Nat Med: A comprehensive summary of the harmful effects of COVID-19 on organs other than the lungs.

23, 2020 /PRNewswire/ -- At the start of the new crown pneumonia outbreak in New York City, DrAakriti Gupta realized just days after caring for critically ill patients that it was much more than a respiratory disease"I was on the front line from the beginningI've observed a lot of blood clots, even if they don't have diabetes, they have high blood sugar, and many people experience heart and kidney damage," said Gupta, the first cardiovascular physician in Columbia to be deployed to the COVID Intensive Care Unit at Columbia University's Irvine Medical Centerearly March, there were few clinical guidance on the non-respiratory effects of COVID-19, so Gupta decided to combine the results of the literature with the experience of doctors, and he and his colleagues reviewed the latest findings on the effects of COVID-19 on the extrapulmonary organ system and provided clinical guidance to doctorstheir review, published recently in the journal Nature Medicine, entitled Extrapulmonary shows of COVID-19, is the first extensive review of the effects of COVID-19 on all affected organs outside the lungsphoto source: NIAID "Doctors need to treat COVID-19 as a multi-system disease," Gupta said"There's a lot of news about clotting, but it's important to understand that a significant proportion of these patients suffer from kidney, heart and brain damage that doctors need to treat for these diseases and respiratory diseases.""blood clots, inflammation and immune system strains researchers say doctors saw many thrombosis complications in the first few weeks of the pandemic, more than they had expected from their experience with other viral diseasesthese complications can have a profound effect on patientsscientists believe these clotting complications may have been caused by the virus's attack on blood vessel cellswhen the virus attacks blood vessel cells, inflammation increases and the blood begins to form large and small clotsthese blood clots can flow throughout the body, wreaking havoc on organs and perpetuating the vicious cycle of thrombosis inflammationto combat clotting and its devastating effects, clinicians at Columbia University are conducting a randomized clinical trial to investigate the optimal dose and timing of anticoagulant drugs in patients with COVID-19this unstable inflammation also overstimulates the immune system, and although doctors initially avoided using steroids to fully suppress the immune system, a recent clinical trial found that at least one steroid -- dexamethasone -- could reduce the mortality rate of patients who need mechanical ventilation by a thirdrandomized clinical trials are under way for blood clot inflammation and specific components of the immune system, such as leukocyte interleukin-6 signalsscientists around the world are trying to understand at an unprecedented rate how the virus hijacks biological mechanisms that often have protective effects they hope this will help develop more effective, accurate and safer COVID-19 treatments in the near future hitting a blood clot in the heart can lead to a heart attack, but the virus can attack the heart in other ways The mechanism of heart damage is not yet known, as in autopsy cases, the virus is not usually isolated from the heart tissue heart muscles can be damaged by systemic inflammation and the resulting release of cytokines cytokines are proteins secreted by immune cells that usually remove infected cells, but can get out of control in severe COVID-19 cases Despite the extent of heart damage, doctors are unable to use the diagnostic and treatment strategies commonly used in the early stages of a pandemic, including heart biopsies and cardiac catheterization, due to the need to protect people and patients from the spread of the virus this has changed as the prevalence of the disease has declined Another surprising finding renal failure is the high rate of acute kidney injury in patients with COVID-19 in ICU The ACE2 receptors used by the virus to enter cells are highly concentrated in the kidneys, which may be the cause of kidney damage Study of kidney complications in China, but in New York City, clinicians found that up to 50% of patients in ICU had kidney failure photo source: Nature Medicine" about 5 to 10 percent of patients need dialysis this is a very high number "There is currently a lack of data on long-term kidney damage, but a significant number of patients may need permanent dialysis." "Follow-up studies of patients with complications during COVID-19 hospitalization will be critical," the researchers said About one-third of patients with " nervous system may experience neurological symptoms, including headaches, dizziness, fatigue and loss of smell More worryingly , strokes caused by blood clots account for 6 per cent of severe cases and 8 to 9 per cent of delirium COVID-19 patients can intubate for 2 to 3 weeks; intubation takes a very long time and patients need a lot of sedatives before COVID, 'ICU' is a well-known symptom, and this hallucinations may not be the effects of viruses, but more effects of long-term sedation despite being sub-professionally trained as a physician, keep all organ systems in mind when caring for patients in front of them researchers hope their reviews, observations and recommendations will help other clinicians where cases are proliferating () References: Aakriti Gupta et al, Extrapulmonary shows of COVID-19, Nature Medicine (2020) DOI: 10.1038/s41591-020-0968-3 gives-the-first-class-review of COVID-19's effects outside the lung.