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Bergamaschi G, Barteselli C, Calabretta F, Lenti MV, Merli S, Rossi CM, Di Sabatino A. Haematological sequelae in the post-acute phase of symptomatic SARS-CoV-2 infection. Intern Emerg Med 2024; 19:125-133. [PMID: 38001354 DOI: 10.1007/s11739-023-03459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/10/2023] [Indexed: 11/26/2023]
Abstract
Many patients surviving SARS-CoV-2 infection suffer from long-term symptoms (long COVID or post COVID) such as shortness of breath, fatigue, loss of taste or smell and cognitive deterioration. However, few data are available concerning blood cell counts and haematological parameters during the post-COVID period. We analysed haematological data from 83 patients previously admitted to the internal medicine unit of our institution because of symptomatic SARS-CoV-2 infection; all data were obtained within 1-12 months from disease onset. A control group of 70 apparently healthy, age- and sex-matched COVID-19 negative individuals was assessed for comparison. Blood cell counts improved in the post-COVID period, but 81% of patients had persistent abnormalities, compared with 50% in the control group, p < 0.001. Most common haematological findings included anaemia (40%), reduced lymphocyte (43%) or eosinophil counts (38%) and low IgM memory B cells and correlated with advanced age, number of chronic comorbidities, female gender, altered renal function, reduced baseline Hb and procalcitonin concentrations and increased RDW. Data on lymphocytes and IgM memory B cells show that impaired immune responses may persist for up to one year in the post-COVID period, possibly contributing to long-term symptoms, especially in female patients.
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Affiliation(s)
- Gaetano Bergamaschi
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy.
| | - Chiara Barteselli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Francesca Calabretta
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Marco Vincenzo Lenti
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Stefania Merli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Carlo Maria Rossi
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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2
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Akkiz H. Unraveling the Molecular and Cellular Pathogenesis of COVID-19-Associated Liver Injury. Viruses 2023; 15:1287. [PMID: 37376587 DOI: 10.3390/v15061287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 06/29/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) continues to cause substantial morbidity and mortality. Most infections are mild; however, some patients experience severe and potentially fatal systemic inflammation, tissue damage, cytokine storm, and acute respiratory distress syndrome. Patients with chronic liver disease have been frequently affected, experiencing high morbidity and mortality. In addition, elevated liver enzymes may be a risk factor for disease progression, even in the absence of underlying liver disease. While the respiratory tract is a primary target of SARS-CoV-2, it has become evident that COVID-19 is a multisystemic infectious disease. The hepatobiliary system might be influenced during COVID-19 infection, ranging from a mild elevation of aminotransferases to the development of autoimmune hepatitis and secondary sclerosing cholangitis. Furthermore, the virus can promote existing chronic liver diseases to liver failure and activate the autoimmune liver disease. Whether the direct cytopathic effects of the virus, host reaction, hypoxia, drugs, vaccination, or all these risk factors cause liver injury has not been clarified to a large extent in COVID-19. This review article discussed the molecular and cellular mechanisms involved in the pathogenesis of SARS-CoV-2 virus-associated liver injury and highlighted the emerging role of liver sinusoidal epithelial cells (LSECs) in virus-related liver damage.
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Affiliation(s)
- Hikmet Akkiz
- Department of Gastroenterology and Hepatology, Medical Faculty, Bahçeşehir University, Istanbul 34349, Turkey
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3
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Liatsos GD. SARS-CoV-2 induced liver injury: Incidence, risk factors, impact on COVID-19 severity and prognosis in different population groups. World J Gastroenterol 2023; 29:2397-2432. [PMID: 37179584 PMCID: PMC10167898 DOI: 10.3748/wjg.v29.i16.2397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 04/24/2023] Open
Abstract
Liver is unlikely the key organ driving mortality in coronavirus disease 2019 (COVID-19) however, liver function tests (LFTs) abnormalities are widely observed mostly in moderate and severe cases. According to this review, the overall prevalence of abnormal LFTs in COVID-19 patients ranges from 2.5% to 96.8% worldwide. The geographical variability in the prevalence of underlying diseases is the determinant for the observed discrepancies between East and West. Multifactorial mechanisms are implicated in COVID-19-induced liver injury. Among them, hypercytokinemia with "bystander hepatitis", cytokine storm syndrome with subsequent oxidative stress and endotheliopathy, hypercoagulable state and immuno-thromboinflammation are the most determinant mechanisms leading to tissue injury. Liver hypoxia may also contribute under specific conditions, while direct hepatocyte injury is an emerging mechanism. Except for initially observed severe acute respiratory distress syndrome corona virus-2 (SARS-CoV-2) tropism for cholangiocytes, more recent cumulative data show SARS-CoV-2 virions within hepatocytes and sinusoidal endothelial cells using electron microscopy (EM). The best evidence for hepatocellular invasion by the virus is the identification of replicating SARS-CoV-2 RNA, S protein RNA and viral nucleocapsid protein within hepatocytes using in-situ hybridization and immunostaining with observed intrahepatic presence of SARS-CoV-2 by EM and by in-situ hybridization. New data mostly derived from imaging findings indicate possible long-term sequelae for the liver months after recovery, suggesting a post-COVID-19 persistent live injury.
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Affiliation(s)
- George D Liatsos
- Department of Internal Medicine, Hippokration General Hospital, Athens 11527, Attiki, Greece
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Chakraborty R, Sharma D, Kapoor DU, Dwivedi A, Khabiya R, Sen S. Implications of metabolic dysfunction associated fatty liver disease in COVID-19. World J Clin Cases 2023; 11:1275-1286. [PMID: 36926128 PMCID: PMC10013103 DOI: 10.12998/wjcc.v11.i6.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/20/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Metabolic associated fatty liver disorder (MAFLD) characterizes the contributing etiologies (i.e., type 2 diabetes mellitus, metabolic syndrome, overweight) of individuals with fatty liver disease that affects 1/3rd of the world population. In 2020, the coronavirus disease 2019 (COVID-19) crisis was unprecedented, and people with different comorbidities became more susceptible to the infection caused by severe acute respiratory syndrome coronavirus 2. MAFLD patients are frequently obese with added metabolic menace like diabetes, hypertension, and dyslipidemia leading to greater jeopardy of COVID-19. MAFLD patients are 4 to 6-fold more prone towards infections. COVID-19 induces liver injury with elevated levels of aspartate aminotransferase and alanine aminotransferase and insignificantly elevated bilirubin. Hence, MAFLD in COVID-19 patients worsens the condition significantly. The evidence highlighting the interaction between MAFLD and altered liver functioning in COVID-19 suggested that COVID-19 patients with pre-existing MAFLD are at greater risk of morbidity or intensive care unit admission. Direct hepatic injury, enhanced levels of inflammatory cytokines, declined hepatic mitochondrial activity, and compromised immunity are considered as some underlying mechanisms. The main focus of this review is to discuss the implications of metabolic dysfunction associated with fatty liver disease in COVID-19 patients. The review systematically analyzes the effect of striking two worldwide pandemics (MAFLD and COVID-19) together in the present era.
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Affiliation(s)
- Raja Chakraborty
- Institute of Pharmacy, Assam Don Bosco University, Guwahati 782402, Assam, India
| | - Deepak Sharma
- School of Medical Sciences, Adamas University, Kolkata 700126, West Bengal, India
| | - Devesh U Kapoor
- Department of Pharmacy, Dr. Dayaram Patel Pharmacy College, Bardoli 394601, Gujarat, India
| | - Akanksha Dwivedi
- Department of Pharmacy, Acropolis Institute of Pharmaceutical Education & Research, Indore 453771, Madhya Pradesh, India
| | - Rakhi Khabiya
- Department of Pharmacy, Acropolis Institute of Pharmaceutical Education & Research, Indore 453771, Madhya Pradesh, India
| | - Saikat Sen
- Faculty of Pharmaceutical Science, Assam down town University, Guwahati 781026, Assam, India
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Rabaan AA, Smajlović S, Tombuloglu H, Ćordić S, Hajdarević A, Kudić N, Mutai AA, Turkistani SA, Al-Ahmed SH, Al-Zaki NA, Al Marshood MJ, Alfaraj AH, Alhumaid S, Al-Suhaimi E. SARS-CoV-2 infection and multi-organ system damage: A review. Biomol Biomed 2023; 23:37-52. [PMID: 36124445 PMCID: PMC9901898 DOI: 10.17305/bjbms.2022.7762] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
The SARS-CoV-2 infection causes COVID-19, which has affected approximately six hundred million people globally as of August 2022. Organs and cells harboring angiotensin-converting enzyme 2 (ACE2) surface receptors are the primary targets of the virus. However, once it enters the body through the respiratory system, the virus can spread hematogenously to infect other body organs. Therefore, COVID-19 affects many organs, causing severe and long-term complications, even after the disease has ended, thus worsening the quality of life. Although it is known that the respiratory system is most affected by the SARS-CoV-2 infection, many organs/systems are affected in the short and long term. Since the COVID-19 disease simultaneously affects many organs, redesigning diagnostic and therapy policies to fit the damaged organs is strongly recommended. Even though the pathophysiology of many problems the infection causes is unknown, the frequency of COVID-19 cases rises with age and the existence of preexisting symptoms. This study aims to update our knowledge of SARS-CoV-2 infection and multi-organ dysfunction interaction based on clinical and theoretical evidence. For this purpose, the study comprehensively elucidates the most recent studies on the effects of SARS-CoV-2 infection on multiple organs and systems, including respiratory, cardiovascular, gastrointestinal, renal, nervous, endocrine, reproductive, immune, and parts of the integumentary system. Understanding the range of atypical COVID-19 symptoms could improve disease surveillance, limit transmission, and avoid additional multi-organ-system problems.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan,Correspondence to Ali A. Rabaan: ; Huseyin Tombuloglu:
| | - Samira Smajlović
- Laboratory Diagnostics Institute Dr. Dedić, Bihać, Bosnia and Herzegovina
| | - Huseyin Tombuloglu
- Department of Genetics Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia,Correspondence to Ali A. Rabaan: ; Huseyin Tombuloglu:
| | - Sabahudin Ćordić
- Cantonal Hospital “Dr. Irfan Ljubijankić”, Microbiological Laboratory, Bihać, Bosnia and Herzegovina
| | - Azra Hajdarević
- International Burch University, Faculty of Engineering and Natural Sciences, Department of Genetics and Bioengineering, Ilidža, Bosnia and Herzegovina
| | - Nudžejma Kudić
- University of Sarajevo, Faculty of Agriculture and Food Science, Sarajevo, Bosnia and Herzegovina
| | - Abbas Al Mutai
- Research Center, Almoosa Specialist Hospital, Al Mubarraz, Saudi Arabia,College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia,School of Nursing, Wollongong University, Wollongong, NSW, Australia,Nursing Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | - Shamsah H Al-Ahmed
- Specialty Pediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Nisreen A Al-Zaki
- Specialty Pediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Mona J Al Marshood
- Specialty Pediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ebtesam Al-Suhaimi
- Biology Department, College of Science and Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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6
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Ait Hamdan Y, El Amerany F, Desbrières J, Aghrinane A, Oudadesse H, Rhazi M. The evolution of the global COVID-19 epidemic in Morocco and understanding the different therapeutic approaches of chitosan in the control of the pandemic. Polym Bull (Berl) 2022; 80:1-27. [PMID: 36466080 PMCID: PMC9685138 DOI: 10.1007/s00289-022-04579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
In 2020, Coronavirus disease (COVID-19), a new viral respiratory disease caused by a virus that belongs to Coronaviridae family, has been identified. It is a very severe flu that negatively affects the functions of the lung and other respiratory organs. COVID-19 virus can be transmitted between people either by touching an infected person or by direct contact with their respiratory droplets. Therefore, the COVID-19 virus has become a global concern due to its rapid spread and severity. Based on the World Health Organization report from 2 March 2020 to 24 October 2022, the total infected cases and deaths in Morocco are around 1,265,389 (3.46%) and 16,280 (0.04%), respectively. Recently, some scientists have found that chitosan, a polymer existed in nature, can inhibit COVID-19 infection and repair damaged tissue. Therefore, understanding chitosan mechanisms in controlling COVID-19, might lead to innovative strategies in the medical field, such as developing drugs against SARS-CoV-2, and replacing vaccines, which have negative side effects. This review aims to show the evolution of the COVID-19 pandemic worldwide, specifically in Morocco, its pathophysiology, and its ability to silence the immune system. This review also provides an overview of the treatments and measures applied to protect human beings and how chitosan acts and controls COVID-19.
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Affiliation(s)
- Youssef Ait Hamdan
- Interdisciplinary Laboratory in Bio-Resources, Environment and Materials, Higher Normal School, Department of Biology, Cadi Ayyad University, 40000 Marrakech, Morocco
- Univ Rennes, CNRS, ISCR-UMR 6226, F-35000 Rennes, France
| | - Fatima El Amerany
- Interdisciplinary Laboratory in Bio-Resources, Environment and Materials, Higher Normal School, Department of Biology, Cadi Ayyad University, 40000 Marrakech, Morocco
- Laboratory of Sustainable Development and Health Research, Department of Chemistry, Faculty of Science and Technology of Marrakech, Cadi Ayyad University, PO Box 549, 40000 Marrakech, Morocco
| | - Jacques Desbrières
- IPREM, University of Pau and Adour Countries (UPPA), Hélioparc Pau Pyrénées, 2 Avenue P. Angot, 64053 PAU Cedex 09, France
| | - Abdessadek Aghrinane
- Laboratory of Plant Biotechnology, Ecology and Ecosystem Valorization, Faculty of Sciences, University Chouaib Doukkali, 24000 El Jadida, Morocco
| | | | - Mohammed Rhazi
- Interdisciplinary Laboratory in Bio-Resources, Environment and Materials, Higher Normal School, Department of Biology, Cadi Ayyad University, 40000 Marrakech, Morocco
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Lenti MV, Uderzo S, Rossi CM, Melazzini F, Klersy C, Ferretti VV, Di Sabatino A. Determinants of COVID-19-related mortality in an internal medicine setting. Intern Emerg Med 2022; 17:2169-2173. [PMID: 35906347 PMCID: PMC9520996 DOI: 10.1007/s11739-022-03057-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Stefano Uderzo
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Carlo Maria Rossi
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Melazzini
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Virginia Valeria Ferretti
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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Targoński R, Gąsecka A, Prowancki A, Targoński R. An alternative to airborne droplet transmission route of SARS-CoV-2, the feco-oral route, as a factor shaping COVID-19 pandemic. Med Hypotheses 2022; 166:110903. [PMID: 35791352 PMCID: PMC9247218 DOI: 10.1016/j.mehy.2022.110903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 01/08/2023]
Abstract
The Chinese scenario, a rapid increase in the frequency of SARS-CoV-2 infections and sudden decline, is uncommon worldwide. Enormous differences in COVID-19 severity among individual countries are the striking findings of the pandemics. It has been demonstrated that a mild course of COVID-19 is associated with gastrointestinal symptoms, less inflammatory response, and better prognosis. The presence of SARS-CoV-2 was observed longer in the gastrointestinal tract than in respiratory swabs, promoting feco-oral transmissions and mild virus attenuation. The spread of the pandemic and its severity might, consequently, depends on the dominant environmental route of infection and emerging immunity. We hypothesize that the feco-oral SARS-CoV-2 transmission may help to achieve the long-term immunity against COVID-19, since it enables the continuous contact with viral antigens in the gastrointestinal tract, resulting in lower mortality rate. To conclude, countries producing rice through traditional methods developed rapidly emerging long-lasting population immunity, possibly through increased SARS-CoV-2 antigen exposure in the gastrointestinal tract. Our hypothesis brings attention to this potential route of herd immunity against SARS-CoV-2 which warrants further investigation in the future.
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Affiliation(s)
- Ryszard Targoński
- Cardiology and Internal Medicine Clinic, Metropolitan Hospital in Olsztyn, University of University of Warmia and Mazury, Olsztyn, Poland
| | - Aleksandra Gąsecka
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Adrian Prowancki
- Cardiology and Internal Medicine Clinic, Metropolitan Hospital in Olsztyn, University of University of Warmia and Mazury, Olsztyn, Poland
- Department of Human Physiology and Pathophysiology, University of University of Warmia and Mazury, Olsztyn, Poland
| | - Radosław Targoński
- 1 Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
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Albanesi M, Cozzi D, Cavigli E, Moroni C, Frezzetti G, Bartolini L, Miele V. Systemic Emergencies in COVID-19 Patient: A Pictorial Review. Tomography 2022; 8:1041-51. [PMID: 35448718 PMCID: PMC9031887 DOI: 10.3390/tomography8020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Since the first report of the outbreak in Wuhan, China in December 2019, as of 1 September 2021, the World Health Organization has confirmed more than 239 million cases of the novel coronavirus (SARS-CoV-2) infectious disease named coronavirus disease 2019 (COVID-19), with more than 4.5 million deaths. Although SARS-CoV-2 mainly involves the respiratory tract, it is considered to be a systemic disease. Imaging plays a pivotal role in the diagnosis of all manifestations of COVID-19 disease, as well as its related complications. The figure of the radiologist is fundamental in the management and treatment of the patient. The authors try to provide a systematic approach based on an imaging review of major multi-organ manifestations of this infection.
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Sinatti G, Santini SJ, Tarantino G, Picchi G, Cosimini B, Ranfone F, Casano N, Zingaropoli MA, Iapadre N, Bianconi S, Armiento A, Carducci P, Ciardi MR, Mastroianni CM, Grimaldi A, Balsano C. PaO 2/FiO 2 ratio forecasts COVID-19 patients' outcome regardless of age: a cross-sectional, monocentric study. Intern Emerg Med 2022; 17:665-673. [PMID: 34637082 PMCID: PMC8505469 DOI: 10.1007/s11739-021-02840-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
We studied the predictive value of the PaO2/FiO2 ratio for classifying COVID-19-positive patients who will develop severe clinical outcomes. One hundred fifty patients were recruited and categorized into two distinct populations ("A" and "B"), according to the indications given by the World Health Organization. Patients belonging the population "A" presented with mild disease not requiring oxygen support, whereas population "B" presented with a severe disease needing oxygen support. The AUC curve of PaO2/FiO2 in the discovery cohort was 0.838 (95% CI 0.771-0.908). The optimal cut-off value for distinguishing population "A" from the "B" one, calculated by Youden's index, with sensitivity of 71.79% and specificity 85.25%, LR+4.866, LR-0.339, was < 274 mmHg. The AUC in the validation cohort of 170 patients overlapped the previous one, i.e., 0.826 (95% CI 0.760-0.891). PaO2/FiO2 ratio < 274 mmHg was a good predictive index test to forecast the development of a severe respiratory failure in SARS-CoV-2-infected patients. Moreover, our work highlights that PaO2/FiO2 ratio, compared to inflammatory scores (hs-CRP, NLR, PLR and LDH) indicated to be useful in clinical managements, results to be the most reliable parameter to identify patients who require closer respiratory monitoring and more aggressive supportive therapies. Clinical trial registration: Prognostic Score in COVID-19, prot. NCT04780373 https://clinicaltrials.gov/ct2/show/NCT04780373 (retrospectively registered).
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Affiliation(s)
- Gaia Sinatti
- School of Emergency and Urgency Medicine, Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L’Aquila, L’Aquila, Italy
| | - Silvano Junior Santini
- School of Emergency and Urgency Medicine, Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L’Aquila, L’Aquila, Italy
| | - Giovanni Tarantino
- Clinical Medicine and Surgery Department, Federico II University Medical School of Naples, Naples, Italy
| | - Giovanna Picchi
- Department of Infectious Disease, San Salvatore Hospital, L’Aquila, Italy
| | - Benedetta Cosimini
- School of Emergency and Urgency Medicine, Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L’Aquila, L’Aquila, Italy
| | - Francesca Ranfone
- School of Emergency and Urgency Medicine, Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L’Aquila, L’Aquila, Italy
| | - Nicolò Casano
- School of Emergency and Urgency Medicine, Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L’Aquila, L’Aquila, Italy
| | | | - Nerio Iapadre
- Department of Infectious Disease, San Salvatore Hospital, L’Aquila, Italy
| | - Simone Bianconi
- Emergency and Acceptance Department, San Pietro Hospital, Rome, Italy
| | | | - Paolo Carducci
- Department of Pneumology, San Salvatore Hospital, L’Aquila, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | | | - Clara Balsano
- School of Emergency and Urgency Medicine, Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L’Aquila, L’Aquila, Italy
- Department of Internal Medicine and Public Health, University of L’Aquila, L’Aquila, Italy
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11
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Abbas HD, Kadhim SJ. A Physiological Study to Evaluate Liver Function in Male and Female Patients Infected with COVID-19 Virus in Najaf City. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
COVID-19 infection usually causes respiratory distress syndrome. Liver impairment has been reported, there is no clear mechanism for liver damage. Liver damage may be due to other factors, such as a viral infection or inflammations in the liver. Lack of information among the residents of the city of Najaf about the differences between males and females infected with the “Corona Virus” disease (“Covid-19”). In this study, we focus on the effects of (“COVID-19”) on liver physiology in 60 (“COVID-19”) patients (20-70 years old). Examinations, taking into account demographic information as well as clinical findings, show that the patient has liver abnormalities. The result indicated increasing of liver enzymes ALT,AST,ALP and TBiL levels on patients with covid-19 Corona Virus.Males patients had a higher risk of liver enzymes level elevation than females. ("TBiL") concentrations were highly increased when compared with control. In critical patients, severe liver cells abnormalities result from ("COVID-19"), which requires follow-up and immediate therapeutic intervention. Because of its strong relationship with the severity of the injury in ("COVID-19"), ALT,AST,ALP, and TBiL it is expected to be of great importance in the future prediction and diagnosis of infection.
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12
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Nicastro E, Ebel NH, Kehar M, Czubkowski P, Ng VL, Michaels MG, Lobritto SJ, Martinez M, Indolfi G. The Impact of Severe Acute Respiratory Syndrome Coronavirus Type 2 on Children With Liver Diseases: A Joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition and Society of Pediatric Liver Transplantation Position Paper. J Pediatr Gastroenterol Nutr 2022; 74:159-170. [PMID: 34694269 PMCID: PMC8673661 DOI: 10.1097/mpg.0000000000003339] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
ABSTRACT Children are seldom affected by severe forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) infection; however, the impact of comorbidities in the clinical presentation and outcome of SARS-CoV2 in children is poorly characterized including that of chronic liver disease (CLD) and those taking immunosuppressive medications for autoimmune liver disease or following liver transplantation (LT). Although not the main target organ, a spectrum of liver involvement has been described in children infected with SARS-CoV2 and those presenting with Multisystem Inflammatory Syndrome in Children (MIS-C). The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) present an evidence-based position paper on liver involvement in children with SARS-CoV2 infection and its impact on those with CLD as well as LT recipients. All children may exhibit acute liver injury from SARS-CoV2 infection, and those with CLD and may experience hepatic decompensation. Preventative and therapeutic measures are discussed.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Vicky L. Ng
- Division of Gastroenterology, Hepatology, and Nutrition, the Hospital for Sick Children, Toronto, ON, Canada
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Steven J. Lobritto
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Mercedes Martinez
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Giuseppe Indolfi
- Meyer Children's University Hospital, Department NEUROFARBA, University of Florence, Firenze, Italy
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13
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Lenti MV, Ferrari MG, Aronico N, Melazzini F, Klersy C, Corazza GR, Di Sabatino A. COVID-19-related symptom clustering in a primary care vs internal medicine setting. Intern Emerg Med 2022; 17:291-294. [PMID: 34043116 PMCID: PMC8156583 DOI: 10.1007/s11739-021-02764-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Nicola Aronico
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | | | - Catherine Klersy
- Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Piazzale Golgi 19, 27100, Pavia, Italy
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14
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Oreh A, Akerele I, Nnabuchi C, Obazee D, Onyegbutulem H. Derangements of liver enzymes in a study of 201 COVID-19 patients in Abuja, Nigeria's federal capital territory. Niger J Med 2022. [DOI: 10.4103/njm.njm_180_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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15
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Kalal CR, Joshi H, Kumar V, Gopal D, Rathod D, Shukla A, Gianchandani T, Bhatt C. Clinical Significance of Liver Function Abnormality in Patients with COVID-19: A Single-center Experience from Western India. J Clin Transl Hepatol 2021; 9:878-888. [PMID: 34966651 PMCID: PMC8666361 DOI: 10.14218/jcth.2020.00099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS The impact of coronavirus disease-2019 (COVID-19) on liver function remains to be fully elucidated. This study was designed to investigate such and determine the clinical significance in determining mortality risk. METHODS A retrospective study was conducted in patients with COVID-19 from March 2020 to July 2020. Clinical details were retrieved from electronic medical records to obtain clinical characteristics, medical history, laboratory tests, therapeutic intervention, and outcome data. RESULTS A total of 184 patients with COVID-19 were included (median age: 45.5 years), comprised of 62.5% men. In total, 22 (12.0%) patients had severe infection and 162 (88.0%) had mild to moderate infection. Overall, 95 (51.6%) showed abnormal liver function test (LFT) and 17 (9.2%) showed normal LFT at admission. The median age, hospital stay, and LFT were significantly higher in severe vs. non-severe infection (p<0.001). Out of 12 deaths, the majority were due to severe infection (n=11). Deaths were also due to acute respiratory distress syndrome (n=5), cardiac reasons (n=3), and sepsis with multiorgan failure (n=3). The median age, hospital stay and number of intensive care unit admissions were higher in patients having abnormal LFT compared to normal LFT. Incidence of elevated aspartate aminotransferase (42.8% and 40.4%), alanine transaminase (43.7% and 41.6%), and hypoalbuminemia (71.4% and72.7%) at admission and discharge were more common in severe infection. The mean survival was significantly lower in severe infection compared to those with non-severe disease (17.2 vs. 52.3 days; p<0.001). CONCLUSIONS Incidence of abnormal liver function was higher in patients with severe COVID-19 and was associated with prolonged hospital stay; mortality was associated with severity of COVID-19. For ruling out the risk of liver injury, it is crucial to vigilantly monitor the liver function parameters in patients with COVID-19 admitted to hospital.
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Affiliation(s)
- Chetan R. Kalal
- Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
- Correspondence to: Chetan R. Kalal, Hepatology, Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra 400004, India. Tel: +91-8506873687, E-mail:
| | - Harshad Joshi
- Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Vivek Kumar
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Divya Gopal
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Darshana Rathod
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ashish Shukla
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Tarang Gianchandani
- Department of Administration, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Chetan Bhatt
- Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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16
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Cococcia S, Lenti MV, Santacroce G, Achilli G, Borrelli de Andreis F, Di Sabatino A. Liver-spleen axis dysfunction in COVID-19. World J Gastroenterol 2021; 27:5919-5931. [PMID: 34629809 PMCID: PMC8475007 DOI: 10.3748/wjg.v27.i35.5919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/01/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly through the respiratory route. Besides interstitial pneumonia, a number of other clinical manifestations were noticed in COVID-19 patients. In particular, liver and spleen dysfunctions have been described both as complications of COVID-19 and as potential predisposing factors for severe COVID-19. Liver damage is rather common in COVID-19 patients, and it is most likely multifactorial, caused by the direct insult of SARS-CoV-2 to the liver by the cytokine storm triggered by the virus, by the use of hepatotoxic drugs, and as a consequence of hypoxia. Although generally mild, liver impairment has been found to be associated with a higher rate of intensive care unit admission. A higher mortality rate was reported among chronic liver disease patients. Instead, spleen impairment in patients with COVID-19 has been poorly described. The main anatomical changes are the architectural derangement of the B cell compartment, white pulp atrophy, and reduction or absence of lymphoid follicles, while, from a functional point of view, the IgM memory B cell pool is markedly depleted. The outcome of COVID-19 in asplenic or hyposplenic patients is yet to be defined. In this review, we will summarise the current knowledge regarding the impact of SARS-CoV-2 on the liver and spleen function, as well as the outcome of patients with a pre-existent liver disease or defective spleen function.
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Affiliation(s)
- Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
- Department of Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | - Giovanni Santacroce
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | - Giovanna Achilli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | | | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
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17
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Demirtas CO, Keklikkiran C, Ergenc I, Erturk Sengel B, Eskidemir G, Cinel I, Odabasi Z, Korten V, Yilmaz Y. Liver stiffness is associated with disease severity and worse clinical scenarios in coronavirus disease 2019: A prospective transient elastography study. Int J Clin Pract 2021; 75:e14363. [PMID: 33993597 PMCID: PMC8237050 DOI: 10.1111/ijcp.14363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pre-existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID-19). The present study aimed to investigate the association of liver stiffness measurement (LSM) with disease severity and clinical course of COVID-19. METHODS We prospectively recruited consecutive hospitalised adult patients with COVID-19 in a 3-month period. Demographic, laboratory, clinical and vibration-controlled transient elastography (VCTE) features were recorded at entry, and all patients were prospectively followed-up. Severe liver fibrosis was defined as an LSM value higher than 9.6 kPA. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes. RESULTS Out of 98 eligible patients with COVID-19, 12 (12.2%) had severe liver fibrosis. Patients with severe liver fibrosis had higher baseline disease severity (P = .022), more commonly required oxygen treatment at entry (P = .010), and had intensive-care unit (ICU) requirements during the 6 (1-39)-day median follow-up time (P = .017). The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR): 7.685, 95% confidence interval (CI): 1.435-41.162, P = .017) and ICU requirement (OR: 46.656, 95% CI: 2.144-1015.090, P = .014). LSM was correlated with alanine aminotransferase levels (P = .005, r: 0.283), but not with other markers of acute hepatic injury or inflammation. CONCLUSION Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.
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Affiliation(s)
- Coskun Ozer Demirtas
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
| | - Caglayan Keklikkiran
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
| | - Ilkay Ergenc
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
| | - Buket Erturk Sengel
- Department of Infectious DiseasesSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Gunes Eskidemir
- Department of Critical Care MedicineSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Ismail Cinel
- Department of Critical Care MedicineSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Zekaver Odabasi
- Department of Infectious DiseasesSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Volkan Korten
- Department of Infectious DiseasesSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Yusuf Yilmaz
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
- Institute of GastroenterologyMarmara UniversityIstanbulTurkey
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18
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Tarik Aslan A, Yasemin Balaban H. An overview of SARS-COV-2-related hepatic injury. Hepatol Forum 2021; 2:122-7. [PMID: 35784909 DOI: 10.14744/hf.2021.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/24/2021] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), is highly contagious and has a variety of clinical manifestations, including liver injury. There have been a few reports indicating acute-on chronic liver failure among COVID-19 patients, however, patients with COVID-19-related liver injury are generally asymptomatic and present with a mild to moderate elevation in serum hepatic enzymes. Severe COVID-19 patients have high rates of liver injury with poorer outcomes. The pattern of abnormalities in liver biochemical indicators may be hepatocellular, cholestatic, or mixed. Although the pathogenesis of hepatic injury is not yet completely understood, causes of liver damage include systemic inflammatory response syndrome, ischemia-reperfusion injury, side effects of medications, and underlying chronic liver disease. While viral RNA has been detected in hepatocytes, it remains unknown if the coronavirus has the capacity to cause cytopathic effects in hepatic tissue. Additionally, it is important to remember that the current upheaval to daily life and access to healthcare caused by the COVID-19 pandemic has had a significant and negative effect on other patients with chronic liver disease. The objective of this review was to summarize the current literature on COVID-19-related hepatic injury with an examination of clinical features, potential pathogenesis, and histopathological findings of this entity.
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19
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Tamburin S, Mantovani E, De Bernardis E, Zipeto D, Lugoboni F. COVID-19 and related symptoms in patients under disulfiram for alcohol use disorder. Intern Emerg Med 2021; 16:1729-1731. [PMID: 33464469 PMCID: PMC7814518 DOI: 10.1007/s11739-021-02633-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy.
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | | | - Donato Zipeto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
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20
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Caruso D, Zerunian M, Pucciarelli F, Lucertini E, Bracci B, Polidori T, Guido G, Polici M, Rucci C, Iannicelli E, Laghi A. Imaging of abdominal complications of COVID-19 infection. BJR Open 2021; 2:20200052. [PMID: 34381937 PMCID: PMC8320136 DOI: 10.1259/bjro.20200052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/30/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) first described in Wuhan, Hubei
Province, China in the last months of 2019 and then declared as a pandemic. Typical
symptoms are represented by fever, cough, dyspnea and fatigue, but SARS-CoV-2
infection can also cause gastrointestinal symptoms (vomiting, diarrhoea, abdominal
pain, loss of appetite) or be totally asymptomatic. As reported in literature, many
patients with COVID-19 pneumonia had a secondary abdominal involvement (bowel,
pancreas, gallbladder, spleen, liver, kidneys), confirmed by laboratory tests and
also by radiological features. Usually the diagnosis of COVID-19 is suspected and
then confirmed by real-time reverse-transcription-polymerase chain reaction (RT-PCR),
after the examination of the lung bases of patients, admitted to the emergency
department with abdominal symptoms and signs, who underwent abdominal-CT. The aim of
this review is to describe the typical and atypical abdominal imaging findings in
patients with SARS-CoV-2 infection reported since now in literature.
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Affiliation(s)
- Damiano Caruso
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Marta Zerunian
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Pucciarelli
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Elena Lucertini
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Benedetta Bracci
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Tiziano Polidori
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Gisella Guido
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Michela Polici
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Carlotta Rucci
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Elsa Iannicelli
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Andrea Laghi
- Radiology section, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
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21
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Saviano A, Wrensch F, Ghany MG, Baumert TF. Liver Disease and Coronavirus Disease 2019: From Pathogenesis to Clinical Care. Hepatology 2021; 74:1088-1100. [PMID: 33332624 PMCID: PMC8209116 DOI: 10.1002/hep.31684] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that emerged in late 2019, is posing an unprecedented challenge to global health. Coronavirus disease 2019 (COVID-19), the clinical disease caused by SARS-CoV-2, has a variable presentation ranging from asymptomatic infection to life-threatening acute respiratory distress syndrome and multiorgan failure. Liver involvement is common during COVID-19 and exhibits a spectrum of clinical manifestations from asymptomatic elevations of liver function tests to hepatic decompensation. The presence of abnormal liver tests has been associated with a more severe presentation of COVID-19 disease and overall mortality. Although SARS-CoV-2 RNA has been detected in the liver of patients with COVID-19, it remains unclear whether SARS-CoV-2 productively infects and replicates in liver cells and has a direct liver-pathogenic effect. The cause of liver injury in COVID-19 can be attributed to multiple factors, including virus-induced systemic inflammation, hypoxia, hepatic congestion, and drug-induced liver disease. Among patients with cirrhosis, COVID-19 has been associated with hepatic decompensation and liver-related mortality. Additionally, COVID-19's impact on health care resources can adversely affect delivery of care and outcomes of patients with chronic liver disease. Understanding the underlying mechanisms of liver injury during COVID-19 will be important in the management of patients with COVID-19, especially those with advanced liver disease. This review summarizes our current knowledge of SARS-CoV-2 virus-host interactions in the liver as well the clinical impact of liver disease in COVID-19.
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Affiliation(s)
- Antonio Saviano
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
- Institut Hospitalo‐UniversitairePôle Hépato‐digestifNouvel Hôpital CivilStrasbourgFrance
| | - Florian Wrensch
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
| | - Marc G. Ghany
- Liver Diseases BranchNational Institute of DiabetesDigestive and Kidney DiseasesNational Institutes of HealthBethesdaMD
| | - Thomas F. Baumert
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
- Institut Hospitalo‐UniversitairePôle Hépato‐digestifNouvel Hôpital CivilStrasbourgFrance
- Institut Universitaire de FranceParisFrance
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22
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Goldman DL, Aldrich ML, Hagmann SHF, Bamford A, Camacho-Gonzalez A, Lapadula G, Lee P, Bonfanti P, Carter CC, Zhao Y, Telep L, Pikora C, Naik S, Marshall N, Katsarolis I, Das M, DeZure A, Desai P, Cao H, Chokkalingam AP, Osinusi A, Brainard DM, Méndez-Echevarría A. Compassionate Use of Remdesivir in Children With Severe COVID-19. Pediatrics 2021; 147:peds.2020-047803. [PMID: 33883243 DOI: 10.1542/peds.2020-047803] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Remdesivir shortens time to recovery in adults with severe coronavirus disease 2019 (COVID-19), but its efficacy and safety in children are unknown. We describe outcomes in children with severe COVID-19 treated with remdesivir. METHODS Seventy-seven hospitalized patients <18 years old with confirmed severe acute respiratory syndrome coronavirus 2 infection received remdesivir through a compassionate-use program between March 21 and April 22, 2020. The intended remdesivir treatment course was 10 days (200 mg on day 1 and 100 mg daily subsequently for children ≥40 kg and 5 mg/kg on day 1 and 2.5 mg/kg daily subsequently for children <40 kg, given intravenously). Clinical data through 28 days of follow-up were collected. RESULTS Median age was 14 years (interquartile range 7-16, range <2 months to 17 years). Seventy-nine percent of patients had ≥1 comorbid condition. At baseline, 90% of children required supplemental oxygen and 51% required invasive ventilation. By day 28 of follow-up, 88% of patients had a decreased oxygen-support requirement, 83% recovered, and 73% were discharged. Among children requiring invasive ventilation at baseline, 90% were extubated, 80% recovered, and 67% were discharged. There were 4 deaths, of which 3 were attributed to COVID-19. Remdesivir was well tolerated, with a low incidence of serious adverse events (16%). Most adverse events were related to COVID-19 or comorbid conditions. Laboratory abnormalities, including elevations in transaminase levels, were common; 61% were grades 1 or 2. CONCLUSIONS Among 77 children treated with remdesivir for severe COVID-19, most recovered and the rate of serious adverse events was low.
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Affiliation(s)
| | | | - Stefan H F Hagmann
- Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New York, New York
| | - Alasdair Bamford
- Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | | | | | - Philip Lee
- Children's Hospital at Montefiore, New York, New York
| | | | | | - Yang Zhao
- Gilead Sciences Inc, Foster City, California; and
| | - Laura Telep
- Gilead Sciences Inc, Foster City, California; and
| | | | - Sarjita Naik
- Gilead Sciences Inc, Foster City, California; and
| | | | | | - Moupali Das
- Gilead Sciences Inc, Foster City, California; and
| | - Adam DeZure
- Gilead Sciences Inc, Foster City, California; and
| | - Polly Desai
- Gilead Sciences Inc, Foster City, California; and
| | - Huyen Cao
- Gilead Sciences Inc, Foster City, California; and
| | | | - Anu Osinusi
- Gilead Sciences Inc, Foster City, California; and
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23
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Shi L, Xu J, Xiao W, Wang Y, Jin Y, Chen S, Duan G, Yang H, Wang Y. Asthma in patients with coronavirus disease 2019: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2021; 126:524-534. [PMID: 33609770 PMCID: PMC7889465 DOI: 10.1016/j.anai.2021.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unclear whether asthma has an influence on contracting coronavirus disease 2019 (COVID-19) or having worse outcomes from COVID-19 disease. OBJECTIVE To explore the prevalence of asthma in patients with COVID-19 and the relationship between asthma and patients with COVID-19 with poor outcomes. METHODS The pooled prevalence of asthma in patients with COVID-19 and corresponding 95% confidence interval (CI) were estimated. The pooled effect size (ES) was used to evaluate the association between asthma and patients with COVID-19 with poor outcomes. RESULTS The pooled prevalence of asthma in patients with COVID-19 worldwide was 8.3% (95% CI, 7.6-9.0) based on 116 articles (119 studies) with 403,392 cases. The pooled ES based on unadjusted effect estimates revealed that asthma was not associated with reduced risk of poor outcomes in patients with COVID-19 (ES, 0.91; 95% CI, 0.78-1.06). Similarly, the pooled ES based on unadjusted effect estimates revealed that asthma was not associated with the reduced risk of mortality in patients with COVID-19 (ES, 0.88; 95% CI, 0.73-1.05). However, the pooled ES based on adjusted effect estimates indicated that asthma was significantly associated with reduced risk of mortality in patients with COVID-19 (ES 0.80, 95% CI 0.74-0.86). CONCLUSION The pooled prevalence of asthma in patients with COVID-19 was similar to that in the general population, and asthma might be an independent protective factor for the death of patients with COVID-19, which suggests that we should pay high attention to patients co-infected asthma and COVID-19 and take locally tailored interventions and treatment. Further well-designed studies with large sample sizes are required to verify our findings.
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Affiliation(s)
- Li Shi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jie Xu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wenwei Xiao
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ying Wang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China.
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
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Melazzini F, Reduzzi M, Quaglini S, Fumoso F, Lenti MV, Di Sabatino A. Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients. Front Med (Lausanne) 2021; 8:637375. [PMID: 33996852 PMCID: PMC8119630 DOI: 10.3389/fmed.2021.637375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/09/2021] [Indexed: 01/03/2023] Open
Abstract
Pulmonary embolism (PE) is a frequent, life-threatening COVID-19 complication, whose diagnosis can be challenging because of its non-specific symptoms. There are no studies assessing the impact of diagnostic delay on COVID-19 related PE. The aim of our exploratory study was to assess the diagnostic delay of PE in COVID-19 patients, and to identify potential associations between patient- or physician-related variables and the delay. This is a single-center observational retrospective study that included 29 consecutive COVID-19 patients admitted to the San Matteo Hospital Foundation between February and May 2020, with a diagnosis of PE, and a control population of 23 non-COVID-19 patients admitted at our hospital during the same time lapse in 2019. We calculated the patient-related delay (i.e., the time between the onset of the symptoms and the first medical examination), and the physician-related delay (i.e., the time between the first medical examination and the diagnosis of PE). The overall diagnostic delay significantly correlated with the physician-related delay (p < 0.0001), with the tendency to a worse outcome in long physician-related diagnostic delay (p = 0.04). The delay was related to the presence of fever, respiratory symptoms and high levels of lactate dehydrogenase. It is important to rule out PE as soon as possible, in order to start the right therapy, to improve patient's outcome and to shorten the hospitalization.
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Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Margherita Reduzzi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Frater JL, Wang T, Lee YS. Laboratory hematologic features of COVID-19 associated liver injury: A systematic review. World J Meta-Anal 2021; 9:193-207. [DOI: 10.13105/wjma.v9.i2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/31/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver injury is a common complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The utility of laboratory hematology data in the diagnosis and risk stratification of patients with coronavirus disease 2019 (COVID-19) has not been comprehensively examined.
AIM To address the following. (1) Are the abnormalities in hematologic parameters seen in the general population of patients with COVID-19 also seen in those patients with associated liver injury? (2) Is liver injury in COVID-19 a sign of severe disease and does liver injury correlate with hematologic markers of severe disease? And (3) What is the quality of this evidence?
METHODS To address these questions, a comprehensive systematic review was performed. We searched the peer reviewed medical literature using MEDLINE (PubMed interface), Web of Science, and EMBASE for cohort studies that specifically addressed liver injury and COVID-19 without limitation of date of publication or language. A quality assessment of the studies was performed using the Newcastle-Ottawa Scale.
RESULTS Thirty-two articles were suitable for inclusion in our systematic review. These included 22 articles with a cohort of COVID-19 patients with liver injury, 5 comparing non-severe vs severe COVID-19 populations in which liver injury was addressed, and 5 other cohort studies with a focus on liver injury. White blood cell count, absolute neutrophil count, absolute lymphocyte count (ALC), and hemoglobin were the parameters most helpful in distinguishing COVID-19 with liver injury from COVID-19 without liver injury. ALC and d-dimer were identified as being potentially useful in distinguishing non-severe from severe COVID-19. Liver injury was more frequently seen in cohorts with severe disease. Most studies were of high quality (24/48, 86%) with 4/28 (14%) of moderate quality and 0 of low quality.
CONCLUSION Our study supports the use of select hematologic parameters in diagnosis and risk stratification of liver injury in COVID-19 patients. Although of overall high quality, the current medical literature is limited by the small number of studies with high statistical power and the variable definition of COVID-19 liver injury in the literature.
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Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Tianjiao Wang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Yi-Shan Lee
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, United States
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26
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Frater JL, Wang T, Lee YS. Laboratory hematologic features of COVID-19 associated liver injury: A systematic review. World J Meta-Anal 2021. [DOI: 10.13105/wjma.v9.i2.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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27
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Leulseged TW, Hassen IS, Ayele BT, Tsegay YG, Abebe DS, Edo MG, Maru EH, Zewde WC, Naylor LK, Semane DF, Dresse MT, Tezera BB. Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country. PLoS One 2021; 16:e0246087. [PMID: 33720944 PMCID: PMC7959358 DOI: 10.1371/journal.pone.0246087] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
AIM To identify laboratory biomarkers that predict disease severity and outcome among COVID-19 patients admitted to the Millennium COVID-19 Care Center in Ethiopia. METHODS A retrospective cohort study was conducted among 429 COVID-19 patients who were on follow up from July to October 2020. Data was described using frequency tables. Robust Poisson regression model was used to identify predictors of COVID-19 severity where adjusted relative risk (ARR), P-value and 95 CI for ARR were used to test significance. Binary Logistic regression model was used to assess the presence of statistically significant association between the explanatory variables and COVID-19 outcome where adjusted odds ratio (AOR), P-value and 95%CI for AOR were used for testing significance. RESULTS Among the 429 patients studied, 182 (42.4%) had Severe disease at admission and the rest 247 (57.6%) had Non-severe disease. Regarding disease outcome, 45 (10.5%) died and 384 (89.5%) were discharged alive. Age group (ARR = 1.779, 95%CI = 1.405-2.252, p-value <0.0001), Neutrophil to Lymphocyte ratio (NLR) (ARR = 4.769, 95%CI = 2.419-9.402 p-value <0.0001), Serum glutamic oxaloacetic transaminase (SGOT) (ARR = 1.358, 95%CI = 1.109-1.662 p-value = 0.003), Sodium (ARR = 1.321, 95%CI = 1.091-1.600 p-value = 0.004) and Potassium (ARR = 1.269, 95%CI = 1.059-1.521 p-value = 0.010) were found to be significant predictors of COVID-19 severity. The following factors were significantly associated with COVID-19 outcome; age group (AOR = 2.767, 95%CI = 1.099-6.067, p-value = 0.031), white blood cell count (WBC) (AOR = 4.253, 95%CI = 1.918-9.429, p-value = 0.0001) and sodium level (AOR = 3.435, 95%CI = 1.439-8.198, p-value = 0.005). CONCLUSIONS Assessing and monitoring the laboratory markers of WBC, NLR, SGOT, sodium and potassium levels at the earliest stage of the disease could have a considerable role in halting disease progression and death.
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Affiliation(s)
- Tigist W. Leulseged
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ishmael S. Hassen
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Birhanu T. Ayele
- Faculty of Medicine and Health Sciences, Divison of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa
| | - Yakob G. Tsegay
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Daniel S. Abebe
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mesay G. Edo
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Endalkachew H. Maru
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wuletaw C. Zewde
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lydia K. Naylor
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dejene F. Semane
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Menayit T. Dresse
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bereket B. Tezera
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Abstract
The effect of SARS-CoV-2 infection on humanity has gained worldwide attention and importance due to the rapid transmission, lack of treatment options and high mortality rate of the virus. While scientists across the world are searching for vaccines/drugs that can control the spread of the virus and/or reduce the risks associated with infection, patients infected with SARS-CoV-2 have been reported to have tissue/organ damage. With most tissues/organs having limited regenerative potential, interventions that prevent further damage or facilitate healing would be helpful. In the past few decades, biomaterials have gained prominence in the field of tissue engineering, in view of their major role in the regenerative process. Here we describe the effect of SARS-CoV-2 on multiple tissues/organs, and provide evidence for the positive role of biomaterials in aiding tissue repair. These findings are further extrapolated to explore their prospects as a therapeutic platform to address the tissue/organ damage that is frequently observed during this viral outbreak. This study suggests that the biomaterial-based approach could be an effective strategy for regenerating tissues/organs damaged by SARS-CoV-2.
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Affiliation(s)
- Himadri Shekhar Roy
- Department of Biological Science, Institute of Nanoscience and Technology (INST), Habitat Centre, Sector 64, Phase 10, Mohali-160062, Punjab, India.
| | - Rupali Singh
- Department of Biological Science, Institute of Nanoscience and Technology (INST), Habitat Centre, Sector 64, Phase 10, Mohali-160062, Punjab, India.
| | - Deepa Ghosh
- Department of Biological Science, Institute of Nanoscience and Technology (INST), Habitat Centre, Sector 64, Phase 10, Mohali-160062, Punjab, India.
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29
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Marasco G, Lenti MV, Cremon C, Barbaro MR, Stanghellini V, Di Sabatino A, Barbara G. Implications of SARS-CoV-2 infection for neurogastroenterology. Neurogastroenterol Motil 2021; 33:e14104. [PMID: 33591607 PMCID: PMC7995160 DOI: 10.1111/nmo.14104] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, infects gastrointestinal epithelial cells expressing angiotensin-converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS-CoV-2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID-19. Liver and pancreas dysfunctions have also been described as non-respiratory complications of COVID-19 and add further emphasis to the common view of SARS-CoV-2 infection as a systemic disease with multiorgan involvement. PURPOSE The aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS-CoV-2 infection, including the crosstalk with the gut microbiota, the fecal-oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID-19.
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Affiliation(s)
- Giovanni Marasco
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesUniversity of BolognaItaly
| | - Marco Vincenzo Lenti
- First Department of Internal MedicineFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | | | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesUniversity of BolognaItaly
| | - Antonio Di Sabatino
- First Department of Internal MedicineFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical SciencesUniversity of BolognaItaly
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30
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Assaf D, Gutman Y, Neuman Y, Segal G, Amit S, Gefen-Halevi S, Shilo N, Epstein A, Mor-Cohen R, Biber A, Rahav G, Levy I, Tirosh A. Utilization of machine-learning models to accurately predict the risk for critical COVID-19. Intern Emerg Med 2020; 15:1435-1443. [PMID: 32812204 PMCID: PMC7433773 DOI: 10.1007/s11739-020-02475-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 12/20/2022]
Abstract
Among patients with Coronavirus disease (COVID-19), the ability to identify patients at risk for deterioration during their hospital stay is essential for effective patient allocation and management. To predict patient risk for critical COVID-19 based on status at admission using machine-learning models. Retrospective study based on a database of tertiary medical center with designated departments for patients with COVID-19. Patients with severe COVID-19 at admission, based on low oxygen saturation, low partial arterial oxygen pressure, were excluded. The primary outcome was risk for critical disease, defined as mechanical ventilation, multi-organ failure, admission to the ICU, and/or death. Three different machine-learning models were used to predict patient deterioration and compared to currently suggested predictors and to the APACHEII risk-prediction score. Among 6995 patients evaluated, 162 were hospitalized with non-severe COVID-19, of them, 25 (15.4%) patients deteriorated to critical COVID-19. Machine-learning models outperformed the all other parameters, including the APACHE II score (ROC AUC of 0.92 vs. 0.79, respectively), reaching 88.0% sensitivity, 92.7% specificity and 92.0% accuracy in predicting critical COVID-19. The most contributory variables to the models were APACHE II score, white blood cell count, time from symptoms to admission, oxygen saturation and blood lymphocytes count. Machine-learning models demonstrated high efficacy in predicting critical COVID-19 compared to the most efficacious tools available. Hence, artificial intelligence may be applied for accurate risk prediction of patients with COVID-19, to optimize patients triage and in-hospital allocation, better prioritization of medical resources and improved overall management of the COVID-19 pandemic.
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Affiliation(s)
- Dan Assaf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Surgery C Department, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ya'ara Gutman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Surgery C Department, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yair Neuman
- The Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gad Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Corona Department and Internal Medicine "T", The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Sharon Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Microbiology Laboratory, The Chaim Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel
| | - Shiraz Gefen-Halevi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Microbiology Laboratory, The Chaim Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel
| | - Noya Shilo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Corona Intensive Care Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Avi Epstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Emergency Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ronit Mor-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Endocrine Oncology Bioinformatics Lab, The Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Biber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Amit Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Endocrine Oncology Bioinformatics Lab, The Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
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Sinjari B, D'Ardes D, Santilli M, Rexhepi I, D'Addazio G, Di Carlo P, Chiacchiaretta P, Caputi S, Cipollone F. SARS-CoV-2 and Oral Manifestation: An Observational, Human Study. J Clin Med 2020; 9:E3218. [PMID: 33036482 DOI: 10.3390/jcm9103218] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022] Open
Abstract
The correlation between SARS-CoV-2 and oral manifestations is still controversial. The aim of this observational study was to determine the oral manifestation of the hospitalized patients for COVID-19. A total of 20 patients met the inclusion criteria and gave their signed informed consent. A questionnaire of 32 questions regarding the oral and systemic health condition was administrated to these patients during the convalescence. A descriptive statistic was performed. Data were analysed through the use of χ2 test, to assess the statistical significance. A statistically significant increase of about 30% of reporting xerostomia during hospitalization was observed (p = 0.02). Meanwhile, a decrease of oral hygiene was observed during the hospitalization, even if a non-statistically significant difference was shown between the two study time points (before and after hospitalization). During the hospitalization period, 25% of patients reported impaired taste, 15% burning sensation, and 20% difficulty in swallowing. An interesting result was that among the systemic conditions, hypertension was observed in 39% of patients and mostly in female patients (62.5%). Further studies are necessary to better understand the symptoms of this new virus in order to faster detect its presence in humans. Probably, a multidisciplinary team following the COVID-19 patients could be of key importance in treating this disease.
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