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Clinical / Research

Clinical Considerations

Last Updated on 03/06/2021 @ 1:31 PM EST

Contents

  1. General
  2. Cardiovascular Involvement
  3. Pediatrics
  4. Presentation
  5. Coagulopathy
  6. Renal Involvement
  7. Neuro Involvement
  8. Gastrointestinal Involvement
  9. Dermatologic Involvement
  10. Chemosensory Dysfunction
  11. OB/GYN Considerations
  12. Multisystem Inflammatory Syndrome in Adults (MIS-A)
  13. Other
  1. General
    1. NEJM: Mild or Moderate COVID-19 (Diagram)
    2. Medium-Term Effects of SARS-CoV-2 Infection on Multiple Vital Organs, Exercise Capacity, Cognition, Quality of Life and Mental Health, Post-Hospital Discharge
    3. Spontaneous Pneumothorax As A Complication of COVID-19 Pneumonia
    4. Extrapulmonary Manifestations of COVID-19

  2. Cardiovascular Involvement

  3. Pediatrics

  4. Presentation
    1. Cough, Fever, Myalgia, Fatigue, and Nasal Congestion Are the Most Common Presenting Symptoms in Adults
      • Mizrahi B, et al. Longitudinal Symptom Dynamics of COVID-19 Infection. Nat Commun. Dec 2020.

        • Data from 206,377 patients showed the most prevalent symptoms in non-hospitalized adult patients with mild disease were cough, fever, myalgia, fatigue, and nasal congestion. In children, the most prevalent were fever, cough, abdominal pain, and fatigue. Disturbances of the sensations of smell and taste were found in up to 10% of the patients starting 3 weeks prior to the diagnosis. Individuals with loss of smell and taste tend to have a shorter time to recovery compared with those experiencing shortness of breath.

  5. Coagulopathy (Pathophysiology Diagram)
    1. VTE Prevalence in Hospitalized COVID-19 is 6–17% in non-ICU Patients and 23–28% in ICU Patients; PE Prevalence is 4–8% and ~14% in non-ICU and ICU Patients, Respectively
    2. Elevated D-dimer and Coagulopathy are Commonly Associated with Severe Clinical Manifestations of COVID-19
    3. Systemic Anticoagulation May Improve Survival in COVID-19

  6. Prognostic Indicators and Biomarkers
    1. Elevated IL-6 and TNF-α May Be Predictors of Respiratory Failure in Severe COVID-19
    2. Obesity and Fasting Blood Glucose Predict Mortality in Patients with COVID-19 Independent of Diabetes History
    3. Increased Neutrophil Activators (G-CSF, IL-8) and Effectors (RETN, LCN2, HGF, MMP8) are Hallmarks of Critical Illness in COVID-19
    4. Type-I Interferon Deficiency (No IFN-β and Low IFN-α) May Be a Hallmark of Severe COVID-19
    5. Calprotectin Levels Appear to Positively Correlate with Disease Severity
    6. Thrombocytopenia Appears to be Associated with Increased Disease Severity and Higher Mortality in COVID-19
    7. Abnormal Liver Tests Occur in Most Hospitalized COVID-19 Patients and May Be Associated with Worse Outcomes
    8. Elevated and Increasing Red Blood Cell Distribution Width at Admission May Be Associated with a Higher Mortality Risk for Patients with SARS-CoV-2

  7. Renal Involvement (Infographic)
    1. AKI Occurs in 26-32% of Hospitalized COVID-19 Patients and is Associated with a 3-Fold Increase in Mortality

  8. Neuro Involvement
    1. Indirect Neurological Complications (Confusion, Headache, etc.) Are Common; Acute Cerebrovascular Disease and Seizures Due to Dysregulation of Systemic Heomeostasis and Coagulopathy Have Been Observed; There is Little Evidence of Direct Neurological Involvement
    2. This Is No Epidemiological or Phenotypic Evidence of SARS-CoV-2 Being Causative of Guillain-Barré Syndrome; Guillain-Barré Syndrome Incidence Has Fallen during the Pandemic
    3. Association of COVID-19 with the Development of Parkinson’s Disease Is Not Currently Supported by Evidence

  9. Gastrointestinal Involvement
    1. Digestive Symptoms Are Common in COVID-19 and May Be Associated with a Worse Prognosis
    2. Acute Mesenteric Ischemia from Small Vessel Thrombosis and Cholestasis are Common in COVID-19 Inpatients
    3. Role of PPIs

  10. Dermatologic Involvement
    1. Common Cutaneous Manifestations of COVID-19 Include Chilblain-like, Maculopapular, Vesicular, Urticarial, and Other Lesions and Nondescript Rashes
    2. Cutaneous Lesions are Most Commonly Seen on the Toes, Soles, Fingers, Extremities, and/or Heels (“COVID Toes”)

  11. Chemosensory Dysfunction
    1. Chemosensory Dysfunction, including Anosmia and/or Ageusia, is Strongly Associated with COVID‐19 and May Be Associated with Mild Disease
  12. OB/GYN Considerations
    1. General
    2. Pregnant Women Appear to Have More Severe Illness Requiring Intensive Care and Mechanical Ventilation and Higher Case Fatality Rates; Risk Factors Include Hypertension, Asthma, Preexisting Diabetes, and High BMI
    3. Maternal SARS-CoV-2 Infection in Pregnancy is Not Associated with Adverse Pregnancy Outcomes; Neonatal Infection Occur in 3% of Infants
    4. Maternal IgG Antibodies Are in Most Cases Transferred Across the Placenta After Asymptomatic and Symptomatic Infection During Pregnancy and May Induce Natural Passive Immunity
    5. Separation of Affected Mothers and Newborns Is Not Warranted, and Direct Breastfeeding Appears to Be Safe

  13. Multisystem Inflammatory Syndrome in Adults (MIS-A)
    1. Adults of All Ages with Current or Previous SARS-CoV-2 Infection Can Develop a Hyperinflammatory Syndrome Resembling MIS-C
    2. For information on Multisystem Inflammatory Syndrome in Children (MIS-C), see Pediatrics

  14. Other
    1. Use of NSAIDs in Patients with COVID-19 is Safe and Does Not Lead to More Severe Disease
    2. Trained Immunity: A Tool for Reducing Susceptibility to and the Severity of SARS-CoV-2 Infection
    3. Critically Ill COVID-19 Patients with Blood Group A or AB Appear to Be at Increased Risk for Mechanical Ventilation and More Severe Disease than Patients with Blood Group O or B; Further Research Is Needed to Determine if Anti-A Antibody Inhibits the Interaction between SARS-CoV-2 and the ACE2 Receptor
    4. Additional Extrapulmonary Manifestations
    5. Risk of Concurrent Nosocomial Bacterial and Fungal Superinfections
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