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Topics in Antiviral Medicine ; 29(1):69-70, 2021.
Article in English | EMBASE | ID: covidwho-1250818


Background: SARS-CoV2 can infect enterocytes, and plasma cells and lymphocytes infiltrate the GI tract. In HIV, increased intestinal permeability and the ensuing microbial translocation are thought to contribute to systemic inflammation. We hypothesize that severe COVID-19 is associated with increased intestinal permeability, leading to microbial translocation and systemic inflammation. Methods: Serum/plasma samples were obtained from participants enrolled in a longitudinal COVID-19 study. Participants had Mild (outpatient), Moderate (inpatient but not requiring Intensive Care Unit (ICU) level care or mechanical ventilation), or Severe (inpatient requiring ICU level care and mechanical ventilation or ECMO) COVID-19. Intestinal fatty acid binding protein (iFABP), lipopolysaccharide binding protein (LBP), and soluble CD14 (sCD14) were measured by ELISA. Student's t-tests were used for between group comparisons, and paired t-tests were used for within group comparisons. Results: Participants with Moderate and Severe COVID-19 presentations were older compared to the Mild group (p<0.001) (Mild: 42.2 years (range: 20-63 years), Moderate: 64.2 years (range: 33-97 years);Severe: 61.9 years (range: 32-86 years)). The Severe group had a greater proportion of men (69% vs 36%) than women and a greater proportion of black/African Americans (27% vs 6%) than whites versus the Mild group. iFABP, LBP, and sCD14 levels were significantly higher in participants with Moderate or Severe disease compared to Mild disease (Table 1), with no significant differences between Moderate and Severe groups. Among the 65 participants with samples from two timepoints (mean separation of 24.3+/-22.4 days), sCD14, iFABP, and LBP did not change significantly. Conclusion: Levels of biomarkers of enterocyte turnover (iFABP), microbial translocation (LBP), and lipopolysaccharide-induced monocyte activation (sCD14) were increased in patients with Moderate and Severe COVID-19 compared to Mild COVID-19. Whether interventions that improve gut health will attenuate the cytokine storm that precipitates Severe COVID-19 needs further study.

Topics in Antiviral Medicine ; 29(1):210, 2021.
Article in English | EMBASE | ID: covidwho-1250705


Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) have been increasingly recognized. Cardiac, pulmonary, and neuropsychiatric symptoms have been reported to persist up to two months after hospitalization. However, much remains to be learned about the durable long-term effects of COVID-19 for patients and the health care system. Here, we describe the persistence of COVID-19 sequelae up to six months after presentation. Methods: We examined the electronic medical records of the first 1190 patients diagnosed with SARS-CoV-2 infection by reverse transcriptase polymerase chain reaction assay and hospitalized at a quaternary-care center in New York City. All initial hospital presentations occurred between March 1 and April 8, 2020. We manually abstracted data for two follow-up periods representing three-and six-months post-hospitalization. Abstracted information included type and dates of encounters;use of tele-health;presence and persistence of symptoms;morbidity;and mortality. Descriptive statistics for categorical and continuous variables were tabulated and distributions were examined by visit;at presentation, three months and six months. Results: Patients had a median age of 60 and 61 years at three and six months, respectively. About 45% were female and 50% identified as Hispanic/Latinx. Of 1190 patients, 78% (N=928) survived their initial hospitalization. Among the 61% (n=570) of survivors who had follow-up encounters at three and six months, patients frequently reported cardiopulmonary symptoms (35.7% and 28%), dyspnea (22.1% and 15.9%), generalized symptoms (25.4 % and 26.4%) and neuropsychiatric symptoms (20.1% and 24.2%). Tele-health encounters represented 59% and 28.2% of encounters at three and six-months, respectively. Twenty-percent of patients had reduced mobility or reduced independence in the six months after hospitalization. Of survivors, 17% weredischarged to a nursing or rehabilitation facility and 10.3% remained there at three months post-hospitalization. Conclusion: The prevalence was high of at least one COVID-associated symptom six months after hospitalization. Cardiopulmonary symptoms were most common and persisted longer than previously reported. Providers, patients, and their families must be sensitized to and anticipate these potential sequelae. Further follow-up and studies of COVID-19 survivors are necessary to confirm these findings and investigate outcomes beyond six months. (Figure Presented).