease, Stratification, intensive care, Prognosis, ICU, clinical manifestations, Patient, death, non-invasive ventilation, Hospital admission, prognostic, Admission, predict, COVID-19 patients, association, hospitalized COVID-19 patient, Analysis, Cox regression, Injury, distress, endothelial function, COVID-19 patient, composite endpoint, brachial artery, In-hospital death, In-hospital, Non-invasive, higher risk, 95% CI, increased risk, Cox regression analysis, Radiographic, pathogenic, multivariable analyses, enrolled, clinically, eight, brachial, patients died, the median, univariable, 【제목키워드】 Artery, Dilation, with COVID-19,