scholarly journals Case Report: Myopathy in Critically Ill COVID-19 Patients: A Consequence of Hyperinflammation?

2021 ◽  
Vol 12 ◽  
Author(s):  
Viviana Versace ◽  
Luca Sebastianelli ◽  
Davide Ferrazzoli ◽  
Leopold Saltuari ◽  
Markus Kofler ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Motor Nerve ◽  
Elevated Serum ◽  
Intensive Care Treatment ◽  
Motor Nerve Conduction ◽  
Reactive Protein ◽  
Compound Muscle Action Potentials ◽  
Prolonged Duration ◽  
Inflammatory State ◽  
Myopathic Changes

Introduction: COVID-19-associated muscular complications may comprise myalgia, weakness, wasting, and rhabdomyolysis. Skeletal muscle damage in COVID-19 may be due to direct infection by the virus SARS-CoV-2 through interaction with the ACE2 receptor, systemic hyper-inflammatory state with cytokine release and homeostatic perturbation, an autoimmune process, or myotoxic drugs. Disclosing the cause of weakness in an individual patient is therefore difficult.Case Description: We report two patients, who survived typical COVID-19 pneumonia requiring intensive care treatment and who developed early on myalgia and severe proximal weakness in all four limbs. Laboratory exams revealed elevated serum creatine kinase and markedly increased C-reactive protein and interleukin 6, concurring with a systemic inflammatory response. On admission in neurorehabilitation (4 and 7 weeks after COVID-19 onset, respectively), the patients presented with proximal flaccid tetraparesis and limb-girdle muscle atrophy. Motor nerve conduction studies showed decreased amplitude and prolonged duration of compound muscle action potentials (CMAPs) with normal distal motor latencies and normal conduction velocities in median and ulnar nerves. Needle electromyography in proximal muscles revealed spontaneous activity in one and myopathic changes in both patients.Discussion: Clinical, laboratory, and electrodiagnostic findings in these patients were unequivocally consistent with myopathy. Interestingly, increased distal CMAP duration has been described in patients with critical illness myopathy (CIM) and reflects slow muscle fiber conduction velocity due to membrane hypo-excitability, possibly induced by inflammatory cytokines. By analogy with CIM, the pathogenesis of COVID-19-related myopathy might also depend on hyperinflammation and metabolic pathways that may affect muscles in a pathophysiological continuum from hypo-excitability to necrosis.

scholarly journals Lymphopenia predicted illness severity and recovery in patients with COVID-19: A single-center, retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241659
Author(s):  
Jiheng Liu ◽  
Heng Li ◽  
Ming Luo ◽  
Jiyang Liu ◽  
Lingzhen Wu ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Retrospective Study ◽  
Clinical Laboratory ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
Single Center ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prolonged Duration ◽  
Duration Of Hospitalization

The outbreak of SARS-CoV-2 began in December 2019 and rapidly became a pandemic. The present study investigated the significance of lymphopenia on disease severity. A total of 115 patients with confirmed COVID-19 from a tertiary hospital in Changsha, China, were enrolled. Clinical, laboratory, treatment and outcome data were gathered and compared between patients with and without lymphopenia. The median age was 42 years (1–75). Fifty-four patients (47.0%) of the 115 patients had lymphopenia on admission. More patients in the lymphopenia group had hypertension (30.8% vs. 10.0%, P = 0.006) and coronary heart disease (3.6% vs. 0%, P = 0.029) than in the nonlymphopenia group, and more patients with leukopenia (48.1% vs 14.8%, P<0.001) and eosinopenia (92.6% vs 54.1%, P<0.001) were observed. Lymphopenia was also correlated with severity grades of pneumonia (P<0.001) and C-reactive protein (CRP) level (P = 0.0014). Lymphopenia was associated with a prolonged duration of hospitalization (17.0 days vs. 14.0 days, P = 0.002). Lymphocyte recovery appeared the earliest, prior to CRP and chest radiographs, in severe cases, which suggests its predictive value for disease improvement. Our results demonstrated the clinical significance of lymphopenia for predicting the severity of and recovery from COVID-19, which emphasizes the need to dynamically monitor lymphocyte count.

scholarly journals Lymphopenia acted as an adverse factor for severity in patients with COVID-19: a single-centered, retrospective study

2020 ◽  
Author(s):  
Jiheng Liu ◽  
Heng Li ◽  
Ming Luo ◽  
Jiyang Liu ◽  
Lingzhen Wu ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Clinical Laboratory ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prolonged Duration ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease ◽  
Adverse Factor

Abstract Purpose: The outbreak of SARS-CoV-2 began in December and rapidly caused a pandemic. To investigate the significance of lymphopenia for the severity of the disease, this study was performed.Methods: 115 patients confirmed COVID-19 from a tertiary hospital in Changsha, China were enrolled. The clinical, laboratory, treatment and outcome data were collected and compared between patients with lymphopenia or not.Results: The median age was 42 years (1-75). 54 patients (47.0%) of the patients had lymphopenia on admission. In the group of lymphopenia, more patients had hypertension (30.8% vs 10.0%, P=0.006) and coronary heart disease (3.6% vs 0%, P=0.029) and more patients with leucopenia (48.1% vs 14.8%, P<0.001) and eosinophilia (92.6% vs 54.1%, P<0.001) were observed. Lymphopenia was also correlated with severity grades of pneumonia (P<0.001) and C-reactive protein (CRP) level (P=0.0014). Lymphopenia was associated with a prolonged duration of hospitalization (17.0 days vs 14.0 days, P=0.002). Moreover, the recovery of lymphocyte appeared the earliest before CRP and chest radiographs in severe cases, suggesting its predictive value for disease improvement. Conclusion: Our results showed the clinical significance of lymphopenia for predicting the severity of COVID-19 and the recovery of the disease, emphasizing the need to monitor the lymphocyte count dynamically.

The Pattern of Ventricular Remodeling Influences the Level of Oxidative Stress in Heart Failure Patients

2017 ◽  
Vol 68 (7) ◽  
pp. 1506-1511
Author(s):  
Cerasela Mihaela Goidescu ◽  
Anca Daniela Farcas ◽  
Florin Petru Anton ◽  
Luminita Animarie Vida Simiti
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Ventricular Remodeling ◽  
Clinical Laboratory ◽  
Left Ventricular ◽  
Control Group ◽  
Reactive Protein ◽  
Lv Mass ◽  
Few Data

Oxidative stress (OS) is increased in chronic diseases, including cardiovascular (CV), but there are few data on its effects on the heart and vessels. The isoprostanes (IsoP) are bioactive compounds, with 8-iso-PGF25a being the most representative in vivo marker of OS. They correlate with the severity of heart failure (HF), but because data regarding OS levels in different types of HF are scarce, our study was aimed to evaluate it by assessing the urinary levels of 8-iso-PGF2aand its correlations with various biomarkers and parameters. Our prospective study included 53 consecutive patients with HF secondary to ischemic heart disease or dilative cardiomyopathy, divided according to the type of HF (acute, chronic decompensated or chronic compensated HF). The control group included 13 hypertensive patients, effectively treated. They underwent clinical, laboratory - serum NT-proBNP, creatinine, uric acid, lipids, C reactive protein (CRP) and urinary 8-iso-PGF2a and echocardiographic assessment. HF patients, regardless the type of HF, had higher 8-iso-PGF2a than controls (267.32pg/�mol vs. 19.82pg/�mol, p[0.001). The IsoP level was directly correlated with ejection fraction (EF) (r=-0.31, p=0.01) and NT-proBNP level (r=0.29, p=0.019). The relative wall thickness (RWT) was negatively correlated with IsoP (r=-0.55, p[0.001). Also 8-iso-PGF25a was higher by 213.59pg/�mol in the eccentric left ventricular (LV) hypertrophy subgroup comparing with the concentric subgroup (p=0.014), and the subgroups with severe mitral regurgitation (MR) and moderate/severe pulmonary hypertension (PAH) had the highest 8-iso-PGF2a levels. Male sex, severe MR, moderate/severe PAH, high LV mass and low RWT values were predictive for high OS level in HF patients.Eccentric cardiac remodeling, MR severity and PAH severity are independent predictors of OS in HF patients.

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