Extrapulmonary manifestations of COVID-19

Abstract

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can result in a hyperin ammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury, and thrombotic complications, among other sequelae. Statins, which are known to have anti-in ammatory and antithrombotic properties, have been studied in the setting of other viral infections and ARDS, but their bene t has not been assessed in COVID-19. Thus, we sought to determine whether antecedent statin use is associated with lower in-hospital mortality in patients hospitalized for COVID-19. This is a retrospective analysis of patients admitted with COVID-19 from February 1 st through May 12 th , 2020 with study period ending on June 11 th , 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline socio-demographic and clinical characteristics, and outpatient medications. The primary endpoint included in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users,

Temporal Landscape of Human Gut RNA and DNA Viromes in SARS-CoV-2 Infection and Severity

“…and in ammation markers in blood, 4 (Myxococcus phage, Bacteroides phage, Murmansk poxvirus, and Sphaerotilus phage) also inversely correlated with human age. This nding may at least partly explain the observation that elderly individuals are prone to unfavorable severe COVID-19 outcomes [2,25] and shed light on the importance of gut viruses in human pathophysiology.…”

“…In particular, 8 out of the 9 DNA virus species showed strong negative correlation with blood levels of the in ammation indicators LDH, neutrophil count, white cell count, or CRP (Figure 4k). Interestingly, Myxococcus phage, Bacteroides phage, Murmansk poxvirus, and Sphaerotilus phage also inversely correlated with host age (Figure 4k), which may partly account for the observation that elderly individuals were at higher risk for unfavorable severe COVID-19 outcomes [2,25]. These data suggest that RNA and DNA viruses may counteract the effect of SARS-CoV-2 infection predisposing infected subjects to a less severe COVID-19 course.…”

Full recovery from severe SARS-CoV-2 infection after requiring extracorporeal membrane oxygenation and continuous hemodiafiltration

“…Among extrapulmonary injuries of severe SARS-CoV-2 infection, renal impairment was observed in both cases presented here, consistent with plausible mechanisms already described, such as direct viral infection by engaging angiotensin-converting enzyme 2 receptors with co-expressed transmembrane serine proteases triggering renal endothelial damage. 5 Multiple antibiotics, extracorporeal circulation, and transient perfusion imbalance might also have contributed to causing decreased renal function. Great care was taken to maintain end-organ perfusion with appropriate oxygen delivery, management of which might minimize the duration of temporary hemodia ltration.…”

Myocardial Injury in Post Mortem Biopsies of Patients with COVID-19

“…COVID-19 is mainly a respiratory disease, causing viral pneumonia and acute respiratory distress syndrome. However, in most critical cases, cardiovascular manifestations have been related to poor outcomes 2 . Myocardial injury (de ned by troponin blood levels above the 99th-percentile upper reference) was observed in 7 to 17% 3 of patients and was signi cantly and independently associated with mortality 4 .…”