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Endothelium is a known target of Covid-19. However, little is known about the effect of chronic immunosuppression in modulating endothelial dysfunction. This study aimed to evaluate the association between endothelial injury biomarkers and mortality in solid organ transplant (SOT) recipients hospitalized due to Covid-19.
Prospective cohort including SOT recipients from two Brazilian transplant centers between July 2020 and July 2021. Only patients with a positive RT-PCR for SARS-CoV-2 requiring hospitalization were included. The evaluated biomarkers were VCAM-1, syndecan-1, and angiopoietins 1 and 2 (ANG-1 and ANG-2), collected within 24h of hospital admission. Patients were followed for 3 months after the diagnosis of Covid-19.
The sample consisted of 52 patients, 59.6% male, with a mean age of 56 ± 14 years, kidney transplant recipients (76.9%) for a long period (median of 6 years). Twenty-nine (55.8%) patients died. In univariate analysis, there was no difference between the groups of surviving patients and those who deceased regarding the biomarkers ANG-1 (64.0 ± 13.7 vs. 60.2 ± 16.9 ng/mL, p=0.392), VCAM-1 (2,721 ± 865 vs. 2,933 ± 1,281 ng/mL, p=0.501), and syndecan-1 [343.0 (IQR 113.6 - 463.0) vs. 515.2 (IQR 173.0 - 4,102.3) ng/mL, p=0.194). However, the mean values of ANG-2 (3.8 ± 2.3 vs. 6.0 ± 3.4 ng/mL, p=0.012), as well as the ANG-2/ANG-1 ratio (0.06 vs. 0.08, p=0.009), were significantly higher among those patients who experienced mortality. In multivariate analysis, adjusted for confounders, syndecan-1 level > 720 ng/mL was independently associated with mortality (HR 10.9, 95% CI: 2.428 – 49.344, p=0.002).
Endothelial damage are associated with Covid-19 mortality in SOT recipients, as demonstrated in immunocompetent individuals, suggesting that immunosuppression does not significantly modulate endothelial dysfunction caused by the infection.