Journal of Clinical Medicine

Editorial

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Open AccessEditorial

COVID-19 and Gastrointestinal Disease: Current Insights and Future Management

by Jonathan Kopel and Hemant Goyal

J. Clin. Med. 2023, 12(7), 2727; https://doi.org/10.3390/jcm12072727 - 6 Apr 2023

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Abstract

The first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan, Hubei Province, China, in December 2019, marking a pivotal moment in human history [...] Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

Research

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18 pages, 697 KiB

Open AccessArticle

Liver Function Tests in COVID-19: Assessment of the Actual Prognostic Value

by Urszula Tokarczyk, Krzysztof Kaliszewski, Anna Kopszak, Łukasz Nowak, Karolina Sutkowska-Stępień, Maciej Sroczyński, Monika Sępek, Agata Dudek, Dorota Diakowska, Małgorzata Trocha, Damian Gajecki, Jakub Gawryś, Tomasz Matys, Justyna Maciejiczek, Valeriia Kozub, Roman Szalast, Marcin Madziarski, Anna Zubkiewicz-Zarębska, Krzysztof Letachowicz, Katarzyna Kiliś-Pstrusińska, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Janusz Sokołowski, Barbara Adamik, Krzysztof Kujawa, Adrian Doroszko, Katarzyna Madziarska and Ewa Anita Jankowska Show full author list Hide full author list

J. Clin. Med. 2022, 11(15), 4490; https://doi.org/10.3390/jcm11154490 - 1 Aug 2022

Cited by 5 | Viewed by 2242

Abstract

Deviations in laboratory tests assessing liver function in patients with COVID-19 are frequently observed. Their importance and pathogenesis are still debated. In our retrospective study, we analyzed liver-related parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), [...] Read more.

Deviations in laboratory tests assessing liver function in patients with COVID-19 are frequently observed. Their importance and pathogenesis are still debated. In our retrospective study, we analyzed liver-related parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), albumin, comorbidities and other selected potential risk factors in patients admitted with SARS-CoV-2 infection to assess their prognostic value for intensive care unit admission, mechanical ventilation necessity and mortality. We compared the prognostic effectiveness of these parameters separately and in pairs to the neutrophil-to-lymphocyte ratio (NLR) as an independent risk factor of in-hospital mortality, using the Akaike Information Criterion (AIC). Data were collected from 2109 included patients. We created models using a sample with complete laboratory tests n = 401 and then applied them to the whole studied group excluding patients with missing singular variables. We estimated that albumin may be a better predictor of the COVID-19-severity course compared to NLR, irrespective of comorbidities (p < 0.001). Additionally, we determined that hypoalbuminemia in combination with AST (OR 1.003, p = 0.008) or TBIL (OR 1.657, p = 0.001) creates excellent prediction models for in-hospital mortality. In conclusion, the early evaluation of albumin levels and liver-related parameters may be indispensable tools for the early assessment of the clinical course of patients with COVID-19. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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9 pages, 243 KiB

Open AccessArticle

Psychological Effects and Medication Adherence among Korean Patients with Inflammatory Bowel Disease during the Coronavirus Disease 2019 Pandemic: A Single-Center Survey

by Ji Eun Ryu, Sung-Goo Kang, Sung Hoon Jung, Shin Hee Lee and Sang-Bum Kang

J. Clin. Med. 2022, 11(11), 3034; https://doi.org/10.3390/jcm11113034 - 27 May 2022

Cited by 4 | Viewed by 1817

Abstract

Background and Aim. This study evaluated the impact of coronavirus disease 2019 (COVID-19) on the mental health of inflammatory bowel disease (IBD) patients. We quantified anxiety, depression, and medication adherence among IBD patients through a single-center survey in South Korea during the COVID-19 [...] Read more.

Background and Aim. This study evaluated the impact of coronavirus disease 2019 (COVID-19) on the mental health of inflammatory bowel disease (IBD) patients. We quantified anxiety, depression, and medication adherence among IBD patients through a single-center survey in South Korea during the COVID-19 pandemic. Methods. An electronic survey was made available to patients at the IBD clinic in Daejeon St. Mary’s hospital from July 2021 to September 2021. The validated Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety. The Korean version of the Medication Adherence Rating Scale (KMARS) questionnaire was used to assess medication adherence. Results. In total, 407 patients (56.5%; ulcerative colitis, 43.5%; Crohn’s disease) participated in the survey. Among the respondents, 14.5% showed significant anxiety and 26.3% showed significant depression. Female sex, presence of mental disease, unvaccinated status, and the presence of Crohn’s disease were associated with greater risks of anxiety and depression. Among medications, immunomodulators were associated with a greater risk of anxiety. In terms of KMARS, patients reported favorable medication adherence despite the psychological burden of the pandemic. The KMARS score was 7.3 ± 1.5 (mean ± SD) of 10.0 points. High anxiety and depression were associated with a slight decrease in medication adherence. Conclusions. COVID-19 has increased anxiety and depression among IBD patients, whose medication adherence has nevertheless remained good. Furthermore, anxiety and depression were found to have a negative correlation with adherence. Our results provide insights concerning psychological response and medication adherence among IBD patients in South Korea during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

10 pages, 235 KiB

Open AccessArticle

The Effects of COVID-19 on Clinical Outcomes of Non-COVID-19 Patients Hospitalized for Upper Gastrointestinal Bleeding during the Pandemic

by Nonthalee Pausawasdi, Ekawat Manomaiwong, Uayporn Kaosombatwattana, Khemajira Karaketklang and Phunchai Charatcharoenwitthaya

J. Clin. Med. 2022, 11(9), 2461; https://doi.org/10.3390/jcm11092461 - 27 Apr 2022

Cited by 4 | Viewed by 1767

Abstract

This study aims to investigate the effects of COVID-19 on clinical outcomes of non-COVID-19 patients hospitalized for upper gastrointestinal bleeding (UGIB) during the pandemic. A retrospective review is conducted. We recruited patients with UGIB admitted during the pandemic’s first wave (April 2020 to [...] Read more.

This study aims to investigate the effects of COVID-19 on clinical outcomes of non-COVID-19 patients hospitalized for upper gastrointestinal bleeding (UGIB) during the pandemic. A retrospective review is conducted. We recruited patients with UGIB admitted during the pandemic’s first wave (April 2020 to June 2020), and the year before the pandemic. The outcomes between the two groups were compared using propensity score matching (PSM). In total, 60 patients (pandemic group) and 460 patients (prepandemic group) are included. Patients admitted during the pandemic (mean age of 67 ± 14 years) had a mean Glasgow–Blatchford score of 10.8 ± 3.9. They were older (p = 0.045) with more underlying malignancies (p = 0.028), had less history of NSAID use (p = 0.010), had a lower platelet count (p = 0.007), and had lower serum albumin levels (p = 0.047) compared to those admitted before the pandemic. Esophagogastroduodenoscopy (EGD) was performed less frequently during the pandemic (43.3% vs. 95.4%, p < 0.001). Furthermore, the procedure was less likely to be performed within 24 h after admission (p < 0.001). After PSM, admissions during the pandemic were significantly associated with decreased chances of receiving an endoscopy (adjusted odds Ratio (OR), 0.02; 95% CI, 0.003–0.06, p < 0.001) and longer hospital stay (adjusted OR, 2.17; 95% CI, 1.13–3.20, p < 0.001). Additionally, there was a slight increase in 30-day mortality without statistical significance (adjusted OR, 1.92; 95% CI, 0.71–5.19, p = 0.199) and a marginally higher rebleeding rate (adjusted OR, 1.34; 95% CI, 0.44–4.03, p = 0.605). During the pandemic, the number of EGDs performed in non-COVID-19 patients with UGIB decreased with a subsequent prolonged hospitalization and potentially increased 30-day mortality and rebleeding rate. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

17 pages, 303 KiB

Open AccessArticle

Assessment of Gastrointestinal Symptoms and Dyspnea in Patients Hospitalized due to COVID-19: Contribution to Clinical Course and Mortality

by Krzysztof Kaliszewski, Dorota Diakowska, Łukasz Nowak, Urszula Tokarczyk, Maciej Sroczyński, Monika Sępek, Agata Dudek, Karolina Sutkowska-Stępień, Katarzyna Kiliś-Pstrusińska, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Janusz Sokołowski, Barbara Adamik, Krzysztof Kujawa, Adrian Doroszko, Katarzyna Madziarska and Ewa Anita Jankowska

J. Clin. Med. 2022, 11(7), 1821; https://doi.org/10.3390/jcm11071821 - 25 Mar 2022

Cited by 6 | Viewed by 2463

Abstract

Gastrointestinal manifestations may accompany the respiratory symptoms of COVID-19. Abdominal pain (AP) without nausea and vomiting is one of the most common. To date, its role and prognostic value in patients with COVID-19 is still debated. Therefore, we performed a retrospective analysis of [...] Read more.

Gastrointestinal manifestations may accompany the respiratory symptoms of COVID-19. Abdominal pain (AP) without nausea and vomiting is one of the most common. To date, its role and prognostic value in patients with COVID-19 is still debated. Therefore, we performed a retrospective analysis of 2184 individuals admitted to hospital due to COVID-19. We divided the patients into four groups according to presented symptoms: dyspnea, n = 871 (39.9%); AP, n = 97 (4.4%); AP with dyspnea together, n = 50 (2.3%); and patients without dyspnea and AP, n = 1166 (53.4%). The patients with AP showed tendency to be younger than these with dyspnea, but without AP (63.0 [38.0–70.0] vs. 65.0 [52.0–74.0] years, p = 0.061), and they were more often females as compared to patients with dyspnea (57.7% vs. 44.6%, p = 0.013, for females). Patients with AP as a separate sign of COVID-19 significantly less often developed pneumonia as compared to individuals with dyspnea or with dyspnea and AP together (p < 0.0001). Patients with AP or AP with dyspnea were significantly less frequently intubated or transferred to the intensive care unit (p = 0.003 and p = 0.031, respectively). Individuals with AP alone or with dyspnea had significantly lower rate of mortality as compared to patients with dyspnea (p = 0.003). AP as a separate symptom and also as a coexisting sign with dyspnea does not predispose the patients with COVID-19 to the worse clinical course and higher mortality. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

20 pages, 1063 KiB

Open AccessArticle

Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry

by Yamile Zabana, Ignacio Marín-Jiménez, Iago Rodríguez-Lago, Isabel Vera, María Dolores Martín-Arranz, Iván Guerra, Javier P. Gisbert, Francisco Mesonero, Olga Benítez, Carlos Taxonera, Ángel Ponferrada-Díaz, Marta Piqueras, Alfredo J. Lucendo, Berta Caballol, Míriam Mañosa, Pilar Martínez-Montiel, Maia Bosca-Watts, Jordi Gordillo, Luis Bujanda, Noemí Manceñido, Teresa Martínez-Pérez, Alicia López, Cristina Rodríguez-Gutiérrez, Santiago García-López, Pablo Vega, Montserrat Rivero, Luigi Melcarne, Maria Calvo, Marisa Iborra, Manuel Barreiro de-Acosta, Beatriz Sicilia, Jesús Barrio, José Lázaro Pérez, David Busquets, Isabel Pérez-Martínez, Mercè Navarro-Llavat, Vicent Hernández, Federico Argüelles-Arias, Fernando Ramírez Esteso, Susana Meijide, Laura Ramos, Fernando Gomollón, Fernando Muñoz, Gerard Suris, Jone Ortiz de Zarate, José María Huguet, Jordina Llaó, Mariana Fe García-Sepulcre, Mónica Sierra, Miguel Durà, Sandra Estrecha, Ana Fuentes Coronel, Esther Hinojosa, Lorenzo Olivan, Eva Iglesias, Ana Gutiérrez, Pilar Varela, Núria Rull, Pau Gilabert, Alejandro Hernández-Camba, Alicia Brotons, Daniel Ginard, Eva Sesé, Daniel Carpio, Montserrat Aceituno, José Luis Cabriada, Yago González-Lama, Laura Jiménez, María Chaparro, Antonio López-San Román, Cristina Alba, Rocío Plaza-Santos, Raquel Mena, Sonsoles Tamarit-Sebastián, Elena Ricart, Margalida Calafat, Sonsoles Olivares, Pablo Navarro, Federico Bertoletti, Horacio Alonso-Galán, Ramón Pajares, Pablo Olcina, Pamela Manzano, Eugeni Domènech, Maria Esteve and on behalf of the ENEIDA registry of GETECCU Show full author list Hide full author list

J. Clin. Med. 2022, 11(2), 421; https://doi.org/10.3390/jcm11020421 - 14 Jan 2022

Cited by 9 | Viewed by 4120

Abstract

We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA [...] Read more.

We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March–July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8–27 and 4.5, 95% CI: 1.3–15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3–11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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7 pages, 726 KiB

Open AccessArticle

An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

by Gian Eugenio Tontini, Giovanni Aldinio, Nicoletta Nandi, Alessandro Rimondi, Dario Consonni, Massimo Iavarone, Paolo Cantù, Angelo Sangiovanni, Pietro Lampertico and Maurizio Vecchi

J. Clin. Med. 2022, 11(1), 109; https://doi.org/10.3390/jcm11010109 - 25 Dec 2021

Viewed by 2224

Abstract

Background: COVID-19 pandemic has profoundly changed the activities and daily clinical scenarios, subverting organizational requirements of our Gastroenterology Units. AIM: to evaluate the clinical needs and outcomes of the gastroenterological ward metamorphosis during the COVID-19 outbreaks in a high incidence scenario. Methods: we [...] Read more.

Background: COVID-19 pandemic has profoundly changed the activities and daily clinical scenarios, subverting organizational requirements of our Gastroenterology Units. AIM: to evaluate the clinical needs and outcomes of the gastroenterological ward metamorphosis during the COVID-19 outbreaks in a high incidence scenario. Methods: we compared the pertinence of gastroenterological hospitalization, modality of access, mortality rate, days of hospitalization, diagnostic and interventional procedures, age, Charlson comorbidity index, and frequency of SARS-CoV-2 infections in patients and healthcare personnel across the first and the second COVID-19 outbreaks in a COVID-free gastroenterological ward in the metropolitan area of Milan, that was hit first and hardest during the first COVID-19 outbreak since March 2020. Results: pertinence of gastroenterological hospitalization decreased both during the first and, to a lesser degree, the second SARS-CoV2 waves as compared to the pre-COVID era (43.6, 85.4, and 96.2%, respectively), as occurred to the admissions from domicile, while age, comorbidities, length of stay and mortality increased. Endoscopic and interventional radiology procedures declined only during the first wave. Hospitalized patients resulted positive to a SARS-CoV-2 nasopharyngeal swab in 10.2% of cases during the first COVID-19 outbreak after a median of 7 days since admission (range 1–15 days) and only 1 out of 318 patients during the second wave (6 days after admission). During the first wave, 19.5% of healthcare workers tested positive for SARS-CoV-2. Conclusions: a sudden metamorphosis of the gastroenterological ward was observed during the first COVID-19 outbreak with a marked reduction in the gastroenterological pertinence at the admission, together with an increase in patients’ age and multidisciplinary complexity, hospital stays, and mortality, and a substantial risk of developing a SARS-CoV-2 test positivity. This lesson paved the way for the efficiency of hospital safety protocols and admission management, which contributed to the improved outcomes recorded during the second COVID-19 wave. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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12 pages, 647 KiB

Open AccessArticle

FibroScan-AST Score Predicts 30-Day Mortality or Need for Mechanical Ventilation among Patients Hospitalized with COVID-19

by Marko Zelenika, Marko Lucijanic, Tomislav Bokun, Tonci Bozin, Mislav Barisic Jaman, Ida Tjesic Drinkovic, Frane Pastrovic, Anita Madir, Ivica Luksic, Nevenka Piskac Zivkovic, Kresimir Luetic, Zeljko Krznaric, Rajko Ostojic, Tajana Filipec Kanizaj, Ivan Bogadi, Lucija Virovic Jukic, Michal Kukla and Ivica Grgurevic

J. Clin. Med. 2021, 10(19), 4355; https://doi.org/10.3390/jcm10194355 - 24 Sep 2021

Cited by 6 | Viewed by 3014

Abstract

Background: Liver involvement in Coronavirus disease 2019 (COVID-19) has been recognised. We aimed to investigate the correlation of non-invasive surrogates of liver steatosis, fibrosis and inflammation using transient elastography (TE) and FibroScan-AST (FAST) score with (a) clinical severity and (b) 30-day composite outcome [...] Read more.

Background: Liver involvement in Coronavirus disease 2019 (COVID-19) has been recognised. We aimed to investigate the correlation of non-invasive surrogates of liver steatosis, fibrosis and inflammation using transient elastography (TE) and FibroScan-AST (FAST) score with (a) clinical severity and (b) 30-day composite outcome of mechanical ventilation (MV) or death among patients hospitalized due to COVID-19. Method: Patients with non-critical COVID-19 at admission were included. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed by TE. Clinical severity of COVID-19 was assessed by 4C Mortality Score (4CMS) and need for high-flow nasal cannula (HFNC) oxygen supplementation. Results: 217 patients were included (66.5% males, median age 65 years, 4.6% with history of chronic liver disease). Twenty-four (11.1%) patients met the 30-day composite outcome. Median LSM, CAP and FAST score were 5.2 kPa, 274 dB/m and 0.31, respectively, and neither was associated with clinical severity of COVID-19 at admission. In multivariate analysis FAST > 0.36 (OR 3.19, p = 0.036), 4CMS (OR 1.68, p = 0.002) and HFNC (OR 7.03, p = 0.001) were independent predictors of adverse composite outcome. Conclusion: Whereas LSM and CAP failed to show correlation with COVID-19 severity and outcomes, FAST score was an independent risk factor for 30-day mortality or need for MV. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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Review

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23 pages, 1167 KiB

Open AccessReview

Gut as an Alternative Entry Route for SARS-CoV-2: Current Evidence and Uncertainties of Productive Enteric Infection in COVID-19

by Laure-Alix Clerbaux, Sally A. Mayasich, Amalia Muñoz, Helena Soares, Mauro Petrillo, Maria Cristina Albertini, Nicolas Lanthier, Lucia Grenga and Maria-Joao Amorim

J. Clin. Med. 2022, 11(19), 5691; https://doi.org/10.3390/jcm11195691 - 26 Sep 2022

Cited by 16 | Viewed by 4296

Abstract

The gut has been proposed as a potential alternative entry route for SARS-CoV-2. This was mainly based on the high levels of SARS-CoV-2 receptor expressed in the gastrointestinal (GI) tract, the observations of GI disorders (such as diarrhea) in some COVID-19 patients and [...] Read more.

The gut has been proposed as a potential alternative entry route for SARS-CoV-2. This was mainly based on the high levels of SARS-CoV-2 receptor expressed in the gastrointestinal (GI) tract, the observations of GI disorders (such as diarrhea) in some COVID-19 patients and the detection of SARS-CoV-2 RNA in feces. However, the underlying mechanisms remain poorly understood. It has been proposed that SARS-CoV-2 can productively infect enterocytes, damaging the intestinal barrier and contributing to inflammatory response, which might lead to GI manifestations, including diarrhea. Here, we report a methodological approach to assess the evidence supporting the sequence of events driving SARS-CoV-2 enteric infection up to gut adverse outcomes. Exploring evidence permits to highlight knowledge gaps and current inconsistencies in the literature and to guide further research. Based on the current insights on SARS-CoV-2 intestinal infection and transmission, we then discuss the potential implication on clinical practice, including on long COVID. A better understanding of the GI implication in COVID-19 is still needed to improve disease management and could help identify innovative therapies or preventive actions targeting the GI tract. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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21 pages, 1429 KiB

Open AccessReview

Mechanisms Leading to Gut Dysbiosis in COVID-19: Current Evidence and Uncertainties Based on Adverse Outcome Pathways

by Laure-Alix Clerbaux, Julija Filipovska, Amalia Muñoz, Mauro Petrillo, Sandra Coecke, Maria-Joao Amorim and Lucia Grenga

J. Clin. Med. 2022, 11(18), 5400; https://doi.org/10.3390/jcm11185400 - 14 Sep 2022

Cited by 24 | Viewed by 4538

Abstract

Alteration in gut microbiota has been associated with COVID-19. However, the underlying mechanisms remain poorly understood. Here, we outlined three potential interconnected mechanistic pathways leading to gut dysbiosis as an adverse outcome following SARS-CoV-2 presence in the gastrointestinal tract. Evidence from the literature [...] Read more.

Alteration in gut microbiota has been associated with COVID-19. However, the underlying mechanisms remain poorly understood. Here, we outlined three potential interconnected mechanistic pathways leading to gut dysbiosis as an adverse outcome following SARS-CoV-2 presence in the gastrointestinal tract. Evidence from the literature and current uncertainties are reported for each step of the different pathways. One pathway investigates evidence that intestinal infection by SARS-CoV-2 inducing intestinal inflammation alters the gut microbiota. Another pathway links the binding of viral S protein to angiotensin-converting enzyme 2 (ACE2) to the dysregulation of this receptor, essential in intestinal homeostasis—notably for amino acid metabolism—leading to gut dysbiosis. Additionally, SARS-CoV-2 could induce gut dysbiosis by infecting intestinal bacteria. Assessing current evidence within the Adverse Outcome Pathway framework justifies confidence in the proposed mechanisms to support disease management and permits the identification of inconsistencies and knowledge gaps to orient further research. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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22 pages, 518 KiB

Open AccessReview

Acute Mesenteric Ischemia in COVID-19 Patients

by Dragos Serban, Laura Carina Tribus, Geta Vancea, Anca Pantea Stoian, Ana Maria Dascalu, Andra Iulia Suceveanu, Ciprian Tanasescu, Andreea Cristina Costea, Mihail Silviu Tudosie, Corneliu Tudor, Gabriel Andrei Gangura, Lucian Duta and Daniel Ovidiu Costea

J. Clin. Med. 2022, 11(1), 200; https://doi.org/10.3390/jcm11010200 - 30 Dec 2021

Cited by 28 | Viewed by 5694

Abstract

Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and [...] Read more.

Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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12 pages, 707 KiB

Open AccessReview

Liver Injury in Patients with Coronavirus Disease 2019 (COVID-19)—A Narrative Review

by Liliana Łykowska-Szuber, Karolina Wołodźko, Anna Maria Rychter, Aleksandra Szymczak-Tomczak, Iwona Krela-Kaźmierczak and Agnieszka Dobrowolska

J. Clin. Med. 2021, 10(21), 5048; https://doi.org/10.3390/jcm10215048 - 28 Oct 2021

Cited by 10 | Viewed by 2499

Abstract

While respiratory symptoms are prevalent in SARS-CoV-2 infected patients, growing evidence indicates that COVID-19 affects a wide variety of organs. Coronaviruses affect not only the respiratory system, but also the circulatory, nervous and digestive systems. The most common comorbidities in COVID-19 patients are [...] Read more.

While respiratory symptoms are prevalent in SARS-CoV-2 infected patients, growing evidence indicates that COVID-19 affects a wide variety of organs. Coronaviruses affect not only the respiratory system, but also the circulatory, nervous and digestive systems. The most common comorbidities in COVID-19 patients are hypertension, followed by diabetes, cardiovascular, and respiratory disease. Most conditions predisposing to SARS-CoV-2 infection are closely related to the metabolic syndrome. Obesity and chronic diseases, including liver disease, are associated with the induction of pro-inflammatory conditions and a reduction in immune response disorders, leading to the suspicion that these conditions may increase the susceptibility to SARS-CoV2 infection and the risk of complications. The definition of liver damage caused by COVID-19 has not yet been established. COVID-19 may contribute to both primary and secondary liver injury in people with pre-existing chronic disease and impaired liver reserves, leading to exacerbation of underlying disease, liver decompensation, or acute chronic liver failure. Therefore, many researchers have interpreted it as clinical or laboratory abnormalities in the course of the disease and treatment in patients with or without pre-existing liver disease. The research results available so far indicate that patients with liver disease require special attention in the event of COVID-19 infection. Full article

(This article belongs to the Special Issue COVID-19 and Gastrointestinal Disease: Current Insights and Future Management)

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