Jessica G Shantha1, Sara C Auld2,3, Casey Anthony1, Laura Ward4, Max W Adelman4, Cheryl L Maier5, Kenneth W Price1, Jesse T Jacob3,4, Tolulope Fashina1, Casey Randleman1, Lucy T Xu1, Joshua Barnett1, Ofer Sadan6, Prem A Kandiah6, Jay B Varkey4, Colleen S Kraft4,5, Nadine Rouphael4, Susanne Linderman7, Rafi Ahmed7, Carolyn Drews-Botsch8, Jesse J Waggoner4, Max Weinmann2, David J Murphy2, Steven Yeh1,9. 1. Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA. 2. Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA. 3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 4. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA. 5. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA. 6. Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA, USA. 7. Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA. 8. Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA. 9. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA.
Abstract
PURPOSE: To assess the prevalence of retinopathy and its association with systemic morbidity and laboratory indices of coagulation and inflammatory dysfunction in severe COVID-19. DESIGN: Retrospective, observational cohort study. METHODS: Adult patients hospitalized with severe COVID-19 who underwent ophthalmic examination from April to July 2020 were reviewed. Retinopathy was defined as one of the following: 1) Retinal hemorrhage; 2) Cotton wool spots; 3) Retinal vascular occlusion. We analyzed medical comorbidities, sequential organ failure assessment (SOFA) scores, clinical outcomes, and laboratory values for their association with retinopathy. RESULTS: Thirty-seven patients with severe COVID-19 were reviewed, the majority of whom were female (n = 23, 62%), Black (n = 26, 69%), and admitted to the intensive care unit (n = 35, 95%). Fourteen patients had retinopathy (38%) with retinal hemorrhage in 7 (19%), cotton wool spots in 8 (22%), and a branch retinal artery occlusion in 1 (3%) patient. Patients with retinopathy had higher SOFA scores than those without retinopathy (8.0 vs. 5.3, p = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors (p < .01). Peak D-dimer levels were 28,971 ng/mL in patients with retinopathy compared to 12,575 ng/mL in those without retinopathy (p = .03). Peak CRP was higher in patients with cotton wool spots versus those without cotton wool spots (354 mg/dL vs. 268 mg/dL, p = .03). Multivariate logistic regression modeling showed an increased risk of retinopathy with higher peak D-dimers (aOR 1.32, 95% CI 1.01-1.73, p = .04) and male sex (aOR 9.6, 95% CI 1.2-75.5, p = .04). CONCLUSION: Retinopathy in severe COVID-19 was associated with greater systemic disease morbidity involving multiple organs. Given its association with coagulopathy and inflammation, retinopathy may offer insight into disease pathogenesis in patients with severe COVID-19.
PURPOSE: To assess the prevalence of retinopathy and its association with systemic morbidity and laboratory indices of coagulation and inflammatory dysfunction in severe COVID-19. DESIGN: Retrospective, observational cohort study. METHODS: Adult patients hospitalized with severe COVID-19 who underwent ophthalmic examination from April to July 2020 were reviewed. Retinopathy was defined as one of the following: 1) Retinal hemorrhage; 2) Cotton wool spots; 3) Retinal vascular occlusion. We analyzed medical comorbidities, sequential organ failure assessment (SOFA) scores, clinical outcomes, and laboratory values for their association with retinopathy. RESULTS: Thirty-seven patients with severe COVID-19 were reviewed, the majority of whom were female (n = 23, 62%), Black (n = 26, 69%), and admitted to the intensive care unit (n = 35, 95%). Fourteen patients had retinopathy (38%) with retinal hemorrhage in 7 (19%), cotton wool spots in 8 (22%), and a branch retinal artery occlusion in 1 (3%) patient. Patients with retinopathy had higher SOFA scores than those without retinopathy (8.0 vs. 5.3, p = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors (p < .01). Peak D-dimer levels were 28,971 ng/mL in patients with retinopathy compared to 12,575 ng/mL in those without retinopathy (p = .03). Peak CRP was higher in patients with cotton wool spots versus those without cotton wool spots (354 mg/dL vs. 268 mg/dL, p = .03). Multivariate logistic regression modeling showed an increased risk of retinopathy with higher peak D-dimers (aOR 1.32, 95% CI 1.01-1.73, p = .04) and male sex (aOR 9.6, 95% CI 1.2-75.5, p = .04). CONCLUSION: Retinopathy in severe COVID-19 was associated with greater systemic disease morbidity involving multiple organs. Given its association with coagulopathy and inflammation, retinopathy may offer insight into disease pathogenesis in patients with severe COVID-19.
Authors: Maximilian Ackermann; Stijn E Verleden; Mark Kuehnel; Axel Haverich; Tobias Welte; Florian Laenger; Arno Vanstapel; Christopher Werlein; Helge Stark; Alexandar Tzankov; William W Li; Vincent W Li; Steven J Mentzer; Danny Jonigk Journal: N Engl J Med Date: 2020-05-21 Impact factor: 91.245
Authors: Alessandro Invernizzi; Alessandro Torre; Salvatore Parrulli; Federico Zicarelli; Marco Schiuma; Valeria Colombo; Andrea Giacomelli; Mario Cigada; Laura Milazzo; Annalisa Ridolfo; Ivano Faggion; Laura Cordier; Marta Oldani; Sara Marini; Paolo Villa; Giuliano Rizzardini; Massimo Galli; Spinello Antinori; Giovanni Staurenghi; Luca Meroni Journal: EClinicalMedicine Date: 2020-09-20
Authors: Paula M Marinho; Allexya A A Marcos; André C Romano; Heloisa Nascimento; Rubens Belfort Journal: Lancet Date: 2020-05-12 Impact factor: 79.321
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