Abstract
Purpose: To assess the prevalence of retinopathy and its association with systemic morbidity and laboratory indices of coagulation and inflammatory dysfunction in severe COVID-19.
Design: Retrospective, observational cohort study.
Methods: 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.
Results: 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 < .01). Peak D-dimer levels were 28,971 ng/mL in patients with retinopathy compared to 12,575 ng/mL in those without retinopathy ( 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).
Conclusion: 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.
Keywords: COVID-19; ophthalmic disease; retinopathy.
【저자키워드】 COVID-19, retinopathy, ophthalmic disease, 【초록키워드】 Inflammation, Hospitalized, Respiratory failure, intensive care, severe COVID-19, Comorbidities, CRP, clinical outcomes, Laboratory, Coagulation, Coagulopathy, Prevalence, Shock, morbidity, female, Patient, Logistic regression, SOFA, disease, association, D-dimer level, Invasive mechanical ventilation, Inflammatory, Male sex, retinopathy, hemorrhage, Organ failure, SOFA score, dysfunction, black, Observational cohort study, disease pathogenesis, Vasopressor, 95% CI, increased risk, multivariate, multiple organs, offer, cotton, peak, greater, defined, analyzed, majority, Adult patient, ophthalmic, peak D-dimer, Retinal, vascular occlusion, 【제목키워드】 retinopathy, systemic,