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.

中文翻译：

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严重 COVID-19 中的视网膜病变和全身性疾病发病率

 抽象的

 目的

评估严重 COVID-19 患者视网膜病变的患病率及其与全身发病率以及凝血和炎症功能障碍实验室指标的关系。

 设计

回顾性、观察性队列研究。

 方法

对 2020 年 4 月至 7 月期间接受眼科检查的重症 COVID-19 住院成年患者进行了回顾。视网膜病变定义为以下情况之一： 1) 视网膜出血； 2）棉絮斑； 3）视网膜血管阻塞。我们分析了医疗合并症、序贯器官衰竭评估 (SOFA) 评分、临床结果以及与视网膜病变相关的实验室值。

 结果

对 37 名重症 COVID-19 患者进行了审查，其中大多数是女性 (n = 23, 62%)、黑人 (n = 26, 69%)，并入住重症监护室 (n = 35, 95 %）。 14 名患者患有视网膜病变 (38%)，其中 7 名患者 (19%) 出现视网膜出血，8 名患者 (22%) 出现棉絮斑，1 名患者 (3%) 出现视网膜分支动脉闭塞。视网膜病变患者的 SOFA 评分高于无视网膜病变患者（8.0 vs. 5.3， p = .03），需要有创机械通气的呼吸衰竭发生率和需要血管加压药的休克发生率更高（ p < .01）。视网膜病变患者的 D-二聚体峰值水平为 28,971 ng/mL，而无视网膜病变患者的峰值 D-二聚体水平为 12,575 ng/mL ( p = .03)。有棉絮斑的患者的 CRP 峰值高于没有棉絮斑的患者（354 mg/dL vs. 268 mg/dL， p = .03）。多变量逻辑回归模型显示，D-二聚体峰值较高（aOR 1.32，95% CI 1.01–1.73， p = .04）和男性（aOR 9.6，95% CI 1.2–75.5， p = .04）患视网膜病变的风险增加）。

 结论

重症 COVID-19 患者的视网膜病变与涉及多个器官的全身性疾病发病率升高相关。鉴于其与凝血障碍和炎症的相关性，视网膜病变可能有助于深入了解重症 COVID-19 患者的疾病发病机制。