The following is a summary of “Portal hypertension-like pattern in coronavirus disease 2019 acute respiratory distress syndrome,” published in the August 2024 issue of Critical Care by Dondossola et al.

The most common feature of coronavirus disease 2019 (COVID-19) is respiratory failure, and abdominal organ involvement was frequently observed. 

They examined COVID-19 patients with acute respiratory distress syndrome (ARDS) (n=31) or mild pneumonia (n=60), evaluating thoracoabdominal circulation using Doppler ultrasound and computed tomography. Additionally, non-COVID-19 patients with ARDS (n=10) or portal hypertension (n=10) were included for comparison.

The results showed that patients with COVID-19 ARDS exhibited hyperdynamic visceral flow and increased portal velocity, hepatic artery resistance index, and spleen diameter compared to those with mild pneumonia (P=0.001). Splanchnic circulatory parameters significantly correlated with the primary respiratory indexes (P<0.001) and pulmonary artery diameter (P=0.02). The chest and abdominal vascular remodeling pattern of patients with COVID-19 ARDS resembled the PH group but differed from the non-COVID-ARDS group. A more severe COVID-19 presentation was associated with worse liver dysfunction and enhanced inflammatory activation; these parameters correlated with abdominal (P=0.04) and chest imaging measures (P=0.03).

They concluded patients with COVID-19 ARDS demonstrated abdominal and lung vascular modifications resembling portal hypertension, suggesting a portal hyperflow-like syndrome that may contribute to the unique characteristics of critically ill patients with respiratory failure.

Source: sciencedirect.com/science/article/pii/S0883944124002466