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Persistent Systemic Microbial Translocation and Intestinal Damage During Coronavirus Disease-19
Alessandra Oliva1, Maria Claudia Miele1, Federica Di Timoteo1
1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Abstract:
Microbial translocation (MT) and intestinal damage (ID) are poorly explored in COVID-19. Aims were to assess whether alteration of gut permeability and cell integrity characterize COVID-19 patients, whether it is more pronounced in severe infections and whether it influences the development of subsequent bloodstream infection (BSI). Furthermore, we looked at the potential predictive role of TM and ID markers on Intensive Care Unit (ICU) admission and in-hospital mortality. Over March-July 2020, 45 COVID-19 patients were enrolled. Markers of MT [LPB (Lipopolysacharide Binding Protein) and EndoCab IgM] and ID [I-FABP (Intestinal Fatty Acid Binding Protein)] were evaluated at COVID-19 diagnosis and after 7 days. As a control group, age- and gender-matched healthy donors (HDs) enrolled during the same study period were included. Median age was 66 (56-71) years. Twenty-one (46.6%) were admitted to ICU and mortality was 22% (10/45). Compared to HD, a high degree of MT and ID was observed. ICU patients had higher levels of MT, but not of ID, than non-ICU ones. Likewise, patients with BSI had lower EndoCab IgM than non-BSI. Interestingly, patients with high degree of MT and low ID were likely to be admitted to ICU (AUC 0.822). Patients with COVID-19 exhibited high level of MT, especially subjects admitted to ICU. COVID-19 is associated with gut permeability.
Insights
COVID-19 patients show significant microbial translocation and intestinal damage compared to healthy donors. These gut alterations are more pronounced in severe cases and may predict Intensive Care Unit admission.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Microbial translocation and intestinal damage are understudied in COVID-19.
- Assessing gut permeability and cell integrity in COVID-19 is crucial for understanding disease severity.
Purpose of the Study:
- To determine if gut permeability and cell integrity are altered in COVID-19 patients.
- To investigate if these alterations are more severe in critical COVID-19.
- To explore the predictive value of gut permeability markers for ICU admission and mortality.
Main Methods:
- Evaluated markers of microbial translocation (Lipopolysacharide Binding Protein, EndoCab IgM) and intestinal damage (Intestinal Fatty Acid Binding Protein) in 45 COVID-19 patients.
- Compared COVID-19 patients with age- and gender-matched healthy donors.
- Assessed markers at diagnosis and 7 days post-diagnosis.
Main Results:
- COVID-19 patients exhibited significantly higher microbial translocation and intestinal damage than healthy donors.
- Intensive Care Unit patients had higher microbial translocation levels than non-ICU patients.
- High microbial translocation and low intestinal damage predicted Intensive Care Unit admission.
Conclusions:
- COVID-19 is associated with increased gut permeability and microbial translocation.
- These gut alterations are particularly evident in severe COVID-19 cases requiring Intensive Care Unit admission.
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