Abstract
To address urgent need for strategies to limit mortality from coronavirus disease 2019 (COVID-19), this review describes experimental, clinical and epidemiological evidence that suggests that chronic sub-optimal hydration in the weeks before infection might increase risk of COVID-19 mortality in multiple ways. Sub-optimal hydration is associated with key risk factors for COVID-19 mortality, including older age, male sex, race-ethnicity and chronic disease. Chronic hypertonicity, total body water deficit and/or hypovolemia cause multiple intracellular and/or physiologic adaptations that preferentially retain body water and favor positive total body water balance when challenged by infection. Via effects on serum/glucocorticoid-regulated kinase 1 (SGK1) signaling, aldosterone, tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), aquaporin 5 (AQP5) and/or Na + /K + -ATPase, chronic sub-optimal hydration in the weeks before exposure to COVID-19 may conceivably result in: greater abundance of angiotensin converting enzyme 2 (ACE2) receptors in the lung, which increases likelihood of COVID-19 infection, lung epithelial cells which are pre-set for exaggerated immune response, increased capacity for capillary leakage of fluid into the airway space, and/or reduced capacity for both passive and active transport of fluid out of the airways. The hypothesized hydration effects suggest hypotheses regarding strategies for COVID-19 risk reduction, such as public health recommendations to increase intake of drinking water, hydration screening alongside COVID-19 testing, and treatment tailored to the pre-infection hydration condition. Hydration may link risk factors and pathways in a unified mechanism for COVID-19 mortality. Attention to hydration holds potential to reduce COVID-19 mortality and disparities via at least 5 pathways simultaneously.
Keywords: ACE2 receptors; AQP5; COVID-19; Chronic hydration; Drinking water intervention; Hypertonicity; Mortality; SGK1; Saliva osmolality; VEGF.
【저자키워드】 COVID-19, Mortality, ACE2 receptors, AQP5, Chronic hydration, Drinking water intervention, Hypertonicity, SGK1, Saliva osmolality, VEGF., 【초록키워드】 Treatment, coronavirus disease, public health, Tumor, Coronavirus disease 2019, ACE2, Risk factors, Infection, lung, risk factor, angiotensin converting enzyme, aldosterone, chronic disease, airway, COVID-19 testing, tumor necrosis factor, COVID-19 infection, Older age, pathway, ACE2 receptors, epithelial cells, epidemiological, receptor, Hydration, TNF-alpha, mechanism, Lung epithelial cells, Signaling, Evidence, angiotensin, Hypovolemia, Pathways, Male sex, AQP5, Hypertonicity, SGK1, COVID-19 mortality, airways, chronic, balance, exposure to, water, tumor necrosis, drinking water, active transport, total body water, Transport, vascular endothelial growth factor, Attention, endothelial, tumor necrosis factor-alpha, Vascular, enzyme, favor, VEGF, growth factor, hypotheses, intake, risk reduction, positive, kinase, exaggerated immune response, Effect, recommendation, risk of COVID-19, limit, likelihood, aquaporin, body water, capillary leakage, Water balance, greater, reduced, increase, reduce, hypothese, lung epithelial cell, total body, Via, 【제목키워드】 risk factor,