Clinical characteristics of moderate and severe cases with COVID-19 in Wuhan, China: a retrospective study

Clinical and Inflammatory Profile of COVID-19 Infection at a Tertiary Care Centre in Northern Part of Tamil Nadu – A Retrospective Study

Introduction

The coronavirus disease (COVID-19) pandemic has incurred high costs for the entire planet. The complex interactions between the host, virus, and environment have resulted in various clinical outcomes. It is crucial to comprehend sickness severity and outcome predictors to provide early preventative measures for a better outcome. The current study aimed to determine the association of clinical and inflammatory profiles with the outcome of COVID-19 infection in patients admitted to the intensive care unit.

Methods

This retrospective study was done in patients admitted to intensive care units for COVID-19 with a positive reverse transcriptase polymerase chain reaction (RTPCR) assay. A total of 125 patients above 18 years were included in the study. The patient’s age, gender, and co-morbidities like type 2 diabetes mellitus, hypertension, respiratory illness, and coronary artery disease were noted. The patient’s symptomatology, vital signs, oxygen saturation (Spo2), need for inotropes, and non-invasive positive pressure ventilator support (NIPPV) were observed. Computed tomography severity score (CTSS) and hematological and inflammatory parameters at the time of admission were noticed. Patient’s management and treatment outcomes as survivors and non-survivors were noted.

Results

The mean age was significantly greater in non-survivors. The common symptoms were fever, respiratory distress, cough, muscle pain, and sore throat. The leucocyte count, C-reactive protein (CRP), urea, creatinine, interleukin-6 (IL-6), and lactate dehydrogenase (LDH) were greater, and platelet counts were lower significantly in the non-survivors group. On multivariable logistic regression, CT severity score, NIPPV, and IL-6 had an odds ratio of 1.17, 0.052, and 1.03, respectively. IL-6 had a sensitivity of 81.5% and a specificity of 81.8% with a cut-off value of 37.5.

Conclusion

Vigilant monitoring of leucocyte count, CRP, urea, creatinine, IL-6, LDH, platelet count, and CT severity score is essential for managing COVID-19 infection. IL-6 was found to be a significant marker as a predictor of outcome in our study.

Haematological Traits in Symptomatic and Asymptomatic COVID-19 Positive Patients for Predicting Severity and Hospitalization

Objective

The present investigation aims on the clinical attributes and haematological parameters between symptomatic (COVID-19 ICU) and asymptomatic (COVID-19 homes isolation) patients as predisposing sign for COVID-19 related mortality.

Materials and Methods

A retrospective cohort research was conducted of admitted patients to ICU, who were suffering from severe COVID-19 in Aseer Central Hospital, Abha, Kingdom of Saudi Arabia (KSA) from July 2020 until September 2020. The study included individuals with COVID -19 and ICU admission as symptomatic group and others who are COVID-19 positives with quarantine as asymptomatic group. Epidemiological, clinical and haematological laboratory data were retrospectively collected, analysed with control subjects.

Results

Of the 38 ICU patients studied, the most common symptoms were fever and respiratory distress (100%), cough (86.8%). Majority were of Saudi origin (78.9%). Eighteen (47.4%) COVID-19 ICU patients showed leukocytosis, 6 (15.8%) had severe thrombocytopenia (with most having thrombocytopenia), 18 (47.4%) were anaemic. A significant correlation was observed between the WBC, RBC, Hb, platelets, neutrophil and lymphocyte count between ICU inmates compared with quarantine (p < 0.001) and RBC, Hb, neutrophil and lymphocyte count with control groups (p < 0.001).

Conclusion

From the observations it is evident that, the blood tests have potential clinical value in predicting COVID-19 progression. Further, patient characteristics including age, leukocyte count, RBC, platelets and differential leukocyte counts may be significant predictors for monitoring the progression of the critical illness observed in SARS-COV-2 patients. Also, treatment procedures can be re-defined further to reduce COVID-19 mortalities in more critically ill COVID-19 individuals.

The significance of antiglobulin (Coombs) test reactivity in patients with COVID-19

Previous case reports have described patients with COVID-19-associated autoimmune hemolytic anemia (AIHA), and cold agglutinin disease (CAD) which is characterized by a positive direct antiglobulin (DAT) or "Coombs" test, yet the mechanism is not well understood. To investigate the significance of Coombs test reactivity among COVID-19 patients, we conducted a retrospective study on hospitalized COVID-19 patients treated at NMC Royal Hospital between 15 April and 30 May 2020. There were 27 (20%) patients in the Coombs-positive group and 108 (80%) in the Coombs-negative group. The cold agglutinin titer was examined in 22 patients due to symptoms suggestive of cold agglutinin disease, and all tested negative. We demonstrated a significant association with reactive Coombs test results in univariate analysis through clinical findings such as ICU admission rate, the severity of COVID-19, and several laboratory findings such as CRP, D-dimer, and hemoglobin levels lactate dehydrogenase, and RDW-CV. However, only hemoglobin levels and disease severity had a statistically significant association in multivariate analysis. A possible explanation of COVID-19-associated positive Coombs is cytokine storm-induced hyperinflammation, complement system activation, alterations of RBCs, binding of SARS-CoV-2 proteins to hemoglobin or its metabolites, and autoantibody production. Coombs-positive patients were tested for hemolysis using indirect bilirubin, consumed haptoglobin, and/or peripheral smear that ruled out any evidence of hemolysis. Understanding this etiology sheds new light on RBC involvement as a pathophysiological target for SARS-CoV-2 by interfering with their function; consequently, therapies capable of restoring RBC function, such as erythrocytapheresis, could be repurposed for the treatment of worsening severe and critical COVID-19.

Characterization of Two Heterogeneous Lethal Mouse-Adapted SARS-CoV-2 Variants Recapitulating Representative Aspects of Human COVID-19

New emerging severe acute respiratory syndrome 2 (SARS-CoV-2) has caused a worldwide pandemic. Several animal models of coronavirus disease 2019 (COVID-19) have been developed and applied to antiviral research. In this study, two lethal mouse-adapted SARS-CoV-2 variants (BMA8 and C57MA14) with different virulence were generated from different hosts, which are characterized by high viral replication titers in the upper and lower respiratory tract, pulmonary pathology, cytokine storm, cellular tropism, lymphopenia, and neutrophilia. Two variants exhibit host genetics-related and age-dependent morbidity and mortality in mice, exquisitely reflecting the clinical manifestation of asymptomatic, moderate, and severe COVID-19 patients. Notably, both variants equally weaken the neutralization capacity of the serum derived from COVID-19 convalescent, but the C57MA14 variant showed a much higher virulence than the BMA8 variant in vitro. Q489H substitution in the receptor-binding domain (RBD) of BMA8 and C57MA14 variants results in the receptors of SARS-CoV-2 switching from human angiotensin-converting enzyme 2 (hACE2) to murine angiotensin-converting enzyme 2 (mACE2). Additionally, A22D and A36V mutation in E protein were first reported in our study, which potentially contributed to the virulence difference between the two variants. Of note, the protective efficacy of the novel bacterium-like particle (BLP) vaccine candidate was validated using the BMA8- or C57MA14-infected aged mouse model. The BMA8 variant- and C57MA14 variant-infected models provide a relatively inexpensive and accessible evaluation platform for assessing the efficacy of vaccines and novel therapeutic approaches. This will promote further research in the transmissibility and pathogenicity mechanisms of SARS-CoV-2.

Hematological profile and biochemical markers of COVID-19 non-survivors: A retrospective analysis

Background

Coronavirus disease is primarily transmitted through the respiratory route and bodily contact. The fatality in COVID-19 cases was alarming in the initial days. This study analyzes hematological and biochemical markers of COVID-19 non-survivors.

Material and methods

In this single-center study, records of 249 patients hospitalized with COVID-19 were studied for hematological profile and biochemical markers. Records of patients with laboratory-confirmed COVID-19 disease hospitalized between April 14, 2020, to August 15, 2020, were included in the analysis.

Results

Significantly, the disease mortality was associated with increased procalcitonin (P < 0.05), C-reactive protein (P < 0.05), aspartate transaminase (P < 0.05), serum potassium (P < 0.05), neutrophils count (P < 0.05), white blood cell count (P < 0.05), prothrombin time (P < 0.05) and activated prothrombin time (P < 0.05) in patients reported abnormal x-ray findings. Further, patients with abnormal radiological findings significantly showed a reduced level of lymphocyte counts (P < 0.05), oxygen saturation (P < 0.05), and partial oxygen pressure (P < 0.05). Reduced level of aspartate aminotransferase (P < 0.05), alanine aminotransferase (P < 0.05) and lactate dehydrogenase (P < 0.05) reported significant association with mortality among patients with COVID-19.

Conclusions

The clinicians may consider the hematological and biochemical parameters in the patients with COVID-19 in future decision-making. These indicators might support clinical decisions to identify high fatality cases and poor diagnosis in the initial admission phase. In COVID-19 patients, we recommend close monitoring on procalcitonin, C-reactive protein, neutrophils count, and white blood cell count as a clinical indicator for potential progression to critical illness.

SARS-CoV-2 Induced Neurological Manifestations Entangles Cytokine Storm That Implicates For Therapeutic Strategies

The new coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can present with neurological symptoms and induce neurological complications. The involvement in both the central and peripheral nervous systems in COVID-19 patients has been associated with direct invasion of the virus and the induction of cytokine storm. This review discussed the pathways for the virus invasion into the nervous system and characterized the SARS-CoV-2 induced cytokine storm. In addition, the mechanisms underlying the immune responses and cytokine storm induction after SARS-CoV-2 infection were also discussed. Although some neurological symptoms are mild and disappear after recovery from infection, some severe neurological complications contribute to the mortality of COVID-19 patients. Therefore, the insight into the cause of SARS-CoV-2 induced cytokine storm in context with neurological complications will formulate the novel management of the disease and further identify new therapeutic targets for COVID-19.

Heart-lung interactions in COVID-19: prognostic impact and usefulness of bedside echocardiography for monitoring of the right ventricle involvement

Due to the SARS-CoV-2 infection–related severe pulmonary tissue damages associated with a relative specific widespread thrombotic microangiopathy, the pathophysiologic role of heart–lung interactions becomes crucial for the development and progression of right ventricular (RV) dysfunction. The high resistance in the pulmonary circulation, as a result of small vessel thrombosis and hypoxemia, is the major cause of right heart failure associated with a particularly high mortality in severe COVID-19. Timely identification of patients at high risk for RV failure, optimization of mechanical ventilation to limit its adverse effects on RV preload and afterload, avoidance of medication-related increase in the pulmonary vascular resistance, and the use of extracorporeal membrane oxygenation in refractory respiratory failure with hemodynamic instability, before RV failure develops, can improve patient survival. Since it was confirmed that the right-sided heart is particularly involved in the clinical deterioration of patients with COVID-19 and pressure overload-induced RV dysfunction plays a key role for patient outcome, transthoracic echocardiography (TTE) received increasing attention. Limited TTE focused on the right heart appears highly useful in hospitalized COVID-19 patients and particularly beneficial for monitoring of critically ill patients. In addition to detection of right-sided heart dilation and RV dysfunction, it enables assessment of RV-pulmonary arterial coupling and evaluation of RV adaptability to pressure loading which facilitate useful prognostic statements to be made. The increased use of bedside TTE focused on the right heart could facilitate more personalized management and treatment of hospitalized patients and can contribute towards reducing the high mortality associated with SARS-CoV-2 infection.

Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an infectious disease characterized by cough, fever, and fatigue and 20% of cases will develop into severe conditions resulting from acute lung injury with the manifestation of the acute respiratory distress syndrome (ARDS) that accounts for more than 50% of mortality. Currently, it has been reported that some comorbidities are linked with an increased rate of severity and mortality among COVID-19 patients. To assess the role of comorbidity in COVID-19 progression, we performed a systematic review with a meta-analysis on the relationship of COVID-19 severity with 8 different underlying diseases.

METHODS

PubMed, Web of Science, and CNKI were searched for articles investigating the prevalence of comorbidities in severe and non-severe COVID-19 patients. A total of 41 studies comprising 12,526 patients were included.

RESULTS

Prevalence of some commodities was lower than that in general population such as hypertension (19% vs 23.2%), diabetes (9% vs 10.9%), chronic kidney disease (CKD) (2% vs 9.5%), chronic liver diseases (CLD) (3% vs 24.8%) and chronic obstructive pulmonary disease (COPD) (3% vs 8.6%), while some others including cancer (1% vs 0.6%), cardiovascular disease (6% vs 1.8%) and cerebrovascular disease (2% vs 0.9%) exhibited greater percentage in COVID-19. Cerebrovascular disease (OR = 3.70, 95%CI 2.51-5.45) was found to be the strongest risk factor in disease exacerbation, followed by CKD (OR = 3.60, 95%CI 2.18-5.94), COPD (OR = 3.14, 95% CI 2.35-4.19), cardiovascular disease (OR = 2.76, 95% CI 2.18-3.49), malignancy (OR = 2.63, 95% CI 1.75-3.95), diabetes (OR = 2.49, 95% CI 2.10-2.96) and hypertension (OR = 2.13, 95% CI 1.81-2.51). We found no correlation between CLD and increased disease severity (OR = 1.32, 95% CI 0.96-1.82).

CONCLUSION

The impact of all eight underlying diseases on COVID-19 deterioration seemed to be higher in patients outside Hubei. Based on different comorbidities, COVID-19 patients tend to be at risk of developing poor outcomes to a varying degree. Thus, tailored infection prevention and monitoring and treatment strategies targeting these high-risk subgroups might improve prognosis during the COVID-19 pandemic.

Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis

Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the most threatening pandemic in modern history. The aim of this systematic review and meta-analysis was to investigate the associations between serum albumin concentrations and COVID-19 disease severity and adverse outcomes. A systematic literature search was conducted in PubMed, from inception to October 30, 2020. Sixty-seven studies in 19,760 COVID-19 patients (6141 with severe disease or poor outcome) were selected for analysis. Pooled results showed that serum albumin concentrations were significantly lower in patients with severe disease or poor outcome (standard mean difference, SMD: - 0.99 g/L; 95% CI, - 1.11 to - 0.88, p < 0.001). In multivariate meta-regression analysis, age (t =  - 2.13, p = 0.043), publication geographic area (t = 2.16, p = 0.040), white blood cell count (t =  - 2.77, p = 0.008) and C-reactive protein (t =  - 2.43, p = 0.019) were significant contributors of between-study variance. Therefore, lower serum albumin concentrations are significantly associated with disease severity and adverse outcomes in COVID-19 patients. The assessment of serum albumin concentrations might assist with early risk stratification and selection of appropriate care pathways in this group.

Anemia in patients with Covid-19: pathogenesis and clinical significance

COVID-19 patients typically present with lower airway disease, although involvement of other organ systems is usually the rule. Hematological manifestations such as thrombocytopenia and reduced lymphocyte and eosinophil numbers are highly prevalent in COVID-19 and have prognostic significance. Few data, however, are available about the prevalence and significance of anemia in COVID-19. In an observational study, we investigated the prevalence, pathogenesis and clinical significance of anemia among 206 patients with COVID-19 at the time of their hospitalization in an Internal Medicine unit. The prevalence of anemia was 61% in COVID-19, compared with 45% in a control group of 71 patients with clinical and laboratory findings suggestive of COVID-19, but nasopharyngeal swab tests negative for SARS-CoV-2 RNA (p = 0.022). Mortality was higher in SARS-CoV-2 positive patients. In COVID-19, females had lower hemoglobin concentration than males and a higher prevalence of moderate/severe anemia (25% versus 13%, p = 0.032). In most cases, anemia was mild and due to inflammation, sometimes associated with iron and/or vitamin deficiencies. Determinants of hemoglobin concentration included: erythrocyte sedimentation rate, serum cholinesterase, ferritin and protein concentrations and number of chronic diseases affecting each patient. Hemoglobin concentration was not related to overall survival that was, on the contrary, influenced by red blood cell distribution width, age, lactate dehydrogenase and the ratio of arterial partial oxygen pressure to inspired oxygen fraction. In conclusion, our results highlight anemia as a common manifestation in COVID-19. Although anemia does not directly influence mortality, it usually affects elderly, frail patients and can negatively influence their quality of life.

Wireless COVID-19 Telehealth: Leukocytes Encryption Guided by Amino Acid Matrix

In this era of wireless COVID-19 telehealth, visiting hospital for regular follow-ups could invite coronavirus in someone's body. Opting for proactive E-health services is the best thing. It helps the remote patients to share their confidential data through secured encryption. Telehealth services are emerging element in these proactive medical sciences. It helps the remote patients to share their confidential data through secured transmission. In this paper, amino acid guided matrix encoding scheme has been proposed. White blood cell count or Leukocute count is a dominant indicator of patients' health condition, even amid COVID-19. An abnormal growth in leukocyte count is mainly caused due to an infection, cancer, or any other severe symptoms. It initiates internal haematological inflammations, cardiovascular diseases, Type II diabetes, etc. Therefore, tracking leukocyte count may for disease diagnosis and further treatments. The leukocyte count is generally done in different pathologies, and the data evaluation needs the expertise of a pathologist. In this paper, a technique involving security measures to transmit the result of the histological test with the help of cryptography has been proposed. The data to be transferred to the concerned physician for further diagnosis with the help of proposed way of encryption using amino acids, which ensures no data loss, no data modification, no data theft in the middle of transmission. The proposed encryption method using the amino acid codes has produced results showing satisfactory performances such as p-values found to be 7.215544e-04 and 8.48904e-03 for the key stream and cipher key matrix monobit test respectively, and 8.10245e-04 and 8.10245e-04 for the key stream and cipher key matrix frequency test respectively. It may be used as a transmission module in any wireless COVID-19 Telehealth Systems.