Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA.
Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Ocul Immunol Inflamm. 2021 May 19;29(4):743-750. doi: 10.1080/09273948.2021.1952278. Epub 2021 Aug 31.
To assess the prevalence of retinopathy and its association with systemic morbidity and laboratory indices of coagulation and inflammatory dysfunction in severe COVID-19.
Retrospective, observational cohort study.
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.
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, = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors ( < .01). Peak D-dimer levels were 28,971 ng/mL in patients with retinopathy compared to 12,575 ng/mL in those without retinopathy ( = .03). Peak CRP was higher in patients with cotton wool spots versus those without cotton wool spots (354 mg/dL vs. 268 mg/dL, = .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, = .04) and male sex (aOR 9.6, 95% CI 1.2-75.5, = .04).
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.
评估严重 COVID-19 患者中视网膜病变的患病率及其与系统性发病和凝血及炎症功能障碍的实验室指标的关系。
回顾性观察性队列研究。
对 2020 年 4 月至 7 月间因严重 COVID-19 住院并接受眼科检查的成年患者进行了回顾性分析。视网膜病变定义为以下之一：1）视网膜出血；2）棉絮斑；3）视网膜血管闭塞。我们分析了与视网膜病变相关的合并症、序贯器官衰竭评估（SOFA）评分、临床结局和实验室值。
共回顾了 37 例严重 COVID-19 患者，其中大多数为女性（n=23，62%）、黑人（n=26，69%）和入住重症监护病房（n=35，95%）。14 例（38%）患者患有视网膜病变，其中 7 例（19%）为视网膜出血，8 例（22%）为棉絮斑，1 例（3%）为视网膜分支动脉阻塞。与无视网膜病变的患者相比，有视网膜病变的患者 SOFA 评分更高（8.0 比 5.3， =.03），需要有创机械通气的呼吸衰竭和需要升压药的休克发生率更高（ <.01）。视网膜病变患者的 D-二聚体峰值为 28971ng/mL，而无视网膜病变患者的 D-二聚体峰值为 12575ng/mL（ =.03）。与无棉絮斑的患者相比，有棉絮斑的患者 CRP 峰值更高（354mg/dL 比 268mg/dL， =.03）。多变量逻辑回归模型显示，D-二聚体峰值升高（aOR 1.32，95%CI 1.01-1.73， =.04）和男性（aOR 9.6，95%CI 1.2-75.5， =.04）与视网膜病变的风险增加相关。
严重 COVID-19 中的视网膜病变与涉及多个器官的更大系统疾病发病率相关。鉴于其与凝血障碍和炎症的关系，视网膜病变可能为严重 COVID-19 患者的疾病发病机制提供深入了解。
