Immunoinflammatory, Thrombohaemostatic, and Cardiovascular Mechanisms in COVID-19

Gencer, Selin; Lacy, Michael; Atzler, Dorothee; Vorst, Emiel P. C. van der; Döring, Yvonne; Weber, Christian

doi:10.1055/s-0040-1718735

Cited by 50 publications

(57 citation statements)

References 149 publications

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“…COVID-19 involves principally respiratory tract, and the clinical presentation was very similar to that recorded during the Severe Acute Respiratory Syndrome (SARS) outbreak of 2003 [2,3]. The virus rapidly spread worldwide, and it is responsible for a pandemic state with relevant clinical, psychological and economic consequences [4][5][6].…”

Section: Introductionmentioning

confidence: 83%

Anxiety and Gastrointestinal Symptoms Related to COVID-19 during Italian Lockdown

Abenavoli

Cinaglia

Lombardo³

et al. 2021

JCM

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The first case of infection by SARS-CoV-2 (i.e., COVID-19) was officially recorded by the Italian National Health Service on 21 February 2020. Respiratory tract manifestations are the most common symptoms, such as gastrointestinal symptoms (GISs) like nausea or sickness, diarrhea, and anorexia, and psychological effects may be reported in affected individuals. However, similar symptoms may be observed in healthy people as a consequence of an anxiety state. Methods: We analyzed GISs and anxiety state during the COVID-19 lockdown period; from 9 March 2020 to 4 May 2020. A web-based survey consisting of 131 items was administered to 354 students affiliated with the School of Medicine of the University “Magna Graecia” of Catanzaro; Italy. A set of statistical analyses was performed to analyze the relationships among the answers to assess a correlation between the topics of interest. Results: The statistical analysis showed that 54.0% of interviewed reported at least one GISs, 36.16% of which reported a positive history for familial GISs (FGISs). The 354 subjects included in our cohort may be stratified as follows: 25.99% GISs and FGISs, 27.97% GISs and no-FGISs, 10.17% no-GISs and FGISs, 35.87% no-GISs and no-FGISs. Results indicated an anxiety state for 48.9% of respondents, of which 64.74% also presented GISs. In addition, considered dietary habits, we detect the increased consumption of hypercaloric food, sweetened drinks, and alcoholic beverages. Conclusions: The increase of GISs during the lockdown period in a population of medical students, may be correlated to both dietary habits and anxiety state due to a concern for one’s health.

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Section: Introductionmentioning

confidence: 83%

Anxiety and Gastrointestinal Symptoms Related to COVID-19 during Italian Lockdown

Abenavoli

Cinaglia

Lombardo³

et al. 2021

JCM

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“…These findings could be explained by the multiple pathogenic mechanisms linked to the SARS-CoV-2 infection, including thrombo-inflammatory microangiopathy and angiotensin-converting enzyme (ACE) 2 disruption. 6 , 21 …”

Section: Discussionmentioning

confidence: 99%

“… 23 , 24 Complement cascade activation is, in turn, a response to an endothelial injury secondary to local renin-angiotensin system disruption. 6 , 21 Endothelial cells express high levels of angiotensin-converting enzyme 2 (ACE 2) receptors, which are used by SARS-CoV-2 to gain entry into the cell that is then disrupted. 25 Endothelial damage and subsequent thrombo-inflammatory microangiopathy lead to a hypercoagulative state that may explain the microvascular occlusion and the consequent multi-organ failure that characterizes advanced disease.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography Features in Post-COVID-19 Pneumonia Patients: A Pilot Study

Cennamo

Reibaldi

Montorio

et al. 2021

American Journal of Ophthalmology

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Purpose : To investigate retinal vessel density changes in macular and papillary regions in post SARS-CoV-2 pneumonia patients by means of optical coherence tomography angiography (OCTA). Design : Prospective, observational, cohort study. Methods : Forty eyes of 40 patients (mean age 49.7 ± 12.6) post SARS-CoV-2 infection and 40 healthy subjects were enrolled in this study. Covid-19 patients had to be fully recovered from Covid-19 pneumonia and were evaluated 6 months after Covid-19 infection. The primary outcome was the results of the OCTA study of the following vascular structures: vessel density (VD) in the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillaries (RPC), compared to those of controls. We also evaluated the structural spectral domain (SD)-OCT parameters: ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL). Results : The patients showed a significant reduction in VD of the SCP in whole image and in the DCP in all sectors compared to healthy subjects (p<0.05). Covid-19 patients featured a reduced VD of the RPC compared to controls (p<0.001). No difference was found in the GCC, while the RNFL was reduced in the COVID-19 group compared to controls (p=0.012). Significant correlations were found between the RNFL and VD of the SCP, DCP, RPC and FAZ area in the Covid-19 group (p<0.05). Conclusion : OCTA showed retinal vascular changes in subjects fully recovered from Covid-19 pneumonia. These findings could be a consequence of a thrombotic microangiopathy that affected retinal structures as well as other systemic organs. OCTA could represent a valid, non-invasive biomarker of early vascular dysfunction after SARS-CoV-2 infection.

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“…There is evidence of viral inclusion [4] in the endothelium and diffuse inflammation (endothelialitis), which trigger a systemic release of inflammatory cytokines. [5] Such conditions diminish the endothelium's protective properties.…”

Section: Introductionmentioning

confidence: 99%

Sulodexide in the Treatment of Patients with Early Stages of COVID-19: A Randomized Controlled Trial

Gonzalez-Ochoa¹,

Raffetto

Hernández³

et al. 2021

Thromb Haemost

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Background Sulodexide has pleiotropic properties within the vascular endothelium that can prove beneficial for the treatment of patients with COVID-19. We aimed to evaluate the effect of sulodexide when used in the early clinical stages of COVID-19. Methods In an outpatient setting, we conducted a randomized controlled trial with a parallel-group design. Including patients within three days of clinical onset, who were at a high risk of severe clinical progression due to chronic comorbidities. Participants were randomly assigned to receive an oral dose of sulodexide (500 LRU twice a day) or placebo for 21 days. Primary outcomes were need-length of hospitalization and need-length of oxygen support. Results Between June 5 and August 30, 2020, 243 patients were included in the per-protocol analysis. 124 of them received sulodexide, while 119 received placeboes. At 21 days follow-up, 17.7% patients required hospitalization in the sulodexide group compared to 29.4% in the placebo group, p=0.03. 29.8% required oxygen support in the sulodexide group vs 42% in the placebo group, p=0.05 and for fewer days [9 (7.2 SD) in the sulodexide group vs. 11.5 (9.6 SD) in the placebo group; p=0.02]. There was no between-group difference concerning the length of hospital stay. Interpretation Early intervention in COVID-19 patients with sulodexide reduced hospital admissions and oxygen support requirements. This has beneficial implications in the patient's well-being, making sulodexide a favorable medication until an effective vaccine or an antiviral becomes available. Funding Researcher independently initiated, partially funded by Alfasigma, Mexico. ISRCTN registry listed under ID ISRCTN59048638.

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Immunoinflammatory, Thrombohaemostatic, and Cardiovascular Mechanisms in COVID-19

Cited by 50 publications

References 149 publications

Anxiety and Gastrointestinal Symptoms Related to COVID-19 during Italian Lockdown

Anxiety and Gastrointestinal Symptoms Related to COVID-19 during Italian Lockdown

Optical Coherence Tomography Angiography Features in Post-COVID-19 Pneumonia Patients: A Pilot Study

Sulodexide in the Treatment of Patients with Early Stages of COVID-19: A Randomized Controlled Trial

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