Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies

Costa, Fernanda Farias; Rosário, Wilian Reis; Farias, Ana Cláudia Ribeiro; Souza, Ramon Guimarães de; Gondim, Roberta Sabrine Duarte; Barroso, Wermerson Assunção

doi:10.1016/j.dsx.2020.06.016

Cited by 129 publications

(122 citation statements)

References 56 publications

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“…Patient comorbidities including hypertension, diabetes, obesity, and heart disease are associated with higher risk of severe COVID-19 disease. 3 , 4 , 19 , 20 , 21 while patients with additional common diseases including asthma and chronic obstructive lung disease (COPD) are advised to take extra precautions in the USA. 22 Reported COVID-19 inpatient mortality rates vary by city/region, 23 between countries, 1 , 3 , 4 , 16 , 17 , 19 , 23 , 24 , 25 and by disease severity.…”

Section: Introductionmentioning

confidence: 99%

Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic)

Vizcaychipi¹,

Shovlin²,

McCarthy³

et al. 2020

The Brazilian Journal of Infectious Diseases

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Introduction Our goal was to evaluate if traffic-light driven personalized care for COVID-19 was associated with improved survival in acute hospital settings. Methods Discharge outcomes were evaluated before and after prospective implementation of a real-time dashboard with feedback to ward-based clinicians. Thromboembolism categories were “medium-risk” (D-dimer >1000 ng/mL or CRP >200 mg/L); “high-risk” (D-dimer >3000 ng/mL or CRP >250 mg/L) or “suspected” (D-dimer >5000 ng/mL). Cytokine storm risk was categorized by ferritin. Results 939/1039 COVID-19 positive patients (median age 67 years, 563/939 (60%) male) completed hospital encounters to death or discharge by 21st May 2020. Thromboembolism flag criteria were reached by 568/939 (60.5%), including 238/275 (86.6%) of the patients who died, and 330/664 (49.7%) of the patients who survived to discharge, p < 0.0001. Cytokine storm flag criteria were reached by 212 (22.6%) of admissions, including 80/275 (29.1%) of the patients who died, and 132/664 (19.9%) of the patients who survived, p < 0.0001. The maximum thromboembolism flag discriminated completed encounter mortality (no flag: 37/371 [9.97%] died; medium-risk: 68/239 [28.5%]; high-risk: 105/205 [51.2%]; and suspected thromboembolism: 65/124 [52.4%], p < 0.0001). Flag criteria were reached by 535 consecutive COVID-19 positive patients whose hospital encounter completed before traffic-light introduction: 173/535 (32.3% [95% confidence intervals 28.0, 36.0]) died. For the 200 consecutive admissions after implementation of real-time traffic light flags, 46/200 (23.0% [95% confidence intervals 17.1, 28.9]) died, p = 0.013. Adjusted for age and sex, the probability of death was 0.33 (95% confidence intervals 0.30, 0.37) before traffic light implementation, 0.22 (0.17, 0.27) after implementation, p < 0.001. In subgroup analyses, older patients, males, and patients with hypertension ( p ≤ 0.01), and/or diabetes ( p = 0.05) derived the greatest benefit from admission under the traffic light system. Conclusion Personalized early interventions were associated with a 33% reduction in early mortality. We suggest benefit predominantly resulted from early triggers to review/enhance anticoagulation management, without exposing lower-risk patients to potential risks of full anticoagulation therapy.

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Section: Introductionmentioning

confidence: 99%

Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic)

Vizcaychipi¹,

Shovlin²,

McCarthy³

et al. 2020

The Brazilian Journal of Infectious Diseases

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“…14 Due to the chronic hyperglycemic state seen in type 2 diabetes mellitus and chronic inflammatory state owing to excessive adipose tissue in obese patients, a delayed and depressed immune response and impaired immune memory is observed with increased risk of mortality due to COVID-19. 16 Our patient being obese, diabetic and hypertensive elderly male, he was predisposed to develop severe COVID-19 illness. Prolonged stay in ICU along with use of sedatives results in longer period of immobilization.…”

Section: Discussionmentioning

confidence: 83%

Rehabilitation of mechanically ventilated elderly patient with COVID-19 of a dedicated COVID tertiary hospital: a case report

2020

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<p class="abstract">Corona virus disease 2019 (COVID-19), a highly communicable disease caused by severe acute respiratory syndrome-corona virus 2 (SARS-CoV2) which originated in Wuhan, China has affected 213 countries worldwide and has caused an economic crisis. As of August 10, 2020, India’s recovery rate is 63%. Most of the critical cases requiring intensive care unit (ICU) management are elderly patients with co-morbidities. The case report is of an elderly, comorbid patient who was intubated and put on a mechanical ventilator. At a time when critical patients on mechanical ventilator hardly survived, this patient survived and was successfully weaned from the ventilator and extubated. The case report emphasizes physical therapy management along with medical management for an elderly SARS CoV2 survivor with co-morbidities, and his journey from the onset of symptoms to being mechanically ventilated to performing his daily activities with minimal discomfort.</p><p class="abstract"> </p>

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“…15,16 Increasing evidence notes that a western diet and lifestyle, as well as aging, drive the pandemic of chronic noninfectious degenerative diseases, termed "civilization diseases" (i.e., metabolic syndrome, cancer, and autoimmune and neurodegenerative diseases), and dramatically increase the susceptibility to and severity of infectious pandemics, such as the current COVID-19 pandemic. 59 Therefore, a better understanding of the immunometabolic signaling networks that coordinate immune responses to environmental cues is warranted, with the ultimate goal of identifying new therapeutic strategies.…”

Section: Metabolic Cues Can Inform Pathogenic Myelopoiesismentioning

confidence: 99%

Implications of metabolism-driven myeloid dysfunctions in cancer therapy

et al. 2020

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Immune homeostasis is maintained by an adequate balance of myeloid and lymphoid responses. In chronic inflammatory states, including cancer, this balance is lost due to dramatic expansion of myeloid progenitors that fail to mature to functional inflammatory neutrophils, macrophages, and dendritic cells (DCs), thus giving rise to a decline in the antitumor effector lymphoid response. Cancer-related inflammation orchestrates the production of hematopoietic growth factors and cytokines that perpetuate recruitment and activation of myeloid precursors, resulting in unresolved and chronic inflammation. This pathologic inflammation creates profound alterations in the intrinsic cellular metabolism of the myeloid progenitor pool, which is amplified by competition for essential nutrients and by hypoxia-induced metabolic rewiring at the tumor site. Therefore, persistent myelopoiesis and metabolic dysfunctions contribute to the development of cancer, as well as to the severity of a broad range of diseases, including metabolic syndrome and autoimmune and infectious diseases. The aims of this review are to (1) define the metabolic networks implicated in aberrant myelopoiesis observed in cancer patients, (2) discuss the mechanisms underlying these clinical manifestations and the impact of metabolic perturbations on clinical outcomes, and (3) explore new biomarkers and therapeutic strategies to restore immunometabolism and differentiation of myeloid cells towards an effector phenotype to increase host antitumor immunity. We propose that the profound metabolic alterations and associated transcriptional changes triggered by chronic and overactivated immune responses in myeloid cells represent critical factors influencing the balance between therapeutic efficacy and immune-related adverse effects (irAEs) for current therapeutic strategies, including immune checkpoint inhibitor (ICI) therapy.

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Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies

Cited by 129 publications

References 56 publications

Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic)

Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic)

Rehabilitation of mechanically ventilated elderly patient with COVID-19 of a dedicated COVID tertiary hospital: a case report

Implications of metabolism-driven myeloid dysfunctions in cancer therapy

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