COVID-19 and Long-Term Outcomes: Lessons from Other Critical Care Illnesses and Potential Mechanisms.

Academic Article

Abstract

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that is currently causing a pandemic and has been termed Coronavirus disease 2019 (COVID-19). The elderly or those with preexisting conditions like diabetes, hypertension, coronary heart disease, chronic obstructive pulmonary disease, cerebrovascular disease, or kidney dysfunction are more likely to develop severe cases when infected. COVID-19 patients admitted to the intensive care unit (ICU) have higher mortality than non-ICU patients. Critical illness has consistently posed a challenge not only in terms of mortality, but also in regard to long-term outcomes of survivors. Patients who survive acute critical illness including, but not limited to, pulmonary and systemic insults associated with ARDS, pneumonia, systemic inflammation, and mechanical ventilation, will likely suffer from Post-ICU Syndrome (PICS), a phenomenon of cognitive, psychiatric, and/or physical disability following treatment in the ICU. Post-ICU morbidity and mortality continues to be a cause for concern when considering large-scale studies showing 12-month mortality risks of 11.8% to 21%. Previous studies have demonstrated that multiple mechanisms, including cytokine release, mitochondrial dysfunction and even amyloids may lead to end-organ dysfunction in patients. We hypothesize that COVID-19 infection will lead to PICS via potentially similar mechanisms as other chronic critical illness and cause long-term morbidity and mortality in patients. We consider a variety of mechanisms and questions that not only consider the short-term impact of the COVID-19 pandemic, but its long-term effects that may not yet be imagined. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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    Keywords

  • SARS-CoV-2, amyloid, chronic critical illness, cytokine storm, mitochondrial dysfunction
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    Author List

  • Arbov E; Tayara A; Wu S; Rich TC; Wagener BM