COVID‐19, adaptative immune response and metabolic‐associated liver disease

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Abstract

Metabolic diseases are associated with a higher risk of a severer coronavirus disease 2019 (COVID‐19) course, since fatty liver is commonly associated with metabolic disorders, fatty liver itself is considered as a major contributor to low‐grade inflammation in obesity and diabetes. Recently a comprehensive term, metabolic (dysfunction) associated fatty liver disease (MAFLD), has been proposed. The hepatic inflammatory status observed in MAFLD patients is amplified in presence of severe acute respiratory syndrome coronavirus 2 infection. Intestinal dysbiosis is a powerful activator of inflammatory mediator production of liver macrophages. The intestinal microbiome plays a key role in MAFLD progression, which results in non‐alcoholic steatohepatitis and liver fibrosis. Therefore, patients with metabolic disorders and COVID‐19 can have a worse outcome of COVID‐19. This literature review attempts to disentangle the mechanistic link of MAFLD from COVID‐19 complexity and to improve knowledge on its pathophysiology.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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Author and article information

Contributors

Luca Miele:

ORCID: https://orcid.org/0000-0003-3464-0068

luca.miele@policlinicogemelli.it , luca.miele@unicatt.it

Journal

Journal ID (nlm-ta): Liver Int

Journal ID (iso-abbrev): Liver Int

Journal ID (doi): 10.1111/(ISSN)1478-3231

Journal ID (publisher-id): LIV

Title: Liver International

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1478-3223

ISSN (Electronic): 1478-3231

Publication date (Electronic): 28 September 2021

Publication date (Print): November 2021

Publication date PMC-release: 28 September 2021

Volume: 41

Issue: 11 ( doiID: 10.1111/liv.v41.11 )

Pages: 2560-2577

Affiliations

[ ¹ ] Dipartimento di Scienze Mediche e Chirurgiche Fondazione Policlinico Universitario A.Gemelli IRCCS Rome Italy

[ ² ] Dipartimento di Medicina e Chirurgia Traslazionale Scuola di Medicina e Chirurgia Università Cattolica del Sacro Cuore Rome Italy

[ ³ ] Open Innovation Manager Scientific Directorate Fondazione Policlinico Universitario A.Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

[ ⁴ ] Dipartimento di Scienze di laboratorio e infettivologiche Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy

Author notes

[*] [* ] Correspondence:

Luca Miele, MD, PhD, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, 8, Largo Gemelli. 00168 Rome, Italy.

Email: luca.miele@ 123456policlinicogemelli.it ; luca.miele@ 123456unicatt.it

Author information

Luca Miele https://orcid.org/0000-0003-3464-0068

Cecilia Napodano https://orcid.org/0000-0002-8720-6284

Umberto Basile https://orcid.org/0000-0002-8328-2570

Antonio Gasbarrini https://orcid.org/0000-0003-4863-6924

Antonio Grieco https://orcid.org/0000-0002-0544-8993

Article

Publisher ID: LIV15061

DOI: 10.1111/liv.15061

PMC ID: 8661993

PubMed ID: 34555255

SO-VID: b805b042-ea6a-41ac-8df4-8984e570b537

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.