• Daniele Dondossola, Caterina Lonati, Alessia Pini, Daniela Bignamini, Alberto Zanella, Rosa Lombardi, Vittorio Scaravilli, Vincenzo La Mura, Laura Forzenigo, Pierpaolo Biondetti, Giacomo Grasselli, Anna Fracanzani, PH-COVID collaborator group, Chiara Paleari, Annalisa Cespiati, Serena Todaro, Emanuele Cattaneo, Marianna Di Feliciantonio, Giordano Sigon, Carlo Valsecchi, Amedeo Guzzardella, Michele Battistin, and Federica Iuculano.
• General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20019 Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20019 Milan, Italy. Electronic address: daniele.dondossola@policlinico.mi.it.
• J Crit Care. 2024 Aug 1; 82: 154759154759.

ObjectivesAlthough respiratory failure is the most common feature in coronavirus disease 2019 (COVID-19), abdominal organ involvement is likewise frequently observed. To investigate visceral and thoracic circulation and abdominal organ damage in COVID-19 patients.Materials And MethodsA monocentric observational study was carried on. In COVID-19 patients affected by acute respiratory distress syndrome (ARDS) (n = 31) or mild pneumonia (n = 60) thoracoabdominal circulation was evaluated using Doppler-ultrasound and computed tomography. The study also included non-COVID-19 patients affected by ARDS (n = 10) or portal hypertension (n = 10) for comparison of the main circulatory changes.ResultsPatients affected by COVID-19 ARDS showed hyperdynamic visceral flow and increased portal velocity, hepatic artery resistance-index, and spleen diameter relative to those with mild-pneumonia (p = 0.001). Splanchnic circulatory parameters significantly correlated with the main respiratory indexes (p < 0.001) and pulmonary artery diameter (p = 0.02). The chest and abdominal vascular remodeling pattern of COVID-19 ARDS patients resembled the picture observed in the PH group, while differed from that of the non-COVID ARDS group. A more severe COVID-19 presentation was associated with worse liver dysfunction and enhanced inflammatory activation; these parameters both correlated with abdominal (p = 0.04) and chest imaging measures (p = 0.03).ConclusionIn COVID-19 ARDS patients there are abdominal and lung vascular modifications that depict a portal hypertension-like pattern. The correlation between visceral vascular remodeling, pulmonary artery enlargement, and organ damage in these critically ill patients is consistent with a portal hyperlfow-like syndrome that could contribute to the peculiar characteristics of respiratory failure in these patients.Clinical Relevance Statementour data suggest that the severity of COVID-19 lung involvement is directly related to the development of a portal hyperflow-like syndrome. These observations should help in defining the need for a closer monitoring, but also to develop dedicated therapeutic strategies.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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