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Surendran VA, Ibrahim JM, Thodi RC, Nair AS, Sukumaran ST. Diterpenoid and C20 diterpenoid alkaloid as a potent inhibitor of SARS-CoV-2 main protease (M pro): from Piper barberi Gamble, an endemic and endangered species of Southern Western Ghats. J Biomol Struct Dyn 2024; 42:6997-7013. [PMID: 37482792 DOI: 10.1080/07391102.2023.2238075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
The present study investigated the phytochemicals and in silico anti-nCoV properties of Piper barberi, an endangered and endemic species of Southern Western Ghats. Using conventional soxhlet extraction method, the leaf and stem were extracted separately with methanol (PBLM and PBSM). The bioactive compounds from the extracts were identified using HR-LCMS/MS-qTOF analysis. These compounds were subjected to various in silico analyses to identify potential drug candidates against nCoV. The HR LCMS/MS analysis of PBLM and PBSM revealed the presence of phenols, flavonoids, alkaloids, and terpenoids in it and this is the first report of the phytoconstituents present in the species P. barberi. All the identified bioactive compounds were subjected to predict ADMET. Out of 49 identified compounds, only 31 passed drug-likeness properties and toxicity tests. Molecular interaction studies were conducted using the AutoDockTools 4.2.6., which showed that only 13 compounds exhibited acceptable binding affinity with the nCoV target Mpro. Structural stability and binding free energy analyses of the five compounds with the higher binding affinity indicated that the bioactive compounds Hetisine and Ajaconine are stable with both hydrogen bonds and hydrophobic interactions. Hetisine shows stable binding among these two compounds with two hydrogen bond interactions with the crucial catalytic dyad residue (His41). Thus, this study concludes that these compounds might potentially be used as an alternative drug candidate for managing nCoV. However, further experimental validation, including in vitro and in vivo assays, is required to substantiate the results.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
| | - Junaida M Ibrahim
- Department of Computational Biology & Bioinformatics, University of Kerala, Thiruvananthapuram, India
| | | | - Achuthsankar S Nair
- Department of Computational Biology & Bioinformatics, University of Kerala, Thiruvananthapuram, India
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Ma S, Hao R, Lu YW, Wang HP, Hu J, Qi YX. Identification and Validation of Novel Metastasis-Related Immune Gene Signature in Breast Cancer. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:199-219. [PMID: 38634039 PMCID: PMC11021863 DOI: 10.2147/bctt.s448642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
Background Distant metastasis remains the leading cause of death among patients with breast cancer (BRCA). The process of cancer metastasis involves multiple mechanisms, including compromised immune system. However, not all genes involved in immune function have been comprehensively identified. Methods Firstly 1623 BRCA samples, including transcriptome sequencing and clinical information, were acquired from Gene Expression Omnibus (GSE102818, GSE45255, GSE86166) and The Cancer Genome Atlas-BRCA (TCGA-BRCA) dataset. Subsequently, weighted gene co-expression network analysis (WGCNA) was performed using the GSE102818 dataset to identify the most relevant module to the metastasis of BRCA. Besides, ConsensusClusterPlus was applied to divide TCGA-BRCA patients into two subgroups (G1 and G2). In the meantime, the least absolute shrinkage and selection operator (LASSO) regression analysis was used to construct a metastasis-related immune genes (MRIGs)_score to predict the metastasis and progression of cancer. Importantly, the expression of vital genes was validated through reverse transcription quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry (IHC). Results The expression pattern of 76 MRIGs screened by WGCNA divided TCGA-BRCA patients into two subgroups (G1 and G2), and the prognosis of G1 group was worse. Also, G1 exhibited a higher mRNA expression level based on stemness index score and Tumor Immune Dysfunction and Exclusion score. In addition, higher MRIGs_score represented the higher probability of progression in BRCA patients. It was worth mentioning that the patients in the G1 group had a high MRIGs_score than those in the G2 group. Importantly, the results of RT-qPCR and IHC demonstrated that fasciculation and elongation protein zeta 1 (FEZ1) and insulin-like growth factor 2 receptor (IGF2R) were risk factors, while interleukin (IL)-1 receptor antagonist (IL1RN) was a protective factor. Conclusion Our study revealed a prognostic model composed of eight immune related genes that could predict the metastasis and progression of BRCA. Higher score represented higher metastasis probability. Besides, the consistency of key genes in BRCA tissue and bioinformatics analysis results from mRNA and protein levels was verified.
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Affiliation(s)
- Shen Ma
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050035, People’s Republic of China
| | - Ran Hao
- Institutes of Health Research, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
| | - Yi-Wei Lu
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050035, People’s Republic of China
| | - Hui-Po Wang
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050035, People’s Republic of China
| | - Jie Hu
- Institutes of Health Research, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
- Department of Science and Technology, Hebei Medical University, Shijiazhuang, Hebei, 050017, People’s Republic of China
| | - Yi-Xin Qi
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050035, People’s Republic of China
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Jerah AA, Farasani A, Abu-Tawil HI, Kuriri H, Kuriri A, Alkhayrat M, Kariri K, Kariri SA, Abdelwahab SI. Evaluation of Biochemical Characteristics in a Retrospective Cohort of COVID-19 Patients. Cureus 2024; 16:e58889. [PMID: 38800147 PMCID: PMC11117081 DOI: 10.7759/cureus.58889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has had a significant impact on global health and healthcare systems. This retrospective study aimed to assess the association between biochemical parameters and outcomes in COVID-19 patients in Jazan, Saudi Arabia. METHODS After establishing the inclusion criteria and obtaining ethical approval, data from 156 reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients were collected from electronic medical records from a general hospital in Samtah, Jazan, from April 2020 to October 2021. The collected data included patient demographics and liver, kidney, heart, and electrolyte function marker levels. Descriptive, inferential, and principal component analyses were conducted. RESULTS Survival rates varied according to age and body mass index (BMI). Statistical analysis demonstrated that the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), sodium (Na), potassium (K), blood urea nitrogen (BUN), creatinine (Cr), creatine kinase (CK), CK myocardial band (MB), and lactate dehydrogenase (LDH) were significantly higher (P < 0.05) than the reference values, as assessed using the one-sample t-test. Principal component analysis (PCA) also revealed an underlying pattern in the variation of these biochemical markers. These findings suggest that certain biochemical parameters may serve as useful indicators for monitoring the condition of COVID-19 patients. CONCLUSION This retrospective study in Jazan, Saudi Arabia highlights the association between biochemical parameters and outcomes in COVID-19 patients. Elevated levels of markers of liver, kidney, heart, and electrolyte function suggest organ damage and dysregulation. The pattern identified through PCA provides insights into disease severity. Monitoring these parameters may serve as valuable indicators for assessing COVID-19 patients. Further research is needed to validate these findings, explore their potential for personalized treatment strategies, and improve patient outcomes during the ongoing pandemic.
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Affiliation(s)
- Ahmed Ali Jerah
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, SAU
| | - Abdullah Farasani
- Biomedical Research Unit, Medical Research Center, Jazan University, Jazan, SAU
| | - Hisham I Abu-Tawil
- Department of Laboratory and Blood Bank, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, SAU
- Department of Clinical Laboratory and Blood Bank, King Faisal Medical City For Southern Regions, Abha, SAU
| | - Hadi Kuriri
- Department of Clinical Laboratory and Blood Bank, King Faisal Medical City For Southern Regions, Abha, SAU
- Department of Clinical Laboratory and Blood Bank, Samtah General Hospital, Samtah, SAU
| | - Anwar Kuriri
- Department of Medical Administration, Samtah General Hospital, Samtah, SAU
| | - Mansour Alkhayrat
- Department of Medical Administration, Samtah General Hospital, Samtah, SAU
| | - Kholood Kariri
- Department of Nursing Administration, Samtah General Hospital, Samtah, SAU
| | - Sami Ali Kariri
- Department of Pharmacy, Samtah General Hospital, Samtah, SAU
| | - Siddig I Abdelwahab
- Biomedical Research Unit, Medical Research Center, Jazan University, Jazan, SAU
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Yang R, Feng J, Wan H, Zeng X, Ji P, Zhang J. Liver injury associated with the severity of COVID-19: A meta-analysis. Front Public Health 2023; 11:1003352. [PMID: 36817905 PMCID: PMC9932800 DOI: 10.3389/fpubh.2023.1003352] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Background The current 2019 novel coronavirus disease (COVID-19) pandemic is a major threat to global health. It is currently uncertain whether and how liver injury affects the severity of COVID-19. Therefore, we conducted a meta-analysis to determine the association between liver injury and the severity of COVID-19. Methods A systematic search of the PubMed, Embase, and Cochrane Library databases from inception to August 12, 2022, was performed to analyse the reported liver chemistry data for patients diagnosed with COVID-19. The pooled odds ratio (OR), weighted mean difference (WMD) and 95% confidence interval (95% CI) were assessed using a random-effects model. Furthermore, publication bias and sensitivity were analyzed. Results Forty-six studies with 28,663 patients were included. The pooled WMDs of alanine aminotransferase (WMD = 12.87 U/L, 95% CI: 10.52-15.23, I 2 = 99.2%), aspartate aminotransferase (WMD = 13.98 U/L, 95% CI: 12.13-15.83, I 2 = 98.2%), gamma-glutamyl transpeptidase (WMD = 20.67 U/L, 95% CI: 14.24-27.10, I 2 = 98.8%), total bilirubin (WMD = 2.98 μmol/L, 95% CI: 1.98-3.99, I 2 = 99.4%), and prothrombin time (WMD = 0.84 s, 95% CI: 0.46-1.23, I 2 = 99.4%) were significantly higher and that of albumin was lower (WMD = -4.52 g/L, 95% CI: -6.28 to -2.75, I 2 = 99.9%) in severe cases. Moreover, the pooled OR of mortality was higher in patients with liver injury (OR = 2.72, 95% CI: 1.18-6.27, I 2 = 71.6%). Conclusions Hepatocellular injury, liver metabolic, and synthetic function abnormality were observed in severe COVID-19. From a clinical perspective, liver injury has potential as a prognostic biomarker for screening severely affected patients at early disease stages. Systematic review registration https://www.crd.york.ac.uk/prospero/, Identifier: CRD42022325206.
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Affiliation(s)
- Ruiqi Yang
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jihua Feng
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huan Wan
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaona Zeng
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Pan Ji
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianfeng Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China,Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China,*Correspondence: Jianfeng Zhang ✉
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Cekic S, Karali Z, Cicek F, Canitez Y, Sapan N. The Impact of the COVID-19 Pandemic in Adolescents with Asthma. J Korean Med Sci 2021; 36:e339. [PMID: 34931499 PMCID: PMC8688346 DOI: 10.3346/jkms.2021.36.e339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is affecting people at any age and there is limited information about the effect of the COVID-19 pandemic on quality of life (QoL) in adolescents with asthma. In the present study, it was aimed to assess the attitudes of adolescents with asthma toward the COVID-19 pandemic and determine the effects of the pandemic on their QoL. METHODS In total, 125 adolescents with asthma and 98 healthy adolescents participated in the present study. The questionnaire form consisted of three parts. In the first part, all the participants were asked whether they complied with the protective measures against COVID-19. The second part included questions for measuring the participants' level of concern about COVID-19, while the third part consisted of EUROHIS-QOL 8. RESULTS The patient and control groups were similar in terms of the female/male ratio (55/70 and 48/50, respectively) and mean participant age (14.6 ± 2 and 15.1 ± 1.65 years, respectively) (P = 0.459 and P = 0.062, respectively). The prevalence of COVID-19 in the patients (n = 2, 1.6%) was lower than that in the controls (n = 6, 6.1%); however, the difference was not statistically significant (P = 0.142). The total EUROHIS-QOL score was significantly lower in the patients (31.2 ± 6.7) than in the controls (33.7 ± 4.4) (P < 0.001). The total QoL scores of asthmatic adolescents without other allergic disease (31.4 ± 6.7) was also lower than those of the controls (33.7 ± 4.4) (P = 0.009). Treatment disruption was significantly more common in patients who received subcutaneous immunotherapy (n = 20, 48.8%) than in those who did not (n = 8, 9.5%) (P < 0.001). Moreover, the patients had lower EUROHIS-QOL scores in the overall QoL, general health, finance, and home domains. CONCLUSION Our results indicate that the mean QoL score of asthmatic adolescents during COVID-19 pandemic is lower than in the healthy population. Disruption in their treatment was most common in patients with asthma who were receiving subcutaneous immunotherapy.
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Affiliation(s)
- Sukru Cekic
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Zuhal Karali
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Fatih Cicek
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Yakup Canitez
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nihat Sapan
- Division of Pediatric Allergy, Uludag University Faculty of Medicine, Bursa, Turkey.
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Rastogi V, Banwait R, Singh D, Toklu H, Finer L, Parajuli D, Ganti L. Prevalence of hepatopancreatic injury and clinical outcomes in patients with COVID-19 in USA. Int J Emerg Med 2021; 14:68. [PMID: 34742236 PMCID: PMC8572059 DOI: 10.1186/s12245-021-00393-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background (1) To determine the prevalence of hepatopancreatic injury in coronavirus disease 2019 (COVID-19) patients. (2) To correlate hepatopancreatic injury in COVID-19 with mortality, disease severity, and length of stay in this cohort. Results Forty-five thousand three hundred sixty patients were included in the analysis, 62.82% of which had either hepatic or pancreatic injury. There was a significant upward trend in transaminases, alkaline phosphatase, prothrombin time, bilirubin, lactate dehydrogenase, and lipase and a downward trend in albumin with an increase in disease severity. COVID-19-positive patients with hepato-pancreatic injury have a significantly higher mortality (OR 3.39, 95%CI 3.15–3.65) after controlling for the differences in age, sex, race/ethnicity, liver cirrhosis, and medication exposures. They also have increased disease severity (OR 2.7, 95%CI 2.5–2.9 critical vs mild/moderate; OR 1.4, 95% CI 1.3–1.5 severe vs mild/moderate) and longer hospital length of stay (2 days). Conclusion COVID-19 can cause liver injury. Mortality, disease severity, and hospital length of stay are increased in COVID-19 patients with hepatopancreatic injury. Graphical Abstract ![]()
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Affiliation(s)
- Vaibhav Rastogi
- HCA Healthcare Graduate Medical Education, Nashville, Tennessee, USA.,Envision Physician Services, Plantation, Florida, USA
| | - Ranjit Banwait
- Department of Clinical Sciences, University of Central Florida College of Medicine, Florida, Orlando, USA
| | - Devina Singh
- Department of Clinical Sciences, University of Central Florida College of Medicine, Florida, Orlando, USA
| | - Hale Toklu
- HCA Healthcare Graduate Medical Education, Nashville, Tennessee, USA.,Department of Clinical Sciences, University of Central Florida College of Medicine, Florida, Orlando, USA
| | - Lexie Finer
- HCA Healthcare Graduate Medical Education, Nashville, Tennessee, USA
| | - Dipendra Parajuli
- Department of Gastroenterology, University of Louisville, Louisville, Kentucky, USA
| | - Latha Ganti
- HCA Healthcare Graduate Medical Education, Nashville, Tennessee, USA. .,Envision Physician Services, Plantation, Florida, USA. .,Department of Clinical Sciences, University of Central Florida College of Medicine, Florida, Orlando, USA.
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Gaspar R, Castelo Branco C, Macedo G. Liver and COVID-19: From care of patients with liver diseases to liver injury. World J Hepatol 2021; 13:1367-1377. [PMID: 34786172 PMCID: PMC8568576 DOI: 10.4254/wjh.v13.i10.1367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases. We performed a comprehensive review about how COVID-19 can affect the liver, the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on COVID-19. We analyze the relationship between COVID-19 and non-alcoholic fatty liver disease, alcoholic liver disease, viral hepatitis, autoimmune liver disease, cirrhosis, hepatocellular carcinoma and liver transplantation, as well as the approach to SARS-CoV-2 vaccination.
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Affiliation(s)
- Rui Gaspar
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Catarina Castelo Branco
- Department of Internal Medicine, Centro Hospitalar e Universitário do Porto, Porto 4100, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
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Expression and Possible Significance of ACE2 in the Human Liver, Esophagus, Stomach, and Colon. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6949902. [PMID: 34484401 PMCID: PMC8410421 DOI: 10.1155/2021/6949902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
Angiotensin-converting enzyme 2 (ACE2) has been identified as the key receptor of SARS coronavirus that plays a key role in the pathogenesis of SARS. It is known that ACE2 mRNA can be expressed in most organs. However, the protein expression of ACE2 is not clear yet. To explore the role of ACE2 as a precipitating factor in digestive organ damage in COVID-19, this study investigated the expression of ACE2 protein in the human liver, esophagus, stomach, and colon. The result showed that ACE2 can be expressed in the liver, esophagus, stomach, and colon, which suggests SARS-CoV-2 may enter the digestive system through ACE2 and cause liver damage and gastrointestinal damage. It is hoped that the result of the study will provide a new strategy for the prevention and treatment of digestive organ damage under COVID-19.
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Latifi M, Anvari Tafti M, Davari Dolatabadi N, Rafiei Z, Allahbakhshian Farsani L. E-Health: The Impact of Social Network on Self Care Behavior in Heart Failure Patients toward COVID-19 Epidemic. Adv Biomed Res 2021; 10:15. [PMID: 34476223 PMCID: PMC8378447 DOI: 10.4103/abr.abr_195_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/03/2020] [Accepted: 12/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background Patients with heart failure are one of the high-risk groups for coronary artery. Distance education of self-care behaviors can be effective in preventing the disease. The aim of this study was to investigate the effect of social networks in explaining the awareness of cardiovascular patients' self-care behaviors toward COVID-19. Materials and Methods In the present survey study, 227 patients with a history of heart failure were selected from Shahid Rajaei Hospital in Tehran by the available sampling method (May to July 2020). Data collection tools were the standard European Self-Care Behavior Questionnaire for heart failure and the Dorty Elizabeth Orem self-care model. Data were analyzed using SPSS Version 22. Results The results of the Pearson correlation coefficient showed a positive and relatively strong linear relationship between the variable of the degree of persistence in the use of networks with the eight dimensions of self-care behavior except psychological emotion control (r = -0.39, P = 0.315). Furthermore, a significant weak inverse relationship between the dimension of "cooperation with physicians and treatment staff" (r = -0.22, P = 0.129). Moreover, psychological support (r = -0/034, P = 0.446) was observed with the use of networks. Multivariate regression analysis revealed that the type of activity and participation in networks has a greater share and effect in increasing the score of self-care behavior of 0.55. Conclusions Since the use of networks has a positive effect on patients' self-care behavior, the use of these networks is recommended as a community-based approach in the health system and to improve health and health outcomes.
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Affiliation(s)
- Masoomeh Latifi
- PhD in Information Sciences and Knowledge Studies, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Motahare Anvari Tafti
- Department of Emergency Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Davari Dolatabadi
- Associate Professor of Health Information Management, Department of Health Information Technology, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Rafiei
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leili Allahbakhshian Farsani
- PhD in Knowledge and Information Sciences, Vice Chancellor for Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
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Gromova OA, Torshin II, Chuchalin AG, Kozhevnikova EN, Malyavskaya SI. Roles of active forms of vitamin D in supporting innate immune systems and in reducing excess inflammation in COVID-19. TERAPEVT ARKH 2021; 93:948-953. [DOI: 10.26442/00403660.2021.08.200918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 01/15/2023]
Abstract
A reduced supply of micronutrient vitamin D leads to a more severe course of coronavirus infection (COVID-19). Vitamin D deficiency is combined with a decrease in innate antiviral immunity and excess of inflammation. Vitamin D supplementation stimulates the synthesis of antibacterial peptides and is important for weakening the cytokine storm, reducing excessive acute and chronic inflammation, and also for compensating for chronic comorbid pathologies. Active forms of vitamin D (alfacalcidol, etc.) are of particular importance for compensating for vitamin D deficiency in elderly patients, endocrine-immune dysfunction, sarcopenia, chronic renal failure (in which the metabolism of vitamin D in the kidneys is disturbed).
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Anushiravani A, Khosravi B, Saberzadeh-Ardestani B, Ghasemi A, Kalantari S, Sorouri M, Mojtabavi H, Ghaemi O, Radmard AR, Kasaeian A, Motamedi O, Poustchi H, Sima AR. A Reliable Prognostic Marker for Liver Dysfunction in COVID-19 Infection. Middle East J Dig Dis 2021; 13:193-199. [PMID: 36606213 PMCID: PMC9489456 DOI: 10.34172/mejdd.2021.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/02/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In December 2019, COVID-19 emerged from China and spread to become a pandemic, killing over 1,350,000 up to November 18, 2020. Some patients with COVID-19 have abnormal liver function tests. We aimed to determine the clinical significance of liver chemistries in patients with COVID-19. METHODS We performed a cross-sectional study of 1044 consecutive patients with confirmed COVID-19 in two referral hospitals in Tehran, Iran, from February to April 2020. All cases were diagnosed by clinical criteria and confirmed by characteristic changes in the spiral chest computed tomography (CT) and nucleic acid testing of the nasopharyngeal samples. We evaluated the association between abnormal liver enzymes or function tests and survival, intensive care unit (ICU) admission and fatty liver changes in CT scans. RESULTS The mean age was 61.01 ± 16.77 years, and 57.68% were male. Of 495 patients with elevated alanine transaminase (ALT) levels, 194 had chest CT scans, in which fatty liver disease was seen in 38.1%. 41 patients (21.13%) had moderate to severe, and 33 (17.01%) had borderline fatty liver disease. Bilirubin, albumin, and partial thromboplastin time (PTT), along with other markers such as HCO3, C-reactive protein (CRP), triglyceride, and length of admission, were significantly associated with ICU admission and mortality. Prothrombin time (PT), platelet count, and low-density lipoprotein (LDL) levels were also correlated with mortality. Fasting blood sugar (FBS) and pH were important indices in ICU admitted patients. CONCLUSION Liver function tests accurately predict a worse prognosis in patients with COVID-19. However, liver enzymes were only slightly increased in those who died or needed ICU admission and were not related to the fatty liver changes.
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Affiliation(s)
- Amir Anushiravani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Saberzadeh-Ardestani
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghasemi
- Zanjan MRI Center, Radiology Department, Vali-e-Asr Hospital, Zanjan, Iran
| | - Saeed Kalantari
- Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Sorouri
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Helia Mojtabavi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Ghaemi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Motamedi
- Department of Radiology, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Sima
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
,Corresponding Author: Ali Reza Sima, M.D. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Kargar Shomali Avenue, Tehran, Iran Tel: + 98 21 82415000 Fax: + 98 21 82415400
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12
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Liu S, Tang MM, Du J, Gong ZC, Sun SS. COVID-19 in gastroenterology and hepatology: Lessons learned and questions to be answered. World J Clin Cases 2021; 9:4199-4209. [PMID: 34141782 PMCID: PMC8173430 DOI: 10.12998/wjcc.v9.i17.4199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/26/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) presents primarily as a lower respiratory tract infection, increasing data suggests multiorgan, including the gastrointestinal (GI) tract and liver, involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AIM To provide a comprehensive overview of COVID-19 in gastroenterology and hepatology. METHODS Relevant studies on COVID-19 related to the study aim were undertaken through a literature search to synthesize the extracted data. RESULTS We found that digestive symptoms and liver injury are not uncommon in patients with COVID-19 and varies in different individuals. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Other atypical GI symptoms, such as loss of smell and taste and GI bleeding, have also been reported along with the evolvement of COVID-19. Liver chemistry abnormalities mainly include elevation of aspartate transferase, alanine transferase, and total bilirubin. It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus to the angiotensin converting enzyme-2 receptor located on several different human cells. CONCLUSION Standardized criteria should be established for diagnosis and grading of the severity of GI symptoms in COVID-19 patients. Gastroenterology and hepatology in special populations, such as children and elderly, should be the focus of further research. Future long-term data regarding GI symptoms should not be overlooked.
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Affiliation(s)
- Shao Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Pharmacy, The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha 410008, Hunan Province, China
- Institute of Hospital Pharmacy, Central South University, Changsha 410008, Hunan Province, China
| | - Mi-Mi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Pharmacy, The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha 410008, Hunan Province, China
- Institute of Hospital Pharmacy, Central South University, Changsha 410008, Hunan Province, China
| | - Jie Du
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Pharmacy, The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha 410008, Hunan Province, China
- Institute of Hospital Pharmacy, Central South University, Changsha 410008, Hunan Province, China
| | - Zhi-Cheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Pharmacy, The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha 410008, Hunan Province, China
- Institute of Hospital Pharmacy, Central South University, Changsha 410008, Hunan Province, China
| | - Shu-Sen Sun
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA 01119, United States
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13
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Wang MK, Yue HY, Cai J, Zhai YJ, Peng JH, Hui JF, Hou DY, Li WP, Yang JS. COVID-19 and the digestive system: A comprehensive review. World J Clin Cases 2021; 9:3796-3813. [PMID: 34141737 PMCID: PMC8180220 DOI: 10.12998/wjcc.v9.i16.3796] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/10/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.
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Affiliation(s)
- Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Hai-Yan Yue
- Department of Digestive Diseases, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jin Cai
- Department of Geriatrics, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
- Department of Infectious Diseases, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Yu-Jia Zhai
- Department of Outpatient Services, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jian-Hui Peng
- Department of Quality Management, Guangdong Second Provincial General Hospital (Pazhou Campus), Guangzhou 510317, Guangdong Province, China
| | - Ju-Fen Hui
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Deng-Yong Hou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Wei-Peng Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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14
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Karuppan MKM, Devadoss D, Nair M, Chand HS, Lakshmana MK. SARS-CoV-2 Infection in the Central and Peripheral Nervous System-Associated Morbidities and Their Potential Mechanism. Mol Neurobiol 2021; 58:2465-2480. [PMID: 33439437 PMCID: PMC7805264 DOI: 10.1007/s12035-020-02245-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
The recent outbreak of SARS-CoV-2 infections that causes coronavirus-induced disease of 2019 (COVID-19) is the defining and unprecedented global health crisis of our time in both the scale and magnitude. Although the respiratory tract is the primary target of SARS-CoV-2, accumulating evidence suggests that the virus may also invade both the central nervous system (CNS) and the peripheral nervous system (PNS) leading to numerous neurological issues including some serious complications such as seizures, encephalitis, and loss of consciousness. Here, we present a comprehensive review of the currently known role of SARS-CoV-2 and identify all the neurological problems reported among the COVID-19 case reports throughout the world. The virus might gain entry into the CNS either through the trans-synaptic route via the olfactory neurons or through the damaged endothelium in the brain microvasculature using the ACE2 receptor potentiated by neuropilin-1 (NRP-1). The most critical of all symptoms appear to be the spontaneous loss of breathing in some COVID-19 patients. This might be indicative of a dysfunction within the cardiopulmonary regulatory centers in the brainstem. These pioneering studies, thus, lay a strong foundation for more in-depth basic and clinical research required to confirm the role of SARS-CoV-2 infection in neurodegeneration of critical brain regulatory centers.
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Affiliation(s)
- Mohan Kumar Muthu Karuppan
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Dinesh Devadoss
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Madhavan Nair
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Hitendra S Chand
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Madepalli K Lakshmana
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
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15
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Sun Y, Ding C, Chen Q, Xie J, Yu J, Shi Y, Jiang C, Zhang Z, He H, Ge Y, Li W, He J, Gao Y. Digital PCR assay for the effective detection of COVID-19 patients with SARS-CoV-2 low viral load. J Virol Methods 2021; 295:114185. [PMID: 34051244 PMCID: PMC8149472 DOI: 10.1016/j.jviromet.2021.114185] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 12/23/2022]
Abstract
Objective Viral nucleic acid detection by real-time reverse transcription polymerase chain reaction (qPCR) is the current standard method for diagnosis of SARS-CoV-2 infection. However, due to low viral load in some COVID-19 patients, false negative results from this method have been repeatedly reported. Method In this study, we compared the sensitivity and specificity of digital PCR (dPCR) in simulated samples and clinical samples with qPCR assay through a series of vigorous tests. Results The results showed that dPCR was more sensitive than qPCR especially for samples with low viral load (≤3 copies). In addition, dPCR had similar specificity as qPCR and could effectively distinguish other human coronaviruses and influenza virus from SARS-CoV-2. More importantly, dPCR was more sensitive than qPCR in detecting the virus in the “negative” samples from recurrent COVID-19 patients. Conclusions In summary, dPCR could serve as a powerful complement to the current qPCR method for SARS-CoV-2 detection, especially for the samples with extremely low viral load, such as recurrent COVID-19 patients.
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Affiliation(s)
- Yong Sun
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China
| | - Chengchao Ding
- First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Qingqing Chen
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China
| | - Jiajia Xie
- First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Junling Yu
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China
| | - Yonglin Shi
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China
| | - Chengcheng Jiang
- First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Zhuhui Zhang
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China
| | - Hongliang He
- First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Yinglu Ge
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China
| | - Wenting Li
- First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jun He
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, 230601, China; Key Laboratory for Medical and Health of the 13th Five-Year Plan, 12560, Fanhua Avenue, Hefei, Anhui, China.
| | - Yong Gao
- First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
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16
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Stawinski PM, Dziadkowiec KN, Al-Abbasi B, Suarez L, Simms L, Dewaswala N, Torres P, Al Rubaye A, Pino J, Marcus A. Model of End-Stage Liver Disease (MELD) Score as a Predictor of In-Hospital Mortality in Patients with COVID-19: A Novel Approach to a Classic Scoring System. Cureus 2021; 13:e15179. [PMID: 34178500 PMCID: PMC8216703 DOI: 10.7759/cureus.15179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Limited data is available for reliable and accurate predictors of in-hospital mortality in patients diagnosed with COVID-19. Methods This scientific study is a retrospective cohort study of patients without a known history of liver diseases who were hospitalized with COVID-19 viral infection. Patients were stratified into low score groups (Model of End-Stage Liver Disease [MELD] score <10) and high score groups (MELD ≥10). Clinical outcomes were evaluated, including in-hospital mortality, hospital length of stay, and intensive care unit length of stay (ICU LOS). Results Our cohort of 186 COVID-19 positive patients included 88 (47%) women with a mean age of 60 years in the low score group and mean age of 73 years in the high score group. Patients in the high score group were older in age (p<0.0001) and more likely to have history of diabetes mellitus (p=0.0020), stage 3 chronic kidney disease (CKD) (p=0.0013), hypertension (p<0.0001), stroke/transient ischemic attack (TIA) (p=0.0163), asthma (p=0.0356), dementia (p<0.0001), and chronic heart failure (p=0.0055). The in-hospital mortality or discharge to hospice rate was significantly higher in the high-score group as opposed to the low-score group (p=0.0014). Conversely, there was no significant difference among both groups in the hospital length of stay (LOS) and ICU LOS (p=0.6929 and p=0.7689, respectively). Conclusion Patients hospitalized with COVID-19 infection and found to have a MELD score greater than or equal to 10 were found to have a higher mortality as compared to their counterparts. Conversely a low MELD score is a very strong indicator of a more favorable prognosis, indicating hospital survival. We propose using the MELD score as an adjunct for risk stratifying patients diagnosed with COVID-19 without prior history of liver dysfunction.
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Affiliation(s)
- Peter M Stawinski
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | | | - Baher Al-Abbasi
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | - Laura Suarez
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | - Larnelle Simms
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | - Nakeya Dewaswala
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | - Pedro Torres
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | - Ayat Al Rubaye
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | - Jesus Pino
- Cardiology, University of Miami JFK Medical Center, Atlantis, USA
| | - Akiva Marcus
- Gastroenterology and Hepatology, University of Miami JFK Medical Center, Atlantis, USA
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17
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Chinnici CM, Russelli G, Bulati M, Miceli V, Gallo A, Busà R, Tinnirello R, Conaldi PG, Iannolo G. Mesenchymal stromal cell secretome in liver failure: Perspectives on COVID-19 infection treatment. World J Gastroenterol 2021; 27:1905-1919. [PMID: 34007129 PMCID: PMC8108038 DOI: 10.3748/wjg.v27.i17.1905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Due to their immunomodulatory potential and release of trophic factors that promote healing, mesenchymal stromal cells (MSCs) are considered important players in tissue homeostasis and regeneration. MSCs have been widely used in clinical trials to treat multiple conditions associated with inflammation and tissue damage. Recent evidence suggests that most of the MSC therapeutic effects are derived from their secretome, including the extracellular vesicles, representing a promising approach in regenerative medicine application to treat organ failure as a result of inflammation/fibrosis. The recent outbreak of respiratory syndrome coronavirus, caused by the newly identified agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has forced scientists worldwide to use all available instruments to fight the infection, including the inflammatory cascade caused by this pandemic disease. The use of MSCs is a valid approach to combat organ inflammation in different compartments. In addition to the lungs, which are considered the main inflammatory target for this virus, other organs are compromised by the infection. In particular, the liver is involved in the inflammatory response to SARS-CoV-2 infection, which causes organ failure, leading to death in coronavirus disease 2019 (COVID-19) patients. We herein summarize the current implications derived from the use of MSCs and their soluble derivatives in COVID-19 treatment, and emphasize the potential of MSC-based therapy in this clinical setting.
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Affiliation(s)
- Cinzia Maria Chinnici
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
- Department of Regenerative Medicine, Fondazione Ri.MED, Palermo 90127, Italy
| | - Giovanna Russelli
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
| | - Matteo Bulati
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
| | - Vitale Miceli
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
| | - Alessia Gallo
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
| | - Rosalia Busà
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
| | - Rosaria Tinnirello
- Neuroscience Unit, CNR Institute of Biomedicine and Molecular Immunology, Palermo 90146, Italy
| | - Pier Giulio Conaldi
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
| | - Gioacchin Iannolo
- Department of Research, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo 90127, Italy
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18
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Licata A, Minissale MG, Distefano M, Montalto G. Liver injury, SARS-COV-2 infection and COVID-19: What physicians should really know? GASTROHEP 2021; 3:121-130. [PMID: 34149320 PMCID: PMC8207035 DOI: 10.1002/ygh2.455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19), which in males, especially in advanced age, can sometimes evolve into acute respiratory distress syndrome. In addition, mild to moderate alterations in liver function tests (LFTs) have been reported in the worst affected patients. Our review aims to analyse data on the incidence and prognostic value of LFT alterations, the underlying mechanisms and the management of pre-existing liver disease in COVID-19 affected patients. METHODS We searched available literature through online PubMed database using terms as "SARS-CoV-2," "Liver damage," "Liver Function tests," "COVID-19," "pre-existing liver disease," "drug-induced liver injury." RESULTS Available evidence suggest that there could be a relationship between SARS-CoV-2 infection and liver damage, although the underlying involved mechanism remains unclear. Cohort studies have shown that high ALT levels, low platelet counts and low albumin levels at admission and during hospitalisation are associated with a high mortality rate. Unfortunately, little is known about the impact of COVID-19 on pre-existing liver damage. While chronic viral infections or NAFLD are associated with an increased risk of COVID-19 progression, patients with cirrhosis may have increased susceptibility to SARS-CoV-2 infection due to their systemic immunocompromised status. DILI seems common among hospitalised patient with severe pneumonia. CONCLUSION Mild to moderate liver impairment during Covid-19 is common, especially in patients with pre-existing liver disease. Further studies should be performed in order to understand how pre-existing liver conditions may influence and worsen progression of liver disease in COVID-19 patients.
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Affiliation(s)
- Anna Licata
- Internal Medicine & Hepatology SectionDepartment of Health Promotion Sciences, Maternal and Infant CareInternal Medicine and Medical SpecialtiesPROMISEUniversity of Palermo School of MedicinePalermoItaly
| | - Maria Giovanna Minissale
- Internal Medicine & Hepatology SectionDepartment of Health Promotion Sciences, Maternal and Infant CareInternal Medicine and Medical SpecialtiesPROMISEUniversity of Palermo School of MedicinePalermoItaly
| | | | - Giuseppe Montalto
- Internal Medicine & Hepatology SectionDepartment of Health Promotion Sciences, Maternal and Infant CareInternal Medicine and Medical SpecialtiesPROMISEUniversity of Palermo School of MedicinePalermoItaly
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19
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Ali FEM, Mohammedsaleh ZM, Ali MM, Ghogar OM. Impact of cytokine storm and systemic inflammation on liver impairment patients infected by SARS-CoV-2: Prospective therapeutic challenges. World J Gastroenterol 2021; 27:1531-1552. [PMID: 33958841 PMCID: PMC8058655 DOI: 10.3748/wjg.v27.i15.1531] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a devastating worldwide pandemic infection caused by a severe acute respiratory syndrome namely coronavirus 2 (SARS-CoV-2) that is associated with a high spreading and mortality rate. On the date this review was written, SARS-CoV-2 infected about 96 million people and killed about 2 million people. Several arguments disclosed the high mortality of COVID-19 due to acute respiratory distress syndrome or change in the amount of angiotensin-converting enzyme 2 (ACE2) receptor expression or cytokine storm strength production. In a similar pattern, hepatic impairment patients co-infected with SARS-CoV-2 exhibited overexpression of ACE2 receptors and cytokine storm overwhelming, which worsens the hepatic impairment and increases the mortality rate. In this review, the impact of SARS-CoV-2 on hepatic impairment conditions we overviewed. Besides, we focused on the recent studies that indicated cytokine storm as well as ACE2 as the main factors for high COVID-19 spreading and mortality while hinting at the potential therapeutic strategies.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Zuhair M Mohammedsaleh
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Mahmoud M Ali
- Pre-graduated students, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Osama M Ghogar
- Pre-graduated students, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
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20
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Aldossary B, Hassan A, Moussa M, Alsaif HS, Alfaraj D. Fulminant hepatic failure in a patient testing re-positive for SARS-CoV-2: a case report. Int J Emerg Med 2021; 14:24. [PMID: 33882839 PMCID: PMC8058753 DOI: 10.1186/s12245-021-00349-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may not elicit lifelong protective immunity and reinfection could occur. Liver function impairment is a common manifestation of coronavirus disease 2019 (COVID-19). However, acute hepatic failure in the setting of COVID-19 is very rare. Case presentation We report the case of a 47-year-old woman who presented with acute abdominal pain and vomiting. Abdominal examination revealed a soft and lax abdomen with mild tenderness in the right upper quadrant. The patient recovered from COVID-19 2 months previously with negative results on reverse transcription-polymerase chain reaction (RT-PCR). Laboratory investigations revealed markedly elevated transaminases with normal results on viral hepatitis serology panel and undetectable blood paracetamol level. Prior to admission, the patient underwent RT-PCR for SARS-CoV-2, which revealed a positive result. The patient experienced rapid deterioration in the neurological status with a remarkable increase in the liver enzyme levels. Despite aggressive resuscitation, the patient suffered irreversible cardiac arrest and died. Conclusion Fulminant hepatic failure is a rare manifestation in patients with re-positive RT-PCR tests for SARS-CoV-2. Clinicians should maintain a high index of suspicion for hepatic injury with active monitoring of liver enzymes.
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Affiliation(s)
- Bader Aldossary
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Ali Hassan
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain.
| | - Mohamed Moussa
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Hind S Alsaif
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Dunya Alfaraj
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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21
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Mnatsakanyan MG, Pogromov AP, Lishuta AS, Fomin VV, Volkova OS, Tashchyan OV, Kuprina IV, Shumskaya YF. Liver and COVID-19: possible mechanisms of damage. TERAPEVT ARKH 2021; 93:427-430. [DOI: 10.26442/00403660.2021.04.200733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023]
Abstract
The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.
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22
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Yip TCF, Lui GCY, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Hui DSC, Chan HLY, Wong GLH. Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19. Gut 2021; 70:733-742. [PMID: 32641471 PMCID: PMC7371491 DOI: 10.1136/gutjnl-2020-321726] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear. DESIGN This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death. RESULTS We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation. CONCLUSION ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.
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Affiliation(s)
- Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Viola Chi-Ying Chow
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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23
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Beck ALDS, Barberato SH, de Almeida ALC, Grau CRPDC, Lopes MMU, Lima RDSL, Cerci RJ, Albricker ACL, Barros FS, Oliveira AJ, de Lira EB, Miglioranza MH, Vieira MLC, Pena JLB, Strabelli TMV, Bihan DCDSL, Tsutsui JM, Rochitte CE. Position Statement on Indications and the Safe Reintroduction of Cardiovascular Imaging Methods in the COVID-19 Scenario - 2021. Arq Bras Cardiol 2021; 116:659-678. [PMID: 33909785 PMCID: PMC8159553 DOI: 10.36660/abc.20210133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Adenalva Lima de Souza Beck
- Universitária de CardiologiaInstituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal - Fundação Universitária de Cardiologia, Brasília, DF – Brasil,Hospital Sírio-LibanêsBrasíliaDFBrasilHospital Sírio-Libanês, Brasília, DF – Brasil
| | - Silvio Henrique Barberato
- CardioEco - Centro de DiagnósticoCuritibaPRBrasilCardioEco - Centro de Diagnóstico Cardiovascular, Curitiba, PR – Brasil,Quanta Diagnóstico e TerapiaCuritibaPRBrasilQuanta Diagnóstico e Terapia, Curitiba, PR – Brasil
| | - André Luiz Cerqueira de Almeida
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasilSanta Casa de Misericórdia de Feira de Santana, Feira de Santana, BA – Brasil
| | - Claudia R. Pinheiro de Castro Grau
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Grupo FleurySão PauloSPBrasilGrupo Fleury, São Paulo, SP – Brasil
| | - Marly Maria Uellendahl Lopes
- Universidade Estadual PaulistaSão PauloSPBrasilUniversidade Estadual Paulista (Unesp), São Paulo, SP – Brasil,Diagnósticos da AméricaSão PauloSPBrasilDiagnósticos da América SA (Dasa), São Paulo, SP – Brasil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil
| | - Rodrigo Júlio Cerci
- Quanta Diagnóstico e TerapiaCuritibaPRBrasilQuanta Diagnóstico e Terapia, Curitiba, PR – Brasil
| | - Ana Cristina Lopes Albricker
- Instituto Mineiro de UltrassonografiaBelo HorizonteMGBrasilInstituto Mineiro de Ultrassonografia (IMEDE), Belo Horizonte, MG – Brasil
| | | | - Alessandra Joslin Oliveira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Edgar Bezerra de Lira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Marcelo Haertel Miglioranza
- Hospital Mãe de DeusPorto AlegreRSBrasilPrevencor – Hospital Mãe de Deus, Porto Alegre, RS – Brasil,Fundação Universitária de CardiologiaInstituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul – Fundação Universitária de Cardiologia, Porto Alegre, RS – Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil,Hospital Felício RochoBelo HorizonteMGBrasilHospital Felício Rocho, Belo Horizonte, MG – Brasil
| | - Tânia Mara Varejão Strabelli
- Hospital Sírio-LibanêsBrasíliaDFBrasilHospital Sírio-Libanês, Brasília, DF – Brasil,Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - David Costa de Souza Le Bihan
- Diagnósticos da AméricaSão PauloSPBrasilDiagnósticos da América SA (Dasa), São Paulo, SP – Brasil,Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Jeane Mike Tsutsui
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor), São Paulo, SP – Brasil,Hospital Pró-CardíacoRio de JaneiroRJBrasilHospital Pró-Cardíaco, Rio de Janeiro, RJ – Brasil
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24
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Zhu H, Zhang L, Ma Y, Zhai M, Xia L, Liu J, Yu S, Duan W. The role of SARS-CoV-2 target ACE2 in cardiovascular diseases. J Cell Mol Med 2021; 25:1342-1349. [PMID: 33443816 PMCID: PMC7875924 DOI: 10.1111/jcmm.16239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
SARS-CoV-2, the virus responsible for the global coronavirus disease (COVID-19) pandemic, attacks multiple organs of the human body by binding to angiotensin-converting enzyme 2 (ACE2) to enter cells. More than 20 million people have already been infected by the virus. ACE2 is not only a functional receptor of COVID-19 but also an important endogenous antagonist of the renin-angiotensin system (RAS). A large number of studies have shown that ACE2 can reverse myocardial injury in various cardiovascular diseases (CVDs) as well as is exert anti-inflammatory, antioxidant, anti-apoptotic and anticardiomyocyte fibrosis effects by regulating transforming growth factor beta, mitogen-activated protein kinases, calcium ions in cells and other major pathways. The ACE2/angiotensin-(1-7)/Mas receptor axis plays a decisive role in the cardiovascular system to combat the negative effects of the ACE/angiotensin II/angiotensin II type 1 receptor axis. However, the underlying mechanism of ACE2 in cardiac protection remains unclear. Some approaches for enhancing ACE2 expression in CVDs have been suggested, which may provide targets for the development of novel clinical therapies. In this review, we aimed to identify and summarize the role of ACE2 in CVDs.
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Affiliation(s)
- Hanzhao Zhu
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
| | - Liyun Zhang
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
| | - Yubo Ma
- Department of Dermatology and VenereologyPeking University First HospitaBeijingChina
| | - Mengen Zhai
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
| | - Lin Xia
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
| | - Jincheng Liu
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
| | - Shiqiang Yu
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
| | - Weixun Duan
- Department of Cardiovascular SurgeryThe First Affiliated HospitalThe Air Force Medical UniversityXi’anChina
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25
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Li G, Yang Y, Gao D, Xu Y, Gu J, Liu P. Is liver involvement overestimated in COVID-19 patients? A meta-analysis. Int J Med Sci 2021; 18:1285-1296. [PMID: 33526990 PMCID: PMC7847626 DOI: 10.7150/ijms.51174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Considering transaminase more than the upper limit of normal value as liver injury might overestimate the prevalence of liver involvement in COVID-19 patients. No meta-analysis has explored the impact of varied definitions of liver injury on the reported prevalence of liver injury. Moreover, few studies reported the extent of hypertransaminasemia stratified by COVID-19 disease severity. Methods: A literature search was conducted using PubMed and Embase. The pooled prevalence of liver injury and hypertransaminasemia was estimated. Results: In total, 60 studies were included. The overall prevalence of liver injury was 25%. Compared to subgroups with the non-strict definition of liver injury (33%) and subgroups without giving detailed definition (26%), the subgroup with a strict definition had a much lower prevalence of liver injury (9%). The overall prevalence of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation was 19% and 22%. The prevalence of elevated ALT and AST were significantly higher in severe COVID-19 cases compare to non-severe cases (31% vs 16% and 44% vs 11%). In critically ill and fatal cases, no difference was found in the prevalence of elevated ALT (24% vs 30%) or AST (54% vs 49%). Sensitivity analyses indicated that the adjusted prevalence of ALT elevation, AST elevation, and liver injury decreased to 14%, 7%, and 12%. Conclusion: The overall prevalence of liver injury and hypertransaminasemia in COVID-19 patients might be overestimated. Only a small fraction of COVID-19 patients have clinically significant liver injury. The prevalence of hypertransaminasemia was significantly higher in severe COVID-19 cases compare to non-severe cases. Hence, in severe COVID-19 patients, more attention should be paid to liver function tests.
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Affiliation(s)
- Gang Li
- Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Yitian Yang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Danyang Gao
- Department of Anesthesiology, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing 100038, China
| | - Yongxing Xu
- Department of Nephrology, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Jianwen Gu
- The Leading Group on COVID-19 Prevention and Control, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Pengfei Liu
- Department of Anesthesiology, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing 100038, China
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26
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Kouhsari E, Azizian K, Sholeh M, Shayestehpour M, Hashemian M, Karamollahi S, Yaghoubi S, Sadeghiifard N. Clinical, epidemiological, laboratory, and radiological characteristics of novel Coronavirus (2019-nCoV) in retrospective studies: A systemic review and meta-analysis. Indian J Med Microbiol 2021; 39:104-115. [PMID: 33610239 PMCID: PMC7667392 DOI: 10.1016/j.ijmmb.2020.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In December 2019, a novel pneumonia related to the 2019 coronavirus unexpectedly developed in Wuhan, China. We aimed to review data of the novel Coronavirus (2019-nCoV) by analyzing all the published retrospective studies on the clinical, epidemiological, laboratory, and radiological characteristics of patients with 2019-nCoV. METHODS We searched in four bibliographic databases PubMed, Scopus, Embase, and Web of Science) for studies March 10, 2020 focused on the clinical, epidemiological, laboratory, and radiological characteristics of patients with 2019-nCoV for meta-analysis. The Newcastle-Ottawa Scale was used to quality assessment, and publication bias was analyzed by Egger's test. In the meta-analysis, a random-effects model with Stata/SE software, v.14.1 (StataCorp, College Station, TX) was used to obtain a pooled incidence rate. RESULTS Fifty studies were included in this systematic review and meta-analysis with 8815 patients and the mean age was 46 years and 4647 (52.7%) were male. The pooled incidences rate of clinical symptoms were: fever (83%, 95% CI: 0.77, 0.89), cough (59%, 95% CI: 0.48, 0.69), myalgia or fatigue (31%, 95% CI: 0.23, 0.39), sputum production (29%, 95% CI: 0.21, 0.39), and dyspnea (19%, 95% CI: 0.12, 0.26). The pooled incidence rate of acute respiratory distress syndrome (ARDS) was (22%, 95% CI: 0.00, 0.60). CONCLUSION The results of this systemic review and meta-analysis present a quantitative pooled incidence rate of different characters of 2019-nCoV and has great potential to develop diagnosis and patient's stratification in 2019-nCoV. However, this conclusions of this study still requisite to be warranted by more careful design, larger sample size multivariate studies to corroborate the results of this meta-analysis.
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Affiliation(s)
- Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Khalil Azizian
- Department of Lab Science, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shayestehpour
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Marzieh Hashemian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Somayeh Karamollahi
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iranshahr, Iran.
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27
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Wan J, Wang X, Su S, Zhang Y, Jin Y, Shi Y, Wu K, Liang J. Digestive symptoms and liver injury in patients with coronavirus disease 2019 (COVID-19): A systematic review with meta-analysis. JGH Open 2020; 4:1047-1058. [PMID: 33319036 PMCID: PMC7731824 DOI: 10.1002/jgh3.12428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/08/2023]
Abstract
Although most COVID-19 patients typically present with respiratory symptoms, many patients could experience digestive symptoms as the major complaint. We performed a systematic review and meta-analysis to investigate the exact prevalence of digestive symptoms and liver injury in COVID-19 patients and compare the difference between patients with and without digestive symptoms. PubMed, Embase, Ovid, Wanfang data, and CNKI were searched until 24 April 2020 to identify studies that reported digestive symptoms and liver injury in COVID-19 patients. A random-effect model was used to combine the data. Finally, 64 studies with 15 141 patients were included. The pooled rate of digestive symptoms and liver dysfunction was 31.8% (95 CI 21.0-42.5%, I 2 = 97.6%) and 27.4% (95 CI 16.9-37.9%, I 2 = 97.9%), respectively. Patients with digestive symptoms were more likely to present with fatigue (OR 2.28, 95 CI 1.66-3.14, P < 0.00001, I 2 = 31%), myalgia (OR 1.96, 95 CI 1.06-3.65, P = 0.03, I 2 = 69%), and acute respiratory disease syndrome (ARDS) (OR 2.94, 95 CI 1.17-7.40, P = 0.02, I 2 = 0) and had a trend to present as severe/critical type (OR 1.87, 95 CI 0.98-3.57, P = 0.06, I 2 = 58%). Severe/critical patients were more likely to present with diarrhea (OR 2.02, 95 CI 1.16-3.50, P = 0.01, I 2 = 64) and have high alanine aminotransferase (ALT) (OR 2.08, 95 CI 1.55-2.81, P < 0.00001, I 2 = 13%,) and aspartate aminotransferase (AST) (OR 3.53, 95 CI 2.76-4.51, P < 0.00001, I 2 = 0). The pooled rate of patients with digestive symptoms was 28.7% (95 CI 17.6-39.8%) and 42.8% (95 CI 23.4-62.3%) in studies from China and out of China, respectively. COVID-19 patients had a high rate of digestive symptoms and liver injury. Patients with digestive symptoms had a trend to develop severe/critical illness.
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Affiliation(s)
- Jian Wan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Xuan Wang
- Department of Neurology, Xijing HospitalFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Song Su
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Yujie Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Yirong Jin
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Yanting Shi
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Kaichun Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
| | - Jie Liang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'anShaanxi ProvinceChina
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28
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Jin L, Tang W, Song L, Luo L, Zhou Z, Fan X, Zhang J, Wu N, Liu K, Chen J. Acute cardiac injury in adult hospitalized COVID-19 patients in Zhuhai, China. Cardiovasc Diagn Ther 2020; 10:1303-1312. [PMID: 33224754 DOI: 10.21037/cdt-20-607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) has already became a public health emergency of international concern. COVID-19 related cardiac injury remains largely unclear. Methods We retrospectively analyzed demographic, clinical, laboratory and cardiovascular imaging data of all consecutively admitted adult COVID-19 patients in Zhuhai, China from January 17th, 2020 to February 18th, 2020. Results A total of 93 patients were included in the study. Acute cardiac injury was found in 9 (9.7%) COVID-19 patients with median level of hypersensitive cardiac troponin I (hs-cTnI) to be 0.085 µg/L (IQR 0.027-0.560 µg/L). Compared with patients without cardiac injury, the median age of patients with cardiac injury was significantly older (65.0 vs. 44.0, P<0.05), hypertension was significantly more common (44.4% vs. 14.3%, P<0.05), and the proportion of severe-critical cases were greater (77.8% vs. 17.9%, P<0.05). Patients with cardiac injury were more likely have elevation of N-terminal proBNP (NT-proBNP) in comparison (66.7% vs. 10.0%, P<0.05). There was no significant difference in echocardiographic parameters between patients with and without cardiac injury. Multivariable logistic regression analysis indicated that older age (OR: 1.093, 95% CI: 1.011-1.182) and increased NT-proBNP (OR: 10.979, 95% CI: 2.024-59.555) were independent risk factors for cardiac injury. Cardiac magnetic resonance (CMR) imaging performed on three patients at around one month after they underwent significant hs-cTnI elevation showed that they had underlying cardiovascular comorbidities. Conclusions Acute cardiac injury was seen in the minority of hospitalized COVID-19 patients in Zhuhai, China. Older age and increased NT-proBNP were associated with acute cardiac injury. Registration number ChiCTR2000030952.
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Affiliation(s)
- Lizi Jin
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Wenyi Tang
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Lizheng Song
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Liyun Luo
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhijuan Zhou
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiuwu Fan
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jinyou Zhang
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Niujian Wu
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kan Liu
- Division of Cardiology, University of Iowa, Iowa City, IA 52240, USA
| | - Jian Chen
- Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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29
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Liu Z, Li J, Long W, Zeng W, Gao R, Zeng G, Chen D, Wang S, Li Q, Hu D, Guo L, Li Z, Wu X. Bilirubin Levels as Potential Indicators of Disease Severity in Coronavirus Disease Patients: A Retrospective Cohort Study. Front Med (Lausanne) 2020; 7:598870. [PMID: 33240911 PMCID: PMC7680876 DOI: 10.3389/fmed.2020.598870] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives: The coronavirus disease (COVID-19) pandemic has caused a large number of deaths. Some patients with severe or critical COVID-19 have been observed to have elevated bilirubin levels. Studies on the association of bilirubin level and mortality in patients with COVID-19 are limited. This study aimed to examine the role of bilirubin levels in COVID-19 severity and mortality. Methods: A retrospective cohort study was conducted in patients hospitalized with COVID-19 in Leishenshan Hospital in Wuhan, China. Cox regression analyses and logistic regression analyses were conducted to investigate the risks for mortality and disease severity, respectively. Kaplan–Meier analyses with log-rank tests were performed to assess the association between bilirubin level and survival. Results: In total, 1,788 patients with COVID-19 were included in the analysis. 5.8% (4/69) of patients in the elevated serum total bilirubin (STB) group died, compared to 0.6% (11/1,719) of patients in the non-elevated STB group. The median alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities in the elevated STB group were 29 U/L [interquartile range (IQR): 16–45 U/L] and 22 U/L (IQR: 13–37 U /L), respectively, which were significantly higher than the median ALT (median: 23, IQR: 15–37) and AST (median: 20, IQR: 16–26) activities in the non-elevated STB group (both p < 0.05). Patients with an elevated STB level showed increased mortality [hazard ratio (HR): 9.45, P = 0.002], elevated conjugated bilirubin (CB) levels (HR: 4.38, P = 0.03), and an elevated ratio of CB to unconjugated bilirubin (UCB, CB/UCB) (HR: 2.49, P = 0.01). CB/UCB was positively correlated with disease severity (odds ratio: 2.21, P = 0.01). Conclusions: COVID-19 patients with elevated STB and CB levels had a higher mortality, and CB/UCB was predictive of disease severity and mortality. Thus, it is necessary to pay special attention to COVID-19 patients with elevated bilirubin levels in clinical management.
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Affiliation(s)
- Zeming Liu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinpeng Li
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Long
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rongfen Gao
- Department of Rheumatology and Immunology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guang Zeng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Danyang Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shipei Wang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qianqian Li
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Di Hu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaohui Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Wu X, Liu L, Jiao J, Yang L, Zhu B, Li X. Characterisation of clinical, laboratory and imaging factors related to mild vs. severe covid-19 infection: a systematic review and meta-analysis. Ann Med 2020; 52:334-344. [PMID: 32755287 PMCID: PMC7877997 DOI: 10.1080/07853890.2020.1802061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Early detection of disease progression associated with severe COVID-19, and access to proper medical care lowers fatality rates of severe cases. Currently, no studies had systematically examined the variables in detecting severe COVID-19. METHOD Systematic searching of electronic databases identified observational studies which recruited participants with confirmed COVID-19 infection who were divided into different groups according to disease severity were identified. RESULTS To analysis 41 studies with 5064 patients were included.Patients who are elderly (SMD, 1.90; 95% CI, 1.01 to 2.8), male (OR, 1.71; 95% CI, 1.39 to 2.11) and have comorbidities or flu-like symptoms were significantly associated with the development to severe cases. Severe cases were associated with significant increased WBC (OR, 5.83; 95% CI, 2.76 to 12.32), CRP (OR, 3.62; 95% CI, 1.62 to 8.03), D-dimer (SMD, 1.69; 95% CI, 1.09 to 2.28), AST (OR, 4.64; 95% CI, 3.18 to 6.77) and LDH (OR, 7.94; 95% CI, 2.09 to 30.21). CT manifestation of bilateral lung involvement (OR, 4.55; 95% CI, 2.17 to 9.51) was associated with the severe cases. Conclusions and Relevance: Our findings offer guidance for a wide spectrum of clinicians to early identify severe COVID-19 patients, transport to specialised centres, and initiate appropriate treatment. Key Messages This systematic review and meta-analysis examined 41 studies including 5,064 patients with confirmed COVID-19. Severe cases were associated with age, male gender, and with fever, cough and respiratory diseases, increased WBC, CRP, D-dimer, AST and LDH levels. Furthermore, CT manifestation of bilateral lung involvement was associated with the severe cases. These findings provide guidance to health professionals with early identification of severe COVID-19 patients, transportation to specialised care and initiate appropriate supportive treatment.
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Affiliation(s)
- Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Lei Liu
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinghua Jiao
- Department of Anesthesiology, Central Hospital, Shenyang Medical College, Shenyang, China
| | - Lina Yang
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bo Zhu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Aziz M, Haghbin H, Lee-Smith W, Goyal H, Nawras A, Adler DG. Gastrointestinal predictors of severe COVID-19: systematic review and meta-analysis. Ann Gastroenterol 2020; 33:615-630. [PMID: 33162738 PMCID: PMC7599357 DOI: 10.20524/aog.2020.0527] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has created a need to identify potential predictors of severe disease. We performed a systematic review and meta-analysis of gastrointestinal predictors of severe COVID-19. METHODS An extensive literature search was performed using PubMed, Embase, Web of Science and Cochrane. Odds ratio (OR) and mean difference (MD) were calculated for proportional and continuous outcomes using a random-effect model. For each outcome, a 95% confidence interval (CI) and P-value were generated. RESULTS A total of 83 studies (26912 patients, mean age 43.5±16.4 years, 48.2% female) were included. Gastrointestinal predictors of severe COVID-19 included the presence of diarrhea (OR 1.50, 95%CI 1.10-2.03; P=0.01), elevated serum aspartate aminotransferase (AST) (OR 4.00, 95%CI 3.02-5.28; P<0.001), and elevated serum alanine aminotransferase (ALT) (OR 2.54, 95%CI 1.91-3.37; P<0.001). Significantly higher levels of mean AST (MD 14.78 U/L, 95%CI 11.70-17.86 U/L; P<0.001), ALT (MD 11.87 U/L, 95%CI 9.23-14.52 U/L; P<0.001), and total bilirubin (MD 2.08 mmol/L, 95%CI 1.36-2.80 mmol/L; P<0.001) were observed in the severe COVID-19 group compared to non-severe COVID-19 group. CONCLUSION Gastrointestinal symptoms and biomarkers should be assessed early to recognize severe COVID-19.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Hossein Haghbin)
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Hossein Haghbin)
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio (Wade Lee-Smith)
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania (Hemant Goyal)
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio (Ali Nawras)
| | - Douglas G. Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah (Douglas G. Adler), USA
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Moutchia J, Pokharel P, Kerri A, McGaw K, Uchai S, Nji M, Goodman M. Clinical laboratory parameters associated with severe or critical novel coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One 2020; 15:e0239802. [PMID: 33002041 PMCID: PMC7529271 DOI: 10.1371/journal.pone.0239802] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To date, several clinical laboratory parameters associated with Coronavirus disease 2019 (COVID-19) severity have been reported. However, these parameters have not been observed consistently across studies. The aim of this review was to assess clinical laboratory parameters which may serve as markers or predictors of severe or critical COVID-19. METHODS AND FINDINGS We conducted a systematic search of MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases from 2019 through April 18, 2020, and reviewed bibliographies of eligible studies, relevant systematic reviews, and the medRxiv pre-print server. We included hospital-based observational studies reporting clinical laboratory parameters of confirmed cases of COVID-19 and excluded studies having large proportions (>10%) of children and pregnant women. Two authors independently carried out screening of articles, data extraction and quality assessment. Meta-analyses were done using random effects model. Meta-median difference (MMD) and 95% confidence interval (CI) was calculated for each laboratory parameter. Forty-five studies in 6 countries were included. Compared to non-severe COVID-19 cases, severe or critical COVID-19 was characterised by higher neutrophil count (MMD: 1.23 [95% CI: 0.58 to 1.88] ×109 cells/L), and lower lymphocyte, CD4 and CD8 T cell counts with MMD (95% CI) of -0.39 (-0.47, -0.31) ×109 cells/L, -204.9 (-302.6, -107.1) cells/μl and -123.6 (-170.6, -76.6) cells/μl, respectively. Other notable results were observed for C-reactive protein (MMD: 36.97 [95% CI: 27.58, 46.35] mg/L), interleukin-6 (MMD: 17.37 [95% CI: 4.74, 30.00] pg/ml), Troponin I (MMD: 0.01 [0.00, 0.02] ng/ml), and D-dimer (MMD: 0.65 [0.45, 0.85] mg/ml). CONCLUSIONS Relative to non-severe COVID-19, severe or critical COVID-19 is characterised by increased markers of innate immune response, decreased markers of adaptive immune response, and increased markers of tissue damage and major organ failure. These markers could be used to recognise severe or critical disease and to monitor clinical course of COVID-19.
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Affiliation(s)
- Jude Moutchia
- Bamenda Regional Hospital, Bamenda, Cameroon
- EHESP–French School of Public Health, Paris, France
| | - Pratik Pokharel
- EHESP–French School of Public Health, Paris, France
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Aldiona Kerri
- EHESP–French School of Public Health, Paris, France
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Kaodi McGaw
- EHESP–French School of Public Health, Paris, France
- University of Cambridge, Cambridge, United Kingdom
| | - Shreeshti Uchai
- EHESP–French School of Public Health, Paris, France
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Miriam Nji
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States of America
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Wu Y, Li H, Guo X, Yoshida EM, Mendez-Sanchez N, Levi Sandri GB, Teschke R, Romeiro FG, Shukla A, Qi X. Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis. Hepatol Int 2020; 14:621-637. [PMID: 32710250 PMCID: PMC7380163 DOI: 10.1007/s12072-020-10074-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients. METHODS PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients. RESULTS Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04). CONCLUSIONS Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients.
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Affiliation(s)
- Yanyan Wu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People’s Republic of China
| | - Hongyu Li
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
| | - Eric M. Yoshida
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | - Nahum Mendez-Sanchez
- Liver Research Unit Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Hanau, Germany
| | | | - Akash Shukla
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Parel, Mumbai India
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840 Liaoning Province People’s Republic of China
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Xie Y, Wang Z, Liao H, Marley G, Wu D, Tang W. Epidemiologic, clinical, and laboratory findings of the COVID-19 in the current pandemic: systematic review and meta-analysis. BMC Infect Dis 2020; 20:640. [PMID: 32867706 PMCID: PMC7457225 DOI: 10.1186/s12879-020-05371-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected the world deeply, with more than 14,000,000 people infected and nearly 600,000 deaths. This review aimed to summarize the epidemiologic traits, clinical spectrum, CT results and laboratory findings of the COVID-19 pandemic. METHODS We scoped for relevant literatures published during 1st December 2019 to 16th July 2020 based on three databases using English and Chinese languages. We reviewed and analyzed the relevant outcomes. RESULTS The COVID-19 pandemic was found to have a higher transmission rate compared to SARS and MERS and involved 4 stages of evolution. The basic reproduction number (R0) is 3.32 (95% CI:3.24-3.39), the incubation period was 5.24 days (95% CI:3.97-6.50, 5 studies) on average, and the average time for symptoms onset varied by countries. Common clinical spectrums identified included fever (38.1-39.0 °C), cough and fatigue, with Acute Respiratory Distress Syndrome (ARDS) being the most common complication reported. Body temperatures above 39.0 °C, dyspnea, and anorexia were more common symptoms in severe patients. Aged over 65 years old, having co-morbidities, and developing complications were the commonest high-risk factors associated with severe conditions. Leucopenia and lymphopenia were the most common signs of infection while liver and kidney damage were rare but may cause bad outcomes for patients. The bilateral, multifocal Ground-Glass Opacification (GGO) on peripheral, and the consolidative pulmonary opacity were the most frequent CT results and the tendency of mortality rates differed by region. CONCLUSIONS We provided a bird's-eye view of the COVID-19 during the current pandemic, which will help better understanding the key traits of the disease. The findings could be used for disease's future research, control and prevention.
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Affiliation(s)
- Yewei Xie
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Zaisheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Huipeng Liao
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Gifty Marley
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Dan Wu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- London School of Hygiene & Tropical Medicine, London, UK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.
- University of North Carolina Project-China, Guangzhou, China.
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Yang RX, Zheng RD, Fan JG. Etiology and management of liver injury in patients with COVID-19. World J Gastroenterol 2020; 26:4753-4762. [PMID: 32921955 PMCID: PMC7459209 DOI: 10.3748/wjg.v26.i32.4753] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/23/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of novel coronavirus disease 2019 (COVID-19) has resulted in global emergence. With the expansion of related research, in addition to respiratory symptoms, digestive system involvement such as nausea, vomiting, and diarrhea have also been reported with COVID-19. Besides, abnormal liver function is also frequent in biochemical tests of COVID-19 patients, which is correlated with the severity and mortality of the disease course. The etiology of liver injury in patients with COVID-19 might include viral immunologic injury, drug-induced liver injury, the systemic inflammatory response, hypoxic hepatitis, and the exacerbation of preexisting liver disease. Although liver injuries in COVID-19 are often transient and reversible, health workers need to pay attention to preexisting liver disease, monitor liver function, strengthen supportive treatment, and reduce the chance of drug-induced liver injury. This article reviews the epidemiological characteristics, etiology, management, and preventive strategies for liver injury in patients with COVID-19.
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Affiliation(s)
- Rui-Xu Yang
- Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Rui-Dan Zheng
- Diagnosis and Treatment Center for Liver Diseases, Zhengxing Hospital, Zhangzhou 363000, Fujian Province, China
| | - Jian-Gao Fan
- Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China
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Xie Y, Wang Z, Liao H, Marley G, Wu D, Tang W. Epidemiologic, Clinical, and Laboratory Findings of the COVID-19 in the current pandemic: Systematic Review and Meta-analysis. RESEARCH SQUARE 2020:rs.3.rs-28367. [PMID: 32702720 PMCID: PMC7336699 DOI: 10.21203/rs.3.rs-28367/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic has affected the world deeply, with more than 3,000,000 people infected and nearly 200,000 deaths. This review aimed to summarize the epidemiologic traits, clinical spectrum, CT results and laboratory findings of the COVID-19 pandemic. Methods We scoped for relevant literatures published during 1 st Dec 2019 to 23 rd Apr 2020 based on four databases using English and Chinese languages. We reviewed and analyzed the relevant clinic outcomes of COVID-19. Results The COVID-19 pandemic was found to have a higher transmission rate compared to SARS and MERS and involved 4 stages of evolution. The basic reproduction number (R 0 ) is 3.32 (95% CI:3.24-3.39), the incubation period was 5.24 days (95% CI:3.97-6.50, 5 studies) on average, and the average time for symptoms onset varied by countries. Common clinical spectrums identified included fever (38.1-39.0°C), cough and fatigue, with Acute Respiratory Distress Syndrome (ARDS) being the most common complication reported. Body temperatures above 39.0 °C, dyspnea, and anorexia were more common symptoms in severe patients. Aged over 60 years old, having co-morbidities, and developing complications were the commonest high-risk factors associated with severe conditions. Leucopenia and lymphopenia were the most common signs of infection while liver and kidney damage were rare but may cause bad outcomes for patients. The bilateral, multifocal Ground-Glass Opacification (GGO) on peripheral, and the consolidative pulmonary opacity were the most frequent CT results and the tendency of mortality rates differed by region. Conclusions We provided a bird's-eye view of the COVID-19 during the current pandemic, which will help better understanding the key traits of the disease. The findings could be used for disease's future research, control and prevention.
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Affiliation(s)
- Yewei Xie
- University of North Carolina at Chapel Hill-China Project
| | - Zaisheng Wang
- University of North Carolina at Chapel Hill-China Project
| | - Huipeng Liao
- University of North Carolina at Chapel Hill-China Project
| | | | - Dan Wu
- London School of Hygiene and Tropical Medicine
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Gong Y, Ma TC, Xu YY, Yang R, Gao LJ, Wu SH, Li J, Yue ML, Liang HG, He X, Yun T. Early Research on COVID-19: A Bibliometric Analysis. ACTA ACUST UNITED AC 2020; 1:100027. [PMID: 32914141 PMCID: PMC7403001 DOI: 10.1016/j.xinn.2020.100027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022]
Abstract
In December 2019, an outbreak of pneumonia, which was named COVID-2019, emerged as a global health crisis. Scientists worldwide are engaged in attempts to elucidate the transmission and pathogenic mechanisms of the causative coronavirus. COVID-19 was declared a pandemic by the World Health Organization in March 2020, making it critical to track and review the state of research on COVID-19 to provide guidance for further investigations. Here, bibliometric and knowledge mapping analyses of studies on COVID-19 were performed, including more than 1,500 papers on COVID-19 available in the PubMed and China National Knowledge Infrastructure databases from January 1, 2020 to March 8, 2020. In this review, we found that because of the rapid response of researchers worldwide, the number of COVID-19-related publications showed a high growth trend in the first 10 days of February; among these, the largest number of studies originated in China, the country most affected by pandemic in its early stages. Our findings revealed that the epidemic situation and data accessibility of different research teams have caused obvious difference in emphases of the publications. Besides, there was an unprecedented level of close cooperation and information sharing within the global scientific community relative to previous coronavirus research. We combed and drew the knowledge map of the SARS-CoV-2 literature, explored early status of research on etiology, pathology, epidemiology, treatment, prevention, and control, and discussed knowledge gaps that remain to be urgently addressed. Future perspectives on treatment, prevention, and control are also presented to provide fundamental references for current and future coronavirus research.
China initiated COVID-19-related research in considerable scope and depth at the early stage of the outbreak Researchers all over the world have rapidly launched unprecedented joint research efforts The knowledge map of SARS-CoV-2 is becoming increasingly comprehensive, and knowledge gaps to be filled have been identified The next step is to consider other factors conducive to research innovation, such as public and private's cooperation, equitable health system
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Affiliation(s)
- Yue Gong
- National Science Library, Chinese Academy of Sciences, Beijing 100190, China
| | - Ting-Can Ma
- Wuhan Library, Chinese Academy of Science, Wuhan 430071, China.,Department of Library, Information and Archives Management, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Yang-Yang Xu
- China Center for Information Industry Development, Beijing 100036, China
| | - Rui Yang
- Key Laboratory of Plant Resources and Beijing Botanical Garden, Institute of Botany, Chinese Academy of Sciences, Beijing 100093, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lan-Jun Gao
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Si-Hua Wu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Jing Li
- University of Chinese Academy of Sciences, Beijing 100049, China.,CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Ming-Liang Yue
- Wuhan Library, Chinese Academy of Science, Wuhan 430071, China
| | - Hui-Gang Liang
- Wuhan Library, Chinese Academy of Science, Wuhan 430071, China
| | - Xiao He
- National Science Library, Chinese Academy of Sciences, Beijing 100190, China
| | - Tao Yun
- China Science and Technology Exchange Center, Beijing 100045, China
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Yang R, Gui X, Zhang Y, Xiong Y. The challenge of resuming classes for young students in Wuhan, China. Expert Rev Respir Med 2020; 14:763-766. [PMID: 32375523 PMCID: PMC7212539 DOI: 10.1080/17476348.2020.1761792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Rongrong Yang
- Department of Infectious Diseases, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Xien Gui
- Department of Infectious Diseases, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yongxi Zhang
- Department of Infectious Diseases, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yong Xiong
- Department of Emergency, Zhongnan Hospital, Wuhan University, Wuhan, China
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39
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Li S, Li J, Zhang Z, Tan L, Shao T, Li M, Li X, Holmes JA, Lin W, Han M. COVID-19 induced liver function abnormality associates with age. Aging (Albany NY) 2020; 12:13895-13904. [PMID: 32721928 PMCID: PMC7425469 DOI: 10.18632/aging.103720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that may cause fever, dry cough, fatigue and shortness of breath. The impact of COVID-19 on liver function is not well described. Results: We found that the overall frequency of LFT abnormality was 17.6%. Frequency of LFT abnormality was significantly greater in patients with severe/critical (SC) COVID-19 compared to those with mild/moderate (MM) COVID-19 (32.4% vs 11.6%, p=0.011). Among patients with LFT abnormality, the median age was significantly higher in the SC group compared to the MM group (52 vs 39 years, p=0.021). Conclusion: COVID-19 is frequently associated with mild liver function abnormality, particularly in individuals with severe/critical COVID-19 who were older. Liver function should be monitored carefully during infection, with judicious use of hepatotoxic agents where possible and avoidance of prolonged hypotension to minimize liver injury in older patients. Methods: The No. 2 People’s Hospital of Fuyang City in China has admitted a total of 159 patients with confirmed COVID-19 since the outbreak from January 2020 to March 2020. We analyzed the incidence of liver function test (LFT) abnormality in these patients with confirmed COVID-19 infection.
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Affiliation(s)
- Shasha Li
- Department of Hepatology, The Second People's Hospital of Fuyang, Fuyang 236015, Anhui Province, P.R. China
| | - Jinsong Li
- Department of Hepatology, The Second People's Hospital of Fuyang, Fuyang 236015, Anhui Province, P.R. China
| | - Zhenhua Zhang
- Department of Hepatology, The Second Hospital of Anhui Medical University, Hefei 236015, Anhui Province, P.R. China
| | - Lin Tan
- Department of Hepatology, The Second People's Hospital of Fuyang, Fuyang 236015, Anhui Province, P.R. China
| | - Tuo Shao
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ming Li
- Department of Hepatology, The Second People's Hospital of Fuyang, Fuyang 236015, Anhui Province, P.R. China
| | - Xiuyong Li
- Blood Purification Center, The Second People's Hospital of Fuyang, Fuyang 236015, Anhui Province, P.R. China
| | - Jacinta A Holmes
- Department of Gastroenterology, St Vincent's Hospital, University of Melbourne, Fitzroy 3065, VIC, Australia
| | - Wenyu Lin
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mingfeng Han
- Department of Respiratory, The Second People's Hospital of Fuyang, Fuyang 236015, Anhui Province, P.R. China
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40
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Dong R, Chu Z, Yu F, Zha Y. Contriving Multi-Epitope Subunit of Vaccine for COVID-19: Immunoinformatics Approaches. Front Immunol 2020; 11:1784. [PMID: 32849643 PMCID: PMC7399176 DOI: 10.3389/fimmu.2020.01784] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/03/2020] [Indexed: 01/10/2023] Open
Abstract
COVID-19 has recently become the most serious threat to public health, and its prevalence has been increasing at an alarming rate. The incubation period for the virus is ~1-14 days and all age groups may be susceptible to a fatality rate of about 5.9%. COVID-19 is caused by a novel single-stranded, positive (+) sense RNA beta coronavirus. The development of a vaccine for SARS-CoV-2 is an urgent need worldwide. Immunoinformatics approaches are both cost-effective and convenient, as in silico predictions can reduce the number of experiments needed. In this study, with the aid of immunoinformatics tools, we tried to design a multi-epitope vaccine that can be used for the prevention and treatment of COVID-19. The epitopes were computed by using B cells, cytotoxic T lymphocytes (CTL), and helper T lymphocytes (HTL) base on the proteins of SARS-CoV-2. A vaccine was devised by fusing together the B cell, HTL, and CTL epitopes with linkers. To enhance the immunogenicity, the β-defensin (45 mer) amino acid sequence, and pan-HLA DR binding epitopes (13aa) were adjoined to the N-terminal of the vaccine with the help of the EAAAK linker. To enable the intracellular delivery of the modeled vaccine, a TAT sequence (11aa) was appended to C-terminal. Linkers play vital roles in producing an extended conformation (flexibility), protein folding, and separation of functional domains, and therefore, make the protein structure more stable. The secondary and three-dimensional (3D) structure of the final vaccine was then predicted. Furthermore, the complex between the final vaccine and immune receptors (toll-like receptor-3 (TLR-3), major histocompatibility complex (MHC-I), and MHC-II) were evaluated by molecular docking. Lastly, to confirm the expression of the designed vaccine, the mRNA of the vaccine was enhanced with the aid of the Java Codon Adaptation Tool, and the secondary structure was generated from Mfold. Then we performed in silico cloning. The final vaccine requires experimental validation to determine its safety and efficacy in controlling SARS-CoV-2 infections.
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Affiliation(s)
- Rong Dong
- Department of Biomedicine, Guizhou University School of Medicine, Guiyang, China
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Diseases (Guizhou Provincial People's Hospital), Guiyang, China
| | - Zhugang Chu
- Department of Urinary Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fuxun Yu
- NHC Key Laboratory of Pulmonary Immunological Diseases (Guizhou Provincial People's Hospital), Guiyang, China
| | - Yan Zha
- Department of Biomedicine, Guizhou University School of Medicine, Guiyang, China
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Diseases (Guizhou Provincial People's Hospital), Guiyang, China
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41
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Sisti G, Schiattarella A, Sisti A. Treatment of COVID-19 in Pregnancy with Hydroxychloroquine and Azithromycin: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020123. [PMID: 33525254 PMCID: PMC7927503 DOI: 10.23750/abm.v91i4.10216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/27/2022]
Abstract
The combination of hydroxychloroquine (HCQ) and azithromycin could represent a suitable treatment for SarS-CoV-2 positive pregnancies. The authors report one of the first cases of COVID-19 positive pregnant woman successfully treated with HCQ in April 2020. (www.actabiomedica.it)
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Affiliation(s)
- Giovanni Sisti
- Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, NY USA.
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Andrea Sisti
- Department of Plastic Surgery, Cleveland Clinic, Ohio, USA.
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42
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Prediction of the Rehabilitation Duration and Risk Management for Mild-Moderate COVID-19. Disaster Med Public Health Prep 2020; 14:652-657. [PMID: 32576328 PMCID: PMC7369334 DOI: 10.1017/dmp.2020.214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: More than 80% of coronavirus disease 2019 (COVID-19) cases are mild or moderate. In this study, a risk model was developed for predicting rehabilitation duration (the time from hospital admission to discharge) of the mild-moderate COVID-19 cases and was used to conduct refined risk management for different risk populations. Methods: A total of 90 consecutive patients with mild-moderate COVID-19 were enrolled. Large-scale datasets were extracted from clinical practices. Through the multivariable linear regression analysis, the model was based on significant risk factors and was developed for predicting the rehabilitation duration of mild-moderate cases of COVID-19. To assess the local epidemic situation, risk management was conducted by weighing the risk of populations at different risk. Results: Ten risk factors from 44 high-dimensional clinical datasets were significantly correlated to rehabilitation duration (P < 0.05). Among these factors, 5 risk predictors were incorporated into a risk model. Individual rehabilitation durations were effectively calculated. Weighing the local epidemic situation, threshold probability was classified for low risk, intermediate risk, and high risk. Using this classification, risk management was based on a treatment flowchart tailored for clinical decision-making. Conclusions: The proposed novel model is a useful tool for individualized risk management of mild-moderate COVID-19 cases, and it may readily facilitate dynamic clinical decision-making for different risk populations.
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43
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Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care 2020; 24:255. [PMID: 32456658 PMCID: PMC7249975 DOI: 10.1186/s13054-020-02995-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, OH USA
| | - Ragheb Assaly
- Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, OH USA
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44
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Wu J, Song S, Cao HC, Li LJ. Liver diseases in COVID-19: Etiology, treatment and prognosis. World J Gastroenterol 2020; 26:2286-2293. [PMID: 32476793 PMCID: PMC7243650 DOI: 10.3748/wjg.v26.i19.2286] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China causing coronavirus disease-2019 (COVID-19). Numerous studies have shown varying degrees of liver damage in patients infected with SARS-CoV-2. However, in previous case studies of COVID-19, the exact cause of liver injury has not been clearly elucidated, nor is there clear evidence of the interaction between liver injury and COVID-19. This study will analyze the causes of liver injury in COVID-19 and the influence of liver-related complications on the treatment and prognosis of COVID-19.
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Affiliation(s)
- Jian Wu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Department of Laboratory Medicine, The Third People’s Hospital of Yancheng City, Yancheng 224001, Jiangsu Province, China
| | - Shu Song
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Hong-Cui Cao
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, Hangzhou 310003, Zhejiang Province, China
| | - Lan-Juan Li
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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45
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Chaudhry F, Kainth T, Sakla NM, Singh G, Marian V. Extrapulmonary Gastrointestinal Presentation of Coronavirus (COVID-19): A Case Report and Review of Literature. Cureus 2020; 12:e8104. [PMID: 32542159 PMCID: PMC7292724 DOI: 10.7759/cureus.8104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is currently the causative agent for a global health emergency and is predominantly associated with respiratory symptoms. In this case, a patient presented to the emergency department with gastrointestinal symptomatology without associated respiratory findings and was subsequently diagnosed with COVID-19 based on incidental findings from an abdominal computed tomography (CT) study. Given the patient's lack of respiratory symptoms, diagnosis and treatment were ultimately delayed. During this global health crisis, an improved understanding of the various presentations of COVID-19 is paramount in an effort to initiate immediate treatment and prevent further transmission.
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Affiliation(s)
- Faiza Chaudhry
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
| | - Tejasvi Kainth
- Language Access and Internal Medicine, Winnipeg Regional Health Authority, Winnipeg, CAN
| | - Nicole M Sakla
- Radiology, Newark Beth Israel Medical Center and Children's Hospital of New Jersey, Newark, USA
| | - Gagandeep Singh
- Radiology, Newark Beth Israel Medical Center and Children's Hospital of New Jersey, Newark, USA
| | - Valentin Marian
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
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46
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Kukla M, Skonieczna-Żydecka K, Kotfis K, Maciejewska D, Łoniewski I, Lara LF, Pazgan-Simon M, Stachowska E, Kaczmarczyk M, Koulaouzidis A, Marlicz W. COVID-19, MERS and SARS with Concomitant Liver Injury-Systematic Review of the Existing Literature. J Clin Med 2020; 9:E1420. [PMID: 32403255 PMCID: PMC7290752 DOI: 10.3390/jcm9051420] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/10/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.
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Affiliation(s)
- Michał Kukla
- Department of Internal Medicine and Geriatrics, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Cracow, Poland;
- Department of Endoscopy, University Hospital in Cracow, 2 Jakubowskiego St., 30-688 Cracow, Poland
- 1st Infectious Diseases Ward, Gromkowski Regional Specialist Hospital, Wroclaw, 5 Koszarowa St., 50-149 Wroclaw, Poland;
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Dominika Maciejewska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Igor Łoniewski
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Luis. F. Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Monika Pazgan-Simon
- 1st Infectious Diseases Ward, Gromkowski Regional Specialist Hospital, Wroclaw, 5 Koszarowa St., 50-149 Wroclaw, Poland;
- Department of Infectious Diseases, Wroclaw Medical University, 5 Koszarowa St., 50-149 Wroclaw, Poland
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-252 Szczecin, Poland
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47
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Castro-Rodriguez JA, Forno E. Asthma and COVID-19 in children - a systematic review and call for data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.04.20090845. [PMID: 32511474 PMCID: PMC7273242 DOI: 10.1101/2020.05.04.20090845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
RATIONALE Whether asthma constitutes a risk factor for COVID-19 is unclear. METHODS We performed a systematic literature search in three stages: First, we reviewed PubMed, EMBASE and CINAHL for systematic reviews of SARS-CoC-2 and COVID-19 in pediatric populations, and reviewed their primary articles; next, we searched PubMed for studies on COVID-19 or SARS-CoV-2 and asthma/wheeze, and evaluated whether the resulting studies included pediatric populations; lastly, we repeated the second search in BioRxiv.org and MedRxiv.org to find pre-prints that may have information on pediatric asthma. RESULTS In the first search, eight systematic reviews were found, of which five were done in pediatric population; after reviewing 67 primary studies we found no data on pediatric asthma as a comorbidity for COVID-19. In the second search, we found 25 results in PubMed, of which five reported asthma in adults, but none included data on children. In the third search, 14 pre-prints in MedRxiv were identified with data on asthma, but again none with pediatric data. We found only one report by the U.S. CDC stating that 40/345 (~11.5%) children with data on chronic conditions had "chronic lung diseases including asthma". CONCLUSION There is scarcely any data on whether childhood asthma (or other pediatric respiratory diseases) constitute risk factors for SARS-CoV-2 infection or COVID-19 severity. Studies are needed that go beyond counting the number of cases in the pediatric age range.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, US
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48
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Zippi M, Fiorino S, Occhigrossi G, Hong W. Hypertransaminasemia in the course of infection with SARS-CoV-2: Incidence and pathogenetic hypothesis. World J Clin Cases 2020; 8:1385-1390. [PMID: 32368531 PMCID: PMC7190951 DOI: 10.12998/wjcc.v8.i8.1385] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 02/05/2023] Open
Abstract
In patients infected with severe acute respiratory syndrome coronavirus 2, the respiratory symptoms, such as fever, cough and dyspnea, are the most frequent clinical manifestations. These patients may also present with less well-defined symptoms like diarrhea, nausea, vomiting and/or abdominal discomfort both at the time of diagnosis and during the clinical course. In a few cases, these symptoms may also present before the appearance of respiratory symptoms. To penetrate the body, Severe acute respiratory syndrome coronavirus 2 uses ACE2 receptors, which are present not only in respiratory epithelium but also in gastrointestinal mucosa and liver cholangiocytes. In several cases, viral RNA is detectable in the stool of patients with coronavirus disease 2019 (COVID-19). The liver damage seems to show a multifactorial origin. About 2%-11% of patients with COVID-19 have known underlying hepatic pathologies. In 14%-53% of COVID-19 cases, there is an alteration of the indices of liver cytolysis and is more frequently observed in severe forms of COVID-19, especially during hospitalization.
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Affiliation(s)
- Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome 00157, Italy
| | - Sirio Fiorino
- Unit of Internal Medicine, Maggiore Hospital, Local Health Unit of Bologna, Bologna 40133, Italy
| | - Giuseppe Occhigrossi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome 00157, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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49
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Tay SW, Teh KKJ, Wang LM, Ang TL. Impact of COVID-19: perspectives from gastroenterology. Singapore Med J 2020; 61:460-462. [PMID: 32279480 DOI: 10.11622/smedj.2020051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Shu Wen Tay
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Kevin Kim Jun Teh
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Lai Mun Wang
- Pathology Section, Department of Laboratory Medicine, Changi General Hospital, Singapore.,Pathology ACP, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.,Medicine ACP, SingHealth Duke-NUS Academic Medical Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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50
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Borges do Nascimento IJ, Cacic N, Abdulazeem HM, von Groote TC, Jayarajah U, Weerasekara I, Esfahani MA, Civile VT, Marusic A, Jeroncic A, Carvas Junior N, Pericic TP, Zakarija-Grkovic I, Meirelles Guimarães SM, Luigi Bragazzi N, Bjorklund M, Sofi-Mahmudi A, Altujjar M, Tian M, Arcani DMC, O’Mathúna DP, Marcolino MS. Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. J Clin Med 2020; 9:E941. [PMID: 32235486 PMCID: PMC7230636 DOI: 10.3390/jcm9040941] [Citation(s) in RCA: 306] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023] Open
Abstract
A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. We performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever (82%, 95% confidence interval (CI) 56%-99%; n = 4410), cough (61%, 95% CI 39%-81%; n = 3985), muscle aches and/or fatigue (36%, 95% CI 18%-55%; n = 3778), dyspnea (26%, 95% CI 12%-41%; n = 3700), headache in 12% (95% CI 4%-23%, n = 3598 patients), sore throat in 10% (95% CI 5%-17%, n = 1387) and gastrointestinal symptoms in 9% (95% CI 3%-17%, n = 1744). Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83-1.03 × 109/L, n = 464) and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54-45.91 mg/dL; n = 1637). Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%-1.0%; n = 53,631). Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30130-100, Brazil; (I.J.B.d.N.); (S.M.M.G.); (M.S.M.)
| | - Nensi Cacic
- Cochrane Croatia, University of Split School of Medicine, Split 21000, Croatia; (N.C.); (A.M.); (A.J.); (T.P.P.); (I.Z.-G.)
| | | | - Thilo Caspar von Groote
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Münster, 48149 Münster, Germany
| | - Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo 00700, Sri Lanka;
| | - Ishanka Weerasekara
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan 2308, Australia;
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Meisam Abdar Esfahani
- Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran 16846, Iran; (M.A.E.); (A.S.-M.)
| | - Vinicius Tassoni Civile
- Cochrane Brazil, Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo 04021-001, Brazil;
| | - Ana Marusic
- Cochrane Croatia, University of Split School of Medicine, Split 21000, Croatia; (N.C.); (A.M.); (A.J.); (T.P.P.); (I.Z.-G.)
| | - Ana Jeroncic
- Cochrane Croatia, University of Split School of Medicine, Split 21000, Croatia; (N.C.); (A.M.); (A.J.); (T.P.P.); (I.Z.-G.)
| | | | - Tina Poklepovic Pericic
- Cochrane Croatia, University of Split School of Medicine, Split 21000, Croatia; (N.C.); (A.M.); (A.J.); (T.P.P.); (I.Z.-G.)
| | - Irena Zakarija-Grkovic
- Cochrane Croatia, University of Split School of Medicine, Split 21000, Croatia; (N.C.); (A.M.); (A.J.); (T.P.P.); (I.Z.-G.)
| | - Silvana Mangeon Meirelles Guimarães
- University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30130-100, Brazil; (I.J.B.d.N.); (S.M.M.G.); (M.S.M.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Maria Bjorklund
- Faculty of Medicine, Lund University, SE-221-00 Lund, Sweden;
| | - Ahmad Sofi-Mahmudi
- Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran 16846, Iran; (M.A.E.); (A.S.-M.)
| | - Mohammad Altujjar
- Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA;
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales 2052, Australia;
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100088, China
| | - Diana Maria Cespedes Arcani
- Department of Cardiovascular and Thoracic Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430070, China;
| | - Dónal P. O’Mathúna
- Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH 43210, USA;
- School of Nursing, Psychotherapy and Community Health, Dublin City University, D04V1W8 Dublin, Ireland
| | - Milena Soriano Marcolino
- University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30130-100, Brazil; (I.J.B.d.N.); (S.M.M.G.); (M.S.M.)
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