tetano
Editor, Senior Moderator
J Crit Care
. 2024 Mar 9:82:154759.
doi: 10.1016/j.jcrc.2024.154759. Online ahead of print. Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome
Daniele Dondossola[SUP] 1 [/SUP], Caterina Lonati[SUP] 2 [/SUP], Alessia Pini[SUP] 3 [/SUP], Daniela Bignamini[SUP] 4 [/SUP], Alberto Zanella[SUP] 5 [/SUP], Rosa Lombardi[SUP] 4 [/SUP], Vittorio Scaravilli[SUP] 6 [/SUP], Vincenzo La Mura[SUP] 7 [/SUP], Laura Forzenigo[SUP] 8 [/SUP], Pierpaolo Biondetti[SUP] 8 [/SUP], Giacomo Grasselli[SUP] 5 [/SUP], Anna Fracanzani[SUP] 9 [/SUP]; PH-COVID collaborator group; Chiara Paleari[SUP] 6 [/SUP], Annalisa Cespiati[SUP] 4 [/SUP], Serena Todaro[SUP] 6 [/SUP], Emanuele Cattaneo[SUP] 6 [/SUP], Marianna Di Feliciantonio[SUP] 6 [/SUP], Giordano Sigon[SUP] 4 [/SUP], Carlo Valsecchi[SUP] 6 [/SUP], Amedeo Guzzardella[SUP] 6 [/SUP], Michele Battistin[SUP] 2 [/SUP], Federica Iuculano[SUP] 4 [/SUP]
Affiliations
Objectives: Although respiratory failure is the most common feature in coronavirus disease 2019 (COVID-19), abdominal organ involvement is likewise frequently observed. To investigate visceral and thoracic circulation and abdominal organ damage in COVID-19 patients.
Materials and methods: A monocentric observational study was carried on. In COVID-19 patients affected by acute respiratory distress syndrome (ARDS) (n = 31) or mild pneumonia (n = 60) thoracoabdominal circulation was evaluated using Doppler-ultrasound and computed tomography. The study also included non-COVID-19 patients affected by ARDS (n = 10) or portal hypertension (n = 10) for comparison of the main circulatory changes.
Results: Patients affected by COVID-19 ARDS showed hyperdynamic visceral flow and increased portal velocity, hepatic artery resistance-index, and spleen diameter relative to those with mild-pneumonia (p = 0.001). Splanchnic circulatory parameters significantly correlated with the main respiratory indexes (p < 0.001) and pulmonary artery diameter (p = 0.02). The chest and abdominal vascular remodeling pattern of COVID-19 ARDS patients resembled the picture observed in the PH group, while differed from that of the non-COVID ARDS group. A more severe COVID-19 presentation was associated with worse liver dysfunction and enhanced inflammatory activation; these parameters both correlated with abdominal (p = 0.04) and chest imaging measures (p = 0.03).
Conclusion: In COVID-19 ARDS patients there are abdominal and lung vascular modifications that depict a portal hypertension-like pattern. The correlation between visceral vascular remodeling, pulmonary artery enlargement, and organ damage in these critically ill patients is consistent with a portal hyperlfow-like syndrome that could contribute to the peculiar characteristics of respiratory failure in these patients.
Clinical relevance statement: our data suggest that the severity of COVID-19 lung involvement is directly related to the development of a portal hyperflow-like syndrome. These observations should help in defining the need for a closer monitoring, but also to develop dedicated therapeutic strategies.
Keywords: COVID-19; Coronavirus disease 2019; Portal hypertension; Porto-pulmonary hypertension.
. 2024 Mar 9:82:154759.
doi: 10.1016/j.jcrc.2024.154759. Online ahead of print. Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome
Daniele Dondossola[SUP] 1 [/SUP], Caterina Lonati[SUP] 2 [/SUP], Alessia Pini[SUP] 3 [/SUP], Daniela Bignamini[SUP] 4 [/SUP], Alberto Zanella[SUP] 5 [/SUP], Rosa Lombardi[SUP] 4 [/SUP], Vittorio Scaravilli[SUP] 6 [/SUP], Vincenzo La Mura[SUP] 7 [/SUP], Laura Forzenigo[SUP] 8 [/SUP], Pierpaolo Biondetti[SUP] 8 [/SUP], Giacomo Grasselli[SUP] 5 [/SUP], Anna Fracanzani[SUP] 9 [/SUP]; PH-COVID collaborator group; Chiara Paleari[SUP] 6 [/SUP], Annalisa Cespiati[SUP] 4 [/SUP], Serena Todaro[SUP] 6 [/SUP], Emanuele Cattaneo[SUP] 6 [/SUP], Marianna Di Feliciantonio[SUP] 6 [/SUP], Giordano Sigon[SUP] 4 [/SUP], Carlo Valsecchi[SUP] 6 [/SUP], Amedeo Guzzardella[SUP] 6 [/SUP], Michele Battistin[SUP] 2 [/SUP], Federica Iuculano[SUP] 4 [/SUP]
Affiliations
- PMID: 38461659
- DOI: 10.1016/j.jcrc.2024.154759
Objectives: Although respiratory failure is the most common feature in coronavirus disease 2019 (COVID-19), abdominal organ involvement is likewise frequently observed. To investigate visceral and thoracic circulation and abdominal organ damage in COVID-19 patients.
Materials and methods: A monocentric observational study was carried on. In COVID-19 patients affected by acute respiratory distress syndrome (ARDS) (n = 31) or mild pneumonia (n = 60) thoracoabdominal circulation was evaluated using Doppler-ultrasound and computed tomography. The study also included non-COVID-19 patients affected by ARDS (n = 10) or portal hypertension (n = 10) for comparison of the main circulatory changes.
Results: Patients affected by COVID-19 ARDS showed hyperdynamic visceral flow and increased portal velocity, hepatic artery resistance-index, and spleen diameter relative to those with mild-pneumonia (p = 0.001). Splanchnic circulatory parameters significantly correlated with the main respiratory indexes (p < 0.001) and pulmonary artery diameter (p = 0.02). The chest and abdominal vascular remodeling pattern of COVID-19 ARDS patients resembled the picture observed in the PH group, while differed from that of the non-COVID ARDS group. A more severe COVID-19 presentation was associated with worse liver dysfunction and enhanced inflammatory activation; these parameters both correlated with abdominal (p = 0.04) and chest imaging measures (p = 0.03).
Conclusion: In COVID-19 ARDS patients there are abdominal and lung vascular modifications that depict a portal hypertension-like pattern. The correlation between visceral vascular remodeling, pulmonary artery enlargement, and organ damage in these critically ill patients is consistent with a portal hyperlfow-like syndrome that could contribute to the peculiar characteristics of respiratory failure in these patients.
Clinical relevance statement: our data suggest that the severity of COVID-19 lung involvement is directly related to the development of a portal hyperflow-like syndrome. These observations should help in defining the need for a closer monitoring, but also to develop dedicated therapeutic strategies.
Keywords: COVID-19; Coronavirus disease 2019; Portal hypertension; Porto-pulmonary hypertension.