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Biomarkers of Endothelial Dysfunction Are Associated With Poor Outcome in Covid-19 Patients: A Systematic Review and Meta-Analysis Publisher Pubmed



Mohebbi A1 ; Haybar H2 ; Nakhaei Moghaddam F3 ; Rasti Z1 ; Vahid MA4, 5 ; Saki N4, 5
Authors
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Authors Affiliations
  1. 1. Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  3. 3. Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
  4. 4. Department of Medical Laboratory, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  5. 5. Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Source: Reviews in Medical Virology Published:2023


Abstract

Numerous studies have linked coronavirus disease 2019 (COVID-19) with endothelial dysfunction and reported elevated levels of endothelial biomarkers in this disease. We conducted a systematic review and meta-analysis of the published evidence in this respect. A systematic literature search of PubMed and Scopus databases was performed to find studies investigating biomarkers of endothelial dysfunction in COVID-19 patients. Pooled standardized mean differences and their 95% confidence intervals were calculated for each biomarker using random effect model. 74 studies with 7668 patients were included. In comparison to patients with good outcome, those with poor outcome had higher levels of von Willebrand factor (vWF) (SMD: 0.83, 95% CI: 0.59–1.07, p < 0.00001), vWF:ADAMTS13 (1.23, (0.77–1.7), p < 0.00001), angiopoietin-2 (Ang-2) (1.06 (0.6–1.51), p < 0.0001), E-selectin (1.09 (0.55–1.63), p < 0.0001), P-selectin (0.59 (0.24–0.94), p = 0.001), syndecan-1 (0.99 (0.6–1.37), p < 0.00001), mid-regional pro-adrenomedullin (MR-proADM) (1.52 (1.35–1.68), p < 0.00001), vascular endothelial growth factor (0.27 (0.02–0.53), p = 0.03), soluble fms-like tyrosine kinase-1 (sFLT-1) (1.93 (0.65–3.21), p = 0.03) and lower levels of ADAMTS13 antigen (−0.69 (−0.9 to −0.47) p < 0.00001) and activity (−0.84 (−1.06 to −0.61) p < 0.0000). Plasminogen activator inhibitor-1 and tissue plasminogen activator levels were not different between the two groups (p < 0.05). There were elevated levels of endothelial dysfunction biomarkers in COVID-19 patients with poor outcome, indicating their possible role in disease severity and prognosis. In particular, MR-proADM, vWF, syndecan-1 and sFLT-1 showed a significant association with poor outcome in these patients. © 2023 John Wiley & Sons Ltd.
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