ABSTRACT
Introduction: Novel coronavirus disease 2019 (COVID-19) is not only connected with respiratory distress syndrome, but also with gastrointestinal symptoms, hepatic injury and multiorgan and systemic inflammation. Considering the wide range of hepatokines and myokines activities they may influence pathogenesis and infection course. Aims & Methods: Our aim was to assess concentrations of pentraxin 3 (PTX3), fibroblast grow factor 21 (FGF21), irisin and fetuin A among COVID- 19 patients with emphasis on their relationship with COVID-19 severity, concomitant metabolic abnormalities and liver dysfunction. An observational single center cohort study included 70 COVID-19 patients and healthy controls. Hepatokines serum concentrations were measured with enzyme-linked immunosorbent assay in serum collected at the moment of admission to hospital, before any treatment was applied. Results: Serum fetuin A concentrations significantly decreased in COVID- 19 patients compared to healthy volunteers (243.4 [195.0-275.8] vs 333.5 [303.0-371.4] μg/ml;p<0.001). There was no significant difference in serum irisin, FGF21 and PTX3 levels between both groups. Alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) activities, and ferritin levels were significantly higher in COVID-19 patients (34.0 [20.0-52.5] vs 21.0 [16.0-25.7] U/l;p=0.02, 33.5 [20.0-62.5] vs 14.0 [10.7-24.2] U/l;p=0.003 and 210.0 [114.7-487.0] vs 16.5 [13.0-19.6] μg/l;p<0.001, respectively). Fetuin A levels were down-regulated in COVID-19 patients with higher GGT activity and ferritin concentration (258.8 [219.9-310.9] vs 221.9 [182.1- 256.3] μg/ml;p=0.004 and 257.7 [238.3-311.1] vs 220.5 [178.5-264.1] μg/ ml;p=0.001, respectively). HOMA-IR and C-reactive protein were significantly elevated in COVID-19 patients. The presence of gastrointestinal (GI) symptoms did not influence analyzed hepatokines levels. Pneumonia was found in 32.8% of patients. Fetuin A concentration significantly decreased in patients with pneumonia (217.4 [188.3-248.8] vs 256.3 [218.9-285.7] ng/ml;p<0.001), and those requiring admission to intensive care unit (ICU) (194.0 [124.8-229.8] vs 252.4 [209.4- 276.6] ng/ml;p=0.02). Serum PTX3 concentration significantly increased in ITU patients (4769.0 [2896.9-8394.6] vs 2278.2 [1876.9-3106.3] ng/ml;p<0.001). Conclusion: Surprisingly, pointing to proinflammatory and insulin impairing action of fetuin A, its levels were significantly lower in COVID-19 patients despite of higher HOMA-IR, CRP and ferritin levels. Even, more surprising was significant reduction of fetuin A in patients with pneumonia, those requiring ICU and those with higher ferritin levels and HOMA-IR. It suggests that fetuin A deficiency predispose to more serious COVID-19 course, glucose metabolism abnormalities and its measurement may be additional marker of disease severity. Up-regulated PTX3 may also suggest COVID-19 severity. Impaired liver function revealed by GGT activity was associated with serum fetuin A depletion. Predictive factor which could predispose to a more severe course of COVID-19, including the presence of pneumonia and ICU hospitalization, was GGT activity.
ABSTRACT
Introduction: More than 2.5 million people in Europe are diagnosed with inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. It remains unknown if variations in IBD care and education differs across Europe and to help address this question, we conducted this European Variation In IBD PracticE suRvey (VIPER) to study potential differences. Aims & Methods: This trainee-initiated survey, run through SurveyMonkey ®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results: The online survey was completed by 1268 participants from 39 European countries. Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/ district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). GDP was not a factor that dictated confidence in treating patients. IBD patients seen per week, IBD boards and especially IBD specific training were factors increasing confidence in managing IBD patients. Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion: A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.