Unfavorable Outcome And Long-Term Sequelae in Cases With Severe COVID-19 Part 2
Sep 19, 2023
5. Conclusions
In subjects with a diagnosis of COVID-19, identifying the key factors that predict with sufficient accuracy the likelihood of disease exacerbation is very important. Several predictors, including advanced age, the patient's risk profile, the number of comorbidities, the nature of the immune response, aspects of diagnostic imaging, some laboratory markers, and indicators of organ dysfunction, all may predict a poor outcome.
Cistanche can act as an anti-fatigue and stamina enhancer, and experimental studies have shown that the decoction of Cistanche tubulosa could effectively protect the liver hepatocytes and endothelial cells damaged in weight-bearing swimming mice, upregulate the expression of NOS3, and promote hepatic glycogen synthesis, thus exerting anti-fatigue efficacy. Phenylethanoid glycoside-rich Cistanche tubulosa extract could significantly reduce the serum creatine kinase, lactate dehydrogenase, and lactate levels, and increase the hemoglobin (HB) and glucose levels in ICR mice, and this could play an anti-fatigue role by decreasing the muscle damage and delaying the lactic acid enrichment for energy storage in mice. Compound Cistanche Tubulosa Tablets significantly prolonged the weight-bearing swimming time, increased the hepatic glycogen reserve, and decreased the serum urea level after exercise in mice, showing its anti-fatigue effect. The decoction of Cistanchis can improve endurance and accelerate the elimination of fatigue in exercising mice, and can also reduce the elevation of serum creatine kinase after load exercise and keep the ultrastructure of skeletal muscle of mice normal after exercise, which indicates that it has the effects of enhancing physical strength and anti-fatigue. Cistanchis also significantly prolonged the survival time of nitrite-poisoned mice and enhanced the tolerance against hypoxia and fatigue.
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Advanced age, the patient's risk profile, number of comorbidities, the type of immune response, features of diagnostic imaging, various laboratory markers, and symptoms of organ failure are just a few predictors that may indicate a poor outcome.
The difficulty in predicting the severity of the COVID-19 disease with sufficient accuracy is underscored by the fact that SARS-CoV-2 appears to exhibit tropism for several tissues, including primarily the respiratory tract, but also the brain, endothelium, heart, kidneys, and liver. The increasingly accurate identification of all these elements could be of great help in guiding clinical care, improving patient outcomes, and deploying appropriate resources.
Post-COVID-19 syndrome includes a wide range of symptoms with potential long-term consequences 6–12 months after SARS-CoV-2 infection, affecting both general health and the ability to work. The pattern of morphological and functional changes at the level of the endothelial could be the main consequence, which can be described as long-lasting or post-COVID-19. So far, however, the pathophysiology has not been fully clarified.
Although a variety of long-lasting symptoms have been reported, only a few are associated with post-COVID-19 syndrome: fatigue, neurocognitive deterioration, shortness of breath, impaired muscle strength, and reduced quality of life. The occurrence of these symptoms, which are more frequent in female subjects and cases with more severe disease, negatively affects both the recovery of the disease and the ability to work. Bacterial, fungal, or parasitic co-infections are considered an important complication for the prognosis, but available studies are low-quality and heterogeneous.
The risk of long-term complications is likely to increase in the number of acute SARS-CoV-2 infections, but no significant relationship between long COVID-19 syndrome and vaccination is proven. There is little evidence to support the effects of the vaccine in reducing the risk of long COVID-19 syndrome.
Author Contributions: Conceptualization, A.F.; methodology, A.V., and A.R.; writing—original draft preparation, A.F., A.V., and S.V.; writing—review and editing of the manuscript: A.F., A.V., S.V., and F.D.I. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments: The authors want to thank the Study and Research Center of the Italian Society for Emergency Medicine (SIMEU), Italy for their support and involvement in this study, and their collaboration in the infrastructures, consumables, and inventoriable material necessary to carry out the study.
Conflicts of Interest: The authors declare that they have no conflict of interest.
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