Abstract
The COVID-19 pandemic is caused by the SARS CoV-2 virus and can lead to severe lung damage and hyperinflammation. In the context of COVID-19 infection, inflammation-induced degradation of the glycocalyx layer in endothelial cells has been demonstrated. Syndecan-1 (SDC-1) is an established parameter for measuring glycocalyx injury. This prospective, multicenter, observational, cross-sectional study analyzed SDC-1 levels in 24 convalescent patients that had been infected with SARS-CoV-2 with mild disease course without need of hospitalization. We included 13 age-matched healthy individuals and 10 age-matched hospitalized COVID-19 patients with acute mild disease course as controls. In convalescent COVID-19 patients, significantly elevated SDC-1 levels were detected after a median of 88 days after symptom onset compared to healthy controls, whereas no difference was found when compared to SDC-1 levels of hospitalized patients undergoing acute disease. This study is the first to demonstrate signs of endothelial damage in non-pre-diseased, convalescent COVID-19 patients after mild disease progression without hospitalization. The data are consistent with studies showing evidence of persistent endothelial damage after severe or critical disease progression. Further work to investigate endothelial damage in convalescent COVID-19 patients should follow.
Highlights
There was no difference in gender between hospitalized COVID-19 patients and convalescent patients; significantly more women were included in healthy controls (p = 0.046)
COVID-19 patients in a median of 88 days after symptom onset compared with healthy subjects without prior SARS-CoV-2 infection. This was demonstrated in patients after mild disease course, and without prior medical conditions and without regular medication. These results demonstrate for the first time elevated SDC-1 levels as an indication of persistent impairment of glycocalyx after COVID-19 infection with mild disease progression without hospitalization
Our study revealed elevated SDC-1 levels as an implication of persistent endothelial damage in non-pre-diseased, convalescent COVID-19 patients after mild disease progression without hospitalization
Summary
While the infection results in mild to moderate symptoms in most individuals, it triggers severe illness with high mortality in a subgroup of patients. Cells via this mechanism [3,4] This has led to the hypothesis that COVID-19-mediated symptoms are possibly caused by a dysregulation of the vasculature [5,6,7]. Endothelial dysfunction may cause vasoconstriction with resultant organ ischemia, inflammation-induced tissue edema, and a procoagulant effect. The inner surface of all vascular endothelial cells is covered by the glycocalyx. This consists of proteoglycans, glycosaminoglycan side chains, and sialoproteins [8,9,10]. In the context of COVID-19 infection, inflammation-induced degradation of the glycocalyx layer in endothelial cells has been demonstrated. The proteoglycan syndecan-1 (SDC-1) is an important core protein of the endothelial glycocalyx and an established marker of glycocalyx injury [11,12]
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