Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement

• Published in: Microvascular research Vol. 133; p. 104071
• Main Authors: Natalello, Gerlando, De Luca, Giacomo, Gigante, Laura, Campochiaro, Corrado, De Lorenzis, Enrico, Verardi, Lucrezia, Paglionico, Annamaria, Petricca, Luca, Martone, Anna Maria, Calvisi, Stefania, Ripa, Marco, Cavalli, Giulio, Della-Torre, Emanuel, Tresoldi, Moreno, Landi, Francesco, Bosello, Silvia Laura, Gremese, Elisa, Dagna, Lorenzo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2021
• Subjects: Aged; Capillaries - pathology; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - therapy; Female; Humans; Male; Micro-thrombosis; Microangiopathy; Microscopic Angioscopy; Middle Aged; Nailfold videocapillaroscopy; Nails - blood supply; Predictive Value of Tests; Vascular Diseases - etiology; Vascular Diseases - pathology; COVID-19; Micro-thrombosis; Nailfold videocapillaroscopy; Microangiopathy
• ISSN: 0026-2862; 1095-9319; 1095-9319
• DOI: 10.1016/j.mvr.2020.104071

Increasing evidence points to endothelial dysfunction as a key pathophysiological factor in coronavirus disease-2019 (COVID-19). No specific methods have been identified to predict, detect and quantify the microvascular alterations during COVID-19. Our aim was to assess microvasculature through nailfold videocapillaroscopy (NVC) in COVID-19 patients. We performed NVC in patients with a confirmed diagnosis of COVID-19 pneumonia. Elementary alterations were reported for each finger according to a semi-quantitative score. Capillary density, number of enlarged and giant capillaries, number of micro-hemorrhages and micro-thrombosis (NEMO score) were registered. We enrolled 82 patients (mean age 58.8 ± 13.2 years, male 68.3%) of whom 28 during the hospitalization and 54 after recovery and hospital discharge. At NVC examination we found abnormalities classifiable as non-specific pattern in 53 patients (64.6%). Common abnormalities were pericapillary edema (80.5%), enlarged capillaries (61.0%), sludge flow (53.7%), meandering capillaries and reduced capillary density (50.0%). No pictures suggestive of scleroderma pattern have been observed. Acute COVID-19 patients, compared to recovered patients, showed a higher prevalence of hemosiderin deposits as a result of micro-hemorrhages (P = .027) and micro-thrombosis (P < .016), sludge flow (P = .001), and pericapillary edema (P < .001), while recovered patients showed a higher prevalence of enlarged capillaries (P < .001), loss of capillaries (P = .002), meandering capillaries (P < .001), and empty dermal papillae (P = .006). COVID-19 patients present microvascular abnormalities at NVC. Currently ill and recovered subjects are characterized by a different distribution of elementary capillaroscopic alterations, resembling acute and post-acute microvascular damage. Further studies are needed to assess the clinical relevance of NVC in COVID-19. •We assessed and accurately described peripheral microvasculature in COVID-19 patients through nailfold videocapillaroscopy.•Capillary alterations at the nailfold bed suggest a broad COVID-related microvascular involvement.•Different alterations in acutely-ill and recovered patients resemble a transition from acute to post-acute injury.