Microvascular Flow and Reactivity in Patients Presenting in the Acute Phase of COVID-19.
Condition: Coronavirus Infection; Endothelial Dysfunction; Microvascular Rarefaction
MeSH terms: Coronavirus Infections; Microvascular Rarefaction
Study type: Observational

Summary: 
      Considering that the intensity of systemic microvascular changes in patients in the acute
      phase of COVID-19 could be related to disease progression and prognosis, the present
      cross-sectional and observational study aims to investigate the presence of endothelial
      dysfunction in these patients, also looking for to evaluate associations between the presence
      of endothelial dysfunction and demographic, clinical and laboratory variables.
    

Detailed description: 
      An association between the presence of previous cardiovascular disease and adverse prognosis
      has been demonstrated in patients with COVID-19 (coronavirus disease-19), presenting
      increases of up to 5-10 times in mortality.

      As an initial process, the SARS-CoV-2 virus, anchored in the transmembrane
      angiotensin-converting enzyme 2 (ECA2), penetrates host cells, including endothelial cells,
      pericytes and macrophages, in addition to type II pneumocytes.

      Cellular invasion results in massive release of several pro-inflammatory cytokines ("cytokine
      storm"), such as IL-1β, IFN-1 and IL-6, by the cells of the immune system. In turn, cytokines
      increase the process of vascular inflammation and the expression of leukocyte-vascular
      endothelium adhesion proteins, which results in endothelial activation accompanied by a
      pro-coagulant and pro-adhesive phenotype - between leukocytes, platelets, red blood cells and
      vascular endothelium - characteristic of the dysfunctional endothelium in the
      microcirculation, which results in severe changes in the microvascular flow and, as a result,
      in tissue perfusion.

      It is also worth noting that the patients most vulnerable to the development of complications
      are those with pre-existing endothelial dysfunction, associated with several risk factors
      such as male gender and smoking, and comorbidities such as hypertension, diabetes and
      obesity, all of which are associated with poor prognosis in COVID -19.

      Considering that the intensity of systemic microvascular changes in patients in the acute
      phase of COVID-19 could be related to disease progression and prognosis, the present
      cross-sectional and observational study aims to investigate the presence of endothelial
      dysfunction in these patients, also evaluating associations between the presence of
      endothelial dysfunction and demographic, clinical and laboratory variables.
    

Intervention name(s): evaluation of skin microvascular flow and reactivity
Intervention type(s): Other
Intervention description(s): evaluation of skin microvascular flow and reactivity using laser Doppler perfusion monitoring
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        - We will include adult patients will with SARS-CoV-2 positive RT-PCR, admitted to the
        hospital in a ward or intensive care unit.
      
Biospecimen description: 
      ultra frozen plasma samples will be stocked for the evaluation of inflammatory
      anti-inflammatory cytokines