Berkan ARMAĞAN, Bahar ÖZDEMİR, Adalet ALTUNSOY AYPAK, Esragül AKINCI, Özlem KARAKAŞ, Serdar Can GÜVEN, Orhan KÜÇÜKŞAHİN, Ahmet OMMA, Abdulsamet ERDEN

Koronavirüs Hastalığı-2019 Hastalarının Tırnak Dibi Kapilleroskopisi ile Değerlendirilmesi

Amaç: Mikrovaskülopati, Koronavirüs hastalığı-2019 (COVID-19) hastalığı komplikasyonlarında rol alan mekanizmalardan biridir. Tırnak dibi kapilleroskopisi (TDK) mikrovasküleriteyi değerlendirmede kullanılan non-invaziv bir yöntemdir. COVID-19 hastalarında endotel disfonksiyonu ve mikrovaskülopatinin saptanmasında yol gösterici olabilir. Gereç ve Yöntem: Şiddetli akut solunum yolu sendromu-CoV-2 testi pozitif çıkmış 54 hastaya TDK yapıldı ve hastalar kapiller yoğunluk, mimari ve morfoloji açısından değerlendirildi. Anormal ve normal kapilleroskopi bulguları olan hastalar COVID-19 klinik semptomları açısından karşılaştırıldı. Bulgular: Çalışmaya alınan hastaların %72’si erkek, yaş ortalaması ise 35,6±11,6 idi. Toplamda 22 hastada (%41) anormal kapilleroskopik değişikliklerden en az 1 tanesi vardı. Kapilleroskopik yaygın anormallikler ise sırasıyla, perikapiller ödem (%43), genişlemiş ve dilate kapil (%24), tortiyozite kapiller (%22) oldu. Hastaların %17’sinde hiperenflamatuvar yanıt görüldü ve 1 hastada yoğun bakım ihtiyacı oldu. Anormal kapilleroskopik değişliği olan hastalarda hiperenflamatuvar yanıt, antisitokin kullanımı ve tromboz sıklığı artmıştı. Sonuç: COVID-19 hastalarında anormal kapilleroskopik bulgular sıklıkla gözlenmiştir. Anormal kapilleroskopik bulguları olan hastalarda hiperenflamatuvar yanıt ve antisitokin ilaç kullanımı sıklığının artması hiperenflamasyon ile mikrovaskülopati arasında bir ilişki olabileceğini düşündürmektedir. TDK’nın, COVID-19 hastalığı klinik tutulumları ile ilişkisini değerlendirmek için daha fazla çalışmaya ihtiyaç vardır.

Evaluation of Coronavirus Disease-2019 Patients with Nailfold Capillaroscopy

Aim: Microvasculopathy is one of the suspected complications in Coronavirus disease-2019 (COVID-19). Nailfold capillaroscopy is a noninvasive method used to evaluate microvascularity. It can be a guide in detecting endothelial dysfunction and microvasculopathy in COVID-19 patients. Materials and Methods: Severe acute respiratory syndrome-CoV-2 polymerase chain reaction positive 54 patients were evaluated. The 2nd-5th digits of both hands were investigated by nailfold capillaroscopy. Capillary density, capillary architecture and capillary morphology were recorded. Patients with abnormal and normal nailfold capillaroscopy findings were compared in terms of COVID-19 clinical symptoms. Results: Of the patients included in the study, 72% were male and the mean age was 35.6±11.6 years. In total, 22 patients (41%) had at least 1 abnormal capillaroscopy change. Diffuse capillaroscopic abnormalities were as follows: pericapillary edema 43%, enlarged and dilated capillaries 24%, and tortiosteal capillaries 22%. Hyperinflammatory response was observed in 17% of the patients and intensive care was required in only 1 patient. The frequency of hyperinflammatory response, anticytokine use and thrombosis increased in patients with abnormal capillaroscopy. Conclusion: Abnormal capillaroscopy findings were found to be frequent in COVID-19 patients. Higher rates of the hyperinflammatory response and anticytokine drug use in patients with abnormal nailfold findings suggest that there may be a relationship between hyperinflammation and microvasculopathy in COVID-19. Further studies are needed to evaluate the clinical relevance of nailfold abnormalities with clinical manifestations of COVID-19 disease.

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