الفهرس 
COVID-19Only 14 pages are availabe for public view
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Abstract
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) represents a rare but severe complication of severe acute respiratory syndrome coronavirus infection affecting children. Endothelial inflammation and vasculitis are known hallmarks of acute COVID-19 and MIS-C. Vascular endothelial cadherin (VE-cadherin) is a strictly endothelial specific adhesion molecule located at junctions between endothelial cells. It may represent a biomarker of endothelial dysfunction and holds a promise as a marker of critical illness. Aim: Serum levels of VE-cadherin as marker of endothelial dysfunction was assessed among MIS-C patients compared with COVID-19 patients and also, assessed its relation to clinical, laboratory and radiological variables. Methods: Sixty patients were divided into two groups; patients with MIS-C (n=30) with median age 7 (4.5-8) years old and patients COVID-19 (n=30) with median age 5.6 (3.3-7.0) years old. They were compared with 30 healthy controls. Chest X-ray, computed tomography (CT)-chest, electrocardiogram (ECG) and echocardiography were performed. Covid-19 polymerase chain reaction, Covid-19 antibodies, complete blood count, blood gases, C-reactive protein, D-dimer, lactate dehydrogenase, serum ferritin, total creatine kinase and MB fraction, Troponin I, liver and kidney function tests as well as VE-cadherin levels were assessed. Results: VE-cadherin levels were significantly higher in MIS-C patients and COVID-19 patients compared with healthy controls while no significant difference between both patients group. VE-cadherin levels were significantly higher in MIS-C patients with urine output < 2 mL and in MIS-C patients who needed vasoactive support. VE-cadherin levels were significantly higher in MIS-C patients with abnormal chest X-ray and those with left ventricle dilatation. VE-cadherin levels were also significantly higher in COVID-19 patients with abnormal chest X-ray and positive CT-chest. There was a significant negative correlation between VE-cadherin and platelet count in patients with MIS-C while VE-cadherin was positively correlated to creatinine level in both MIS-C and COVID-19 groups. ROC curve analysis showed that VE-cadherin cutoff 24.28 ng/mL could detect MIS-C patients with abnormal chest X-ray results with 77.27% specificity and 100% sensitivity and also, VE-cadherin cutoff 17.5 ng/mL could detect MIS-C patients with LV dilatation with 81.25% specificity and 71.43% sensitivity. ROC curve analysis showed that VE-cadherin cutoff 17.5 ng/mL could detect COVID-19 patients with abnormal chest X-ray results with 69.23% specificity and 100% sensitivity. Conclusion: VE-cadherin levels are equally elevated in children and adolescents with COVID-19 and MIS-C suggesting that endothelial dysfunction is equally present in both diseases. VE-cadherin levels are elevated in patients with abnormal chest X-ray results and positively correlated to creatinine levels. This suggests that VE-Cadherin levels are mainly related to lung and kidney injury in COVID-19 and MIS-C patients. VE-cadherin could be a promising serum biomarker for detection of disease severity in COVID-19 and MIS-C patients. Further larger prospective studies with serial measurement of VE-cadherin levels are needed to verify our results and validate VE-cadherin cutoff that could detect chest abnormalities before incorporation in patients’ therapeutic regimen.