Today several risk factors of a heavy current of COVID-19 are established. Let's talk about them in this article.
The Multimorbidnost is associated with heavy degree of a course of a disease of COVID-19. It is considered that independent risk factors are the chronic obstructive pulmonary disease (COPD), cerebrovascular diseases, a diabetes mellitus of the 2nd type and hypertensia. It was suggested that hypertensia and diabetes can increase duration of elimination of SARS-CoV-2. Interrelation assessment between dysfunction of the immune system at multimorbid patients and infection of SARS-CoV-2 was not carried out. It is interesting that obesity changes a profile of an expression of receptors SARS-CoV-2.
The system inflammation of low degree of manifestation caused by metabolic disturbances as at patients with obesity promotes the strengthened release of cytokines under the influence of such acute provocative factor as a viral infection. As an endocrine part of a pancreas of the person expresses the angiotensin-converting enzyme-2 (ACE2), the coronavirus can get into pancreatic islands and cause the acute dysfunction of β-cells leading to an acute hyperglycemia and a tranzitorny diabetes mellitus of the 2nd type.
HOBL and smoking lead to development of more severe form of COVID-19. At patients with HOBL and at the smoking patients the expression of APF2 was significantly raised, and the level of an expression of its gene was inversely proportional to change of pulmonary function that allows to make the assumption of the dose-dependent answer. The Multimorbidnost is also associated with increase in level of plasminogen. Plasmin and other proteases can split the site of furinovy protease in aculeiform protein of SARS-CoV-2 outside a cell that leads to increase in its contageousness and virulence. The plasmin-associated hyper fibrinolysis causes increase in the D-dimera level in seriously ill patients of patients. Therefore, the system of plasminogen can be a perspective therapeutic target at COVID-19.
During the current pandemic it was reported that men are more subject to risk of development of a severe form of a disease in comparison with women. At the same time there is direct link with an endocrine system as the activity of an androgenovy receptor is necessary for TMPRSS2 gene transcription (this gene activates virus S-protein). The big susceptibility of men to risk can be in turn enhanced at the expense of the inheritance of genetic polymorphism connected with X-chromosome as loci of genes of an androgenovy receptor and APF2 are located on X-chromosome.
Advanced age was also associated with the increased risk of infection and a failure. The weakness of an organism is characterized by multisystem frustration which lead to decrease in physiological reserves. Communication between a syndrome of a senile adynamy and an infectious disease can be caused by the general alarm cascades which reduce immunity though formal assessment of such communication was not carried out during clinical trials. It was also established that the senile adynamy is associated with an insufficient postvaccinal immune response. Age changes of immunity it is characterized by chronic system inflammation of low degree of manifestation, with the increased level of inflammatory markers (SILT - 6 and C-jet protein), the increased susceptibility to an infection.
Except all above-mentioned, there were interesting data when patients with COVID-19 reported about existence of hypersensitivity at them to medicines (11.4%) and small tortoiseshells (1.4%). The respiratory allergy and asthma, on the contrary, are not specified in number of risk factors of infection of SARS-CoV-2. Nevertheless, the data contradicting it about adult patients with asthma were described. At children with asthma and an allergic sensitization from moderated to heavy degree the reduced expression of a gene of APF2, in comparison with children with not allergic asthma was noted. Additional clinical trial confirmed the lowered APF2 expression in cells of an epithelium of the lower respiratory tracts after allergen influence. At last, experiments of in vitro during which cells of an epithelium of a nasal cavity and bronchial tubes were used showed that SILT-13 reduced APF2 expression.
Development of serious complications at infection of SARS-CoV-2 are closely connected with an immune response of patients. There is an acute need for biomarkers which would predict development of heavy complications in patients. Unfortunately, today the medical science has very limited number of data on the biomarkers predicting development of heavy complications at COVID-19.