Abstract
Background . Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is the etiological agent of the coronavirus disease 2019 (COVID-19) pandemic. Among the risk factors associated with the severity of this disease is the presence of several metabolic disorders. For this reason, the aim of this research was to identify the comorbidities and laboratory parameters among COVID-19 patients admitted to the intensive care unit (ICU), comparing the patients who required invasive mechanical ventilation (IMV) with those who did not require IMV, in order to determine the clinical characteristics associated with the COVID-19 severity. Methods. We carried out a cross-sectional study among 152 patients who were admitted to the ICU from April 1 st to July 31 st, 2021, in whom the comorbidities and laboratory parameters associated with the SARS-CoV-2 infection severity were identified. The data of these patients was grouped into two main groups: "patients who required IMV" and "patients who did not require IMV". The nonparametric Mann-Whitney U test for continuous data and the χ 2 test for categorical data were used to compare the variables between both groups. Results. Of the 152 COVID-19 patients who were admitted to the ICU, 66 required IMV and 86 did not require IMV. Regarding the comorbidities found in these patients, a higher prevalence of type 2 diabetes mellitus (T2DM), hypertension and obesity was observed among patients who required IMV vs. those who did not require IMV ( p<0.05). Concerning laboratory parameters, only glucose, Interleukin 6 (IL-6), lactate dehydrogenase (LDH) and C-reactive protein (CRP) were significantly higher among patients who required IMV than in those who did not require IMV ( p<0.05). Conclusion. This study performed in a Mexican population indicates that comorbidities such as: T2DM, hypertension and obesity, as well as elevated levels of glucose, IL-6, LDH and CRP are associated with the COVID-19 severity.
Highlights
Several studies have reported that obesity is a comorbidity that increases the risk of complications in SARS-CoV-2 infection, for the following reasons: (a) it has been suggested that the angiotensin-converting enzyme 2 alanine transaminase (ALT) (ACE-2) receptor expression is higher in adipose tissue than in the lung parenchyma, which makes adipose tissue an important viral reservoir;[19,20] (b) the ReninAngiotensin-Aldosterone System (RAAS), a hormonal cascade which regulates blood pressure and is generally overactive in obese patients, has been linked to SARS-CoV-2 cellular infection as well as myocardial and lung injury;[21,22] and (c) it is well known that obesity is related to an increase in circulating levels of many adipokines and pro-inflammatory mediators released by adipocytes.[10]
For example: (a) it has reported that the endothelial dysfunction in obese patients with hypertension promotes the development of a hypercoagulable pro-thrombotic state, which contributes markedly to life-threatening complications of COVID-19, such as venous thromboembolic disease, systemic vasculitis, endothelial cell apoptosis and multiple organ involvement;[27,28] and (b) it is clear that insulin resistance contributes substantially to the more severe phenotype associated with obesity and type 2 diabetes mellitus (T2DM) in coronavirus disease 2019 (COVID19).29,30 it has been suggested that the SARS-CoV-2 infection could cause disturbances in glucose metabolism, the acute hyperinflammatory state itself could worsen insulin resistance in these patients.[10,30]
The present study aimed to identify the comorbidities and laboratory parameters among COVID-19 patients admitted to the intensive care unit (ICU), comparing those patients who required invasive mechanical ventilation (IMV) to those who did not require IMV, in order to determine the clinical characteristics associated with the COVID-19 severity
Summary
The current pandemic caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) represents one of the greatest public health challenges, which has led to extensive worldwide research efforts to identify individuals at greatest risk of developing critical illness.[1,2,3] The clinical manifestations of the disease caused by SARSCoV-2, known as coronavirus disease 2019 (COVID-19), are highly variable and range from asymptomatic forms, moderate manifestations and even severe complications, such as: pneumonia, respiratory failure, septic shock, multiple organ dysfunction and death.[4,5] the molecular mechanisms involved with COVID-19 severity seem to be complex, due to important immunopathological changes induced by SARS-CoV-2;6–9 as well as metabolic conditions (e.g. obesity, diabetes, hypertension, heart diseases, among others) that underlie the clinical presentation in these patients.[10,11,12,13,14] Regarding latter, a growing body of evidence has suggested that these comorbidities contribute significantly to increased COVID-19 severity and fatal outcomes.[13,15,16,17,18] For instance, several studies have reported that obesity is a comorbidity that increases the risk of complications in SARS-CoV-2 infection, for the following reasons: (a) it has been suggested that the ACE-2 receptor expression (target of SARS-CoV-2) is higher in adipose tissue than in the lung parenchyma, which makes adipose tissue an important viral reservoir (see Figure 1);[19,20] (b) the ReninAngiotensin-Aldosterone System (RAAS), a hormonal cascade which regulates blood pressure and is generally overactive in obese patients, has been linked to SARS-CoV-2 cellular infection as well as myocardial and lung injury;[21,22] and (c) it is well known that obesity is related to an increase in circulating levels of many adipokines and pro-inflammatory mediators released by adipocytes.[10]. The nonparametric Mann–Whitney U test for continuous data and the χ2 test for article can be found at the end of the article
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