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LETTER TO EDITOR
Year : 2022  |  Volume : 22  |  Issue : 2  |  Page : 87-88

Post-COVID-19 death among athletes: Is interleukin-6 screening needed?


1 Department of Public Health, Tuberculosis Program, First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
2 Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
3 Department of General Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Date of Submission07-May-2022
Date of Decision30-May-2022
Date of Acceptance03-Jun-2022
Date of Web Publication30-Aug-2022

Correspondence Address:
Dr. Amr Ahmed
Department of Public Health, Tuberculosis Program, First Health Cluster, Ministry of Health, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjsm.sjsm_10_22

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How to cite this article:
Ahmed A, Refaey N, Brakat AM. Post-COVID-19 death among athletes: Is interleukin-6 screening needed?. Saudi J Sports Med 2022;22:87-8

How to cite this URL:
Ahmed A, Refaey N, Brakat AM. Post-COVID-19 death among athletes: Is interleukin-6 screening needed?. Saudi J Sports Med [serial online] 2022 [cited 2022 Sep 25];22:87-8. Available from: https://www.sjosm.org/text.asp?2022/22/2/87/355189



Dear Editor,

Since COVID-19 or coronavirus disease 2019 (SARS CoV-2) was declared a global pandemic, this pandemic has dramatically impacted the health systems, economy, and lifestyles all around the world. Furthermore, SARS-CoV-2–related illness has a clear impact on physical activity, sport, and athletes of all levels. SARS-CoV-2 can cause medical complications, both short term and long term. The residual effects can complicate medical protocols for returning to play.[1]

Myocarditis is one of the most common causes of sports-related sudden cardiac death in athletes under the age of 35.[2] A common cause of sudden cardiac death in athletes is myocarditis preceded by a viral infection. Concerns about SARS-CoV-2 cardiovascular sequelae in athletes have been accentuated by reports of presumptive myocarditis in several high-profile athletes.[3]

In a cohort study of 1597 university competitive athletes in the United States, 37 athletes (2.3%) developed clinical and subclinical myocarditis after being infected with COVID-19.[4] Furthermore, myocarditis prevalence on cardiovascular magnetic resonance imaging (MRI) in athletes following positive COVID-19 test results is 1%–3%.[5] More than a third of 54 previously healthy college athletes who tested positive for COVID-19 had pericardial inflammation on imaging. Severe cases of myocarditis and pericarditis, in particular, can lead to chronic heart failure or death, posing major public health concerns.[6],[7]

Coronaviruses have the potential to disrupt host immune responses. Several studies have found a “cytokine storm” involving the release of interleukin-1 (IL-1) and IL-6, as well as tumor necrosis factor α and other inflammatory mediators. Myocarditis, arrhythmias, ventricular dysfunction, and sudden death are caused by a “cytokine storm.”[8]

IL-6 is an inflammatory IL that is primarily produced by macrophages and T lymphocytes in response to pathogens. It is crucial to control several viral infections at homeostatic levels, but its increased production significantly contributes to cytokine storms. IL-6 has been considered a critical mediator and a positive predictor of disease severity, radiologic changes, risk for mechanical ventilation, and death.[9]

In a recent study, IL-6 has a direct electrophysiological role of IL-6 in arrhythmogenesis as IL-6 alone was found to be more effective than the combination of azithromycin and hydroxychloroquine in lowering heart rate, increasing PR interval, and increasing QTc. Furthermore, combinations of IL-6, azithromycin, and hydroxychloroquine in vivo or in vitro caused significant bradycardia, conduction problems, QTc prolongation, and asystole.[10]

Skeletal muscles express cytokines through direct autocrine and paracrine effects, so acute and prolonged strenuous exercise raises circulating levels of IL-6, while chronic exercise decreases markers of chronic inflammation.[11] Severe SARS-CoV-2 causes catabolic muscle wasting which raises IL-6 levels.

The resumption of training and competitions without health risks in athletes with cardiovascular complications related to SARS-CoV-2 includes abstinence from competitive sports or aerobic activity for 3–6 months until resolution of myocardial inflammation by cardiac MRI or troponin normalization and monitoring of circulating IL-6 as we consider IL-6 as a relevant tool for prognostic evaluation.[2],[12]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Metzl JD, McElheny K, Robinson JN, Scott DA, Sutton KM, Toresdahl BG. Considerations for return to exercise following mild-to-moderate COVID-19 in the recreational athlete. HSS J 2020;16:102-7.  Back to cited text no. 1
    
2.
Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NA 3rd, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 3: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: A scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015;132:e273-80.  Back to cited text no. 2
    
3.
Schellhorn P, Klingel K, Burgstahler C. Return to sports after COVID-19 infection. Eur Heart J 2020;41:4382-4.  Back to cited text no. 3
    
4.
Daniels CJ, Rajpal S, Greenshields JT, Rosenthal GL, Chung EH, Terrin M, et al. Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: Results from the big ten COVID-19 cardiac registry. JAMA Cardiol 2021;6:1078-87.  Back to cited text no. 4
    
5.
Udelson JE, Rowin EJ, Maron BJ. Return to play for athletes after COVID-19 infection: The fog begins to clear. JAMA Cardiol 2021;6:997-9.  Back to cited text no. 5
    
6.
Brito D, Meester S, Yanamala N, Patel HB, Balcik BJ, Casaclang-Verzosa G, et al. High prevalence of pericardial involvement in college student athletes recovering from COVID-19. JACC Cardiovasc Imaging 2021;14:541-55.  Back to cited text no. 6
    
7.
Husby A, Hansen JV, Fosbøl E, Thiesson EM, Madsen M, Thomsen RW, et al. SARS-CoV-2 vaccination and myocarditis or myopericarditis: Population based cohort study. BMJ 2021;375:e068665.  Back to cited text no. 7
    
8.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the 'Cytokine Storm' in COVID-19. J Infect 2020;80:607-13.  Back to cited text no. 8
    
9.
Liu Z, Li J, Chen D, Gao R, Zeng W, Chen S, et al. Dynamic interleukin-6 level changes as a prognostic indicator in patients with COVID-19. Front Pharmacol 2020;11:1093.  Back to cited text no. 9
    
10.
Zhu X, Wang Y, Xiao Y, Gao Q, Gao L, Zhang W, et al. Arrhythmogenic mechanisms of interleukin-6 combination with hydroxychloroquine and azithromycin in inflammatory diseases. Sci Rep 2022;12:1075.  Back to cited text no. 10
    
11.
Lambert CP, Wright NR, Finck BN, Villareal DT. Exercise but not diet-induced weight loss decreases skeletal muscle inflammatory gene expression in frail obese elderly persons. J Appl Physiol (1985) 2008;105:473-8.  Back to cited text no. 11
    
12.
Hendren NS, Drazner MH, Bozkurt B, Cooper LT Jr. Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation 2020;141:1903-14.  Back to cited text no. 12
    




 

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