ABSTRACT
Globally, over 65 million individuals are estimated to suffer from post-acute sequelae of COVID-19 (PASC). A large number of individuals living with PASC experience cardiovascular symptoms (i.e. chest pain and heart palpitations) (PASC-CVS). The role of chronic inflammation in these symptoms, in particular in individuals with symptoms persisting for >1 year after SARS-CoV-2 infection, remains to be clearly defined. In this cross-sectional study, blood samples were obtained from three different sites in Australia from individuals with i) a resolved SARS-CoV-2 infection (and no persistent symptoms i.e. Recovered), ii) individuals with prolonged PASC-CVS and iii) SARS-CoV-2 negative individuals. Individuals with PASC-CVS, relative to Recovered individuals, had a blood transcriptomic signature associated with inflammation. This was accompanied by elevated levels of pro-inflammatory cytokines (IL-12, IL-1beta;, MCP-1 and IL-6) at approximately 18 months post-infection. These cytokines were present in trace amounts, such that they could only be detected with the use of novel nanotechnology. Importantly, these trace-level cytokines had a direct effect on the functionality of pluripotent stem cell derived cardiomyocytes in vitro. This effect was not observed in the presence of dexamethasone. Plasma proteomics demonstrated further differences between PASC-CVS and Recovered patients at approximately 18 months post-infection including enrichment of complement and coagulation associated proteins in those with prolonged cardiovascular symptoms. Together, these data provide a new insight into the role of chronic inflammation in PASC-CVS and present nanotechnology as a possible novel diagnostic approach for the condition.
Subject(s)
Cardiovascular Diseases , Chest Pain , COVID-19 , InflammationABSTRACT
BackgroundSARS-CoV-2 infection in children is asymptomatic or mildly symptomatic. Clinical characteristics and outcome of children admitted with COVID 19, especially with underlying illnesses, has not been studied. ObjectiveTo study the clinical characteristics and outcome of children admitted, with SARS-CoV-2 infection, to a paediatric multispecialty hospital in Mumbai, the epicentre of the COVID19 pandemic in India. Design and SettingRetrospective observational study of medical records of 969 children admitted between 19 March and 7 August 2020.ParticipantsClinico-demographic characteristics and outcome of COVID 19 positive children admitted during the study period. Variables compared between children who were previously healthy (Group I) and children with co-morbidity (Group II).Main outcomeCOVID 19 disease severity characterisation and factors predicting outcome as discharge or death was studied.Results123 (71M) tested SARS-CoV-2-positive by RT-PCR with median age of presentation of 3 years [IQR 0.7– 6 years]. 47 (38%) had co-morbidities and were more severely affected (p = 0.0146). MIS-C/ KD was common in Group I. Thirty nine (31.7 %) needed intensive care. Fourteen (11.4%) died. Male sex, respiratory manifestation, pulseox saturation <94% at admission, need for ventilation, inotrope, hospital stay of <10 days were independent mortality predictors. Regression analysis revealed oxygen saturation <94% at admission (OR 35.9, 95% CI 1.5-856) and hospital stay <10 days (OR 9.1, 95% CI 1.04 -99.1) as predictors of mortality.ConclusionCOVID 19 in children although considered mild, presence of co-morbidities causes severe disease. Pulseox saturation <94% on admission, hospital stay <10days are predictors of mortality.