Relação entre a sintomatologia da Covid-19 e a inflamação vascular / Relationship between the symptoms of Covid-19 and vascular inflammation

Michelle Kílvia Bezerra Alves, Renan Brito Gadelha, Cláudia Roberta de Andrade

Abstract


A pandemia causada pelo coronavírus (SARS-CoV-2) causou aproximadamente 3 milhões de óbitos em todo o mundo, se tornando o maior desafio médico das ultimas décadas. Embora  a COVID-19 afete principalmente os pulmões, causando pneumonite intersticial e síndrome do desconforto respiratório agudo, também afeta vários órgãos, principalmente o sistema cardiovascular. Devido ao crescente número dos casos de COVID-19, muitos sintomas têm surgido e, a maioria deles tem sido relacionados às variações genéticas dos indivíduos. Assim, é importante o conhecimento dos diferentes sintomas desencadeados na infecção pelo SARS-CoV-2, principalmente com foco na inflamação vascular, estabelecendo uma relação entre a doença e a inflamação vascular e descrevendo os mecanismos e as principais citocinas envolvidas. Assim, o objetivo da presente revisão é descrever os principais sintomas vasculares associados a COVID-19. Os resultados revelaram que os níveis de marcadores inflamatórios, como contagem de leucócitos, proteína C reativa, procalcitonina, dímero D, interleucinas 6 e 10, em pacientes com COVID-19, foram significativamente maiores, podendo ser relacionados à gravidade da doença. A síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) leva à disfunção multissistêmica com evidências emergentes sugerindo que a inflamação vascular é um importante efetor do vírus. As terapias potenciais que tratam da disfunção do sistema vascular e suas consequencias podem ter um papel importante no tratamento da COVID-19 e seus efeitos a longo prazo.


Keywords


Coronavírus, COVID-19, Sintomas, Inflamação Vascular, Citocinas.

References


AL-SAMKARI, Hanny et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of sars-cov-2 infection. Blood, v. 136, n. 4, p. 489-500, 23 jul. 2020. American Society of Hematology. http://dx.doi.org/10.1182/blood.2020006520.

ASKIN, Lutfu; TANR?VERDI, Okan; ASKIN, Husna Sengul. O Efeito da Doença de Coronavírus 2019 nas Doenças Cardiovasculares. Arquivos Brasileiros de Cardiologia, [S.L.], v. 114, n. 5, p. 817-822, maio 2020. Sociedade Brasileira de Cardiologia. http://dx.doi.org/10.36660/abc.20200273.

BRASIL. Coronavírus, 2020. Sobre a doença. Disponível em: https://coronavirus.saude.gov.br/sobre-a-doenca. Acesso em: 23 set. 2020.

CAÑAS, E Gonzalez et al. Acute peripheral arterial thrombosis in COVID-19. Role of endothelial inflammation. British Journal Of Surgery, [S.L.], v. 107, n. 10, p. 444-445, 5 ago. 2020. Oxford University Press (OUP). http://dx.doi.org/10.1002/bjs.11904.

CARUANA, G. et al. Diagnostic strategies for SARS-CoV-2 infection and interpretation of microbiological results. Clinical Microbiology And Infection, [S.L.], v. 26, n. 9, p. 1178-1182, set. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.cmi.2020.06.019.

CHAN, Chieh-Kai et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risks of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Hypertension, [S.L.], v. 76, n. 5, p. 1563-1571, nov. 2020. Ovid Technologies (Wolters Kluwer Health). http://dx.doi.org/10.1161/hypertensionaha.120.15989.

CHEN, Nanshan et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, [S.L.], v. 395, n. 10223, p. 507-513, fev. 2020. Elsevier BV. http://dx.doi.org/10.1016/s0140-6736(20)30211-7.

CONTI, Pio et al. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by COVID-19: anti-inflammatory strategies. Journal Of Biological Regulators And Homeostatic Agents, [S.L.], v. 34, n. 2, p. 1, mar. 2020. Biolife Sas. http://dx.doi.org/10.23812/CONTI-E.

COPPO, Anna et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. The Lancet Respiratory Medicine, [S.L.], v. 8, n. 8, p. 765-774, ago. 2020. Elsevier BV. http://dx.doi.org/10.1016/s2213-2600(20)30268-x.

COSTA, Isabela Bispo Santos da Silva et al. Imagem Cardiovascular e Procedimentos Intervencionistas em Pacientes com Infecção pelo Novo Coronavírus. Arquivos Brasileiros de Cardiologia, [S.L.], v. 115, n. 1, p. 111-126, jul. 2020. Sociedade Brasileira de Cardiologia. http://dx.doi.org/10.36660/abc.20200370.

COSTELA-RUIZ, Víctor J. et al. SARS-CoV-2 infection: the role of cytokines in covid-19 disease. Cytokine & Growth Factor Reviews, [S.L.], v. 54, p. 62-75, ago. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.cytogfr.2020.06.001.

DEFTEREOS, Spyridon G. et al. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019. Jama Network Open, [S.L.], v. 3, n. 6, p. 2013136, 24 jun. 2020. American Medical Association (AMA). http://dx.doi.org/10.1001/jamanetworkopen.2020.13136.

DENG, Qing et al. Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in wuhan, china. International Journal Of Cardiology, [S.L.], v. 311, p. 116-121, jul. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.ijcard.2020.03.087.

DIETZ, Matthieu et al. COVID-19 pneumonia: relationship between inflammation assessed by whole-body fdg pet/ct and short-term clinical outcome. European Journal Of Nuclear Medicine And Molecular Imaging, [S.L.], v. 48, n. 1, p. 260-268, 25 jul. 2020. Springer Science and Business Media LLC. http://dx.doi.org/10.1007/s00259-020-04968-8.

DIORIO, Caroline et al. Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS–CoV-2. Journal Of Clinical Investigation, [S.L.], v. 130, n. 11, p. 5967-5975, 5 out. 2020. American Society for Clinical Investigation. http://dx.doi.org/10.1172/jci140970.

FELSENSTEIN, Susanna et al. COVID-19: immunology and treatment options. Clinical Immunology, [S.L.], v. 215, p. 108448, jun. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.clim.2020.108448.

GOYAL, Parag et al. Clinical Characteristics of Covid-19 in New York City. New England Journal Of Medicine, [S.L.], v. 382, n. 24, p. 2372-2374, 11 jun. 2020. Massachusetts Medical Society. http://dx.doi.org/10.1056/nejmc2010419.

GUO, Tao et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). Jama Cardiology, [S.L.], v. 5, n. 7, p. 811, 1 jul. 2020. American Medical Association (AMA). http://dx.doi.org/10.1001/jamacardio.2020.1017.

GUO, Yan-Rong et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Military Medical Research, Guangdong, v. 7, n. 1, p. 1-10, 13 mar. 2020. Springer Science and Business Media LLC. http://dx.doi.org/10.1186/s40779-020-00240-0.

GUZIK, Tomasz J et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovascular Research, [S.L.], v. 116, n. 10, p. 1666-1687, 30 abr. 2020. Oxford University Press (OUP). http://dx.doi.org/10.1093/cvr/cvaa106.

HABAS, Khaled et al. Resolution of coronavirus disease 2019 (COVID-19). Expert Review Of Anti-Infective Therapy, [S.L.], v. 18, n. 12, p. 1201-1211, 4 ago. 2020. Informa UK Limited. http://dx.doi.org/10.1080/14787210.2020.1797487.

HAMMING, I et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The Journal Of Pathology, [S.L.], v. 203, n. 2, p. 631-637, 7 maio 2004. Wiley. http://dx.doi.org/10.1002/path.1570.

HUANG, Chaolin et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, [S.L.], v. 395, n. 10223, p. 497-506, fev. 2020. Elsevier BV. http://dx.doi.org/10.1016/s0140-6736(20)30183-5.

IJAZ, Talha et al. Deletion of NF-?B/RelA in Angiotensin II-Sensitive Mesenchymal Cells Blocks Aortic Vascular Inflammation and Abdominal Aortic Aneurysm Formation. Arteriosclerosis, Thrombosis, And Vascular Biology, [S.L.], v. 37, n. 10, p. 1881-1890, out. 2017. Ovid Technologies (Wolters Kluwer Health). http://dx.doi.org/10.1161/atvbaha.117.309863.

JI, Pan et al. Association of elevated inflammatory markers and severe COVID-19. Medicine, [S.L.], v. 99, n. 47, p. 23315, 20 nov. 2020. Ovid Technologies (Wolters Kluwer Health). http://dx.doi.org/10.1097/md.0000000000023315.

LI, F. Evidence for a Common Evolutionary Origin of Coronavirus Spike Protein Receptor-Binding Subunits. Journal Of Virology, [S.L.], v. 86, n. 5, p. 2856-2858, 28 dez. 2011. American Society for Microbiology. http://dx.doi.org/10.1128/jvi.06882-11.

LIANG, Chendi et al. Coronary heart disease and COVID-19: a meta-analysis. Medicina Clínica (English Edition), [S.L.], v. 156, n. 11, p. 547-554, jun. 2021. Elsevier BV. http://dx.doi.org/10.1016/j.medcle.2020.12.021.

LIPPI, Giuseppe; LAVIE, Carl J.; SANCHIS-GOMAR, Fabian. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): evidence from a meta-analysis. Progress In Cardiovascular Diseases, [S.L.], v. 63, n. 3, p. 390-391, maio 2020. Elsevier BV. http://dx.doi.org/10.1016/j.pcad.2020.03.001.

LIPPI, Giuseppe; PLEBANI, Mario. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clinica Chimica Acta, [S.L.], v. 505, p. 190-191, jun. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.cca.2020.03.004.

LIU, Fang et al. Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial. Bmj Open, [S.L.], v. 10, n. 7, p. 039519, jul. 2020. BMJ. http://dx.doi.org/10.1136/bmjopen-2020-039519.

LODIGIANI, Corrado et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research, [S.L.], v. 191, p. 9-14, jul. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.thromres.2020.04.024.

LU, Roujian et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet, [S.L.], v. 395, n. 10224, p. 565-574, fev. 2020. Elsevier BV. http://dx.doi.org/10.1016/s0140-6736(20)30251-8.

MATSUSHITA, Kunihiro et al. The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: a systematic review and meta-analysis. Global Heart, [S.L.], v. 15, n. 1, p. 64, 22 set. 2020. Ubiquity Press, Ltd.. http://dx.doi.org/10.5334/gh.814.

MCNICHOLL, Janet et al. Host Genes and HIV: the role of the chemokine receptor gene ccr5 and its allele (32 ccr5). Emerging Infectious Diseases, [S.L.], v. 3, n. 3, p. 261-271, set. 1997. Centers for Disease Control and Prevention (CDC). http://dx.doi.org/10.3201/eid0303.970302.

NGUYEN, Jennifer L. et al. Seasonal Influenza Infections and Cardiovascular Disease Mortality. Jama Cardiology, [S.L.], v. 1, n. 3, p. 274, 1 jun. 2016. American Medical Association (AMA). http://dx.doi.org/10.1001/jamacardio.2016.0433.

PENG, Yudong et al. Clinical Characteristics and Prognosis of 244 Cardiovascular Patients Suffering From Coronavirus Disease in Wuhan, China. Journal Of The American Heart Association, [S.L.], v. 9, n. 19, p. 1-9, 6 out. 2020. Ovid Technologies (Wolters Kluwer Health). http://dx.doi.org/10.1161/jaha.120.016796.

PETREY, Aaron C. et al. Cytokine release syndrome in COVID?19: innate immune, vascular, and platelet pathogenic factors differ in severity of disease and sex. Journal Of Leukocyte Biology, [S.L.], v. 109, n. 1, p. 55-66, 15 set. 2020. Wiley. http://dx.doi.org/10.1002/jlb.3cova0820-410rrr.

QI, Furong et al. Single cell RNA sequencing of 13 human tissues identify cell types and receptors of human coronaviruses. Biochemical And Biophysical Research Communications, [S.L.], v. 526, n. 1, p. 135-140, maio 2020. Elsevier BV. http://dx.doi.org/10.1016/j.bbrc.2020.03.044.

RAOULT, Didier et al. Coronavirus infections: epidemiological, clinical and immunological features and hypotheses. Cell Stress, [S.L.], v. 4, n. 4, p. 66-75, 13 abr. 2020. Shared Science Publishers OG. http://dx.doi.org/10.15698/cst2020.04.216.

RODRIGUEZ-MORALES, Alfonso J. et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Medicine And Infectious Disease, [S.L.], v. 34, p. 101623, mar. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.tmaid.2020.101623.

RUAN, Qiurong et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine, [S.L.], v. 46, n. 5, p. 846-848, 3 mar. 2020. Springer Science and Business Media LLC. http://dx.doi.org/10.1007/s00134-020-05991-x.

SÁNCHEZ-CERRILLO, Ildefonso et al. COVID-19 severity associates with pulmonary redistribution of CD1c+ DCs and inflammatory transitional and nonclassical monocytes. Journal Of Clinical Investigation, [S.L.], v. 130, n. 12, p. 6290-6300, 26 out. 2020. American Society for Clinical Investigation. http://dx.doi.org/10.1172/jci140335.

SHAW, Albert C.; GOLDSTEIN, Daniel R.; MONTGOMERY, Ruth R.. Age-dependent dysregulation of innate immunity. Nature Reviews Immunology, [S.L.], v. 13, n. 12, p. 875-887, 25 out. 2013. Springer Science and Business Media LLC. http://dx.doi.org/10.1038/nri3547.

SHEN, Minzhe et al. Recent advances and perspectives of nucleic acid detection for coronavirus. Journal Of Pharmaceutical Analysis, [S.L.], v. 10, n. 2, p. 97-101, abr. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.jpha.2020.02.010.

SIDDIQI, Hasan K.; MEHRA, Mandeep R.. COVID-19 illness in native and immunosuppressed states: a clinical?therapeutic staging proposal. The Journal Of Heart And Lung Transplantation, [S.L.], v. 39, n. 5, p. 405-407, maio 2020. Elsevier BV. http://dx.doi.org/10.1016/j.healun.2020.03.012.

SILVA, Diogo Leonardo Santos et al. Avaliação da mortalidade por COVID-19 no Brasil. Brazilian Journal of Health Review, [S.L.], v.4, n.4, p. 14756-14766. doi:10.34119/bjhrv4n4-032

SONG, Peipei et al. Cytokine storm induced by SARS-CoV-2. Clinica Chimica Acta, [S.L.], v. 509, p. 280-287, out. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.cca.2020.06.017.

SZEKELY, Yishay et al. Spectrum of Cardiac Manifestations in COVID-19. Circulation, [S.L.], v. 142, n. 4, p. 342-353, 28 jul. 2020. Ovid Technologies (Wolters Kluwer Health). http://dx.doi.org/10.1161/circulationaha.120.047971.

TANG, Ning et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal Of Thrombosis And Haemostasis, [S.L.], v. 18, n. 4, p. 844-847, abr. 2020. Wiley. http://dx.doi.org/10.1111/jth.14768.

TORAIH, Eman A. et al. Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID?19 patients: a meta?regression and decision tree analysis. Journal Of Medical Virology, [S.L.], v. 92, n. 11, p. 2473-2488, 6 jul. 2020. Wiley. http://dx.doi.org/10.1002/jmv.26166.

VARGA, Zsuzsanna et al. Endothelial cell infection and endotheliitis in COVID-19. The Lancet, [S.L.], v. 395, n. 10234, p. 1417-1418, maio 2020. Elsevier BV. http://dx.doi.org/10.1016/s0140-6736(20)30937-5.

WANG, Lin-Fa et al. Review of Bats and SARS. Emerging Infectious Diseases, [S.L.], v. 12, n. 12, p. 1834-1840, 2006. Centers for Disease Control and Prevention (CDC). http://dx.doi.org/10.3201/eid1212.060401.

WIERSINGA, W. Joost et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19). Jama, [S.L.], v. 324, n. 8, p. 782, 25 ago. 2020. American Medical Association (AMA). http://dx.doi.org/10.1001/jama.2020.12839.

WIT, Emmie de et al. SARS and MERS: recent insights into emerging coronaviruses. Nature Reviews Microbiology, [S.L.], v. 14, n. 8, p. 523-534, 27 jun. 2016. Springer Science and Business Media LLC. http://dx.doi.org/10.1038/nrmicro.2016.81.

WRAPP, Daniel et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science, [S.L.], v. 367, n. 6483, p. 1260-1263, 19 fev. 2020. American Association for the Advancement of Science (AAAS). http://dx.doi.org/10.1126/science.abb2507

XIA, Wei et al. Clinical and CT features in pediatric patients with COVID?19 infection: different points from adults. Pediatric Pulmonology, [S.L.], v. 55, n. 5, p. 1169-1174, 5 mar. 2020. Wiley. http://dx.doi.org/10.1002/ppul.24718.

XIONG, Tian-Yuan et al. Coronaviruses and the cardiovascular system: acute and long-term implications. European Heart Journal, [S.L.], v. 41, n. 19, p. 1798-1800, 18 mar. 2020. Oxford University Press (OUP). http://dx.doi.org/10.1093/eurheartj/ehaa231.

YANCY, Clyde W.; FONAROW, Gregg C.. Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter? Jama Cardiology, [S.L.], v. 5, n. 11, p. 1216, 1 nov. 2020. American Medical Association (AMA). http://dx.doi.org/10.1001/jamacardio.2020.3575.

YANG, Xiaobo et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine, [S.L.], v. 8, n. 5, p. 475-481, maio 2020. Elsevier BV. http://dx.doi.org/10.1016/s2213-2600(20)30079-5.

ZENG, Furong et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. International Journal Of Infectious Diseases, [S.L.], v. 96, p. 467-474, jul. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.ijid.2020.05.055.

ZHANG, Chi et al. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. International Journal Of Antimicrobial Agents, [S.L.], v. 55, n. 5, p. 105954, maio 2020. Elsevier BV. http://dx.doi.org/10.1016/j.ijantimicag.2020.105954.

ZHOU, Qiong et al. Interferon-?2b Treatment for COVID-19. Frontiers In Immunology, [S.L.], v. 11, p. 1-6, 15 maio 2020. Frontiers Media SA. http://dx.doi.org/10.3389/fimmu.2020.01061.




DOI: https://doi.org/10.34119/bjhrv4n4-193

Refbacks

  • There are currently no refbacks.