Determinants of endothelial dysfunction in non-critically ill hospitalized COVID-19 patients: a cross-sectional study

Heubel, Alessandro Domingues; Viana, Ariane Aparecida; Linares, Stephanie Nogueira; do Amaral, Vanessa Teixeira; Schafauser, Nathany Souza; de Oliveira, Gustavo Yudi Orikassa; Ramírez, Paula Camila; Martinelli, Bruno; da Silva Alexandre, Tiago; Borghi Silva, Audrey; Ciolac, Emmanuel Gomes; Mendes, Renata Gonçalves

OBJECTIVE: To identify determinants of endothelial dysfunction in patients hospitalized due to acute COVID-19. METHODS: We cross-sectionally studied 109 hospitalized COVID-19 patients in non-critical status. Clinical data (age, sex, comorbidities, and medications) and body mass index (BMI) were assessed. Laboratory tests included serum hemoglobin, leukocytes, lymphocytes, platelets, C-reactive protein, ferritin, D-dimer, and creatinine. Physical status was evaluated using a handgrip dynamometer. Endothelial function was assessed non-invasively using flow-mediated dilation (FMD) method. RESULTS: The sample average age was 51 years, 51% were male, and the most frequent comorbidity was obesity (62%). Univariate analysis showed association of lower FMD with higher BMI, hypertension, use of oral antihypertensive, higher blood levels of creatinine, and larger baseline artery diameter. After adjusting for confounders, the multivariate analysis showed BMI (95% CI -0.26, -0.11; P < 0.001) as the major factor associated with FMD. Other factors associated with FMD were baseline artery diameter (95% CI -1.77, -0.29; P = 0.007) and blood levels of creatinine (95% CI -1.99, -0.16; P = 0.022). CONCLUSIONS: Increased BMI was the major factor associated with endothelial dysfunction in non-critically hospitalized COVID-19 patients. This may explain one of the pathways in which obesity may increase the risk for severe COVID-19.