This is the
Intro Review in
Today’s Practitioner:
Extrapulmonary Manifestations of COVID-19
July 23, 2020 by Kim Stewart :
Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations.
These conditions include thrombotic complications,
myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications.
Given that ACE2, the entry receptor for the causative corona-virus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thrombo-inflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19.
Here, we review the extra-pulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.
Pdf download: [
www.nature.com]
(note that arrhythmias are listed in the Cardiovascular segment starting on page 4 ).
Source: NATURE MEDICINE | VOL 26 | JULY 2020 | 1017–1032 | www.nature.com/naturemedicine
From the Example Insert Box 1 on page 3:
Hematologic and immune system–related manifestations of COVID-19Clinical presentations
• Laboratory markers:
• Cell counts: lymphopenia, leukocytosis, neutrophilia, thrombocytopenia
• Inflammatory markers: elevations in erythrocyte sedimentation rate, C-reactive protein, ferritin, IL-6, lactate dehydrogenase
• Coagulation indices: elevated D-dimer and fibrinogen; prolonged prothrombin time and partial thromboplastin time:
• Arterial thrombotic complications: MI, ischemic stroke, acute limb, and mesenteric ischemia
• Venous thrombotic complications: deep vein thrombosis and pulmonary embolism
• Catheter-related thrombosis: thrombosis in arterial and venous catheters and extracorporeal circuits
• Cytokine-release syndrome: high-grade fevers, hypotension, multi-organ dysfunctionCOVID-19-specific considerations
• Perform longitudinal evaluation of cell counts, inflammatory markers, and coagulation indices in hospitalized patients101
• Recommend enrollment in clinical trials evaluating the benefit and safety of higher-than-usual prophylactic dose or therapeutic dose in the absence of documented thromboembolism36
• If there is evidence of hyper-inflammation, consider enrollment in clinical trials investigating the efficacy of targeted inhibitors of inflammatory cytokines of the innate immune system (e.g., IL-6 and IL-1) or their signaling pathways55
• Global immune-suppression with corticosteroids may have a role in the setting of critical illness associated with cytokine storm55
General considerations
• Perform routine risk assessment for venous thromboembolism for all hospitalized patients
• Strongly consider pharmacological prophylaxis for venous thromboembolism in the absence of absolute contraindications (active bleeding or severe thrombocytopenia)
• Prefer low-molecular-weight heparins or unfractionated heparin over oral anticoagulants in most patients in the inpatient setting
• Consider hepatic and renal function when determining appropriate dose and type of antithrombotic drugs
• Consider post-hospitalization extended thromboprophylaxis on an individual patient basis, particularly for those with a history of critical illness
[
www.nature.com]
