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      Tissue damage from neutrophil-induced oxidative stress in COVID-19

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          Abstract

          The high neutrophil to lymphocyte ratio observed in critically ill patients with COVID-19 is associated with excessive levels of reactive oxygen species (ROS), which promote a cascade of biological events that drive pathological host responses. ROS induce tissue damage, thrombosis and red blood cell dysfunction, which contribute to COVID-19 disease severity. We suggest that free radical scavengers could be beneficial for the most vulnerable patients.

          Abstract

          In this Comment article, Becker and colleagues consider how the excessive release of reactive oxygen species by neutrophils may perpetuate red blood cell dysfunction, thrombosis and tissue damage in severe cases of COVID-19.

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          Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

          F.A. Klok, Kruip MJHA, N.J.M. van der Meer … (2020)
          Introduction We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses. Methods We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first. Results We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41–57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091–0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4–12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35–1.8). Conclusion In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.
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            Targeting potential drivers of COVID-19: Neutrophil extracellular traps

            Betsy J Barnes, José Adrover, Amelia Baxter-Stoltzfus … (2020)
            In this Perspective, autopsy results and literature are presented supporting the hypothesis that neutrophil extracellular traps (NETs) may contribute to organ damage and mortality in COVID-19. If correct, existing drugs that target NETs, although unspecific, may benefit COVID-19 patients.
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              COVID-19: the vasculature unleashed

              Laure-Anne Teuwen, Vincent Geldhof, Alessandra Pasut … (2020)
              On the basis of emerging evidence from patients with COVID-19, we postulate that endothelial cells are essential contributors to the initiation and propagation of severe COVID-19. Here, we discuss current insights into the link between endothelial cells, viral infection and inflammatory changes and propose novel therapeutic strategies.
              Article 0 comments Cited 547 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Chrystel Becker: christel.becker@parisdescartes.fr
                Journal
                Journal ID (nlm-ta): Nat Rev Immunol
                Journal ID (iso-abbrev): Nat. Rev. Immunol
                Title: Nature Reviews. Immunology
                Publisher: Nature Publishing Group UK (London )
                ISSN (Print): 1474-1733
                ISSN (Electronic): 1474-1741
                Publication date (Electronic): 29 July 2020
                Pages: 1-2
                Affiliations
                [1 ]ISNI 0000 0001 2171 2558, GRID grid.5842.b, CNRS, INSERM UMRS 1124, Faculté des sciences fondamentales et biomédicales, , Université de Paris, ; Paris, France
                [2 ]ISNI 0000 0001 2308 1657, GRID grid.462844.8, Centre de Recherche Saint-Antoine, , INSERM UMRS 938, Sorbonne Université, ; Paris, France
                [3 ]ISNI 0000 0001 2308 1657, GRID grid.462844.8, Institute of Cardiometabolism and Nutrition (ICAN), GRC 27 GRECO, , INSERM 1166, Sorbonne Université, ; Paris, France
                [4 ]Université de Paris, CNRS-UMR 7086, Interfaces, Traitements, Organisation et DYnamique des Systèmes (ITODYS), Paris, France
                [5 ]Service de psychiatrie et de psychologie médicale, Sorbonne Université, Hôpital Saint-Antoine, AP-HP, Paris, France
                [6 ]ISNI 0000 0001 2308 1657, GRID grid.462844.8, Service de biochimie endocrinienne et oncologie, Hôpital Pitié-Salpêtrière AP-HP, , Sorbonne Université, ; Paris, France
                Author information
                http://orcid.org/0000-0001-6303-4732
                http://orcid.org/0000-0002-2658-859X
                Article
                Publisher ID: 407
                DOI: 10.1038/s41577-020-0407-1
                PMC ID: 7388427
                PubMed ID: 32728221
                SO-VID: 85b92630-31eb-453c-a27c-200cacf51319
                Copyright © © Springer Nature Limited 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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                Subject: Comment

                Keywords: viral infection,predictive markers
                Data availability:
                Keywords: viral infection, predictive markers

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