Retinopathy and Systemic Disease Morbidity in Severe COVID-19

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, <i>p</i> = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors (<i>p</i> p = .03). Peak CRP was higher in patients with cotton wool spots versus those without cotton wool spots (354 mg/dL vs. 268 mg/dL, <i>p</i> = .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, <i>p</i> = .04) and male sex (aOR 9.6, 95% CI 1.2–75.5, <i>p</i> = .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.

本研究旨在评估新型冠状病毒肺炎（COVID-19）重症患者视网膜病变的患病率，及其与全身疾病负担、凝血功能与炎症功能紊乱实验室指标的关联。本研究为回顾性观察性队列研究，纳入2020年4月至7月期间因重症COVID-19住院并接受眼科检查的成年患者，对其病历资料进行回顾分析。本研究将视网膜病变定义为以下任一情况：1）视网膜出血；2）棉绒斑；3）视网膜血管阻塞。我们分析了患者的合并症、序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA）、临床结局及实验室指标，以探究其与视网膜病变的关联。本研究共纳入37例重症COVID-19患者进行回顾分析，其中大多数为女性（n=23，62%）、黑人（n=26，69%），且入住重症监护病房（n=35，95%）。14例患者（38%）出现视网膜病变，其中7例（19%）存在视网膜出血，8例（22%）存在棉绒斑，1例（3%）发生视网膜分支动脉阻塞。合并视网膜病变的患者序贯器官衰竭评分高于未合并者（8.0 vs 5.3，p=0.03），且需要有创机械通气的呼吸衰竭发生率、需血管活性药物治疗的休克发生率均更高（p=0.03）。存在棉绒斑的患者其C反应蛋白（C-reactive protein, CRP）峰值水平高于无棉绒斑者（354mg/dL vs 268mg/dL，p=0.03）。多因素logistic回归分析显示，D-二聚体峰值水平升高（调整后优势比（adjusted odds ratio, aOR）=1.32，95%置信区间（confidence interval, CI）=1.01~1.73，p=0.04）与男性性别（aOR=9.6，95%CI=1.2~75.5，p=0.04）均会增加重症COVID-19患者发生视网膜病变的风险。重症COVID-19患者合并视网膜病变与多器官受累的全身疾病负担更重相关。鉴于视网膜病变与凝血功能紊乱及炎症状态存在关联，其或可为阐明重症COVID-19患者的疾病发病机制提供新视角。