Different microcirculatory patterns in patients with COVID-19 and non-COVID-19 ARDS: A multicenter cross-sectional study.

PURPOSE: COVID-19 is a systemic illness with widespread microcirculatory involvement. Nevertheless, reports about the characteristics of sublingual microcirculation in patients with COVID-19 are controversial. In fact, total vascular density has been described as decreased, normal, or increased. Our goal was to assess comprehensively the sublingual microcirculation in patients with COVID-19, comparing it with that of patients with non-COVID-19 ARDS and with healthy volunteers.

MATERIALS AND

METHODS

This was a multicenter cross-sectional study. We included mechanically ventilated patients with ARDS secondary to either COVID-19 (n = 62) or non-COVID-19 ARDS (n = 20), from four intensive care units. We also studied healthy volunteers (n = 20). Sublingual microcirculation was assessed by videomicroscopy.

RESULTS

Total vascular density was higher in COVID-19 ARDS than in the other groups (20.5 [18.4-21.7] vs. 17.6 [15.9-18.3] and 17.7 [16.6-19.4] mm/mm2, P < 0.001). Compared with non-COVID-19, COVID-19 group had less alterations in proportion of perfused vessels and microvascular flow index. A multivariate lineal analysis showed that total vascular density was independently associated with proportion of perfused vessels, SOFA score, base excess, and hematocrit.

CONCLUSIONS

Patients with COVID-19 exhibited a distinctive pattern of sublingual microcirculation, mainly characterized by increased vascular density. This finding could be secondary to enhanced angiogenesis.