Review Article

A comprehensive review on COVID-19 infection and comorbidities of various organs

COVID-19 and comorbidities

Abstract

Background: In COVID-19 pandemic, underlying diseases such as cardiovascular disease, respiratory illness, liver and kidney disease or malignancies, have a critical prognostic role for these patients. 

Aim: Due to the increased risk of mortality in patients with established or new-onset comorbidities, we decided to conduct a study to further investigate the possible comorbidities and treatment recommendations of COVID-19.

Method: All articles published by March 25, 2020 on the new coronavirus infection were reviewed and for cutaneous manifestation as a new emerging concern, by April 25, 2020. ScienceDirect, Google scholar, Scopus, PubMed databases were searched and keywords such as "COVID-19", "2019-nCoV", "Coronavirus2019", "SARS-CoV-2”, and "comorbidity" have been used.

Results: the most important comorbidity in elderly patients with confirmed covid-19 was cardiovascular disease, followed by diabetes and chronic respiratory disease, respectively, and on the other hand, covid-19 itself could cause acute heart, lung, liver, kidney and skin disease. Also the prevalence of underlying diseases in died patients or patients with severe COVID-19 are higher than the others. Considering treatment; Drug interactions and careful drug adjustment based on hepatic and renal metabolism are essential.

Conclusion: The results of this study showed that the mortality rate and ICU admission in people with underlying disease is higher than other people. Also we must pay attention to the possible multi-organ damages and comorbidities, for protection and successful treatment of COVID-19. There are some comorbidities like primary cutaneous manifestations that may have diagnostic or prognostic values in COVID-19 course.  

1. Richman DD, Whitley RJ, Hayden FG. Clinical virology: John Wiley & Sons; 2016.
2. Organization WH. Coronavirus disease 2019 (COVID-19) Situation Report-59; 2020.
3. Ibrahim A. Two die of coronavirus in Iran, first fatalities in Middle East. 2020.
4. organization wh. Coronavirus disease (COVID-19) outbreak situation. 2020.
5. Sun P, Qie S, Liu Z, Ren J, Xi JJ. Clinical characteristics of 50466 patients with 2019-nCoV infection. medRxiv. 2020.
6. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506.
7. Novel CPERE. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi. 2020;41(2):145.
8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507-13.
9. Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. The Lancet. 2020.
10. Silva AAMd. On the possibility of interrupting the coronavirus (COVID-19) epidemic based on the best available scientific evidence. SciELO Public Health; 2020.
11. Wu F, Zhao S, Yu B, Chen Y-M, Wang W, Song Z-G, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-9.
12. Niforatos JD, Melnick ER, Faust JS. Covid-19 fatality is likely overestimated. Bmj. 2020;368.
13. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020.
14. Libert C, Dejager L, Pinheiro I. The X chromosome in immune functions: when a chromosome makes the difference. Nature Reviews Immunology. 2010;10(8):594-604.
15. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh C-L, Abiona O, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367(6483):1260-3.
16. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin. BioRxiv. 2020.
17. Pan X-w, Da Xu HZ, Zhou W, Wang L-h, Cui X-g. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Medicine. 2020:1.
18. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine. 2020:1-8.
19. Turner AJ, Hiscox JA, Hooper NM. ACE2: from vasopeptidase to SARS virus receptor. Trends in pharmacological sciences. 2004;25(6):291-4.
20. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
21. Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426(6965):450-4.
22. Luo W, Yu H, Gou J, Li X, Sun Y, Li J, et al. Pathology & Pathobiology. 2020;2020020407.
23. Heymann DL, Shindo N. COVID-19: what is next for public health? The Lancet. 2020;395(10224):542-5.
24. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early clinical and CT manifestations of coronavirus disease 2019 (COVID-19) pneumonia. American Journal of Roentgenology. 2020:1-6.
25. Lai C-C, Shih T-P, Ko W-C, Tang H-J, Hsueh P-R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges. International journal of antimicrobial agents. 2020:105924.
26. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020.
27. Zhu B, Wang Y, Ming J, Chen W, Zhang L. Disease burden of COPD in China: a systematic review. International journal of chronic obstructive pulmonary disease. 2018;13:1353.
28. Zhang J-j, Dong X, Cao Y-y, Yuan Y-d, Yang Y-b, Yan Y-q, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020.
29. Ding Y, He L, Zhang Q, Huang Z, Che X, Hou J, et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS‐CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland. 2004;203(2):622-30.
30. Ding Y, Wang H, Shen H, Li Z, Geng J, Han H, et al. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland. 2003;200(3):282-9.
31. Nicholls JM, Poon LL, Lee KC, Ng WF, Lai ST, Leung CY, et al. Lung pathology of fatal severe acute respiratory syndrome. The Lancet. 2003;361(9371):1773-8.
32. Luo W, Yu H, Gou J, Li X, Sun Y, Li J, et al. Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19). Pathology & Pathobiology. 2020;2020020407.
33. Gautret P, Lagier J-C, Parola P, Meddeb L, Mailhe M, Doudier B, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents. 2020:105949.
34. organization wh. Landscape analysis of therapeutics as 21st March 2020. 2020.
35. Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Bioscience trends. 2020;14(1):69-71.
36. Agostini ML, Andres EL, Sims AC, Graham RL, Sheahan TP, Lu X, et al. Coronavirus susceptibility to the antiviral remdesivir (GS-5734) is mediated by the viral polymerase and the proofreading exoribonuclease. MBio. 2018;9(2):e00221-18.
37. Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020:1-2.
38. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care medicine. 2020:1-3.
39. Chen C, Yan J, Zhou N, Zhao J, Wang D. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua xin xue guan bing za zhi. 2020;48:E008-E.
40. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology. 2020:1-8.
41. Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis—diagnosis, treatment options, and current controversies. Nature Reviews Cardiology. 2015;12(11):670.
42. Riski H, Hovi T, Frick M. Carditis associated with coronavirus infection. Carditis associated with coronavirus infection. 1980;2:100-1.
43. Alhogbani T. Acute myocarditis associated with novel Middle East respiratory syndrome coronavirus. Annals of Saudi medicine. 2016;36(1):78-80.
44. Zhang T, Zhang Y, Cui M, Jin L, Wang Y, Lv F, et al. CaMKII is a RIP3 substrate mediating ischemia-and oxidative stress–induced myocardial necroptosis. Nature medicine. 2016;22(2):175.
45. Wu C, Hu X, Song J, Du C, Xu J, Yang D, et al. Heart injury signs are associated with higher and earlier mortality in coronavirus disease 2019 (COVID-19). medRxiv. 2020.
46. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420-2.
47. NephJC. ACE2 and HYPERTENSION. 2020.
48. Elkind MS, Harrington RA, Benjamin IJ. Role of the American Heart Association in the global COVID-19 pandemic. Am Heart Assoc; 2020.
49. DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. New England Journal of Medicine. 2014;371(7):635-45.
50. Kobayashi M, Bennett NM, Gierke R, Almendares O, Moore MR, Whitney CG, et al. Intervals between PCV13 and PPSV23 vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. 2015;64(34):944-7.
51. Yang J, Feng Y, Yuan M, Yuan S, Fu H, Wu B, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabetic medicine. 2006;23(6):623-8.
52. Schoen K, Horvat N, Guerreiro NF, de Castro I, de Giassi KS. Spectrum of clinical and radiographic findings in patients with diagnosis of H1N1 and correlation with clinical severity. BMC infectious diseases. 2019;19(1):1-8.
53. Song Z, Xu Y, Bao L, Zhang L, Yu P, Qu Y, et al. From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses. 2019;11(1):59.
54. Wang A, Zhao W, Xu Z, Gu J. Timely blood glucose management for the outbreak of 2019 novel coronavirus disease (COVID-19) is urgently needed. Diabetes Research and Clinical Practice. 2020.
55. Deng S-Q, Peng H-J. Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China. Journal of clinical medicine. 2020;9(2):575.
56. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;1(ahead-of-print).
57. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020.
58. on COVID NC. Daily Situation Report on Coronavirus disease (COVID-19) in Iran; March 14, 2020. Archives of Academic Emergency Medicine. 2020;8(1).
59. Kulcsar KA, Coleman CM, Beck SE, Frieman MB. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI insight. 2019;4(20).
60. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. Journal of virology. 2020;94(7).
61. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet Respiratory Medicine. 2020.
62. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. The Lancet Gastroenterology & Hepatology. 2020.
63. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of 2019 novel coronavirus infection in China. MedRxiv. 2020.
64. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet Infectious Diseases. 2020.
65. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal–oral transmission of SARS-CoV-2 possible? The Lancet Gastroenterology & Hepatology. 2020;5(4):335-7.
66. Chau TN, Lee KC, Yao H, Tsang TY, Chow TC, Yeung YC, et al. SARS‐associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology. 2004;39(2):302-10.
67. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020.
68. Fan Z, Chen L, Li J, Tian C, Zhang Y, Huang S, et al. Clinical Features of COVID-19-Related Liver Damage. Available at SSRN 3546077. 2020.
69. Chen J, Ling Y, Xi X, Liu P, Li F, Li T, et al. Efficacies of lopinavir/ritonavir and abidol in the treatment of novel coronavirus pneumonia. Chin J Infect Dis. 2020;38(00).
70. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney impairment is associated with in-hospital death of COVID-19 patients. medRxiv. 2020.
71. Luderer JR, Patel IH, Durkin J, Schneck DW. Age and ceftriaxone kinetics. Clinical Pharmacology & Therapeutics. 1984;35(1):19-25.
72. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020 Mar 26.
73. Zheng, Y. and W. Lai, Dermatology staff participate in fight against Covid-19 in China. Journal of the European Academy of Dermatology and Venereology. n/a(n/a).
74. Arora G, Kassir M, Jafferany M, Galadari H, Lotti T, Satolli F, Sadoughifar R, Sitkowska Z, Goldust M. The COVID-19 outbreak and rheumatologic skin diseases. Dermatol Ther. 2020 Mar 31:e13357.
75. Darlenski R, sankov N.Covid-19 pandemic and the skin - What should dermatologists know? Clin Dermatol. 2020 Mar 24.
76. Emadi S-N, Abtahi-Naeini B. Coronavirus Disease 2019 (COVID-19) and dermatologists: Potential biological hazards of laser surgery in epidemic area. Ecotoxicol Environ Saf. 2020 Apr 6: 110598.
77. Wang C, Rademaker M, Baker C, Foley P. COVID-19 and the use of immunomodulatory and biologic agents for severe cutaneous disease: An Australia/New Zealand consensus statement. Australas J Dermatol. 2020 Apr 7.
78. Shakshouk H, Daneshpazhooh M, Murrell DF, Lehman JS, Treatment considerations for patients with pemphigus during the COVID-19 pandemic, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/j.jaad.2020.04.005.
79.Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, Moreno-Arrones OM, Saceda-Corralo D, Arana-Raja A, Ortega-Quijano D. Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak. J Am Acad Dermatol. 2020 Apr 24. pii: S0190-9622(20)30709-X.
80.Bouaziz JD, Duong T, Jachiet M, Velter C, Lestang P, Cassius C, Arsouze A, Domergue Than Trong E, Bagot M, Begon E, Sulimovic L, Rybojad M. Vascular skin symptoms in COVID-19: a french observational study.J Eur Acad Dermatol Venereol. 2020 Apr 27.
81.Tammaro A, Adebanjo GAR, Parisella FR, Pezzuto A, Rello J. Cutaneous manifestations in COVID-19: the experiences of Barcelona and Rome. J Eur Acad Dermatol Venereol. 2020 Apr 24.

82.Van Damme C, Berlingin E, Saussez S, Accaputo O. Acute urticaria with pyrexia as the first manifestations of a COVID-19 infection. J Eur Acad Dermatol Venereol. 2020 Apr 24.
83.Suchonwanit P, Leerunyakul K, Kositkuljorn C. Cutaneous manifestations in COVID-19: Lessons learned from current evidence. J Am Acad Dermatol. 2020 Apr 24. pii: S0190-9622(20)30710-6.
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IssueVol 59, No 1 (2021) QRcode
SectionReview Article(s)
Published2021-02-14
DOI https://doi.org/10.18502/acta.v59i1.5396
Keywords
COVID-19 2019-nCoV Coronavirus 2019 comorbidity pulmonary cardiac diabetes liver renal cutaneous

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1.
Goodarzi A. A comprehensive review on COVID-19 infection and comorbidities of various organs. Acta Med Iran. 59(1):4-14.