Risk factors for severe and critically ill COVID‐19 patients: A review

Allergy, Journal Year: 2020, Volume and Issue: 76(2), P. 428 - 455

Published: Nov. 13, 2020

The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome 2 (SARS-CoV-2), has an unprecedented global social and economic impact, high numbers deaths. Many risk factors have been identified in progression COVID-19 into a critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver kidney tumors, clinically apparent immunodeficiencies, local early type I interferon secretion capacity, pregnancy. Possible complications include injury, coagulation disorders, thoromboembolism. development lymphopenia eosinopenia are laboratory indicators COVID-19. Laboratory parameters to monitor lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines interleukin (IL)-6, IL-1β, Krebs von den Lungen-6 (KL-6), ferritin. cytokine storm extensive chest computed tomography imaging patterns disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day initiation treatment, quality health care reported influence individual outcomes. this review, we highlight scientific evidence on severity

Language: Английский

---

COVID-19 and multiorgan failure: A narrative review on potential mechanisms

Journal of Molecular Histology, Journal Year: 2020, Volume and Issue: 51(6), P. 613 - 628

Published: Oct. 4, 2020

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in December 2019 form Wuhan, China leads to disease (COVID-19) pandemic. While the common cold symptoms are observed mild cases, COVID-19 is accompanied by multiorgan failure patients. involvement different organs patients results lengthening hospitalization duration and increasing mortality rate. In this review, we aimed investigate patients, particularly cases. Also, tried define potential underlying mechanisms SARS-CoV2 induced failure. multi-organ dysfunction characterized lung failure, liver kidney injury, cardiovascular disease, as well a wide spectrum hematological abnormalities neurological disorders. most important related direct indirect pathogenic features SARS-CoV2. Although presence angiotensin-converting enzyme 2, receptor lung, heart, kidney, testis, liver, lymphocytes, nervous system was confirmed, there controversial findings about observation RNA these organs. Moreover, organ may be cytokine storm, result increased levels inflammatory mediators, endothelial dysfunction, coagulation abnormalities, infiltration cells into Therefore, further investigations needed detect exact pathogenesis. Since several for clinicians, their knowledge help improve outcomes decrease rate morbidity.

Language: Английский

---

Pathophysiological mechanisms of liver injury in COVID‐19

Liver International, Journal Year: 2020, Volume and Issue: 41(1), P. 20 - 32

Published: Nov. 15, 2020

The recent outbreak of coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in a world-wide pandemic. Disseminated lung injury with development acute respiratory distress syndrome (ARDS) is main cause mortality COVID-19. Although liver failure does not seem to occur absence pre-existing disease, hepatic involvement COVID-19 may correlate overall severity and serve as prognostic factor for ARDS. spectrum range from direct infection SARS-CoV-2, indirect systemic inflammation, hypoxic changes, iatrogenic causes such drugs ventilation exacerbation underlying disease. This concise review discusses potential pathophysiological mechanisms SARS-CoV-2 tropism well possibly long-term

Language: Английский

---

What to do next to control the 2019-nCoV epidemic?

The Lancet, Journal Year: 2020, Volume and Issue: 395(10222), P. 391 - 393

Published: Feb. 1, 2020

The 2019 novel coronavirus (2019-nCoV) infection can lead to acute resolved or fatal pneumonia. On the basis of knowledge other coronaviruses, main route human-to-human transmission 2019-nCoV is probably through respiratory droplets. As Feb 4, 2020, statistical data show that outbreak constitutes an epidemic threat in China, where exponential increase patients has reached 20 438 confirmed cases, with 2788 (13·64%) critical condition and 425 (2·08%) deaths; 23 214 additional suspected cases have also been identified so far. most affected city, Wuhan, related regions Hubei province China reported 13 522 (66·16% total cases) 414 deaths from nCoV (97·41% China). 632 recovered discharged hospital. However, downward turning point for new not observed yet (figure). Notably, 159 countries beyond including Japan, Thailand, Singapore, South Korea, Australia, USA, Malaysia, Germany. Because seriousness this outbreak, WHO declared it a public health emergency international concern on Jan 30, followed by USA announcing 31, 2020. During epidemic, rapid robust research important help guide clinical practices policies. Zhu colleagues sampled bronchoalveolar-lavage fluid three used next-generation sequencing PCR characterise virus, they pathogen as falls within subgenus Sarbecovirus genus Betacoronavirus cytopathic effects (structural changes host cells) virus.1Zhu N Zhang D Wang W et al.A pneumonia 2019.N Engl J Med. 2020; (published online 24.)DOI:10.1056/NEJMoa2001017Crossref PubMed Scopus (18596) Google Scholar Their achievement only improves methods diagnosis confirmation clinics but promotes study underlying mechanisms viral infection.2Zhou P Yang X associated probable bat origin.Nature. 3.)DOI:10.1038/s41586-020-2012-7Crossref (14414) Subsequently, collaborations between Chinese scientists rapidly unmasked some virological features 2019-nCoV. A specific nucleic acid assay using RT-PCR was quickly developed infection.3Corman VM Landt O Kaiser M al.Detection real-time RT-PCR.Euro Surveill. 252000045Crossref (5023) Scholar, 4WHOLaboratory testing human (nCoV) infection: interim guidance, 10 January World Health Organization, Geneva2020Google Additionally, angiotensin-converting enzyme 2 shown be putative receptor entry into cells use bioinformatic prediction in-vitro testing.2Zhou 5Xu Chen al.Evolution ongoing Wuhan modeling its spike protein risk transmission.Sci Life Sci. 21.)DOI:10.1007/s11427-020-1637-5Crossref (1605) 6Letko MC Munster V Functional assessment cell usage lineage B β-coronaviruses, 2019-nCoV.bioRxiv. 22.) (preprint)DOI: 10.1101/2020.01.22.915660Google Furthermore, bats are speculated original zoonotic whether intermediate facilitated humans still unknown.7Lu R Zhao Li al.Genomic characterisation epidemiology coronavirus: implications virus origins binding.Lancet. 30)https://doi.org/10.1016/S0140-6736(20)30251-8Scopus (8216) Lastly, evidence person-to-person accumulating,8Phan LT Nguyen TV Luong QC al.Importation Vietnam.N 28.)DOI:10.1056/NEJMc2001272Crossref (811) 9Chan JF Yuan S Kok KH familial cluster indicating transmission: family cluster.Lancet. 24)https://doi.org/10.1016/S0140-6736(20)30154-9Scopus (6200) estimated R0 2·2 (95% CI 1·4–3·9),10Li Q Guan Wu al.Early dynamics coronavirus-infected pneumonia.N 29.)DOI:10.1056/NEJMoa2001316Crossref (10671) full extent mode urgently needed. In Lancet, two retrospective studies Jin Yin-tan Hospital recently provided first-hand epidemiological, clinical, laboratory, radiological imaging, outcomes among 41 patients11Huang C Y al.Clinical infected China.Lancet. 24)https://doi.org/10.1016/S0140-6736(20)30183-5Scopus (32878) 99 patients.12Chen Zhou Dong al.Epidemiological characteristics China: descriptive study.Lancet. 29)https://doi.org/10.1016/S0140-6736(20)30211-7Scopus (14366) Of pneumonia,12Chen average age 55·5 years (SD 13·1) 50 (51%) had chronic diseases. Clinical manifestations were fever (82 [83%] patients), cough (81 [82%] shortness breath (31 [31%] muscle ache (11 [11%] confusion (nine [9%] headache (eight [8%] sore throat (five [5%] rhinorrhoea (four [4%] chest pain (two [2%] diarrhoea nausea vomiting (one [1%] patient). view findings both studies, well accumulated experience, next crucial step would identify proper treatment No fully proven antiviral exists. Guidance China's National Commission suggests taking anti-HIV drug combination lopinavir ritonavir inhaling dose nebulised interferon α therapy.13Chu CM Role lopinavir/ritonavir SARS: initial findings.Thorax. 2004; 59: 252-256Crossref (1314) Many efforts, several trials, such NCT04246242 NCT04252664, progress screen existing drugs those could efficient against first remdesivir, diagnosed patient USA,14Holshue ML DeBolt Lindquist al.First case United States.N 31.)DOI:10.1056/NEJMoa2001191Crossref (4278) encouraged medication. More importantly, conditions often develop serious complications, distress syndrome (17 [17%] patients),12Chen thus medical groups should include physicians expertise infectious diseases care. It noteworthy reduction peripheral blood lymphocytes.11Huang 12Chen Whether immune infiltrate lungs then cause lung lesions (as occurred severe [SARS])15de Wit E van Doremalen Falzarano VJ SARS MERS: recent insights emerging coronaviruses.Nat Rev Microbiol. 2016; 14: 523-534Crossref (2394) clear. Therefore, understand microenvironment map responses infection, which might define stages uncover pathogenesis disease. Recent showed due failure;11Huang however, no reports pathology who died elderly men higher fatality rate than women younger more healthy patients;11Huang needed determine influencing factors finding. development quicker detection acids ensure accuracy diagnosis. Several challenges remain basic research, mutation transmission, infectivity dynamics, infection-associated pathogenicity vivo. Some suggested spread during incubation period9Chan 16Rothe Schunk Sothmann al.Transmission asymptomatic contact Germany.N 30.)DOI:10.1056/NEJMc2001468Crossref (2813) detectable convalescent period.16Rothe found loose stool suggesting potential faecal–oral route. high priority ascertain persistent carriers exist reach accurate definition when considered cured. Moreover, certainty exists about source prophylactic vaccine under development. acknowledged efforts made Government investigate contain outbreak.17Wang Tang Wei F Updated understanding China.DOI: 10.1002/jmv.25689Google For example, authorities initiated measures isolate extended whole province, stranding 35 million residents heavy-travel Spring Festival holidays. At same time, new-built hospitals put use, 2600 beds decision makers holiday period postponed school openings. at least 68 teams, 8000 nurses, provinces cities went fight disease side local staff.18Huaxia68 teams sent aid control. 2020.Xinhuanet. 3, http://www.xinhuanet.com/english/2020-02/03/c_138752003.htmDate accessed: February 2020Google programmes measure different aspects diagnosis, treatment, prevention 2019-nCoV-associated disease.19Ministry Science Technology People's Republic ChinaEmergency scientific programs control coronavirus-induced pneumonia.http://www.most.gov.cn/kjbgz/202001/t20200125_151233.htmDate: 25, 2020Date Novel therapeutic approaches, allogeneic mesenchymal stem cells, expected trials involving projects meet ethical requirements principle informed consent (eg, NCT04252118). drugs, protective equipment, charitable funds inside outside transported area support response. All these aimed maximise minimise occurrence infections, will in-time protect population rest world. faces challenges, infection; there huge people returning trips after vacation; may difficult lack adequate resources communities rural areas province. First-line staff leading role fighting essential strategies we stick early detection, isolation, With professionals treat patients, substantial measures, accelerated hope points resulting events come soon. We declare competing interests. Epidemiological studyThe clustering onset, likely affect older males comorbidities, result even syndrome. general, line MuLBSTA score, warning model predicting mortality Further investigation explore applicability score infection. Full-Text PDF Genomic binding2019-nCoV sufficiently divergent SARS-CoV human-infecting betacoronavirus. Although our phylogenetic analysis animal sold seafood market represent facilitating emergence humans. Importantly, structural able bind future evolution, adaptation, warrant urgent investigation.

Language: Английский

---

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Alimentary Pharmacology & Therapeutics, Journal Year: 2020, Volume and Issue: 52(4), P. 584 - 599

Published: July 8, 2020

Summary Background The incidence of elevated liver chemistries and the presence pre‐existing chronic disease (CLD) have been variably reported in COVID‐19. Aims To assess prevalence CLD, outcomes patients with without underlying CLD/elevated Methods A comprehensive search electronic databases from 1 December 2019 to 24 April 2020 was done. We included studies reporting CLD or patient Results 107 articles (n = 20 874 patients) were for systematic review. pooled 3.6% (95% CI, 2.5‐5.1) among 15 407 COVID‐19 patients. 23.1% (19.3‐27.3) at initial presentation. Additionally, 24.4% (13.5‐40) developed during illness. drug‐induced injury 25.4% (14.2‐41.4). 1587 severely infected 3.9% (3%‐5.2%). odds developing severe 0.81 (0.31‐2.09; P 0.67) compared non‐CLD had increased risk mortality (OR‐3.46 [2.42‐4.95, < 0.001]) (OR‐2.87 [95% 2.29‐3.6, chemistries. Conclusions Elevated are common presentation severity correlates outcome does not alter Further needed analyse compensated decompensated disease.

Language: Английский

---

Review article: COVID‐19 and liver disease—what we know on 1st May 2020

Alimentary Pharmacology & Therapeutics, Journal Year: 2020, Volume and Issue: 52(2), P. 267 - 275

Published: May 14, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of disease 2019 (COVID-19), became a global threat to human health. Liver impairment has been frequently reported as common manifestation, although its clinical significance is still unclear, particularly in patients with underlying chronic liver (CLD).To summarise changes function tests during SARS-CoV-2 infection and impact COVID-19 CLD.A literature review using online database PubMed was done search terms "SARS-CoV-2", "COVID-19", "liver", "cirrhosis" "liver transplantation".COVID-19 associated different degrees abnormal tests, most notably transaminases, which are usually transitory mild degree. Available evidence suggests that injury may result from direct pathogenic effect by virus, systemic inflammation or toxicity commonly used drugs this subset patients. children minimal no increase enzymes, thus presence should trigger evaluation for diseases. Although it seems CLD not at greater risk acquiring infection, those cirrhosis, hepatocellular carcinoma, non-alcoholic fatty disease, autoimmune diseases transplant have severe COVID-19.Abnormal course common, though clinically significant rare. Further research needed focusing on existing liver-related comorbidities treatment outcome COVID-19.

Language: Английский

---

IL-6 signalling pathway inactivation with siltuximab in patients with COVID-19 respiratory failure: an observational cohort study

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2020, Volume and Issue: unknown

Published: April 3, 2020

Abstract Background Severe COVID-19 is characterised by interstitial pneumonia and hyperinflammation, with elevated levels of pro-inflammatory cytokines, such as IL-6. Effective treatments are urgently needed, IL-6 a rational target to reduce hyperinflammation. Methods An observational, control cohort, single-centre study initiated at the Papa Giovanni XXIII Hospital in Bergamo, Italy included patients confirmed nasopharyngeal swab positive for severe acute respiratory syndrome coronavirus 2 RNA requiring ventilatory support. Patients were treated either best supportive care siltuximab or alone. Propensity score matching was applied minimise differences baseline covariates between patient cohorts. The main outcome mortality siltuximab-treated compared matched-control cohort. This ( S iltuximab i n evere CO VID-19, SISCO) registered ClinicalTrials.gov , identifier NCT04322188 . Findings Thirty received siltuximab, while 188 only care. Siltuximab-treated matched 30 using propensity analysis covariates. 30-day rate significantly lower than cohort (HR 0·462, 95% CI 0·221– 0·965); p=0·0399). mean follow-up 33·3 days (range 7–58 days) 22·8 2–45 Sixteen discharged from hospital, four remained on mechanical ventilation, 10 died. Interpretation rapidly progressing failure support may benefit treatment cytokine-driven hyperinflammation associated disease. These findings require validation randomised controlled clinical trial. Funding Italian Association Cancer Research funded study. EUSA Pharma supplied provided funding data collection, analysis, development publication.

Language: Английский

---

Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis

PLoS ONE, Journal Year: 2021, Volume and Issue: 16(6), P. e0253894 - e0253894

Published: June 29, 2021

To describe the laboratory parameters and biomarkers of cytokine storm syndrome associated with severe fatal COVID-19 cases.A search standardized descriptors synonyms was performed on November 28th, 2020 MEDLINE, EMBASE, Cochrane Central Register Controlled Trials, ClinicalTrials.gov, LILACS, IBECS to identify studies interest. Grey literature searches snowballing techniques were additionally utilized yet-unpublished works related citations. Two review authors independently screened retrieved titles abstracts, selected eligible for inclusion, extracted data from included studies, then assessed risk bias using Newcastle-Ottawa Scale. Eligible those including parameters-including serum interleukin-6 levels-from mild, moderate, or cases. Laboratory parameters, such as interleukin-6, ferritin, hematology, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, D-dimer, studies. Meta-analyses conducted estimate mean differences 95% confidence intervals.The database yielded 9,620 records; 40 (containing a total 9,542 patients) in final analysis. Twenty-one (n = 4,313) cases, eighteen 4,681) predictors cases one study 548) Lymphopenia, thrombocytopenia, elevated levels C-Reactive-Protein, neutrophils leucocytes cases.This points leukocytes, neutrophils, lymphocytes, platelets, D-dimer important syndrome. Elevated hyperferritinemia should be considered red flags systemic inflammation poor prognosis COVID-19.

Language: Английский

---

Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview

Nutrition, Journal Year: 2020, Volume and Issue: 81, P. 111016 - 111016

Published: Sept. 8, 2020

Language: Английский

---

COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist

Digestive Diseases, Journal Year: 2020, Volume and Issue: 39(2), P. 119 - 139

Published: Oct. 9, 2020

Background: COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including digestive system. Summary: This review brings new clinically important information for gastroenterologist. includes: mechanisms of tissue damage seen with virus; immunosuppression in patients inflammatory bowel (IBD) and chronic liver additional risks decompensation cirrhosis; impact on gastrointestinal emergencies, endoscopy, diagnosis treatments. These highlight need understand clinical pharmacology, toxicology therapeutic implications drugs commonly used by gastroenterologists their links COVID-19. Key Messages: Any part system may be affected virus, those pre-existing are at greatest risk adverse outcomes. The drug-drug interactions is considerable seriously ill who often require mechanical ventilation life support. Some repurposed against cause or aggravate some COVID-19-related symptoms also induce injury. Ongoing studies will hopefully identify effective more favourable risk-benefit ratio than many tried

Language: Английский

---