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Immunosuppression and cardiovascular dysfunction in patients with severe versus mild coronavirus disease 2019: a case series

ABSTRACT: Abstract Objectives As coronavirus disease 2019 (COVID?19) continues to spread globally, we aimed to describe and compare changes in the immune and cardiovascular systems of patients with mild versus severe COVID?19 at different time points during the course of disease. Methods One hundred and one patients diagnosed with COVID?19 who underwent serial peripheral blood collection and chest computed tomography (CT) imaging were enrolled in this study and grouped by the severity of their illness. Changes in the immune and cardiovascular systems were analysed and compared between groups. Results The study included 43 women and 58 men, with a median age of 45 years (interquartile range [IQR], 16–71). We identified spleen shrinkage in 27.7% of study patients. Ratios of spleen volume to patient (skin) volume were compared, with evidence that severe patients had more splenic shrinkage than mild patients. Lymphopenia was observed in 65.3% of patients, and 27.3% of patients had persistently low levels of lymphocytes after discharge. Tachycardia occurred mainly during the first 2 days of hospitalisation, with increases in creatine kinase–myocardial band levels in 10 (9.9%) patients and arrhythmias in 16 (15.8%) patients. Conclusions In addition to pulmonary manifestations, our study demonstrated that other organ systems can also be affected during COVID?19 infection, with evidence of immunosuppression and cardiovascular dysfunction, which may contribute to increased mortality rates in critically ill COVID?19 patients. In addition to pulmonary manifestations, our study demonstrated that other organ systems can also be affected during COVID?19 infection. The injuries in COVID?19 patients could lead to immunosuppression and cardiovascular dysfunction, which might contribute to increased mortality in critically ill patients.

SUBMITTER: Bao H

PROVIDER: S-EPMC7527927 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:To determine if early CNS symptoms are associated with severe coronavirus disease 2019.DesignA retrospective, observational case series study design.SettingElectronic health records were reviewed for patients from five healthcare systems across the state of Florida, United States.PatientsA clinical sample (n = 36,615) of patients with confirmed diagnosis of coronavirus disease 2019 were included. Twelve percent (n = 4,417) of the sample developed severe coronavirus disease 2019, defined as requiring critical care, mechanical ventilation, or diagnosis of acute respiratory distress syndrome, sepsis, or severe inflammatory response syndrome.InterventionsNone.Measurement and main resultsWe reviewed the electronic health record for diagnosis of early CNS symptoms (encephalopathy, headache, ageusia, anosmia, dizziness, acute cerebrovascular disease) between 14 days before the diagnosis of coronavirus disease 2019 and 8 days after the diagnosis of coronavirus disease 2019, or before the date of severe coronavirus disease 2019 diagnosis, whichever came first. Hierarchal logistic regression models were used to examine the odds of developing severe coronavirus disease 2019 based on diagnosis of early CNS symptoms. Severe coronavirus disease 2019 patients were significantly more likely to have early CNS symptoms (32.8%) compared with nonsevere patients (6.11%; χ2[1] = 3,266.08, p < 0.0001, φ = 0.29). After adjusting for demographic variables and pertinent comorbidities, early CNS symptoms were significantly associated with severe coronavirus disease 2019 (odds ratio = 3.21). Diagnosis of encephalopathy (odds ratio = 14.38) was associated with greater odds of severe coronavirus disease 2019; whereas diagnosis of anosmia (odds ratio = 0.45), ageusia (odds ratio = 0.46), and headache (odds ratio = 0.63) were associated with reduced odds of severe coronavirus disease 2019.ConclusionsEarly CNS symptoms, and specifically encephalopathy, are differentially associated with risk of severe coronavirus disease 2019 and may serve as an early marker for differences in clinical disease course. Therapies for early coronavirus disease 2019 are scarce, and further identification of subgroups at risk may help to advance understanding of the severity trajectories and enable focused treatment.

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Immunosuppression and cardiovascular dysfunction in patients with severe versus mild coronavirus disease 2019: a case series

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