Obesity and COVID-19: what makes obese host so vulnerable?

AbstractThe disease (COVID-19) novel coronavirus pandemic has so far infected millions resulting in the death of over a million people as of Oct 2020. More than 90% of those infected with COVID-19 show mild or no symptoms but the rest of the infected cases show severe symptoms resulting in significant mortality. Age has emerged as a major factor to predict the severity of the disease and mortality rates are significantly higher in elderly patients. Besides, patients with underlying conditions like Type 2 diabetes, cardiovascular diseases, hypertension, and cancer have an increased risk of severe disease and death due to COVID-19 infection. Obesity has emerged as a novel risk factor for hospitalization and death due to COVID-19. Several independent studies have observed that people with obesity are at a greater risk of severe disease and death due to COVID-19. Here we review the published data related to obesity and overweight to assess the possible risk and outcome in Covid-19 patients based on their body weight. Besides, we explore how the obese host provides a unique microenvironment for disease pathogenesis, resulting in increased severity of the disease and poor outcome.

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Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

Rheumatology ◽

10.1093/rheumatology/keaa855 ◽

2020 ◽

Author(s):

Emily Peach ◽

Megan Rutter ◽

Peter Lanyon ◽

Matthew J Grainge ◽

Richard Hubbard ◽

...

Keyword(s):

General Population ◽

Healthcare Services ◽

Mortality Rates ◽

Published Data ◽

Risk Of Death ◽

Increased Risk ◽

Specific Mortality ◽

Population Mortality ◽

The Uk ◽

Recorded Diagnosis

Abstract Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.

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Conjunctivitis and other ocular findings in patients with COVID-19 infection

Annals of Saudi Medicine ◽

10.5144/0256-4947.2021.280 ◽

2021 ◽

Vol 41 (5) ◽

pp. 280-284

Author(s):

Haider Aswad Layikh ◽

Zainab Adel Hashim ◽

Alyaa A. Kadum

Keyword(s):

Viral Infection ◽

Care Center ◽

Severe Disease ◽

Respiratory Illness ◽

Cross Sectional Study ◽

Cross Sectional ◽

Ocular Findings ◽

Standard Deviation Range ◽

Severity Of The Disease ◽

Novel Coronavirus

BACKGROUND: COVID-19 is an acute respiratory illness caused by a novel coronavirus (SARS-CoV-2). COVID-19 that might affect the eye in the form of conjunctivitis and other ocular features. OBJECTIVES: Assess the frequency and clinical profile of conjunctivitis and other ocular findings in Iraqi patients with confirmed COVID-19 infection. DESIGN: Analytical cross-sectional study. SETTING: Secondary care center. PATIENTS AND METHODS: This study involved patients diagnosed with SARS-CoV-2 viral infection of variable disease severity from June 2020 to December 2020. Ocular history and the severity of SARS-CoV-2 viral infection was assessed for all of the patients. MAIN OUTCOME MEASURES: Frequency of conjunctival inflammation and other ocular findings in patients with coronavirus infection. SAMPLE SIZE: 186 patients. RESULTS: The patients had a mean (standard deviation, range) age of 44.4 (18.8, 18–78) years. Conjunctivitis was present in 25 patients (13.4%). There was no significant association between prevalence of conjunctivitis and patient gender ( P =.868). However, conjunctivitis was significantly associated with the severity of the disease ( P =.018): the rate of conjunctivitis was significantly higher in cases with severe disease (28%) in comparison with those with mild to moderate clinical presentation (9.3%). The natural course of conjunctivitis seemed to be mild with no effect on visual acuity and no short-term complications. CONCLUSION: Conjunctivitis can occur in patients with SARS-CoV-2 viral infection, and could be a presenting sign. Conjunctivitis is more common in cases of severe COVID-19 infection and since it could be a presenting sign it might be of benefit in the early diagnosis and treatment of COVID-19. LIMITATION: Single-center study, safety limitations in the examination of the patients. CONFLICT OF INTEREST: None.

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Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer

Cancers ◽

10.3390/cancers12082325 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2325

Author(s):

Carlo Cattrini ◽

Melissa Bersanelli ◽

Maria Maddalena Latocca ◽

Benedetta Conte ◽

Giacomo Vallome ◽

...

Keyword(s):

Hormone Therapy ◽

Sex Hormones ◽

Wide Spectrum ◽

Severe Disease ◽

Host Cells ◽

Testosterone Levels ◽

Increased Risk ◽

Hormonal Therapies ◽

Novel Coronavirus ◽

Transmembrane Serine Protease

The novel coronavirus disease 2019 (COVID-19) shows a wide spectrum of clinical presentations, severity, and fatality rates. The reason older patients and males show increased risk of severe disease and death remains uncertain. Sex hormones, such as estradiol, progesterone, and testosterone, might be implicated in the age-dependent and sex-specific severity of COVID-19. High testosterone levels could upregulate transmembrane serine protease 2 (TMPRSS2), facilitating the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into host cells via angiotensin-converting enzyme 2 (ACE2). Data from patients with prostate cancer treated with androgen-deprivation therapy seem to confirm this hypothesis. Clinical studies on TMPRSS2 inhibitors, such as camostat, nafamostat, and bromhexine, are ongoing. Antiandrogens, such as bicalutamide and enzalutamide, are also under investigation. Conversely, other studies suggest that the immune modulating properties of androgens could protect from the unfavorable cytokine storm, and that low testosterone levels might be associated with a worse prognosis in patients with COVID-19. Some evidence also supports the notion that estrogens and progesterone might exert a protective effect on females, through direct antiviral activity or immune-mediated mechanisms, thus explaining the higher COVID-19 severity in post-menopausal women. In this perspective, we discuss the available evidence on sex hormones and hormone therapy in patients infected with SARS-CoV-2, and we highlight the possible implications for cancer patients, who can receive hormonal therapies during their treatment plans.

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Metabolic syndrome: what is it and what are the implications?

Proceedings of The Nutrition Society ◽

10.1079/pns2005442 ◽

2005 ◽

Vol 64 (3) ◽

pp. 349-357 ◽

Cited By ~ 71

Author(s):

D. I. Shaw ◽

W. L. Hall ◽

C. M. Williams

Keyword(s):

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Abdominal Obesity ◽

Vascular Function ◽

Hdl Cholesterol ◽

The Metabolic Syndrome ◽

Obesity And Overweight ◽

Increased Risk ◽

Diet And Exercise

Obesity and overweight are linked with a cluster of metabolic and vascular disorders that have been termed the metabolic syndrome. Although there is not yet a universally-accepted set of diagnostic criteria, most expert groups agree that the syndrome is characterised by impaired insulin sensitivity and hyperglycaemia, dyslipidaemia (elevated blood triacyglycerols with depressed HDL-cholesterol), abdominal obesity and hypertension. Based on existing published criteria estimates suggest that the syndrome affects a substantial percentage of the middle-aged and elderly populations of most European countries (10–20%) and confers increased risk of type 2 diabetes (2–8.8-fold) and CVD (1.5–6-fold), as well as having a marked effect on morbidity. Although the pathophysiology is incompletely understood, insulin resistance and abdominal obesity are central to subsequent abnormalities in circulating glucose and lipoproteins, and vascular function that lead to type 2 diabetes, atherosclerosis and CVD. The link between metabolic syndrome, type 2 diabetes and CVD, as well as inability to reverse the present rising rates of obesity, will lead to economically-unsustainable costs of health care in the next 10–20 years. Preventative strategies for metabolic syndrome are required to slow rates of progression and to reduce dependence on costly medical management. A notable development is recent evidence that shows that diet and exercise are more effective than drug treatment in preventing the development of type-2 diabetes in high-risk individuals. The LIPGENE project will investigate dietary fat quality as a strategy for the prevention of metabolic syndrome and identify food chain approaches that can support consumer attempts to alter their dietary patterns.

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Post-COVID-19 Pulmonary Fibrosis: Novel Sequelae of the Current Pandemic

Journal of Clinical Medicine ◽

10.3390/jcm10112452 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2452

Author(s):

Shiva Rattan Ambardar ◽

Stephanie L. Hightower ◽

Nikhil A. Huprikar ◽

Kevin K. Chung ◽

Anju Singhal ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Pulmonary Fibrosis ◽

Lung Disease ◽

Severe Disease ◽

Pulmonary Complications ◽

Patient Specific ◽

Pulmonary Vascular Disease ◽

Increased Risk ◽

Risk Of Progression ◽

Novel Coronavirus

Since the initial identification of the novel coronavirus SARS-CoV-2 in December 2019, the COVID-19 pandemic has become a leading cause of morbidity and mortality worldwide. As effective vaccines and treatments begin to emerge, it will become increasingly important to identify and proactively manage the long-term respiratory complications of severe disease. The patterns of imaging abnormalities coupled with data from prior coronavirus outbreaks suggest that patients with severe COVID-19 pneumonia are likely at an increased risk of progression to interstitial lung disease (ILD) and chronic pulmonary vascular disease. In this paper, we briefly review the definition, classification, and underlying pathophysiology of interstitial lung disease (ILD). We then review the current literature on the proposed mechanisms of lung injury in severe COVID-19 infection, and outline potential viral- and immune-mediated processes implicated in the development of post-COVID-19 pulmonary fibrosis (PCPF). Finally, we address patient-specific and iatrogenic risk factors that could lead to PCPF and discuss strategies for reducing risk of pulmonary complications/sequelae.

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Molecular Association of Coronavirus with Diabetes Mellitus Type 2 in Pakistan

Diabetes & Metabolic Disorders ◽

10.24966/dmd-201x/100034 ◽

2020 ◽

Vol 7 (1) ◽

pp. 1-12

Author(s):

Samreen Riaz ◽

Keyword(s):

Infectious Disease ◽

Diabetes Mellitus Type 2 ◽

The Novel ◽

Elevated Blood ◽

Risk Of Death ◽

Previous Diagnosis ◽

Increased Risk ◽

Sugar Levels ◽

Novel Coronavirus

Patients with COVID-19 who have elevated blood sugar levels without a previous diagnosis of diabetes may be at a high risk of death and an increased risk of severe complications from the infectious disease, a new study says. We aimed to briefly review the general characteristics of the novel coronavirus (SARS-CoV-2) and provide a better understanding of the coronavirus disease (COVID-19) in people with diabetes, and its management.

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Elevated D-Dimer Levels are Associated with Increased Risk of Mortality in COVID-19: A Systematic Review and Meta-Analysis

10.1101/2020.04.29.20085407 ◽

2020 ◽

Cited By ~ 3

Author(s):

Siddharth Shah ◽

Kuldeep Shah ◽

Siddharth B Patel ◽

Forum S Patel ◽

Mohammed Osman ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Severe Disease ◽

Case Fatality ◽

Inclusion Criteria ◽

Risk Of Mortality ◽

Increased Risk ◽

Novel Coronavirus ◽

D Dimer

AbstractIntroductionThe 2019 novel Coronavirus (2019-nCoV), now declared a pandemic has an overall case fatality of 2–3% but it is as high as 50% in critically ill patients. D-dimer is an important prognostic tool, often elevated in patients with severe COVID-19 infection and in those who suffered death. In this systematic review, we aimed to investigate the prognostic role of D-dimer in COVID-19 infected patients.MethodsWe searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting admission D-dimer levels in COVID-19 patients and its effect on mortality.Results18 studies (16 retrospective and 2 prospective) with a total of 3,682 patients met the inclusion criteria. The pooled mean difference (MD) suggested significantly elevated D-dimer levels in patients who died versus those survived (MD 6.13 mg/L, 95% CI 4.16 − 8.11, p <0.001). Similarly, the pooled mean D-dimer levels were significantly elevated in patients with severe COVID-19 infection (MD 0.54 mg/L, 95% CI 0.28 − 0.8, p< 0.001). In addition, the risk of mortality was four-fold higher in patients with positive D-dimer vs negative D-dimer (RR 4.11, 95% CI 2.48 − 6.84, p< 0.001) and the risk of developing the severe disease was two-fold higher in patients with positive D-dimer levels vs negative D-dimer (RR 2.04, 95% CI 1.34 − 3.11, p < 0.001).ConclusionOur meta-analysis demonstrates that patients with COVID-19 presenting with elevated D-dimer levels have an increased risk of severe disease and mortality.

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Pancreatitis

AACN Advanced Critical Care ◽

10.4037/15597768-2010-2010 ◽

2010 ◽

Vol 21 (2) ◽

pp. 195-204

Author(s):

Abby Andris

Keyword(s):

Severe Disease ◽

Necrotizing Pancreatitis ◽

Disease Process ◽

Severe Form ◽

Nursing Assessment ◽

Risk Of Mortality ◽

Organ Systems ◽

Increased Risk ◽

Supportive Interventions ◽

Severity Of The Disease

Pancreatitis, or inflammation of the pancreas, has a variety of etiologies. Severity of the disease can range from its mildest form, which resolves quickly with few complications, to its most severe form, necrotizing pancreatitis, which is associated with an increased risk for developing multiple system organ failure and mortality. Treatment of pancreatitis aims to eliminate the etiologic factors for the disease while managing its complications and preventing further disease progression. Patients with mild forms of pancreatitis may improve with symptom management, whereas those with more severe disease will need significant supportive interventions. Most patients are managed medically. Surgery may be indicated for severe pancreatitis. It is important to understand the disease process and its impact on other organ systems when caring for these patients. Accurate assessment of changes in the patient’s condition can lead to interventions that can limit complications and reduce the risk of mortality. This article reviews the pathophysiology of pancreatitis, its diagnosis and treatment, associated complications and their management, and essential nursing assessment and interventions.

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P054 Risk of death during the 2020 UK COVID-19 epidemic among people with rare diseases compared to the general population

Rheumatology ◽

10.1093/rheumatology/keab247.051 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Megan Rutter ◽

Peter C Lanyon ◽

Emily Peach ◽

Matthew J Grainge ◽

Richard B Hubbard ◽

...

Keyword(s):

General Population ◽

Rare Diseases ◽

Absolute Risk ◽

Healthcare Services ◽

Mortality Rates ◽

Baseline Risk ◽

Secondary Outcome ◽

Published Data ◽

Risk Of Death ◽

Increased Risk

Abstract Background/Aims To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 epidemic compared with baseline risk and the risk of death in the general population during COVID-19. Methods A cohort study was performed using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). Coded diagnoses for RAIRD were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated our case ascertainment methods had a positive predictive value >85%. ONS published data were used for general population mortality rates. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. Secondary outcome measures were age-sex standardised mortality rates, and age-stratified mortality rates. Results 168,691 people with RAIRD were alive on 1 March 2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118,379 (70.2%) were female. 1,815 (1.1%) people with RAIRD died during March and April 2020. The ASMR among people with RAIRD was 3669.3 (95% CI 3500.4-3838.1) per 100,000 person-years, which was 1.44 (95% CI 1.42-1.45) times higher than the average ASMR during the same months of the previous 5 years. In the whole population of England, the ASMR during March and April 2020 was 1361.1 (1353.6- 1368.7) per 100,000 people, which was 1.38 times higher than the average ASMR during the same months of the previous 5 years (see related abstract about influenza seasons). Unlike in the general population, sex-specific rates in RAIRD were similar in males and females. When comparing risk of death during COVID-19 to pre-COVID-19, people with RAIRD had an increased risk of death from age 35 upwards, compared to around age 55 upwards in the general population. As the protective effect of being female was not seen in RAIRD, the group at the largest increased risk compared to their pre-COVID-19 risk were women aged 35 upwards. The absolute risk of all-cause death for someone aged 20-29 with RAIRD was similar to someone in the general population aged >20 years older, someone aged 40-49 years with RAIRD similar to someone in the general population 20 years older, and someone aged 60-69 with RAIRD similar to someone in the general population aged >10 years older. Conclusion The excess risk of all-cause death during COVID-19 occurs at a younger age among people with RAIRD than among the general population, and particularly affects females. . We urgently need to quantify how much risk is due to COVID-19 infection and how much due to disruption to healthcare services to inform better guidance about shielding, access to healthcare and vaccine priorities for people with rare diseases. Disclosure M. Rutter: None. P.C. Lanyon: None. E. Peach: None. M.J. Grainge: None. R.B. Hubbard: None. J. Aston: None. M. Bythell: None. S. Stevens: None. F.A. Pearce: None.

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O24 Risk of death during the 2020 UK COVID-19 epidemic and annual influenza seasons among people with vasculitis compared to the general population: a whole-population study using data from the NDRS and the RECORDER project

Rheumatology ◽

10.1093/rheumatology/keab246.023 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Megan Rutter ◽

Peter C Lanyon ◽

Matthew J Grainge ◽

Richard B Hubbard ◽

Emily J Peach ◽

...

Keyword(s):

Mortality Rate ◽

General Population ◽

Mortality Rates ◽

Published Data ◽

Research Support ◽

Risk Of Death ◽

Crude Mortality Rate ◽

Crude Mortality ◽

Increased Risk ◽

Using Data

Abstract Background/Aims To quantify the risk of death among people with vasculitis during the UK 2020 COVID-19 epidemic compared with baseline risk, risk during annual influenza seasons and risk of death in the general population during COVID-19. Methods We performed a cohort study using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) under their legal permissions (CAG 10-02(d)/2015). Coded diagnoses for vasculitis (ANCA-associated vasculitis, Takayasu arteritis, Behçet's disease, and giant cell arteritis) were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated a positive predictive value >85%. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. ONS published data were used for general population mortality rates. Results We identified 55,110 people with vasculitis (median age 74.9 (IQR 64.1-82.7) years, 68.0% female) alive 01 March 2020. During March-April 2020, 892 (1.6%) died of any cause. The crude mortality rate was 9773.0 (95% CI 9152.3-10,435.9) per 100,000 person-years. The ASMR was 2567.5 per 100,000 person-years, compared to 1361.1 (1353.6-1368.7) in the general population (see table). The ASMR in March-April 2020 was 1.4 times higher than the mean ASMR for March-April 2015-2019 (1965.6). The increase in deaths during March-April 2020 occurred at a younger age than in the general population. We went on to investige the effect of previous influenza seasons. The 2014/15 season saw the greatest excess all-cause mortality nationally in recent years, and there were 624 deaths in 38,888 people (6472.5 person-years) with vasculitis in our data (crude mortality rate 9640.8 (8913.3-10427.7); The ASMR was 2657.6, which was marginally higher than the ASMR among people with vasculitis recorded during March-April 2020 during the COVID-19 pandemic. Conclusion People with vasculitis are at increased risk of death during circulating COVID-19 and influenza epidemics. The ASMR among people with vasculitis was high both during the 2014/15 influenza season and during the first wave of the COVID-19 epidemic. COVID-19 vaccination and annual influenza vaccination for people with vasculitis are both important, regardless of patient age. Disclosure M. Rutter: None. P.C. Lanyon: Grants/research support; PCL has received funding for research from Vifor Pharma.. M.J. Grainge: None. R.B. Hubbard: None. E.J. Peach: Grants/research support; EJP has received funding for research from Vifor Pharma. M. Bythell: None. J. Aston: None. S. Stevens: None. F.A. Pearce: Grants/research support; FAP has received funding for research from Vifor Pharma..

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