The dynamic association between COVID-19 and chronic disorders: An updated insight into prevalence, mechanisms and therapeutic modalities

Abstract

The devastating pandemic of coronavirus disease 2019 (COVID-19) has caused thousands of deaths and left millions of restless patients suffering from its complications. Increasing data indicate that the disease presents in a severe form in patients with pre-existing chronic conditions like cardiovascular diseases, diabetes, respiratory system diseases, and renal diseases. This denotes that these patients are more susceptible to COVID-19 and have higher mortality rates compared to patients with no comorbid conditions. Several factors can explain the heightened susceptibility and fatal presentation of COVID-19 in these patients, for example, the enhanced expression of the angiotensin-converting enzyme-2 (ACE2) in specific organs, cytokine storm, and drug interactions contribute to the increased morbidity and mortality. Adding to the findings that individuals with pre-existing conditions may be more susceptible to COVID-19, it has also been shown that COVID-19 can induce chronic diseases in previously healthy patients. Therefore, understanding the interlinked relationship between COVID-19 and chronic diseases helps in optimizing the management of susceptible patients. This review comprehensively described the molecular mechanisms that contribute to worse COVID-19 prognosis in patients with pre-existing comorbidities such as diabetes, cardiovascular diseases, respiratory diseases, gastrointestinal and renal diseases, blood disorders, autoimmune diseases, and finally, obesity. It also focused on how COVID-19 could, in some cases, lead to chronic conditions as a result of long-term multi-organ damage. Lastly, this work carefully discussed the tailored management plans for each specific patient population, aiming to achieve the best therapeutic outcome with minimum complications.

Keywords: COVID-19; Chronic disorders; Management plans; Multi-organ damage; Prognosis.

Graphical abstract

Fig. 1

Diagram depicting the association between COVID-19 and chronic comorbidities. In severe COVID-19 presentation, patients are commonly reported to have several chronic diseases that can get aggravated or induced by SARS-CoV-2 infection due to the abundant presence of ACE2 in different target organs.

Fig. 2

Diagram revealing the mechanism through which SARS-CoV-2 induces diabetic ketoacidosis. ACE2: angiotensin-converting enzyme 2, AT1R: Angiotensin type-1 receptor. AngII: angiotensin -2, GLUT-2: Glucose transporter-2.

Fig. 3

Illustration demonstrating the process initiated by COVID-19 which damages the myocardium. MHC1: major histocompatibility complex-1, ACE2: angiotensin-converting enzyme 2. APC: antigen-presenting cell. TCR: T cell receptor, HGF: hepatocyte growth factor

Fig. 4

Diagram illustrating the pathway used by SARS-CoV-2 to induce respiratory and haematological abnormalities. ACE2: angiotensin-converting enzyme 2, TLR: toll-like receptor NF-kB: nuclear factor kappa B, AngII: angiotensin -2, ARDS: acute respiratory distress.

Fig. 5

Illustration of the association between COVID-19 and liver injury. ACE2: angiotensin-converting enzyme 2; DILI: Drug induced liver injury.