Abstract
Microbial translocation (MT) and intestinal damage (ID) are poorly explored in COVID-19. Aims were to assess whether alteration of gut permeability and cell integrity characterize COVID-19 patients, whether it is more pronounced in severe infections and whether it influences the development of subsequent bloodstream infection (BSI). Furthermore, we looked at the potential predictive role of TM and ID markers on Intensive Care Unit (ICU) admission and in-hospital mortality. Over March–July 2020, 45 COVID-19 patients were enrolled. Markers of MT [LPB (Lipopolysacharide Binding Protein) and EndoCab IgM] and ID [I-FABP (Intestinal Fatty Acid Binding Protein)] were evaluated at COVID-19 diagnosis and after 7 days. As a control group, age- and gender-matched healthy donors (HDs) enrolled during the same study period were included. Median age was 66 (56-71) years. Twenty-one (46.6%) were admitted to ICU and mortality was 22% (10/45). Compared to HD, a high degree of MT and ID was observed. ICU patients had higher levels of MT, but not of ID, than non-ICU ones. Likewise, patients with BSI had lower EndoCab IgM than non-BSI. Interestingly, patients with high degree of MT and low ID were likely to be admitted to ICU (AUC 0.822). Patients with COVID-19 exhibited high level of MT, especially subjects admitted to ICU. COVID-19 is associated with gut permeability.
Highlights
To date, the novel b-coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing the ongoing pandemic has infected over 132 million people and resulted in more than 2.8 million deaths worldwide [1, 2]
We demonstrated that i) patients with COVID-19 exhibited higher levels of gut leakage and intestinal injury than healthy controls, which were maintained over the course of disease; ii) patients with severe form of COVID-19 had higher values of Microbial translocation (MT), but not of intestinal damage (ID), than subjects without severe disease, which was, again, maintained over time; iii) patients who developed n-bloodstream infection (BSI) had a high degree of consumption of neutralizing antibodies against
We showed that the extent of intestinal damage is high in patients with COVID-19 and this represents an additional novelty of the present study, since it is described for the first time
Summary
The novel b-coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing the ongoing pandemic has infected over 132 million people and resulted in more than 2.8 million deaths worldwide [1, 2]. Coronavirus Disease-19 (COVID-19) is characterized by different clinical features, ranging from asymptomatic to severe forms, which involve multiple organs including, amongst others, gut [3]. To this extent, Angiotensin-converting enzyme-2 (ACE-2), the main virus receptors, are expressed on the upper and lower respiratory tract, and on endothelial, intestinal and thyroid cells, contributing to explain the systemic nature of the disease [4, 5]. Recent studies have shown that up to one-third of COVID-19 patients experience gastrointestinal symptoms such as diarrhea and vomiting along with the most common respiratory symptoms, suggesting a gut involvement during the course of infection [6,7,8] Following the virus-receptor binding and its internalization, an especially strong inflammatory response that goes beyond what is required to kill the virus, is mounted, resulting in a high release of cytokines, (the so-called cytokine storm), which is responsible for the widespread inflammation and tissue damage in patients with severe COVID-19 [5].
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