Longitudinal clinical and radiographic evaluation reveals interleukin-6 as an indicator of persistent pulmonary injury in COVID-19

Liao, Baolin; Liu, Zhipeng; Tang, Libo; Li, Linghua; Gan, Qingxin; Shi, Haiyan; Jiao, Qian; Guan, Yubao; Xie, Min; He, Xiaoyun; Zhao, Han; Chen, Weilie; Liu, Yanxia; Li, Liya; Wang, Yaping; Cao, Yi; Shi, Yawei; Li, Yongyin; Lei, Chunliang

doi:10.7150/ijms.49728

Cited by 30 publications

(22 citation statements)

References 42 publications

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“…Our observations resonate with Liao et al 27 , who reported elevated levels of IL-6 and other proinflammatory cytokines in mainly severe cases at weeks 4 and 6 post-discharge. Moreover, the authors established an association between sustained IL-6 levels and persistent pulmonary lesions.…”

Section: Discussionsupporting

confidence: 92%

“…Elevated levels of Ddimer and fibrin/fibrinogen degradation products were observed in our cohort during hospitalisation (Table 3) as reported by others 23 , with D-dimer levels selected to differentiate between severe and mild cases 24 25 . Interestingly, at follow-up, sustained abnormal D-dimer levels were observed in the presence of normalised fibrinogen levels, and platelet counts similar to previous findings [26][27][28] .…”

Section: Discussionsupporting

confidence: 88%

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Severe COVID-19 is associated with sustained biochemical disturbances and prolonged symptomatology; A retrospective single-centre cohort study

Simjanoska

Mitrev

Villa

et al. 2021

Preprint

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Introduction: Coronavirus disease 2019 (COVID-19) is associated with significant acute clinical manifestations, and reports indicate that some patients experience prolonged symptomatology and morbidity. These late clinical manifestations have been termed Post-Acute Sequelae of COVID-19 (PASC) and hypothesised to be associated with clinical severity in the acute infection phase and biochemical abnormalities. Aim: Evaluate the incidence of PASC in previously hospitalised COVID-19 patients and compare the admission and follow-up levels of biochemical parameters stratified according to baseline clinical severity. Methods: N = 168 COVID-19 patients previously hospitalised at the Zan Mitrev Clinic in Skopje, North Macedonia, with matched laboratory data at baseline and follow-up clinical visit > 30 days post-discharge, were stratified according to National Institute of Health clinical severity guidelines as mild, moderate, severe or critical according to admission clinical presentation. We assessed the incidence of PASC and compared the biochemical profile. Results: The median hospitalisation and clinical follow-up period were 11 (9-20) and 53 (30-105) days. The overall incidence of PASC was 56.5% (95/168); most PASC cases were confined to the severe sub-group (61/101, 61.4%). Contrary to mild and moderate cases and a healthy non-COVID-19 control cohort, we observed that severe COVID-19 cases experienced sustained biochemical disturbances, most notably elevated D-dimers and Ferritin of 600 ng/ml (283-1168) and 432 ng/ml (170-916), respectively. Conclusions: Previously hospitalised severe COVID-19 patients are more likely to experience Post-Acute Sequelae of COVID-19 and prolonged biochemical disturbances, evident by abnormal values of D-dimers and Ferritin.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Severe COVID-19 is associated with sustained biochemical disturbances and prolonged symptomatology; A retrospective single-centre cohort study

Simjanoska

Mitrev

Villa

et al. 2021

Preprint

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“…In a news feature article it was reported that these lung damages lessened with time, 88% of patients had visible damage up to 6 weeks after infection, but 2 months after symptom onset this number had fallen to 56% ( 109 ). By examining retrospectively a cohort of 158 mild-to-severe COVID-19 patients, it was shown that these persistent pulmonary damages were also associated with a persistent elevation of IL-6 up to 2 months after infection ( 29 ). At the same follow-up, Chun et al, evaluating 61 prevalently non-critical COVID-19 patients, highlighted also higher levels of Lipocalin 2, suggesting that COVID-19 patients may have an ongoing neutrophil activation that could be amenable to targeted therapy ( 19 ).…”

Section: Resultsmentioning

confidence: 99%

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

et al. 2021

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Whilst the entire world is battling the second wave of COVID-19, a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery, i. e., long-term COVID-19 symptoms. We aimed to assess the current evidence on the long-term symptoms in COVID-19 patients. We did a systematic review on PubMed, Web of Science, EMBASE, and Google Scholar from database inception to February 15, 2021, for studies on long-term COVID-19 symptoms. We included all type of papers that reported at least one long-term COVID-19 symptom. We screened studies using a standardized data collection form and pooled data from published studies. Cohort cross-sectional, case-report, cases-series, case-control studies, and review were graded using specific quality assessment tools. Of 11,361 publications found following our initial search we assessed 218 full-text articles, of which 145 met all selection criteria. We found that 20.70% of reports on long-term COVID-19 symptoms were on abnormal lung functions, 24.13% on neurologic complaints and olfactory dysfunctions, and 55.17% on specific widespread symptoms, mainly chronic fatigue, and pain. Despite the relatively high heterogeneity of the reviewed studies, our findings highlighted that a noteworthy proportion of patients who have suffered from SARS-CoV-2 infection present a “post-COVID syndrome.” The multifaceted understanding of all aspects of the COVID-19 pandemic, including these long-term symptoms, will allow us to respond to all the global health challenges, thus paving the way to a stronger public health.

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“…Elevated blood urea nitrogen (BUN) and D-dimer levels were found to be risk factors for pulmonary dysfunction among survivors of COVID-19 at three-month post-hospital discharge [ 46 ]. Other studies have shown that COVID-19 pulmonary lesions at two-month post-admission were associated with elevated systemic inflammatory biomarkers, such as D-dimer, interleukin-6 (IL-6), and CRP [ 62 , 148 ]. Systemic inflammatory biomarkers (e.g.…”

Section: Possible Risk Factorsmentioning

confidence: 99%

Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments

Yong

2021

Infectious Diseases

928

795

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Long COVID or post-COVID-19 syndrome first gained widespread recognition among social support groups and later in scientific and medical communities. This illness is poorly understood as it affects COVID-19 survivors at all levels of disease severity, even younger adults, children, and those not hospitalized. While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID-19. Other persistent symptoms may include cognitive and mental impairments, chest and joint pains, palpitations, myalgia, smell and taste dysfunctions, cough, headache, and gastrointestinal and cardiac issues. Presently, there is limited literature discussing the possible pathophysiology, risk factors, and treatments in long COVID, which the current review aims to address. In brief, long COVID may be driven by long-term tissue damage (e.g. lung, brain, and heart) and pathological inflammation (e.g. from viral persistence, immune dysregulation, and autoimmunity). The associated risk factors may include female sex, more than five early symptoms, early dyspnoea, prior psychiatric disorders, and specific biomarkers (e.g. D-dimer, CRP, and lymphocyte count), although more research is required to substantiate such risk factors. While preliminary evidence suggests that personalized rehabilitation training may help certain long COVID cases, therapeutic drugs repurposed from other similar conditions, such as myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, and mast cell activation syndrome, also hold potential. In sum, this review hopes to provide the current understanding of what is known about long COVID.

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Longitudinal clinical and radiographic evaluation reveals interleukin-6 as an indicator of persistent pulmonary injury in COVID-19

Cited by 30 publications

References 42 publications

Severe COVID-19 is associated with sustained biochemical disturbances and prolonged symptomatology; A retrospective single-centre cohort study

Severe COVID-19 is associated with sustained biochemical disturbances and prolonged symptomatology; A retrospective single-centre cohort study

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments

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