Is it infection or rather vascular inflammation? Game-changer insights and recommendations from patterns of multi-organ involvement and affected subgroups in COVID-19

Coronavirus disease 2019 (COVID-19) is a serious illness that has rapidly spread throughout the globe The seriousness of complications puts significant pressures on hospital resources, especially the availability of ICU and ventilators Current evidence suggests that COVID-19 pathogenesis majorly involves microvascular injury induced by hypercytokinemia, namely interleukin 6 (IL-6) We recount the suggested inflammatory pathway for COVID-19 and its effects on various organ systems, including respiratory, cardiac, hematologic, reproductive, and nervous organ systems, as well examine the role of hypercytokinemia in the at-risk geriatric and obesity subgroups with upregulated cytokines’ profile In view of these findings, we strongly encourage the conduction of prospective studies to determine the baseline levels of IL-6 in infected patients, which can predict a negative outcome in COVID-19 cases, with subsequent early administration of IL-6 inhibitors, to decrease the need for ICU admission and the pressure on healthcare systems Video abstract: http://links lww com/CAEN/A24 Received 29 April 2020 Accepted 19 May 2020 Supplemental Digital Content is available for this article Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www cardiovascularendocrinology com Correspondence to Antoine Fakhry AbdelMassih, MSc, MD, MSc, Pediatric Cardiology Unit, Pediatric Department, Cairo University Children Hospital, Faculty of Medicine, Cairo University, Kasr Al Ainy Street, Cairo 12411, Egypt, E-mail: antoine abdelmassih@kasralainy edu eg © 2020Wolters Kluwer Health Lippincott Williams Wilkins