Scientists, including those of Indian-origin, have reviewed the latest findings on COVID-19’s effect on organ systems outside the lungs and provided clinical guidance for physicians.
Their review—the first extensive review of COVID-19’s effects on all affected organs outside the lungs—was published on July 10 in Nature Medicine.
“Physicians need to think of COVID-19 as a multisystem disease,” Ankit Gupta, one of the scientists involved in the research, says. “There’s a lot of news about clotting but it’s also important to understand that a substantial proportion of these patients suffer kidney, heart, and brain damage, and physicians need to treat those conditions along with the respiratory disease.”
Gupta, along with senior author Donald Landry, MD, PhD, chair of medicine at Columbia University Vagelos College of Physicians and Surgeons, organized senior co-authors, and Gupta, along with two other colleagues, Mahesh Madhavan, MD, a cardiology fellow at CUIMC, and Kartik Sehgal, MD, a hematology/oncology fellow at Beth Israel Deaconess Medical Center/Harvard Medical School, mobilized clinicians at Columbia, Harvard, Yale, and Mount Sinai Hospital, among other institutions, to review the latest findings on COVID-19’s effect on organ systems outside the lungs and provide clinical guidance for physicians.
“In just the first few weeks of the pandemic, we were seeing a lot of thrombotic complications, more than what we would have anticipated from experience with other viral illnesses,” says Sehgal, “and they can have profound consequences on the patient.”
Scientists think these clotting complications may stem from the virus’s attack on cells that line the blood vessels. When the virus attacks blood vessel cells, inflammation increases, and blood begins to form clots, big and small. These blood clots can travel all over the body and wreak havoc on organs, perpetuating a vicious cycle of thromboinflammation.
To combat clotting and its damaging effects, clinicians at Columbia, many of whom are co-authors on this review, are conducting a randomized clinical trial to investigate the optimal dose and timing of anticoagulation drugs in critically ill patients with COVID-19.
Another surprising finding was the high proportion of COVID-19 patients in the ICU with acute kidney damage.
The ACE2 receptor used by the virus to gain entry into the cells is found in high concentrations in the kidney and could likely be responsible for the renal damage. Studies in China reported renal complications, and in New York City, clinicians saw renal failure in up to 50% of patients in the ICU.
“About 5 to 10% of patients needed dialysis. That’s a very high number,” Gupta says.
Neurological symptoms, including headache, dizziness, fatigue, and loss of smell, may occur in about a third of patients.
More concerning, strokes caused by blood clots occur in up to 6% of severe cases and delirium in 8% to 9%.
“COVID-19 patients can be intubated for two to three weeks; a quarter require ventilators for 30 or more days,” Gupta says.