Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity

Abstract

COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant “cytokine storm”, which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation also plays a major role in the clinical evolution of COVID-19 patients. Pre-existing inflammatory conditions, such as those associated with chronic coronary diseases, type 2 diabetes mellitus or obesity, may be associated with worse clinical outcomes in the context of COVID-19 disease. These comorbidities are reported as powerful predictors of poor outcomes and death following COVID-19 disease. Moreover, in the context of chronic coronary syndrome, the cytokine storm triggered by SARS-CoV-2 infection may favor vulnerabilization and rupture of a silent atheromatous plaque, with consequent acute coronary syndrome, leading to a sudden deterioration of the clinical condition of the patient. This review aims to present the current status of knowledge regarding the link between COVID-19 mortality, systemic inflammation and several major diseases associated with poor outcomes, such as cardiovascular diseases, diabetes and obesity.

Chronic diseases associated with increased likelihood of hospitalization and mortality in 68,913 COVID-19 confirmed cases in Spain: A population-based cohort study

“…obesity, diabetes, congestive heart failure and chronic renal failure) increased the risk of severe infection in both sexes even when adjusting by age and the remaining significant comorbidities, as described in previous studies [19][20][21][22][23][24]. Patients with these conditions seem to be predisposed to potentially serious COVID-19 infections through common pathophysiological pathways, with chronic systemic inflammation at their center [7]. Key aspects include ACE-2-mediated endothelial injury, blood flow stasis due to immobilization, and a state of hypercoagulability induced by prothrombotic circulating factors, which contribute to the occurrence of coagulopathies and thromboembolic events, markedly increasing the risk of severe outcomes [25][26][27][28][29].…”

“…Apart from age, the concurrence of specific chronic conditions has been amply linked through metanalytical data to increased risk of severe infection, with chronic lung and kidney diseases, obesity, diabetes, hypertension, or malignancy as some of the main examples [4,5]. COVID-19 has also been associated with intense multisystemic inflammation and an uncontrolled immune response, leading to cardiovascular complications and poorer outcomes, more so in patients with underlying comorbidities [6,7].…”

Course and Survival of COVID-19 Patients with Comorbidities in Relation to the Trace Element Status at Hospital Admission

“…The mortality in our study was elevated in Se and Zn deficiency, in particular within the groups of obese, chronic cardiac disease, cancer and diabetes patients. These conditions confer an increased mortality risk in COVID-19, and are often associated with (sub-)clinical inflammation, again potentially closing a vicious self-amplifying cycle [54,55]. As cancer and chronic cardiac disease were associated with a higher mortality particularly in the Se-deficient patients, obesity was associated with a higher mortality in Zn-deficient patients and both Se-and Zn-deficiency conferred increased mortality risk in particular for diabetes patients, it is hypothesized that Se and Zn deficiency may aggravate the negative impact of cancer, obesity, chronic cardiac disease and diabetes on an adequate immune response in COVID-19.…”

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

“…On the other hand, the fact that the population analyzed in this study has mainly European ancestry, the findings of this study could not be applied to groups with other ethnicity and exposed to diverse environmental factors. For instance, in Latin America, variables such as the high rates of obesity, the adoption of hepatopathogenic diets, and a sedentary lifestyle could exacerbate liver damage and a hyperinflammatory state in COVID-19 [ 34 ]. Moreover, the exploration of other variables influencing liver health and the immune response including the gut microbiota, genetic background, epigenetic signatures, metabolomic profiles, and interactions with specific lifestyle factors could be part of the scenario [ 35 ].…”