Nailfold Capillaroscopy Findings in Patients with Coronavirus Disease 2019: Broadening the Spectrum of COVID-19 Microvascular Involvement

Overview

Journal Microvasc Res

Specialty Cardiology & Vascular Diseases

Date 2020 Sep 19

PMID 32949574

Citations 35

Authors

Gerlando Natalello

Giacomo De Luca

Laura Gigante

Corrado Campochiaro

Enrico De Lorenzis

Lucrezia Verardi

Annamaria Paglionico

Luca Petricca

Anna Maria Martone

Stefania Calvisi

Marco Ripa

Giulio Cavalli

Emanuel Della-Torre

Moreno Tresoldi

Francesco Landi

Silvia Laura Bosello

Elisa Gremese

Lorenzo Dagna

Affiliations

Soon will be listed here.

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Citing Articles

Automatic assessment of nailfold capillaroscopy software: a pilot study.

Brzezinska O, Rychlicki-Kicior K, Makowska J Reumatologia. 2024; 62(5):346-350.

PMID: 39677877 PMC: 11635619. DOI: 10.5114/reum/194040.

Vascular Pathogenesis in Acute and Long COVID: Current Insights and Therapeutic Outlook.

Kruger A, Joffe D, Lloyd-Jones G, Khan M, Salamon S, Laubscher G Semin Thromb Hemost. 2024; 51(3):256-271.

PMID: 39348850 PMC: 11906225. DOI: 10.1055/s-0044-1790603.

YOLOv8-Based System for Nail Capillary Detection on a Single-Board Computer.

Tuncer S, Yildirim M, Tuncer T, Mulayim M Diagnostics (Basel). 2024; 14(17).

PMID: 39272628 PMC: 11394581. DOI: 10.3390/diagnostics14171843.

Evaluation of Oxidative Stress and Endothelial Dysfunction in COVID-19 Patients.

Berber N, Kurt O, Altintop Geckil A, Erdem M, Raika Kiran T, Otlu O Medicina (Kaunas). 2024; 60(7).

PMID: 39064471 PMC: 11279166. DOI: 10.3390/medicina60071041.

Clinical characteristics and disease course before and after SARS-CoV-2 infection in a large cohort of systemic sclerosis patients.

Avanoglu Guler A, Ozcimen B, Aydogdu M, Sari A, Numune A, Ersan N Turk J Med Sci. 2024; 54(1):76-85.

PMID: 38812619 PMC: 11031159. DOI: 10.55730/1300-0144.5768.

References

Colonna C, Monzani N, Rocchi A, Gianotti R, Boggio F, Gelmetti C . Chilblain-like lesions in children following suspected COVID-19 infection. Pediatr Dermatol. 2020; 37(3):437-440. PMC: 7267284. DOI: 10.1111/pde.14210. View

Monticone G, Colonna L, Palermi G, Bono R, Puddu P . Quantitative nailfold capillary microscopy findings in patients with acrocyanosis compared with patients having systemic sclerosis and control subjects. J Am Acad Dermatol. 2000; 42(5 Pt 1):787-90. DOI: 10.1067/mjd.2000.103046. View

Ciaffi J, Ajasllari N, Mancarella L, Brusi V, Meliconi R, Ursini F . Nailfold capillaroscopy in common non-rheumatic conditions: A systematic review and applications for clinical practice. Microvasc Res. 2020; 131:104036. DOI: 10.1016/j.mvr.2020.104036. View

Pavlov-Dolijanovic S, Damjanov N, Stojanovic R, Vujasinovic Stupar N, Stanisavljevic D . Scleroderma pattern of nailfold capillary changes as predictive value for the development of a connective tissue disease: a follow-up study of 3,029 patients with primary Raynaud's phenomenon. Rheumatol Int. 2011; 32(10):3039-45. DOI: 10.1007/s00296-011-2109-2. View

Sambataro D, Sambataro G, Zaccara E, Maglione W, Polosa R, Afeltra A . Nailfold videocapillaroscopy micro-haemorrhage and giant capillary counting as an accurate approach for a steady state definition of disease activity in systemic sclerosis. Arthritis Res Ther. 2014; 16(5):462. PMC: 4212098. DOI: 10.1186/s13075-014-0462-8. View

Fox S, Akmatbekov A, Harbert J, Li G, Brown J, Vander Heide R . Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020; 8(7):681-686. PMC: 7255143. DOI: 10.1016/S2213-2600(20)30243-5. View

Ciceri F, Beretta L, Scandroglio A, Colombo S, Landoni G, Ruggeri A . Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020; 22(2):95-97. PMC: 10692450. View

Bikdeli B, Madhavan M, Jimenez D, Chuich T, Dreyfus I, Driggin E . COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020; 75(23):2950-2973. PMC: 7164881. DOI: 10.1016/j.jacc.2020.04.031. View

Andracco R, Irace R, Zaccara E, Vettori S, Maglione W, Riccardi A . The cumulative number of micro-haemorrhages and micro-thromboses in nailfold videocapillaroscopy is a good indicator of disease activity in systemic sclerosis: a validation study of the NEMO score. Arthritis Res Ther. 2017; 19(1):133. PMC: 5470283. DOI: 10.1186/s13075-017-1354-5. View

10.

Etehad Tavakol M, Fatemi A, Karbalaie A, Emrani Z, Erlandsson B . Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated?. Biomed Res Int. 2015; 2015:974530. PMC: 4569783. DOI: 10.1155/2015/974530. View

11.

Harzallah I, Debliquis A, Drenou B . Lupus anticoagulant is frequent in patients with Covid-19. J Thromb Haemost. 2020; 18(8):2064-2065. PMC: 7264773. DOI: 10.1111/jth.14867. View

12.

Cavalli G, Luca G, Campochiaro C, Della-Torre E, Ripa M, Canetti D . Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020; 2(6):e325-e331. PMC: 7252085. DOI: 10.1016/S2665-9913(20)30127-2. View

13.

Cutolo M, Sulli A, Pizzorni C, Accardo S . Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000; 27(1):155-60. View

14.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View

15.

Ackermann M, Verleden S, Kuehnel M, Haverich A, Welte T, Laenger F . Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020; 383(2):120-128. PMC: 7412750. DOI: 10.1056/NEJMoa2015432. View

16.

Sardu C, Gambardella J, Morelli M, Wang X, Marfella R, Santulli G . Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence. J Clin Med. 2020; 9(5). PMC: 7290769. DOI: 10.3390/jcm9051417. View

17.

Smith V, Herrick A, Ingegnoli F, Damjanov N, De Angelis R, Denton C . Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev. 2020; 19(3):102458. DOI: 10.1016/j.autrev.2020.102458. View

18.

Kaur S, Tripathi D, Yadav A . The Enigma of Endothelium in COVID-19. Front Physiol. 2020; 11:989. PMC: 7417426. DOI: 10.3389/fphys.2020.00989. View

19.

Eriksson S, Nilsson J, Sturesson C . Non-invasive imaging of microcirculation: a technology review. Med Devices (Auckl). 2014; 7:445-52. PMC: 4267586. DOI: 10.2147/MDER.S51426. View

20.

Pancar G, Kaynar T . Nailfold capillaroscopic changes in patients with chronic viral hepatitis. Microvasc Res. 2020; 129:103970. DOI: 10.1016/j.mvr.2019.103970. View