Medizinische Universität Graz - Research portal
Selected Publication:
Greistorfer, T.
Pathophysiologische und klinische Aspekte Covid-19 assoziierter Vaskulopathien
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 139
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- Authors Med Uni Graz:
- Advisor:
- Hafner Franz
- Jud Philipp
- Altmetrics:
- Abstract:
- The current Covid-19 pandemic, caused by the emerged coronavirus SARS-CoV-2 in late 2019, leads to a tremendous knowledge gain in the field of infection-associated vasculopathies. A complex interaction between the endothelium, immune cells and coagulation seems to trigger these vascular events. Especially, patients with severe Covid-19 develop frequently arterial and venous thrombotic events, and certain vasculitides have also been described in the literature. The aim of this review was to assess the key pathophysiologic and clinical aspects of Covid-19 associated vasculopathies regarding their occurence within the vasculature and the involved mechanisms. Clinical aspects of vasculopathies were reviewed with special emphasis on their epidemiology, clinical features, management and treatment and comparison to non-Covid-19 cohorts. An electronic search was conducted from February 2021 to September 2022 in the following databases: MEDLINE, the Cochrane Library Database, Google scholar, and ClinicalTrials.gov. The received and included article types ranged from laboratory studies and case series, over observational studies and cohort studies to controlled clinical trials and meta-analyses. Pathophysiologic aspects revealed crucial interactions between virus-triggered endothelial dysfunction, NET formation and immunothrombosis in the formation of microthrombi throughout the vasculature. Different biomarkers, including D-dimer, von Willebrand factor (vWF) antigen, soluble thrombomodulin (sTM), plasminogen activator inhibitor 1 (PAI-1), and ADAMTS13-activities were found to indicate the exaggerating mechanisms and are also of prognostic value. Venous thromboembolic events and strokes are more frequently observed in patients with Covid-19 compared to non-Covid-19 patients, while clinical features only showed minor differences despite trends towards more severe courses. Additionally, mortality rates were increased in patients with concomitant Covid-19 and pulmonary embolism (PE), which also applied to most arterial thrombotic complications. While endotheliitis is a common finding in Covid-19, genuine vasculitides related to SARS-CoV-2 are rare findings and predominantly occur as cutaneous small vessel vasculitis and Kawasaki-like disease, typically associated with multisystem inflammatory syndrome. This review indicates that thrombotic events in hospitalized Covid-19 patients are common and arise through a cascade of mechanisms, which can be detected using different biomarkers. While the symptomatology, management and treatment approaches mostly resemble those of non-Covid-19 cases, epidemiology and mortality rates are often increased in hospitalized Covid-19 patients.