|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 87-88
Post-COVID-19 death among athletes: Is interleukin-6 screening needed?
Amr Ahmed1, Neveen Refaey2, Aml M Brakat3
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 Submission||07-May-2022|
|Date of Decision||30-May-2022|
|Date of Acceptance||03-Jun-2022|
|Date of Web Publication||30-Aug-2022|
Dr. Amr Ahmed
Department of Public Health, Tuberculosis Program, First Health Cluster, Ministry of Health, Riyadh
Source of Support: None, Conflict of Interest: None
|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
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.
Myocarditis is one of the most common causes of sports-related sudden cardiac death in athletes under the age of 35. 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.
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. Furthermore, myocarditis prevalence on cardiovascular magnetic resonance imaging (MRI) in athletes following positive COVID-19 test results is 1%–3%. 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.,
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.”
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.
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.
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. 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.,
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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