COVID-19: the key role of pulmonary capillary leakage. An observational cohort study

摘要: Background: COVID-19 induces progressive hypoxemic respiratory failure and acute distress syndrome, mostly due to a dysregulated inflammatory response. Since the first observations of patients, significant hypoalbuminemia was detected. This study aimed investigate hypothesis that in patients is pulmonary capillary leakage test its correlation with indicators function. Methods: 174 92 admitted Intermediate Medicine ward (IMW), 82 Intensive Care Unit (ICU) at Luigi Sacco Hospital Milan were included this study. Findings: Serum albumin concentration decreased whole cohort, ICU displaying lower values than IMW [20 (18-23) vs 28 (24-33) g/L, p<0.0001]. Lower found belonging more compromised group (lower PaO2 FiO2 ratio worst chest X-ray findings). In subset 26 analysis bronchoalveolar lavage fluid (BALF) highlighted high protein concentrations, which correlated Interleukin-8 Interleukin-10 BALF concentration. The length hospitalisation (15-29) 8 (5-14) days, p<0.0001] death rate (52.4% 21.7%, p<0.0001) higher while strict relation between 30 day-survival detected cohort. Electron microscopy examinations eight out ten autopsy lung tissues showed diffuse loosening interendothelial junctional complex. Interpretation: degree can be considered as useful severity marker hospitalised patients. Pulmonary leak syndrome secondary hyperinflammatory state plays key role pathogenesis dysfunction should regarded therapeutic target.