Physicians Conduct First Comprehensive Review of Extrapulmonary Effects of COVID-19

At the start of the outbreak in New York City, after only a few days caring for a severe COVID-19 patient, MD Aakriti Gupta realized that it was not just a respiratory disorder.

“I was at the forefront from the beginning. I observed that patients had a lot of coagulation, high blood sugar levels even without diabetes, and many experienced heart and kidney damage. “Gupta says. The first Columbia Cardiology Fellow to be placed in the COVID Intensive Care Unit at the University of Columbia Irving Medical Center.

In early March, with little clinical guidance on COVID-19’s effects on non-respiratory systems, Gupta merges what doctors are learning from experience with findings from studies that are just beginning to appear in the literature. I decided to.

Gupta co-organized with Dr. Donald Landry, MD, principal author of the Department of Medicine and Surgeons of Internal Medicine and Surgeons, Columbia University, along with its main co-author and two other colleagues, Dr. Mahesh Madavan. CUIMC Cardiology Fellow, Beth Israel Deaconess Medical Center/Harvard Medical University Hematology/Oncology Fellow, Mobilizing Doctors from Columbia, Harvard, Yale, Mount Sinai Hospital and more for the latest findings Review on the effect of COVID-19 Organ system It is located outside the lungs and provides the clinician with clinical guidance.

Their review — the first comprehensive review of the effects of COVID-19 on all affected organs outside the lung — was published in the book today. Natural medicine..

“Doctors need to think of COVID-19 as a multi-system disorder,” Gupta says. “There’s a lot of news about coagulation, but a significant proportion of these patients have kidneys, hearts, Brain injury, And doctors need to treat these conditions along with respiratory disorders. “

Thrombus, inflammation, immune system in overdrive

“In the first few weeks of the pandemic alone, we had more thrombotic complications than we had expected from experience with other viral diseases,” Sehgal said, “they had a significant impact on patients. May give.”

Scientists attribute these coagulation complications to the attack of the virus on the cells that line the blood vessels. When a virus attacks vascular cells, inflammation increases and blood begins to form large and small blood clots. These blood clots travel throughout the body, causing havoc in organs and enduring a vicious cycle of thrombotic inflammation.

To address coagulation and its adverse effects, Colombian clinicians have conducted a randomized clinical trial by co-author of this review, a Colombian clinician, to study anticoagulant drugs in critically ill patients with COVID-19. We are investigating the optimal dose and timing of.

Unrelieved inflammation also Immune systemDoctors initially avoided using steroids to globally suppress the immune system, but a recent clinical trial showed that at least one steroid, dexamethasone, killed 3 minutes in ventilated patients. It turns out that it reduces to 1. Randomization Clinical trial Work is underway to target specific components of thrombotic inflammation and the immune system, including interleukin-6 signaling.

“Scientists around the world are working at an unprecedented rate to understand how this virus hijacks the normally protective biological mechanisms. We hope to help develop more effective, accurate and safe treatments in the future.”

Straight to the heart

Thrombus can cause a heart attack, but the virus attacks the heart in other ways, says one author.

“The mechanism of heart damage is currently unknown because the virus is not frequently isolated from heart tissue in autopsy cases,” says Gupta.

Systemic inflammation and concomitant cytokine release, usually clearing infected cells but potentially uncontrollable in the case of severe COVID-19 can damage myocardium by flooding immune cells There is a possibility.

Despite the degree of heart damage, doctors were unable to utilize diagnostic and therapeutic strategies such as cardiac biopsy and cardiac catheterization. It is usually used in the early stages of a pandemic because it requires protection of personnel and patients from viral infections. This has changed as the prevalence of the disease has declined in New York City.

kidney failure

Another surprising finding was the high proportion of COVID-19 patients in ICU with acute renal injury.

The ACE2 receptor used by the virus to enter cells is found in high concentrations in the kidney and may be the cause of renal damage. A study in China reported renal complications, but in New York City, clinicians saw renal failure in up to 50% of patients with ICU.

“About 5-10% of patients needed dialysis, which is a very high number,” says Gupta.

Data on long-term renal damage are currently lacking, but a significant proportion of patients may require permanent dialysis.

“Future research following patients who have had complications during hospitalization for COVID-19 is very important,” said Madavant.

Neurological effects

About one-third of patients may develop neurological symptoms such as headache, dizziness, fatigue, and loss of smell.

Of further concern is that thrombotic strokes occur in up to 6% of severe cases and delirium occurs in 8% to 9%.

“COVID-19 patients can be intubated for a couple of weeks, one quarter need more than 30 days of ventilation,” Gupta says.

“These are very long periods of intubation and the patient needs a lot of sedation. “ICU delirium” is a well-known condition before COVID, where hallucinations are not viral effects and long-term sedation. May be the effect of. “

“The virus is unusual, and it’s hard not to step back and be impressed by how many symptoms your body has,” Madavant said.

“Despite our out-of-specialty training as a physician, it is our job to keep all organ systems in mind when caring for the patient in front of us. Our review, observations, and We hope the recommendations will help other clinicians with a surge of cases.”

The title of the paper is “COVID-19 Extrapulmonary Symptoms”.