Severe COVID‐19 infection and thrombotic microangiopathy: success does not come easily

Gavriilaki, Eleni; Brodsky, Robert A.

doi:10.1111/bjh.16783

Cited by 181 publications

(182 citation statements)

References 15 publications

Supporting

Mentioning

170

Contrasting

Unclassified

Order By: Relevance

“…10 There is growing speculation that TMAs play a large role in COVID-19. [11][12][13] In this case, we describe a toddler who presented with COVID-19, DKA and aHUS treated with eculizumab. This is the first COVID-19 presentation of its kind.…”

Section: Table Of Contents Summarymentioning

confidence: 99%

Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19

et al. 2021

View full text Add to dashboard Cite

This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

show abstract

Section: Table Of Contents Summarymentioning

confidence: 99%

Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19

et al. 2021

View full text Add to dashboard Cite

show abstract

“…poor glycaemic control and duration of diabetes) are strong risk factors for disease severity ( 54 ). TMA is reported as a frequent event in Covid-19 and is likely to involve endothelium-mediated complement activation ( 55 ). Given high levels of expression of ACE2 in endothelial cells and podocytes, activation of this process may present a unifying mechanism for viral action in a range of susceptible tissues, including kidney and heart.…”

Section: Covid-19 and Thrombotic Microangiopathymentioning

confidence: 99%

Covid-19 and Diabetes: A Complex Bidirectional Relationship

et al. 2020

View full text Add to dashboard Cite

Covid-19 is a recently-emerged infectious disease caused by the novel severe acute respiratory syndrome coronavirus SARS-CoV2. SARS-CoV2 differs from previous coronavirus infections (SARS and MERS) due to its high infectivity (reproduction value, R 0 , typically 2–4) and pre- or asymptomatic transmission, properties that have contributed to the current global Covid-19 pandemic. Identified risk factors for disease severity and death from SARS-Cov2 infection include older age, male sex, diabetes, obesity and hypertension. The reasons for these associations are still largely obscure. Evidence is also emerging that SARS-CoV2 infection exacerbates the underlying pathophysiology of hyperglycemia in people with diabetes. Here, we discuss potential mechanisms through which diabetes may affect the risk of more severe outcomes in Covid-19 and, additionally, how diabetic emergencies and longer term pathology may be aggravated by infection with the virus. We consider roles for the immune system, the observed phenomenon of microangiopathy in severe Covid-19 infection and the potential for direct viral toxicity on metabolically-relevant tissues including pancreatic beta cells and targets of insulin action.

show abstract

“…Thrombotic microangiopathy is a result of increased platelet adhesion to the vascular endothelium, leading to consumption of platelets. The specific laboratory findings are hemolytic anemia with schistocytes, reticulocytosis and decreased haptoglobin, thrombocytopenia, and elevated LDH level [ 32 ]. In COVID-19, severe thrombocytopenia and intravascular hemolysis are not key features.…”

Section: Covid-19-associated Coagulopathymentioning

confidence: 99%

Stroke as a Potential Complication of COVID-19-Associated Coagulopathy: A Narrative and Systematic Review of the Literature

Szegedi

Orbán-Kálmándi

Csiba

et al. 2020

JCM

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) is the most overwhelming medical threat of the past few decades. The infection, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can cause serious illness leading to respiratory insufficiency, and, in severely ill patients, it can progress to multiple organ failure leading to death. It has been noted from the earliest reports that the disease influences the hemostasis system and a hallmark of severe infection is elevated D-dimer levels. The profound coagulation changes in COVID-19 seem to be linked to inflammation-related events and severe endothelial cell injury. Besides the high incidence of venous thromboembolic events in SARS-CoV-2 infections, arterial events, including cerebrovascular events, were found to be associated with the disease. In this review, we aimed to summarize the available literature on COVID-19-associated coagulopathy and thrombosis. Furthermore, we performed a systematic search of the literature to identify the characteristics of stroke in COVID-19. Our findings showed that acute ischemic stroke (AIS) is the most frequent type of stroke occurring in infected patients. In most cases, stroke was severe (median NIHSS:16) and most of the patients had one or more vascular risk factors. Laboratory findings in AIS patients were consistent with COVID-19-associated coagulopathy, and elevated D-dimer levels were the most common finding. The outcome was unfavorable in most cases, as a large proportion of the reported patients died or remained bedridden. Limited data are available as yet on outcomes after acute vascular interventions in COVID-19 patients. In the future, well-designed studies are needed to better understand the risk of stroke in COVID-19, to optimize treatment, and to improve stroke care.

show abstract

Severe COVID‐19 infection and thrombotic microangiopathy: success does not come easily

Cited by 181 publications

References 15 publications

Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19

Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19

Covid-19 and Diabetes: A Complex Bidirectional Relationship

Stroke as a Potential Complication of COVID-19-Associated Coagulopathy: A Narrative and Systematic Review of the Literature

Contact Info

Product

Resources

About