COVID-19’s Collateral Damage on Internal Organs

July 13, 2020
Virus

WE all know that COVID-19’s serious effects on the lungs but a latest study showed how the coronavirus wreak havoc on organs -- kidney, heart, and brain of a patient.

Dr. Aakriti Gupta, a fellow cardiologist at the Columbia University Irving Medical Center, noticed most COVID patients suffer serious clotting and their blood sugars surged even they did not have diabetes, and many were experiencing injury to their hearts and kidneys.

In early March, there wasn't much clinical guidance on the non-respiratory effects of COVID-19, so Gupta decided to coalesce findings from studies that were just beginning to appear in the literature with what the physicians were learning from experience.

Gupta, along with senior author Dr. Donald Landry, chair of medicine at Columbia University Vagelos College of Physicians and Surgeons, organized senior co-authors, and Gupta, along with two other colleagues, Dr. Mahesh Madhavan, a cardiology fellow at CUIMC, and Dr. Kartik Sehgal, 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.

* Blood clots and immune system. Scientists think 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.

The untempered inflammation can also overstimulate the immune system, and though doctors initially shied away from using steroids to globally suppress the immune system, a recent clinical trial has found that at least one steroid, dexamethasone, reduced deaths in ventilated patients by one-third.

* Heart attacks. Clots can cause heart attacks, but the virus attacks the heart in other ways. The heart muscle may be damaged by systemic inflammation and the accompanying cytokine release, a flood of immune cells that normally clears up infected cells but can spiral out of control in severe COVID-19 cases.

"Scientists all over the world are working at an unprecedented rate towards understanding how this virus specifically hijacks the normally protective biological mechanisms. We hope that this would help in the development of more effective, precise, and safer treatments for COVID-19 in the near future," said Sehgal.

* Kidney failure. 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, but in New York City, clinicians saw renal failure in up to 50 percent of patients in the ICU.

Data regarding long-term renal damage are currently lacking, but a significant proportion of patients will likely go on to require permanent dialysis.

* Neurological (brain) Effects. 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 six percent of severe cases and delirium in eight to nine percent.

"This virus is unusual and it's hard not to take a step back and not be impressed by how many manifestations it has on the human body," said Madhavan. (Columbia University Irving Medical Center).