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, p = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors (p 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, p = .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, p = .04) and male sex (aOR 9.6, 95% CI 1.2–75.5, p = .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.

本研究旨在评估重症新型冠状病毒肺炎（COVID-19）患者视网膜病变（retinopathy）的患病率，及其与全身并发症、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。回顾分析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病历资料。本研究将视网膜病变定义为以下任一情况：1）视网膜出血（retinal hemorrhage）；2）棉絮斑（cotton wool spots）；3）视网膜血管阻塞（retinal vascular occlusion）。我们分析了患者的基础合并症、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。本研究共回顾分析37例重症COVID-19患者，其中女性23例（占比62%）、黑人26例（占比69%），35例（95%）收入重症监护病房。14例患者合并视网膜病变（占比38%），其中7例（19%）存在视网膜出血、8例（22%）存在棉絮斑，1例（3%）出现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），且需有创机械通气的呼吸衰竭发生率及需血管加压素治疗的休克发生率更高（p=0.03）。合并棉絮斑患者的C反应蛋白（C-reactive protein, CRP）峰值水平高于未合并者（354mg/dL vs 268mg/dL，p=0.03）。多因素logistic回归分析显示，D-二聚体（D-dimer）峰值升高与视网膜病变风险增加相关（调整后优势比aOR=1.32，95%置信区间CI：1.01~1.73，p=0.04），男性性别同样与视网膜病变风险升高相关（aOR=9.6，95%CI：1.2~75.5，p=0.04）。重症COVID-19患者合并视网膜病变，与累及多器官的全身并发症负担更重相关。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的视角。