ASSESSMENT OF SYSTEMIC INFLAMMATORY-REACTIVE MICROVASCULAR ENDOTHELIOSIS (SIRME) IN COVID-19
Objective. To estimate the value of VEGF-A for assessment of intensity of SIRME, severity and the prognosis of an adverse course of COVID-19. Materials and methods. 160 adult patients with COVID-19 (SARS-CoV-2+ RNA) were observed, mean age 56 years, 110 patients with moderately severe (M-COVID) and 50 patients with severe disease (S-COVID). The SIRME was evaluated by serum VEGF-A using commercial enzyme immunoassay kits according to the manufacturer's instruction. Human VEGF-A (Vascular Endothelial Cell Growth Factor A) «ELISA Kit, Fine Test» (China) were used. VEGF-A median for the control group was: Me (Q1; Q3) = 87.08 (34.87; 182.28). Package of SPSS13U statistical applications (Kruskal-Wallis H Test, ROC-analysis, Mann-Whitney test) was used in data mining. Results. Clinical characteristics of patients with M-COVID were expressed less than with S-COVID and reflected the degree of damage of the respiratory and cardiovascular systems (p < 0.05). The intensity of inflammatory markers and VEGF-A level increased to the maximum in S-COVID, but as respiratory failure and oxygen dependence progressed there was a simultaneous decrease in VEGF-A levels and an increase in inflammation rates, especially when patients were allowed breathing using the artificial pulmonary ventilation. The proposed ratio represented by C-reactive protein (CRP) and VEGF-A proved to be the most informative test for assessing disease severity and SIRME. ROC analysis confirmed high sensitivity and specificity of CRP/VEGF-A ratio for prediction of adverse outcome in artificial pulmonary ventilated patients (p<0.05). Conclusion. VEGF-A score and CRP/VEGF-A ratio represent additional criteria for assessing severity, prognosis of adverse outcome due to progressive SIRME in S-COVID.