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Farias PCS, Bezerra GSN, Neves PAF, Cabral LP, Júnior WLB, Guedes DL, Xavier AT, Medeiros ZM, Lorena VMB, Araújo PSR, de Queiroz Balbino V, de Lima Neto RG. Severe COVID-19 in HIV/Leishmania infantum coinfected patient: a successfully managed case report. BMC Infect Dis 2024; 24:854. [PMID: 39174900 PMCID: PMC11342618 DOI: 10.1186/s12879-024-09691-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 originated in China and swiftly spread worldwide, posing a significant threat to public health. Caused by SARS-CoV-2, it manifests as a flu-like illness that can escalate to Acute Respiratory Distress Syndrome, potentially resulting in fatalities. In countries where HIV/Leishmania infantum is endemic, the occurrence of concurrent SARS-CoV-2/HIV/Leishmania infantum infections is a reality, prompting inquiries into appropriate clinical management. CASE PRESENTATION We present the case of a 48-year-old woman who was hospitalized for 36 days across three different hospitals in the state of Pernambuco, Brazil. She was diagnosed with SARS-CoV-2/HIV/L. infantum coinfection. The patient exhibited severe COVID-19 symptoms, including fever, productive cough, and dyspnea. Throughout her hospitalization, she experienced oxygen saturation levels of ≤ 93%, along with fluctuations in blood pressure, respiratory rate, and heart rate. Her blood tests revealed lymphopenia, leukopenia, and neutropenia, while laboratory results indicated abnormal levels of d-dimer, AST, ALT, lactate dehydrogenase, ferritin, and C-reactive protein. A computed tomography scan revealed 75% involvement of the lung parenchyma with patchy ground-glass opacities. CONCLUSION Against all odds, the patient was discharged. The leukopenia associated with HIV/L. infantum may have played a decisive role. Further studies are necessary to better understand diagnostic strategies and clinical management measures for HIV/L. infantum coinfected patients who are susceptible to SARS-CoV-2 infection.
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Grants
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 310414/2022-9 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
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Affiliation(s)
| | - Gilberto Silva Nunes Bezerra
- Department of Nursing & Healthcare, Technological Univeristy of the Shannon: Midlands Midwest, Athlone, N37 HD68, Ireland
| | - Patrícia Areias Feitosa Neves
- Departamento Medicina Tropical, Universidade Federal de Pernambuco (UFPE), Recife, Brasil
- Departamento de Imunologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Pernambuco, Brasil
| | | | | | - Diego Lins Guedes
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brasil
- Núcleo de Ciências da Vida, Centro Acadêmico Do Agreste, Universidade Federal de Pernambuco, Caruaru, Brasil
| | - Amanda Tavares Xavier
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Pernambuco, Brasil
| | - Zulma Maria Medeiros
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Pernambuco, Brasil
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Lima TE, Ferraz MVF, Brito CAA, Ximenes PB, Mariz CA, Braga C, Wallau GL, Viana IFT, Lins RD. Determination of prognostic markers for COVID-19 disease severity using routine blood tests and machine learning. AN ACAD BRAS CIENC 2024; 96:e20230894. [PMID: 38922277 DOI: 10.1590/0001-376520242023089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/22/2024] [Indexed: 06/27/2024] Open
Abstract
The need for the identification of risk factors associated to COVID-19 disease severity remains urgent. Patients' care and resource allocation can be potentially different and are defined based on the current classification of disease severity. This classification is based on the analysis of clinical parameters and routine blood tests, which are not standardized across the globe. Some laboratory test alterations have been associated to COVID-19 severity, although these data are conflicting partly due to the different methodologies used across different studies. This study aimed to construct and validate a disease severity prediction model using machine learning (ML). Seventy-two patients admitted to a Brazilian hospital and diagnosed with COVID-19 through RT-PCR and/or ELISA, and with varying degrees of disease severity, were included in the study. Their electronic medical records and the results from daily blood tests were used to develop a ML model to predict disease severity. Using the above data set, a combination of five laboratorial biomarkers was identified as accurate predictors of COVID-19 severe disease with a ROC-AUC of 0.80 ± 0.13. Those biomarkers included prothrombin activity, ferritin, serum iron, ATTP and monocytes. The application of the devised ML model may help rationalize clinical decision and care.
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Affiliation(s)
- Tayná E Lima
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Matheus V F Ferraz
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
- Universidade Federal de Pernambuco, Departamento de Química Fundamental, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-560 Recife, PE, Brazil
| | - Carlos A A Brito
- Universidade Federal de Pernambuco, Hospital das Clínicas, Av. Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Pamella B Ximenes
- Hospital dos Servidores Públicos do Estado de Pernambuco, Av. Conselheiro Rosa e Silva, s/n, Espinheiro, 52020-020 Recife, PE, Brazil
| | - Carolline A Mariz
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Parasitologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Cynthia Braga
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Parasitologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Gabriel L Wallau
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Entomologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Isabelle F T Viana
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Roberto D Lins
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
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Walsh P, Hankins A, Bang H. Point-of-care lung ultrasound predicts hyperferritinemia and hospitalization, but not elevated troponin in SARS-CoV-2 viral pneumonitis in children. Sci Rep 2024; 14:5899. [PMID: 38467670 PMCID: PMC10928070 DOI: 10.1038/s41598-024-55590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
SARS-CoV-2 often causes viral pneumonitis, hyperferritinemia, elevations in D-dimer, lactate dehydrogenase (LDH), transaminases, troponin, CRP, and other inflammatory markers. Lung ultrasound is increasingly used to diagnose and stratify viral pneumonitis severity. We retrospectively reviewed 427 visits in patients aged 14 days to 21 years who had had a point-of-care lung ultrasound in our pediatric emergency department from 30/November/2019 to 14/August/2021. Lung ultrasounds were categorized using a 6-point ordinal scale. Lung ultrasound abnormalities predicted increased hospitalization with a threshold effect. Increasingly abnormal laboratory values were associated with decreased discharge from the ED and increased admission to the ward and ICU. Among patients SARS-CoV-2 positive patients ferritin, LDH, and transaminases, but not CRP or troponin were significantly associated with abnormalities on lung ultrasound and also with threshold effects. This effect was not demonstrated in SARS-CoV-2 negative patients. D-Dimer, CRP, and troponin were sometimes elevated even when the lung ultrasound was normal.
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Affiliation(s)
- Paul Walsh
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, USA.
| | - Andrea Hankins
- Sutter Institute for Medical Research, 2801 L Street, Sacramento, CA, USA
- Sutter Health Center for Health Systems Research, Sutter Health, Walnut Creek, CA, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, 1 Shields Ave, Davis, CA, USA
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AlShehhi A, Almansoori TM, Alsuwaidi AR, Alblooshi H. Utilizing machine learning for survival analysis to identify risk factors for COVID-19 intensive care unit admission: A retrospective cohort study from the United Arab Emirates. PLoS One 2024; 19:e0291373. [PMID: 38206939 PMCID: PMC10783720 DOI: 10.1371/journal.pone.0291373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The current situation of the unprecedented COVID-19 pandemic leverages Artificial Intelligence (AI) as an innovative tool for addressing the evolving clinical challenges. An example is utilizing Machine Learning (ML) models-a subfield of AI that take advantage of observational data/Electronic Health Records (EHRs) to support clinical decision-making for COVID-19 cases. This study aimed to evaluate the clinical characteristics and risk factors for COVID-19 patients in the United Arab Emirates utilizing EHRs and ML for survival analysis models. METHODS We tested various ML models for survival analysis in this work we trained those models using a different subset of features extracted by several feature selection methods. Finally, the best model was evaluated and interpreted using goodness-of-fit based on calibration curves,Partial Dependence Plots and concordance index. RESULTS The risk of severe disease increases with elevated levels of C-reactive protein, ferritin, lactate dehydrogenase, Modified Early Warning Score, respiratory rate and troponin. The risk also increases with hypokalemia, oxygen desaturation and lower estimated glomerular filtration rate and hypocalcemia and lymphopenia. CONCLUSION Analyzing clinical data using AI models can provide vital information for clinician to measure the risk of morbidity and mortality of COVID-19 patients. Further validation is crucial to implement the model in real clinical settings.
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Affiliation(s)
- Aamna AlShehhi
- Biomedical Engineering Department,College of Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hiba Alblooshi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Kim J, Qiao F, Singh AK, Won J, Singh I. Efficacies of S-nitrosoglutathione (GSNO) and GSNO reductase inhibitor in SARS-CoV-2 spike protein induced acute lung disease in mice. Front Pharmacol 2023; 14:1304697. [PMID: 38143504 PMCID: PMC10748393 DOI: 10.3389/fphar.2023.1304697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/28/2023] [Indexed: 12/26/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which initially surfaced in late 2019, often triggers severe pulmonary complications, encompassing various disease mechanisms such as intense lung inflammation, vascular dysfunction, and pulmonary embolism. Currently, however, there's no drug addressing all these mechanisms simultaneously. This study explored the multi-targeting potential of S-nitrosoglutathione (GSNO) and N6022, an inhibitor of GSNO reductase (GSNOR) on markers of inflammatory, vascular, and thrombotic diseases related to COVID-19-induced acute lung disease. For this, acute lung disease was induced in C57BL/6 mice through intranasal administration of recombinant SARS-CoV-2 spike protein S1 domain (SP-S1). The mice exhibited fever, body weight loss, and increased blood levels and lung expression of proinflammatory cytokines (e.g., TNF-α and IL-6) as well as increased vascular inflammation mediated by ICAM-1 and VCAM-1 and lung infiltration by immune cells (e.g., neutrophils, monocytes, and activated cytotoxic and helper T cells). Further, the mice exhibited increased lung hyperpermeability (lung Evans blue extravasation) leading to lung edema development as well as elevated blood coagulation factors (e.g., fibrinogen, thrombin, activated platelets, and von Willebrand factor) and lung fibrin deposition. Similar to the patients with COVID-19, male mice showed more severe disease than female mice, along with higher GSNOR expression in the lungs. Optimization of GSNO by treatment with exogenous GSNO or inhibition of GSNOR by N6022 (or GSNO knockout) protects against SP-S1-induced lung diseases in both genders. These findings provide evidence for the potential efficacies of GSNO and GSNOR inhibitors in addressing the multi-mechanistic nature of SARS-CoV-2 SP-associated acute-lung disease.
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Affiliation(s)
- Judong Kim
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Fei Qiao
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Avtar K. Singh
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
- Pathology and Laboratory Medicine Service, Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Jeseong Won
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Inderjit Singh
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
- Research Service, Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
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Kato CD, Nsubuga J, Niyonzima N, Kitibwa A, Matovu E, Othieno E, Ssebugere P, Tumwine AA, Namayanja M. Immunological and biochemical biomarker alterations among SARS-COV-2 patients with varying disease phenotypes in Uganda. BMC Infect Dis 2023; 23:857. [PMID: 38057707 DOI: 10.1186/s12879-023-08854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
Every novel infection requires an assessment of the host response coupled with identification of unique biomarkers for predicting disease pathogenesis, treatment targets and diagnostic utility. Studies have exposed dysregulated inflammatory response induced by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as significant predictor or cause of disease severity/prognosis and death. This study evaluated inflammatory biomarkers induced by SARS-CoV-2 in plasma of patients with varying disease phenotypes and healthy controls with prognostic or therapeutic potential. We stratified SARS-CoV-2 plasma samples based on disease status (asymptomatic, mild, severe, and healthy controls), as diagnosed by RT-PCR SARS-CoV-2. We used a solid phase sandwich and competitive Enzyme-Linked Immunosorbent Assay (ELISA) to measure levels of panels of immunological (IFN-γ, TNF-α, IL-6, and IL-10) and biochemical markers (Ferritin, Procalcitonin, C-Reactive Protein, Angiotensin II, Homocysteine, and D-dimer). Biomarker levels were compared across SARS-CoV-2 disease stratification. Plasma IFN-γ, TNF-α, IL-6, and IL-10 levels were significantly (P < 0.05) elevated in the severe SARS-CoV-2 patients as compared to mild, asymptomatic, and healthy controls. Ferritin, Homocysteine, and D-dimer plasma levels were significantly elevated in severe cases over asymptomatic and healthy controls. Plasma C-reactive protein and Angiotensin II levels were significantly (P < 0.05) higher in mild than severe cases and healthy controls. Plasma Procalcitonin levels were significantly higher in asymptomatic than in mild, severe cases and healthy controls. Our study demonstrates the role of host inflammatory biomarkers in modulating the pathogenesis of COVID-19. The study proposes a number of potential biomarkers that could be explored as SARS-CoV-2 treatment targets and possible prognostic predictors for a severe outcome. The comprehensive analysis of prognostic biomarkers may contribute to the evidence-based management of COVID-19 patients.
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Affiliation(s)
- Charles Drago Kato
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda.
| | - Julius Nsubuga
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda.
| | | | - Annah Kitibwa
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Enock Matovu
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Emmanuel Othieno
- Department of Pathology, Soroti University, P.O. Box 211, Soroti, Uganda
| | - Patrick Ssebugere
- Department of Chemistry, College of Natural Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Amanda Agnes Tumwine
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Monica Namayanja
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda
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Jegorović B, Nikolić A, Milinković N, Ignjatović S, Šipetić-Grujičić S. The utility of serum amyloid A and other acute-phase reactants determination in ambulatory care COVID-19 patients. J Med Biochem 2023; 42:492-504. [PMID: 37790210 PMCID: PMC10542288 DOI: 10.5937/jomb0-42799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 10/05/2023] Open
Abstract
Background The unpredictable course of Coronavirus Disease 19 (COVID-19) is making good severity assessment tools crucial. This study aimed to assess the usefulness of serum amyloid A (SAA) and other acute-phase reactants (APRs) in ambulatory care COVID-19 patients and identified relationships between these markers and disease outcomes. Methods From August to November 2020, patients seen in the outpatient department of the Clinic for Infectious and Tropical Diseases (Belgrade, Serbia) with confirmed COVID-19 were included. Patients were classified into mild, moderate, and severe disease groups based on World Health Organization criteria. SAA, C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), ferritin, fibrinogen, D-dimer, albumin, and transferrin were measured. The median values of all APRs were compared between COVID-19 severity groups, hospitalized and non-hospitalized patients, and survivors and non-survivors. The Receiver operator characteristic (ROC) curve analysis was used for the classification characteristics assessment of individual APRs for the severity of illness, hospitalization, and survival.
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Affiliation(s)
- Boris Jegorović
- University Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases "Prof. Dr. Kosta Todorović", Belgrade
| | - Aleksandra Nikolić
- University of Belgrade, Faculty of Medicine, Institute for Epidemiology, Belgrade
| | - Neda Milinković
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
| | - Svetlana Ignjatović
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade
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Chrzan R, Wizner B, Sydor W, Wojciechowska W, Popiela T, Bociąga-Jasik M, Olszanecka A, Strach M. Artificial intelligence guided HRCT assessment predicts the severity of COVID-19 pneumonia based on clinical parameters. BMC Infect Dis 2023; 23:314. [PMID: 37165346 PMCID: PMC10170419 DOI: 10.1186/s12879-023-08303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The purpose of the study was to compare the results of AI (artificial intelligence) analysis of the extent of pulmonary lesions on HRCT (high resolution computed tomography) images in COVID-19 pneumonia, with clinical data including laboratory markers of inflammation, to verify whether AI HRCT assessment can predict the clinical severity of COVID-19 pneumonia. METHODS The analyzed group consisted of 388 patients with COVID-19 pneumonia, with automatically analyzed HRCT parameters of volume: AIV (absolute inflammation), AGV (absolute ground glass), ACV (absolute consolidation), PIV (percentage inflammation), PGV (percentage ground glass), PCV (percentage consolidation). Clinical data included: age, sex, admission parameters: respiratory rate, oxygen saturation, CRP (C-reactive protein), IL6 (interleukin 6), IG - immature granulocytes, WBC (white blood count), neutrophil count, lymphocyte count, serum ferritin, LDH (lactate dehydrogenase), NIH (National Institute of Health) severity score; parameters of clinical course: in-hospital death, transfer to the ICU (intensive care unit), length of hospital stay. RESULTS The highest correlation coefficients were found for PGV, PIV, with LDH (respectively 0.65, 0.64); PIV, PGV, with oxygen saturation (respectively - 0.53, -0.52); AIV, AGV, with CRP (respectively 0.48, 0.46); AGV, AIV, with ferritin (respectively 0.46, 0.45). Patients with critical pneumonia had significantly lower oxygen saturation, and higher levels of immune-inflammatory biomarkers on admission. The radiological parameters of lung involvement proved to be strong predictors of transfer to the ICU (in particular, PGV ≥ cut-off point 29% with Odds Ratio (OR): 7.53) and in-hospital death (in particular: AIV ≥ cut-off point 831 cm3 with OR: 4.31). CONCLUSIONS Automatic analysis of HRCT images by AI may be a valuable method for predicting the severity of COVID-19 pneumonia. The radiological parameters of lung involvement correlate with laboratory markers of inflammation, and are strong predictors of transfer to the ICU and in-hospital death from COVID-19. TRIAL REGISTRATION National Center for Research and Development CRACoV-HHS project, contract number SZPITALE-JEDNOIMIENNE/18/2020.
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Affiliation(s)
- Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Kopernika 19, Krakow, 31-501, Poland.
| | - Barbara Wizner
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Sydor
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Kopernika 19, Krakow, 31-501, Poland
| | - Monika Bociąga-Jasik
- Department of Infectious Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Strach
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
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Porosnicu TM, Sirbu IO, Oancea C, Sandesc D, Bratosin F, Rosca O, Jipa D, Boeriu E, Bandi SSS, Pricop M. The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050867. [PMID: 37241099 DOI: 10.3390/medicina59050867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Due to the poor prognosis and the very high mortality rate associated with severe SARS-CoV-2 infections, various regimens have been tried to stop the evolution of the inflammatory cascade, such as immunomodulatory therapy and plasma clearance of the acute phase reactants involved. Therefore, the objective of this review was to analyze the effects of using therapeutic plasma exchange (TPE), also known as plasmapheresis, on the inflammatory markers of critically ill COVID-19 patients admitted to the intensive care unit (ICU). Materials and Methods: A thorough scientific database search was performed, and it included a review of articles published on PubMed, Cochrane Database, Scopus, and Web of Science from the beginning of the COVID-19 pandemic in March 2020 until September 2022 that focused on the treatment of SARS-CoV-2 infections using plasma exchange for patients admitted to the ICU. The current study included original articles, reviews, editorials, and short or special communications regarding the topic of interest. Results: A total of 13 articles were selected after satisfying the inclusion criterion of three or more patients enrolled with clinically severe COVID-19 that were eligible for TPE. From the included articles, it was observed that TPE was used as a last-resort salvage therapy that can be regarded as an alternative treatment method when the standard management for these patients fails. TPE significantly decreased the inflammatory status as measured by Interleukin-6 (IL-6), C-reactive protein (CRP), lymphocyte count, and D-dimers, as well as improving the clinical status measured with PaO2/FiO2 and duration of hospitalization. The pooled mortality risk reduction after TPE was 20%. Conclusions: There are sufficient studies and evidence to show that TPE reduces inflammatory mediators and improves coagulation function and the clinical/paraclinical status. Nevertheless, although it was shown that TPE decreases the severe inflammatory status without significant complications, the improvement of survival rate remains unclear.
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Affiliation(s)
- Tamara Mirela Porosnicu
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Intensive Care Unit, "Pius Brinzeu" Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Ioan Ovidiu Sirbu
- Center for Complex Network Sciences, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Dorel Sandesc
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Rosca
- Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Jipa
- Intensive Care Unit, "Pius Brinzeu" Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Estera Boeriu
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Satya Sai Sri Bandi
- Malla Reddy Institute of Medical Sciences, Suraram Main Road 138, Hyderabad 500055, India
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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10
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Plasma N-Cleaved Galectin-9 Is a Surrogate Marker for Determining the Severity of COVID-19 and Monitoring the Therapeutic Effects of Tocilizumab. Int J Mol Sci 2023; 24:ijms24043591. [PMID: 36835000 PMCID: PMC9964849 DOI: 10.3390/ijms24043591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Galectin-9 (Gal-9) is known to contribute to antiviral responses in coronavirus disease 2019 (COVID-19). Increased circulating Gal-9 in COVID-19 is associated with COVID-19 severity. In a while, the linker-peptide of Gal-9 is susceptible to proteolysis that can cause the change or loss of Gal-9 activity. Here, we measured plasma levels of N-cleaved-Gal9, which is Gal9 carbohydrate-recognition domain at the N-terminus (NCRD) with attached truncated linker peptide that differs in length depending on the type of proteases, in COVID-19. We also investigated the time course of plasma N-cleaved-Gal9 levels in severe COVID-19 treated with tocilizumab (TCZ). As a result, we observed an increase in plasma N-cleaved-Gal9 levels in COVID-19 and its higher levels in COVID-19 with pneumonia compared to the mild cases (healthy: 326.1 pg/mL, mild: 698.0 pg/mL, and with pneumonia: 1570 pg/mL). N-cleaved-Gal9 levels were associated with lymphocyte counts, C-reactive protein (CRP), soluble interleukin-2 receptor (sIL-2R), D-dimer, and ferritin levels, and ratio of percutaneous oxygen saturation to fraction of inspiratory oxygen (S/F ratio) in COVID-19 with pneumonia and discriminated different severity groups with high accuracy (area under the curve (AUC): 0.9076). Both N-cleaved-Gal9 and sIL-2R levels were associated with plasma matrix metalloprotease (MMP)-9 levels in COVID-19 with pneumonia. Furthermore, a decrease in N-cleaved-Gal9 levels was associated with a decrease of sIL-2R levels during TCZ treatment. N-cleaved-Gal9 levels showed a moderate accuracy (AUC: 0.8438) for discriminating the period before TCZ from the recovery phase. These data illustrate that plasma N-cleaved-Gal9 is a potential surrogate marker for assessing COVID-19 severity and the therapeutic effects of TCZ.
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11
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Islam MM, Islam S, Ahmed R, Majumder M, Sarkar B, Himu MER, Kawser M, Hossain A, Mia MJ, Parag RR, Bulbul MRH, Ahmed S, Sattar MA, Biswas R, Das M, Rahman MM, Shil RK, Parial R, Chowdhury S, Das M, Noman ASM, Hossain MM. Reduced IFN-γ levels along with changes in hematologic and immunologic parameters are key to COVID-19 severity in Bangladeshi patients. Exp Hematol 2023; 118:53-64.e1. [PMID: 36574579 PMCID: PMC9701580 DOI: 10.1016/j.exphem.2022.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
The manifestation of coronavirus disease 2019 (COVID-19) severity and mortality has been associated with dysregulation of the immune response, often influenced by racial disparities and conferred by changes in hematologic and immunologic parameters. These biological and hematologic parameters as well as cytokine profiles were investigated in a cohort of 61 COVID-19-positive patients (categorized into mild, moderate, and severe groups) from Bangladesh using standard analytical methods. The data reported that the interleukin (IL)-4 and IL-6 levels were significantly increased, whereas the levels of interferon (IFN)-γ were significantly reduced in patients with severe COVID-19 (p < 0.05) compared with those in patients with mild and/or moderate COVID-19. The extent of erythrocyte sedimentation rate (ESR); neutrophil count; and levels of ferritin, C-reactive protein (CRP), and D-dimer (p < 0.05) were found to be significantly increased, whereas the white blood cell (WBC), lymphocyte, eosinophil, and platelet counts (p < 0.05) were observed to be significantly reduced in patients with severe COVID-19 compared with those in the patients in other 2 groups. Our study exhibited a significantly higher IL-6-to-lymphocyte ratio in patients with severe COVID-19 than in those with mild and moderate COVID-19. The calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and ferritin-to-ESR ratio were significantly increased in patients with severe COVID-19. The increase in the IL-4 and IL-6 levels along with CRP and D-dimer levels may envisage a hyperinflammatory environment and immune dysregulation, which contribute to prolonged viral persistence, leading to severe disease. However, the reduced level of IFN-γ can be attributed to a less fatality toll in Bangladesh compared with that in the rest of the world.
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Affiliation(s)
- Mohammed Moinul Islam
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Shafiqul Islam
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh,Stem Cell Genetics, Institute for Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Ridwan Ahmed
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Mohit Majumder
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Bishu Sarkar
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Md. Ejajur Rahman Himu
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Md Kawser
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Alamgir Hossain
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Mohammad Jewel Mia
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Rashed Rezwan Parag
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | | | - Shakeel Ahmed
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - MA Sattar
- Department of Medicine, Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Rajdeep Biswas
- Anaesthesia & ICU department, General Hospital, Chattogram, Bangladesh
| | - Moumita Das
- Anaesthesia & ICU department, General Hospital, Chattogram, Bangladesh
| | - Md. Mizanur Rahman
- EuGEF Research Foundation, Chattogram, Bangladesh,Department of Biochemistry, Rangamati Medical College, Rangamati, Bangladesh
| | - Rajib Kumar Shil
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Ramendu Parial
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Srikanta Chowdhury
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Manisha Das
- EuGEF Research Foundation, Chattogram, Bangladesh
| | - Abu Shadat Mohammod Noman
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh,EuGEF Research Foundation, Chattogram, Bangladesh
| | - Muhammad Mosaraf Hossain
- Department of Biochemistry & Molecular Biology, University of Chittagong, Chattogram, Bangladesh; EuGEF Research Foundation, Chattogram, Bangladesh.
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12
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Hortová-Kohoutková M, Skotáková M, Onyango IG, Slezáková M, Panovský R, Opatřil L, Slanina P, De Zuani M, Mrkva O, Andrejčinová I, Lázničková P, Dvončová M, Mýtniková A, Ostland V, Šitina M, Stokin GB, Šrámek V, Vlková M, Helán M, Frič J. Hepcidin and ferritin levels as markers of immune cell activation during septic shock, severe COVID-19 and sterile inflammation. Front Immunol 2023; 14:1110540. [PMID: 36776891 PMCID: PMC9911830 DOI: 10.3389/fimmu.2023.1110540] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Major clinically relevant inflammatory events such as septic shock and severe COVID-19 trigger dynamic changes in the host immune system, presenting promising candidates for new biomarkers to improve precision diagnostics and patient stratification. Hepcidin, a master regulator of iron metabolism, has been intensively studied in many pathologies associated with immune system activation, however these data have never been compared to other clinical settings. Thus, we aimed to reveal the dynamics of iron regulation in various clinical settings and to determine the suitability of hepcidin and/or ferritin levels as biomarkers of inflammatory disease severity. Cohorts To investigate the overall predictive ability of hepcidin and ferritin, we enrolled the patients suffering with three different diagnoses - in detail 40 patients with COVID-19, 29 patients in septic shock and eight orthopedic patients who were compared to nine healthy donors and all cohorts to each other. Results We showed that increased hepcidin levels reflect overall immune cell activation driven by intrinsic stimuli, without requiring direct involvement of infection vectors. Contrary to hepcidin, ferritin levels were more strongly boosted by pathogen-induced inflammation - in septic shock more than four-fold and in COVID-19 six-fold in comparison to sterile inflammation. We also defined the predictive capacity of hepcidin-to-ferritin ratio with AUC=0.79 and P = 0.03. Discussion Our findings confirm that hepcidin is a potent marker of septic shock and other acute inflammation-associated pathologies and demonstrate the utility of the hepcidin-to-ferritin ratio as a predictor of mortality in septic shock, but not in COVID-19.
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Affiliation(s)
| | - Monika Skotáková
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Isaac G. Onyango
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Miriam Slezáková
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Roman Panovský
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,1st Department of Internal Medicine/Cardioangiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Lukáš Opatřil
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,1st Department of Internal Medicine/Cardioangiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Peter Slanina
- Institute of Clinical Immunology and Allergology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Marco De Zuani
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Ondřej Mrkva
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Ivana Andrejčinová
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petra Lázničková
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Martina Dvončová
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Alexandra Mýtniková
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Michal Šitina
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Gorazd B. Stokin
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,Celica BIOMEDICAL, Ljubljana, Slovenia,Division of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Vladimír Šrámek
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Marcela Vlková
- Institute of Clinical Immunology and Allergology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Helán
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Frič
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia,Department of Modern Immunotherapy, Institute of Hematology and Blood Transfusion, Prague, Czechia,*Correspondence: Jan Frič,
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13
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Relationship Among Clinically Obtained Biomarkers of Inflammation, Hypercoagulability, and Macrophage Activation, and Delirium in Critically Ill Patients With COVID-19. Crit Care Explor 2023; 5:e0851. [PMID: 36699256 PMCID: PMC9851691 DOI: 10.1097/cce.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Critically ill patients with COVID-19 experience high rates of delirium and coma. Whether delirium occurs through novel mechanisms in COVID-19 is not known. We analyzed the relationship among biomarkers of inflammation (C-reactive protein [CRP]), hypercoagulability (d-dimer), and lung macrophage activation (ferritin), and the primary composite outcome of delirium/coma next day. We also measured associations between biomarkers and next day delirium and coma independently, and delirium severity. DESIGN Retrospective, observational cohort study. SETTING ICUs at two large, urban, academic referral hospitals. PATIENTS All consecutive adult patients admitted to the ICU from March 1, 2020, to June 7, 2020, with COVID-19 with clinical biomarkers and delirium assessments performed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Daily concentrations of CRP, d-dimer, and ferritin were obtained. Coma (assessed by Richmond Agitation-Sedation Scale) and delirium (assessed by Confusion Assessment Method for the ICU/Confusion Assessment Method for the ICU-7) were measured bid. A cohort of 197 ICU patients with COVID-19 were included. Higher d-dimer (odds ratio [OR], 1.57; 95% CI, 1.17-2.12; p < 0.01) and ferritin quartiles (OR, 1.36; 95% CI, 1.02-1.81; p < 0.01) were associated with greater odds of the composite outcome of delirium/coma next day. d-dimer was associated with greater odds of next day delirium (OR, 1.49; 95% CI, 1.14-1.94; p < 0.01) and coma independently (OR, 1.52; 95% CI, 1.08-2.14; p = 0.017). Higher ferritin quartiles were associated with greater odds of next day delirium (OR, 1.33; 95% CI, 1.04-1.70; p = 0.026) and coma independently (OR, 1.59; 95% CI, 1.14-2.23; p < 0.01). Higher CRP quartiles were associated with coma (OR, 1.36; 95% CI, 1.03-1.79; p = 0.030) and delirium severity the next day (β = 0.30; se, 0.07; p ≤ 0.01). CONCLUSIONS Our hypothesis-generating study found d-dimer and ferritin were associated with delirium/coma the following day, as well as delirium and coma independently. CRP was associated with next day coma and delirium severity. Larger studies to validate these results are needed.
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14
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Yakut N, Yakut K, Sarihan Z, Kabasakal I, Aydin M, Karabulut N. Predictors of pulmonary involvement in children with COVID-19: How strongly associated is viral load? Pediatr Pulmonol 2023; 58:107-114. [PMID: 36130867 PMCID: PMC9538254 DOI: 10.1002/ppul.26165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to identify risk factors for pulmonary involvement by examining the demographic, clinical, and laboratory characteristics of children with COVID-19. We performed a retrospective single-center study of COVID-19 in children treated at a tertiary care hospital in Turkey from December 2020 to June 2021. During the course of the study, 126 patients were evaluated, of whom 70/126 were male. The patients' ages ranged from 1 to 216 (mean, 4.73 ± 81.11) months. Fever (65.9%), cough (52.4%), and shortness of breath (18.3%) were the most common symptoms of COVID-19. Ten patients required noninvasive mechanical ventilation. Sixty-nine patients (54.8%) had pneumonia. Longer duration of fever, hospitalization, and the presence of cough were significantly associated with pulmonary involvement. Children with pneumonia had significantly higher levels of C-reactive protein (CRP), procalcitonin, erythrocyte sedimentation rate (ESR), and viral load, and significantly lower counts of lymphocytes and thrombocytes. The cutoff viral load, CRP, and procalcitonin values for predicting pulmonary involvement were 26.5 cycle threshold (Ct; 95% confidence interval [CI], 0.54-0.74; sensitivity, 0.65; specificity, 0.56; area under curve [AUC]: 0.647, p = 0.005), 7.85 mg/L (95% CI, 0.56-0.75; sensitivity, 0.66; specificity, 0.64; AUC = 0.656; p = 0.003) and 0.105 ng/ml (95% CI, 0.52-0.72; sensitivity, 0.55; specificity, 0.58; AUC = 0.626; p = 0.02), respectively. High CRP, procalcitonin levels, ESR, and viral load, and low lymphocyte and thrombocyte counts can predict pulmonary involvement in children with COVID-19, so better management may be provided for good prognosis.
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Affiliation(s)
- Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Kahraman Yakut
- Division of Pediatric Cardiology, Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Zeynep Sarihan
- Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Irem Kabasakal
- Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Murat Aydin
- Department of Pediatrics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nuran Karabulut
- Department of Medical Microbiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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15
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Ferritin and procalcitonin in COVID-19 associated acute kidney injury – gender disparities, but similar outcomes. REV ROMANA MED LAB 2023. [DOI: 10.2478/rrlm-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Abstract
Background: Acute kidney injury is a severe complication of COVID-19. Both COVID-19 and related acute kidney injury are reported in the literature to be more prevalent and more severe in males.
Methods: We performed a retrospective analysis of the COVID-19 associated acute kidney injury cases in order to search for differences between genders regarding patients’ and renal outcome.
Results: 250 patients with acute kidney injury were included in the study: 93 women (37.20%), 157 men (62.80%). There were no differences between sexes regarding age. Diabetes mellitus was significantly more present in women. Peak ferritin and procalcitonin levels were significantly higher in men, but other severity markers for COVID-19 did not differ between genders. There were no differences between sexes regarding history of chronic kidney disease, timing of acute kidney injury, need for dialysis or recovery of renal function. ICU admission and in-hospital mortality were similar between men and women.
Conclusions: In our study, COVID-19 related-AKI was more prevalent in men than in women, but the patients’ and renal outcome were similar. Significantly higher ferritin and procalcitonin serum levels registered in male patients when compared to women may have additional explanations beside more severe SARS-CoV-2 infection in males.
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16
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Shakaroun DA, Lazar MH, Horowitz JC, Jennings JH. Serum Ferritin as a Predictor of Outcomes in Hospitalized Patients with Covid-19 Pneumonia. J Intensive Care Med 2023; 38:21-26. [PMID: 35815883 PMCID: PMC9274159 DOI: 10.1177/08850666221113252] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose: Elevated ferritin levels are associated with poor outcomes in Covid-19 patients. Optimal timing of ferritin assessment and the merit of longitudinal values remains unclear. Methods: Patients admitted to Henry Ford Hospital with confirmed SARS-CoV-2 were studied. Regression models were used to determine the relation between ferritin and mortality, need for mechanical ventilation, ICU admission, and days on the ventilator. Results: 2265 patients were evaluated. Patients with an initial ferritin of > 490 ng/mL had an increased risk of death (OR 3.4, P < .001), admission to the ICU (OR 2.78, P < .001) and need for mechanical ventilation (OR 3.9, P < .001). There was no difference between admission and Day 1 ICU ferritin levels (611.5 ng/mL vs. 649 ng/mL respectively; P = .07). The decline in ferritin over ICU days 1-4 was similar between survivors and non-survivors. A change in ferritin levels from admission to ICU Day 1 (P = .330), or from ICU Day 1 to 2 (P = .788), did not predict days on the ventilator. Conclusions: Initial Ferritin levels were highly predictive of ICU admission, the need for mechanical ventilation and in-hospital mortality. However, longitudinal measures of ferritin throughout the hospital stay did not provide additional predictive value.
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Affiliation(s)
- Dania A. Shakaroun
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Michael H. Lazar
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Jeffrey C. Horowitz
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Ohio State University, Columbus, OH, USA
| | - Jeffrey H. Jennings
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI, USA,Jeffrey H. Jennings, Care Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17. 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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17
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R Mohamed E, Ragab D, Taeimah M, Shaltoot H. Risk factors of intensive care admission and mortality in a cohort of 111 Egyptian COVID-19 patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2121479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Enas R Mohamed
- Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina Ragab
- Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Taeimah
- Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Shaltoot
- Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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18
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Carrión-Nessi FS, Castro MP, Freitas-De Nobrega DC, Moncada-Ortega A, Omaña-Ávila ÓD, Mendoza-Millán DL, Marcano-Rojas MV, Trejo NJ, Virriel IV, Chavero M, Camejo-Ávila NA, Rodriguez-Morales AJ, Forero-Peña DA. Clinical-epidemiological characteristics and maternal-foetal outcomes in pregnant women hospitalised with COVID-19 in Venezuela: a retrospective study. BMC Pregnancy Childbirth 2022; 22:905. [PMID: 36471262 PMCID: PMC9720989 DOI: 10.1186/s12884-022-05253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, pregnant women and newborns are more vulnerable to adverse outcomes from coronavirus disease 2019 (COVID-19). However, in Venezuela, there are no integrated data in a national surveillance system to identify the clinical-epidemiological characteristics and maternal-foetal outcomes of pregnant women hospitalised with COVID-19. METHODS A retrospective study was conducted among Venezuelan pregnant women hospitalised with COVID-19 seen at the "Ruiz y Páez" University Hospital Complex and the San Cristobal Central Hospital between June 2020 and September 2021. Information was obtained from physical and digitised clinical records using a purpose-designed proforma to collect epidemiological, clinical, paraclinical, treatment, obstetric and perinatal complications, and maternal-foetal outcomes data. RESULTS A total of 80 pregnant women with confirmed severe acute respiratory syndrome coronavirus 2 infection were seen within the study period, 59 (73.8%) survived and 21 (26.2%) died. The median (interquartile range) age was 29 (23-33) years, the majority being in the third trimester of pregnancy (81.2%; n = 65). Interestingly, four (5%) pregnant women were co-infected with malaria by Plasmodium vivax and three (3.8%) with syphilis. The most frequent symptoms were fever (75%; n = 60), dry cough (68.8%; n = 55), dyspnoea (55%; n = 44), and headache (53.8%; n = 43). The most frequent maternal complications were anaemia (51.5%; n = 66) and hypertensive disorders of pregnancy (17.5%; n = 14). The most frequent perinatal complications were preterm delivery (39.2%; n = 20/51) and oligohydramnios (31.3%; n = 25). A total of 29 (36.3%) adverse foetal outcomes were documented, 21 stillbirth and eight abortions. CONCLUSION This is the first study to describe the clinical-epidemiological behaviour of COVID-19 in hospitalised Venezuelan pregnant women. Anaemia, hypertensive disorders of pregnancy, oligohydramnios, and low birth weight were the most frequent maternal-foetal complications in this population of pregnant women.
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Affiliation(s)
- Fhabián S. Carrión-Nessi
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,“Dr. Francisco Battistini Casalta” Health Sciences School, University of Oriente – Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Mercedes P. Castro
- Obstetrics and Gynaecology Department, San Cristobal Central Hospital, San Cristobal, Venezuela
| | - Diana C. Freitas-De Nobrega
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,“Dr. Francisco Battistini Casalta” Health Sciences School, University of Oriente – Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Augusto Moncada-Ortega
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,grid.8171.f0000 0001 2155 0982“José María Vargas” School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Óscar D. Omaña-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,grid.8171.f0000 0001 2155 0982“Luis Razetti” School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniela L. Mendoza-Millán
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,grid.8171.f0000 0001 2155 0982“Luis Razetti” School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | | | - Nayren J. Trejo
- “Dr. Francisco Battistini Casalta” Health Sciences School, University of Oriente – Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Isabella V. Virriel
- “Dr. Francisco Battistini Casalta” Health Sciences School, University of Oriente – Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Melynar Chavero
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Natasha A. Camejo-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,“Dr. Francisco Battistini Casalta” Health Sciences School, University of Oriente – Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Alfonso J. Rodriguez-Morales
- grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Américas - Institución Universitaria Visión de Las Américas, Pereira, Risaralda Colombia ,grid.411323.60000 0001 2324 5973Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon ,grid.430666.10000 0000 9972 9272Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - David A. Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela ,grid.411226.2Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
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19
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Assante G, Tourna A, Carpani R, Ferrari F, Prati D, Peyvandi F, Blasi F, Bandera A, Le Guennec A, Chokshi S, Patel VC, Cox IJ, Valenti L, Youngson NA. Reduced circulating FABP2 in patients with moderate to severe COVID-19 may indicate enterocyte functional change rather than cell death. Sci Rep 2022; 12:18792. [PMID: 36335131 PMCID: PMC9637119 DOI: 10.1038/s41598-022-23282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022] Open
Abstract
The gut is of importance in the pathology of COVID-19 both as a route of infection, and gut dysfunction influencing the severity of disease. Systemic changes caused by SARS-CoV-2 gut infection include alterations in circulating levels of metabolites, nutrients and microbial products which alter immune and inflammatory responses. Circulating plasma markers for gut inflammation and damage such as zonulin, lipopolysaccharide and β-glycan increase in plasma along with severity of disease. However, Intestinal Fatty Acid Binding Protein / Fatty Acid Binding Protein 2 (I-FABP/FABP2), a widely used biomarker for gut cell death, has paradoxically been shown to be reduced in moderate to severe COVID-19. We also found this pattern in a pilot cohort of mild (n = 18) and moderately severe (n = 19) COVID-19 patients in Milan from March to June 2020. These patients were part of the first phase of COVID-19 in Europe and were therefore all unvaccinated. After exclusion of outliers, patients with more severe vs milder disease showed reduced FABP2 levels (median [IQR]) (124 [368] vs. 274 [558] pg/mL, P < 0.01). A reduction in NMR measured plasma relative lipid-CH3 levels approached significance (median [IQR]) (0.081 [0.011] vs. 0.073 [0.024], P = 0.06). Changes in circulating lipid levels are another feature commonly observed in severe COVID-19 and a weak positive correlation was observed in the more severe group between reduced FABP2 and reduced relative lipid-CH3 and lipid-CH2 levels. FABP2 is a key regulator of enterocyte lipid import, a process which is inhibited by gut SARS-CoV-2 infection. We propose that the reduced circulating FABP2 in moderate to severe COVID-19 is a marker of infected enterocyte functional change rather than gut damage, which could also contribute to the development of hypolipidemia in patients with more severe disease.
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Affiliation(s)
- G Assante
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College, London, UK
| | - A Tourna
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College, London, UK
| | - R Carpani
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - F Ferrari
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - D Prati
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - F Peyvandi
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - F Blasi
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - A Bandera
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - A Le Guennec
- Randall Centre for Cell & Molecular Biophysics, King's College, London, UK
| | - S Chokshi
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College, London, UK
| | - V C Patel
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, King's College, London, UK
- Institute of Liver Studies, King's College Hospital, London, UK
| | - I J Cox
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK.
- Faculty of Life Sciences & Medicine, King's College, London, UK.
| | - L Valenti
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy.
| | - N A Youngson
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK.
- Faculty of Life Sciences & Medicine, King's College, London, UK.
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20
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Muacevic A, Adler JR, Markofski M, Dao K, Shaw E, Odum C, Parisio-Poldiak N, Finer A, Flynn M. Utility of the HScore for Predicting COVID-19 Severity. Cureus 2022; 14:e31969. [PMID: 36589196 PMCID: PMC9795835 DOI: 10.7759/cureus.31969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cytokine release syndrome is a life-threatening condition known to cause fever and multiple organ dysfunction and is suspected to be related to the severity of coronavirus disease 2019 (COVID-19). We sought to examine the utility of the HScore and non-cytokine markers of inflammation for predicting COVID-19 outcomes. We hypothesized that cytokine storm, assessed by a modified HScore, would be linked to more severe COVID-19 symptoms and higher mortality. METHODS A retrospective review of records from a large, private hospital system was conducted on patients with hemophagocytic lymphohistiocytosis (HLH) (2014-2019) and compared to a large cohort of COVID-19-positive patients (2020). Patients with a sufficient number of elements in their record for a modified HScore calculation (n=4663), were further subdivided into population 1 (POP1, n=67; HLH, n=493 COVID-19), which had eight HScore elements, and population 2 (POP2) with six available HScore elements (POP2, n=102; HLH, n=4561 COVID-19). RESULTS Modified HScore predicted COVID-19 severity in POP1 and POP2 as measured by higher odds of being on a ventilator (POP2 OR: 1.46, CI: 1.42-1.5), ICU admission (POP2 OR: 1.38, CI: 1.34-1.42), a longer length of stay (p<0.0001), and higher mortality (POP2 OR: 1.34, CI: 1.31-1.39). C-reactive protein (CRP) and white blood cell (WBC) count were the most consistent non-cytokine predictors of COVID-19 severity. CONCLUSION Cytokine storm, evaluated using a modified HScore, appeared to play a role in the severity of COVID-19 infection, and selected non-cytokine markers of inflammation were predictive of disease severity.
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21
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Severity and Mortality Predictors of COVID-19 Patients with Thrombotic Events-Evidence from the "COVID-One" Hospital in Albania. Vaccines (Basel) 2022; 10:vaccines10111851. [PMID: 36366360 PMCID: PMC9697823 DOI: 10.3390/vaccines10111851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
COVID-19 vaccination leads to lower infection, morbidity, and mortality rates. However, COVID-19 infection leads to the development of coagulopathy-related manifestations in the form of both venous and arterial thromboembolism. This study aimed to assess the severity and mortality predictors of COVID-19 patients with thrombotic events in hospitalized patients in Albania. This is a retrospective study conducted in the “Mother Tereza” University Hospital of Tirana. Data were retrieved from the electronic databases of the hospital and only COVID-19 cases admitted to the infectious department during August−December 2020 were selected. Patients who, at admission, had a C-reactive protein (CRP) (mg/L) more than double and a D-dimer (ng/mL) more than triple according to international standards were included in the study. We performed univariate and multivariable logistic regression analysis, calculating unadjusted and adjusted odds ratios (ORs). A p-value < 0.05 was considered statistically significant. The study population included 60 hospitalized persons with a mean age of 64.4 years. Increased lactate dehydrogenase (LDH) (OR = 2.93; 95% CI = 0.82−10.42, p-value = 0.1) and increased creatine kinase (CK) (OR = 2.17; 95% CI = 0.63−7.46, p-value = 0.22) were related with increased probability of death. Moreover, a decreased number of lymphocytes was associated with increased mortality but with no statistical significance (OR = 0.40; 95% CI = 0.11−1.40, p-value = 0.15). The survival rate was higher for patients without comorbidities (p = 0.045). These results could serve as a baseline and as a reference for healthcare personnel who provides services to hospitalized patients with COVID-19. Further studies should take into consideration the vaccination of the population as well as including more hospitals and patients.
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22
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Matsumura Y, Sugiyama T, Kondo N, Miyahara M, Hanaoka N, Nagashima H, Kasahara Y, Fujiyoshi N, Inada A, Inaba S. Fluid restriction management in the treatment of COVID-19: a single-center observational study. Sci Rep 2022; 12:17339. [PMID: 36243779 PMCID: PMC9569332 DOI: 10.1038/s41598-022-22389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
The relationship between fluid management and the severity of illness, duration of treatment, and outcome of coronavirus disease 2019 (COVID-19) is not fully understood. This study aimed to evaluate whether weight change during hospitalization was associated with COVID-19 severity, length of hospital stay, and route of admission. In this study, we assessed the effectiveness of fluid restriction management in patients with severe COVID-19. COVID-19 patients admitted to our hospital between July 2020 and October 2021 were analyzed. Patients were treated with standard drug therapy based on the Japanese guidelines and respiratory support according to the severity of the disease. Early enteral nutrition, defecation management, and anticoagulation therapy were also administered. Fluid restriction management was performed using furosemide and continuous renal replacement therapy as needed unless hemodynamic instability or hyperlactatemia was present. Patient background, route of admission (ambulance, A; transfer, T), weight at admission and discharge, the severity of illness (oxygen therapy, G1; mechanical ventilation, G2; extracorporeal membrane oxygenation, G3), in-hospital mortality, and length of hospital stay were analyzed. There were 116 subjects: G1 (n = 48), G2 (n = 43), and G3 (n = 25), with ages (median [IQR]) of 58 (47-70), 65 (53-71.5), 56 (51-62) years, 40 (83.3%), 31 (72.1%), and 19 (76.0%) males, respectively. Hospital stays were 4.5 (2-7), 10 (7-16), and 18 (15-26) days, and the in-hospital mortality rates were 0 (0%), 7 (16.3%), and 8 (32%), respectively. Body mass index on admission was 26 (23.1-30.2), 27.1 (22.7-31.1), and 31.5 (27.1-33.1) kg/m2, and weight loss during admission was 1.1 (0-2.9), 4.6 (2.3-5.7), 9.2 (5.6-10.5) kg (P < 0.001, Jonckheere-Terpstra test. Weight loss in the severe group (G2 + G3) was 3.4 (0.5-5.8) kg [A, n = 12] and 5.6 (4.4-9) kg [T, n = 43] [P = 0.026, Mann-Whitney U test]. The lengths of hospital stay were 5 (2-7), 9 (7-15), and 18 (12-26) days [P < 0.001, Jonckheere-Terpstra test]. In our fluid restriction management, patients with severe COVID-19 had significant longer hospital length of stay, weight loss, especially those who were transferred to the hospital.
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Affiliation(s)
- Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan.
| | - Takuya Sugiyama
- Department of Anesthesiology, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Natsuki Kondo
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Masaya Miyahara
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Noriyuki Hanaoka
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Hideaki Nagashima
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Yuki Kasahara
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Naohiko Fujiyoshi
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Azusa Inada
- Department of Anesthesiology, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Shin Inaba
- Department of Anesthesiology, Chiba Emergency Medical Center, Chiba, Chiba, Japan
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23
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Radandish M, Esmaeil N, Khorvash F, Andalib A. Diagnostic Value of Natural Killer Cells, CD56+ CD16+ Natural Killer Cells, NLRP3, and Lactate Dehydrogenase in Severe/Critical COVID-19: A Prospective Longitudinal Study According to the Severe/Critical COVID-19 Definitions. Viral Immunol 2022; 35:616-628. [PMID: 36099205 DOI: 10.1089/vim.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Innate immunity, as the first line of defense of our immune system, plays a crucial role in defending against SARS-CoV-2 infection and also its immunopathogenesis. We aim to investigate the immune status of natural killer (NK) cells, natural killer T (NKT) cells, and NLRP3 gene expression in COVID-19 patient blood samples. The immunophenotype of NK cell subsets and NKT cells was detected by flow cytometry and the expression of NLRP3 gene assessed by reverse transcriptase real-time polymerase chain reaction in 44 COVID-19 patients and 20 healthy individuals. The percentage of most of NK cell subpopulation and NKT cells was significantly decreased in COVID-19 patients. The percentage of CD56dim CD16- NK cell subsets, and NLRP3 gene expression increased. The percentage of total NK cells, CD56+ CD16+ NK cells, and NLRP3 gene expression had acceptable sensitivity and specificity for assisting diagnosis of severe/critical COVID-19. O2 saturation% and lactate dehydrogenase levels showed valuable diagnostic value to identify critical cases. The declined NK and NKT cells in COVID-19 patients and enhanced NLRP3 gene expression were associated with disease severity. Total NK cells, CD56+ CD16+ NK cells, and NLRP3 gene expression might be used as meaningful indicators for assisting diagnosis of severe/critical COVID-19.
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Affiliation(s)
- Maedeh Radandish
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Esmaeil
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzin Khorvash
- Department of Infectious Diseases, Faculty of Medicine, Nosocomial Infections Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Andalib
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Sarkar A, Sanyal S, Majumdar A, Tewari DN, Bhattacharjee U, Pal J, Chakrabarti AK, Dutta S. Development of lab score system for predicting COVID-19 patient severity: A retrospective analysis. PLoS One 2022; 17:e0273006. [PMID: 36084080 PMCID: PMC9462772 DOI: 10.1371/journal.pone.0273006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022] Open
Abstract
Aim To develop an accurate lab score based on in-hospital patients’ potent clinical and biological parameters for predicting COVID-19 patient severity during hospital admission. Methods To conduct this retrospective analysis, a derivation cohort was constructed by including all the available biological and clinical parameters of 355 COVID positive patients (recovered = 285, deceased = 70), collected in November 2020-September 2021. For identifying potent biomarkers and clinical parameters to determine hospital admitted patient severity or mortality, the receiver operating characteristics (ROC) curve and Fischer’s test analysis was performed. Relative risk regression was estimated to develop laboratory scores for each clinical and routine biological parameter. Lab score was further validated by ROC curve analysis of the validation cohort which was built with 50 COVID positive hospital patients, admitted during October 2021-January 2022. Results Sensitivity vs. 1-specificity ROC curve (>0.7 Area Under the Curve, 95% CI) and univariate analysis (p<0.0001) of the derivation cohort identified five routine biomarkers (neutrophil, lymphocytes, neutrophil: lymphocytes, WBC count, ferritin) and three clinical parameters (patient age, pre-existing comorbidities, admitted with pneumonia) for the novel lab score development. Depending on the relative risk (p values and 95% CI) these clinical parameters were scored and attributed to both the derivation cohort (n = 355) and the validation cohort (n = 50). ROC curve analysis estimated the Area Under the Curve (AUC) of the derivation and validation cohort which was 0.914 (0.883–0.945, 95% CI) and 0.873 (0.778–0.969, 95% CI) respectively. Conclusion The development of proper lab scores, based on patients’ clinical parameters and routine biomarkers, would help physicians to predict patient risk at the time of their hospital admission and may improve hospital-admitted COVID-19 patients’ survivability.
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Affiliation(s)
- Arnab Sarkar
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Surojit Sanyal
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Agniva Majumdar
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Devendra Nath Tewari
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Uttaran Bhattacharjee
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Juhi Pal
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Alok Kumar Chakrabarti
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
- * E-mail:
| | - Shanta Dutta
- ICMR- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
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25
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Microbiological and Clinical Findings of SARS-CoV-2 Infection after 2 Years of Pandemic: From Lung to Gut Microbiota. Diagnostics (Basel) 2022; 12:diagnostics12092143. [PMID: 36140544 PMCID: PMC9498253 DOI: 10.3390/diagnostics12092143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 01/08/2023] Open
Abstract
Early recognition and prompt management are crucial for improving survival in COVID-19 patients, and after 2 years of the pandemic, many efforts have been made to obtain an early diagnosis. A key factor is the use of fast microbiological techniques, considering also that COVID-19 patients may show no peculiar signs and symptoms that may differentiate COVID-19 from other infective or non-infective diseases. These techniques were developed to promptly identify SARS-CoV-2 infection and to prevent viral spread and transmission. However, recent data about clinical, radiological and laboratory features of COVID-19 at time of hospitalization could help physicians in early suspicion of SARS-CoV-2 infection and distinguishing it from other etiologies. The knowledge of clinical features and microbiological techniques will be crucial in the next years when the endemic circulation of SARS-CoV-2 will be probably associated with clusters of infection. In this review we provide a state of the art about new advances in microbiological and clinical findings of SARS-CoV-2 infection in hospitalized patients with a focus on pulmonary and extrapulmonary characteristics, including the role of gut microbiota.
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26
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Jo HY, Kim SC, Ahn DH, Lee S, Chang SH, Jung SY, Kim YJ, Kim E, Kim JE, Kim YS, Park WY, Cho NH, Park D, Lee JH, Park HY. Establishment of the large-scale longitudinal multi-omics dataset in COVID-19 patients: data profile and biospecimen. BMB Rep 2022; 55:465-471. [PMID: 35996834 PMCID: PMC9537027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/02/2022] [Accepted: 07/29/2022] [Indexed: 03/08/2024] Open
Abstract
Understanding and monitoring virus-mediated infections has gained importance since the global outbreak of the coronavirus disease 2019 (COVID-19) pandemic. Studies of high-throughput omics-based immune profiling of COVID-19 patients can help manage the current pandemic and future virus-mediated pandemics. Although COVID-19 is being studied since past 2 years, detailed mechanisms of the initial induction of dynamic immune responses or the molecular mechanisms that characterize disease progression remains unclear. This study involved comprehensively collected biospecimens and longitudinal multi-omics data of 300 COVID-19 patients and 120 healthy controls, including whole genome sequencing (WGS), single-cell RNA sequencing combined with T cell receptor (TCR) and B cell receptor (BCR) sequencing (scRNA(+scTCR/BCR)-seq), bulk BCR and TCR sequencing (bulk TCR/BCR-seq), and cytokine profiling. Clinical data were also collected from hospitalized COVID-19 patients, and HLA typing, laboratory characteristics, and COVID-19 viral genome sequencing were performed during the initial diagnosis. The entire set of biospecimens and multi-omics data generated in this project can be accessed by researchers from the National Biobank of Korea with prior approval. This distribution of largescale multi-omics data of COVID-19 patients can facilitate the understanding of biological crosstalk involved in COVID-19 infection and contribute to the development of potential methodologies for its diagnosis and treatment. [BMB Reports 2022; 55(9): 465-471].
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Affiliation(s)
- Hye-Yeong Jo
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Sang Cheol Kim
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Do-hwan Ahn
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | | | - Se-Hyun Chang
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - So-Young Jung
- Division of Biobank, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Young-Jin Kim
- Division of Genome Science, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Eugene Kim
- Division of Biobank, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Jung-Eun Kim
- Division of Bio Bigdata, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Yeon-Sook Kim
- Division of Infectious Disease, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon 35015, Korea
| | - Woong-Yang Park
- Geninus Inc, Seoul 05836, Korea
- Samsung Genome Institute, Samsung Medical Center, Seoul 06351, Korea
| | - Nam-Hyuk Cho
- Department of Microbiology and Immunology, College of Medicine, Seoul National University, Seoul 08826, Korea
| | | | - Ju-Hee Lee
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Hyun-Young Park
- Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
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27
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Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients. Vaccines (Basel) 2022; 10:vaccines10071125. [PMID: 35891289 PMCID: PMC9321523 DOI: 10.3390/vaccines10071125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
Vaccines against severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) infection, which causes coronavirus disease–19 (COVID-19) in humans, have been developed and are being tested for safety and efficacy. We conducted the cross-sectional prospective cohort study on 820 patients who were positive for SARS-CoV-2 and were admitted to Princess Krishnajammanni trauma care centre (PKTCC), Mysore, which was converted to a designated COVID hospital between April 2021 to July 2021. After obtaining the informed consent, RT-PCR report, vaccination certificate and patient history, patients were classified according to their vaccination status. Results from the study showed decreases in serum ferritin levels, clinical symptoms, improvement in oxygen saturation, early recovery in patients having diabetes and hypertension, and a substantial reduction in the overall duration of hospital stay in vaccinated patients compared to unvaccinated patients. Further, fully vaccinated patients showed better outcomes compared to single dose vaccinated and nonvaccinated patients. Taken together, our findings reaffirm the vaccine’s effectiveness in reducing case fatality and promoting faster recovery compared to nonvaccinated patients. Efforts to increase the number of immunized subjects in the community help to achieve herd immunity and offer protection against the severity of COVID-19 and associated complications while minimizing the public health and economic burden.
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28
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A Pilot Study on COVID-19 Positive Subjects: An Excerpt of Post-Infection-Pro-Diabetic Disposition & Related Consequences in Correlation to Hepato-Pancreatic Bio-Markers, Pro-Inflammatory Cytokines and Other Risk Factors. Indian J Clin Biochem 2022; 38:182-192. [PMID: 35756691 PMCID: PMC9206463 DOI: 10.1007/s12291-022-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023]
Abstract
COVID-19, a global pandemic that led to increased morbidity and mortality worldwide since its outcome at the end of the year 2019. A newly discovered variant of severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2) was the arbitrator for spreading the syndrome by droplet transmission causing multi-organ failure in many occasions. A post-infection-pro-diabetic disposition was found evident in this study with the persistence of hepato-pancreatic aberrations in respect of reference range of tissue specific bio-markers in hospital admitted COVID-19 cases. The results of this study show that hyperglycemia is a risk factor in precipitating disease oriented complications to the patients with COVID-19 disease. A post-infection follow- up on glycemic-index and related complexities is a vital need to the COVID-19 infected convalescent subjects. Implementation of guidelines on social measure and awareness of anti-viral interventions may be the only way to prevent COVID-19 transmission.
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Lee JX, Chieng WK, Abdul Jalal MI, Tan CE, Lau SCD. Role of Serum Ferritin in Predicting Outcomes of COVID-19 Infection Among Sickle Cell Disease Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:919159. [PMID: 35712092 PMCID: PMC9196080 DOI: 10.3389/fmed.2022.919159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with sickle cell disease (SCD) are at higher risk of getting severe COVID-19 infection. This systematic review and meta-analysis aimed to determine the role of serum ferritin in predicting ICU admission and mortality among patients with SCD following COVID-19 infection. A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, WHO COVID-19 database, ProQuest, and Cochrane Library for articles published between 1st December 2019 to 31st November 2021. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Eleven articles (7 cohorts and 4 case series) were included in this review. Pooled mean serum ferritin level on admission was 1581.62 ng/mL while pooled proportion of ICU admission and mortality were 0.10 (95% CI 0.06; 0.16, prediction interval 0.04; 0.23, p = 0.29, I2 = 17%) and 0.07 (95% CI 0.05; 0.11, prediction interval 0.04; 0.12, p = 0.68, I2 = 0%) respectively. Meta-regression showed that serum ferritin did not predict for both ICU admission (regression coefficient = 0.0001, p = 0.3523) and mortality (regression coefficient = 0.0001, p = 0.4029). Our analyses showed that serum ferritin may not be a useful marker to predict the outcomes of COVID-19 infection among patients with SCD. More data are required to identify a reliable tool to identify patients with SCD who are at risk of getting severe COVID-19 infection.
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Affiliation(s)
- Jun Xin Lee
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wei Keong Chieng
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Muhammad Irfan Abdul Jalal
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Chai Eng Tan
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sie Chong Doris Lau
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Clinical Characteristics and Predictors of Mortality in Elderly Patients Hospitalized with COVID-19 in Bangladesh: A Multicenter, Retrospective Study. Interdiscip Perspect Infect Dis 2022; 2022:5904332. [PMID: 35698592 PMCID: PMC9188299 DOI: 10.1155/2022/5904332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Elderly patients are at high risk of fatality from COVID-19. The present work aims to describe the clinical characteristics of elderly inpatients with COVID-19 and identify the predictors of in-hospital mortality at admission. Materials and Methods In this retrospective, multicenter cohort study, we included elderly COVID-19 inpatients (n = 245) from four hospitals in Sylhet, Bangladesh, who had been discharged between October 2020 and February 2021. Demographic, clinical, and laboratory data were extracted from hospital records and compared between survivors and nonsurvivors. We used univariable and multivariable logistic regression analysis to explore the risk factors associated with in-hospital death. Principal Results. Of the included patients, 202 (82.44%) were discharged and 43 (17.55%) died in hospital. Except hypertension, other comorbidities like diabetes, chronic kidney disease, ischemic heart disease, and chronic obstructive pulmonary disease were more prevalent in nonsurvivors. Nonsurvivors had a higher prevalence of leukocytosis (51.2 versus 30.7; p=0.01), lymphopenia (72.1 versus 55; p=0.05), and thrombocytopenia (20.9 versus 9.9; p=0.07). Multivariable regression analysis showed an increasing odds ratio of in-hospital death associated with older age (odds ratio 1.05, 95% CI 1.01–1.10, per year increase; p=0.009), thrombocytopenia (OR = 3.56; 95% CI 1.22–10.33, p=0.019), and admission SpO2 (OR 0.91, 95% CI 0.88–0.95; p=0.001). Conclusions Higher age, thrombocytopenia, and lower initial level of SpO2 at admission are predictors of in-hospital mortality in elderly patients with COVID-19.
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Zablockis R, Šlekytė G, Mereškevičienė R, Kėvelaitienė K, Zablockienė B, Danila E. Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study. Medicina (B Aires) 2022; 58:medicina58060769. [PMID: 35744032 PMCID: PMC9227320 DOI: 10.3390/medicina58060769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Objective: Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. Materials and Methods: The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. Results: 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, p = 0.019) and had higher mortality (59.4% vs. 31.5%, p = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24 h (odds ratio (OR) = 0.74, p = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, p = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, p = 0.041) and lymphocyte count (OR = 1.03, p = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm3, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. Conclusion: The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients.
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Affiliation(s)
- Rolandas Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania; (G.Š.); (K.K.); (E.D.)
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania;
- Correspondence:
| | - Goda Šlekytė
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania; (G.Š.); (K.K.); (E.D.)
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania;
| | - Rūta Mereškevičienė
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania;
| | - Karolina Kėvelaitienė
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania; (G.Š.); (K.K.); (E.D.)
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania;
| | - Birutė Zablockienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania;
- Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania; (G.Š.); (K.K.); (E.D.)
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania;
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Kumar A, Weng I, Graglia S, Lew T, Gandhi K, Lalani F, Chia D, Duanmu Y, Jensen T, Lobo V, Nahn J, Iverson N, Rosenthal M, Gordon AJ, Kugler J. Point-of-Care Ultrasound Predicts Clinical Outcomes in Patients With COVID-19. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1367-1375. [PMID: 34468039 PMCID: PMC8661628 DOI: 10.1002/jum.15818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/04/2021] [Accepted: 08/16/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) detects the pulmonary manifestations of COVID-19 and may predict patient outcomes. METHODS We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID-19. Inclusion criteria included adult patients hospitalized for COVID-19 who received lung POCUS with a 12-zone protocol. Each image was interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was the need for intensive care unit (ICU) admission versus no ICU admission. Secondary outcomes included intubation and supplemental oxygen usage. RESULTS N = 160 patients were included. Among critically ill patients, B-lines (94 vs 76%; P < .01) and consolidations (70 vs 46%; P < .01) were more common. For scans collected within 24 hours of admission (N = 101 patients), early B-lines (odds ratio [OR] 4.41 [95% confidence interval, CI: 1.71-14.30]; P < .01) or consolidations (OR 2.49 [95% CI: 1.35-4.86]; P < .01) were predictive of ICU admission. Early consolidations were associated with oxygen usage after discharge (OR 2.16 [95% CI: 1.01-4.70]; P = .047). Patients with a normal scan within 24 hours of admission were less likely to require ICU admission (OR 0.28 [95% CI: 0.09-0.75]; P < .01) or supplemental oxygen (OR 0.26 [95% CI: 0.11-0.61]; P < .01). Ultrasound findings did not dynamically change over a 28-day scanning window after symptom onset. CONCLUSIONS Lung POCUS findings detected within 24 hours of admission may provide expedient risk stratification for important COVID-19 clinical outcomes, including future ICU admission or need for supplemental oxygen. Conversely, a normal scan within 24 hours of admission appears protective. POCUS findings appeared stable over a 28-day scanning window, suggesting that these findings, regardless of their timing, may have clinical implications.
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Affiliation(s)
- Andre Kumar
- Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Isabel Weng
- Quantitative Sciences UnitStanford UniversityStanfordCAUSA
| | - Sally Graglia
- Department of Emergency MedicineUniversity of California San Francisco and Zuckerberg San Francisco General HospitalSan FranciscoCAUSA
| | - Thomas Lew
- Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Kavita Gandhi
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Farhan Lalani
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - David Chia
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Youyou Duanmu
- Department of Emergency MedicineStanford University School of MedicineStanfordCAUSA
| | - Trevor Jensen
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Viveta Lobo
- Department of Emergency MedicineStanford University School of MedicineStanfordCAUSA
| | - Jeffrey Nahn
- Department of Emergency MedicineUniversity of California San Francisco and Zuckerberg San Francisco General HospitalSan FranciscoCAUSA
| | - Nicholas Iverson
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Molly Rosenthal
- Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | | | - John Kugler
- Department of MedicineStanford University School of MedicineStanfordCAUSA
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Camargo Mendoza JP, Rodríguez Ariza DE, Hernández Sabogal JC. Caracterización y factores pronóstico de mortalidad en pacientes ingresados en UCI por COVID-19 en un hospital público de referencia en Bogotá, Colombia. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC8769933 DOI: 10.1016/j.acci.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introducción Objetivo Materiales y métodos Resultados Conclusión
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Ulgen A, Cetin S, Cetin M, Sivgin H, Li W. A composite ranking of risk factors for COVID-19 time-to-event data from a Turkish cohort. Comput Biol Chem 2022; 98:107681. [PMID: 35487152 PMCID: PMC8993420 DOI: 10.1016/j.compbiolchem.2022.107681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/04/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023]
Abstract
Having a complete and reliable list of risk factors from routine laboratory blood test for COVID-19 disease severity and mortality is important for patient care and hospital management. It is common to use meta-analysis to combine analysis results from different studies to make it more reproducible. In this paper, we propose to run multiple analyses on the same set of data to produce a more robust list of risk factors. With our time-to-event survival data, the standard survival analysis were extended in three directions. The first is to extend from tests and corresponding p-values to machine learning and their prediction performance. The second is to extend from single-variable to multiple-variable analysis. The third is to expand from analyzing time-to-decease data with death as the event of interest to analyzing time-to-hospital-release data to treat early recovery as a meaningful event as well. Our extension of the type of analyses leads to ten ranking lists. We conclude that 20 out of 30 factors are deemed to be reliably associated to faster-death or faster-recovery. Considering correlation among factors and evidenced by stepwise variable selection in random survival forest, 10 ~ 15 factors seem to be able to achieve the optimal prognosis performance. Our final list of risk factors contain calcium, white blood cell and neutrophils count, urea and creatine, d-dimer, red cell distribution widths, age, ferritin, glucose, lactate dehydrogenase, lymphocyte, basophils, anemia related factors (hemoglobin, hematocrit, mean corpuscular hemoglobin concentration), sodium, potassium, eosinophils, and aspartate aminotransferase.
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Affiliation(s)
- Ayse Ulgen
- Department of Biostatistics, Faculty of Medicine, Girne American University, Karmi, Cyprus
| | - Sirin Cetin
- Department of Biostatistics, Faculty of Medicine, Tokat Gaziosmanpasa University, Turkey
| | - Meryem Cetin
- Department of Medical Microbiology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Hakan Sivgin
- Department of Internal Medicine, Faculty of Medicine, Tokat Gaziosmanpaşa University, Turkey
| | - Wentian Li
- The Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA,Corresponding author
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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Bashir AM, Mukhtar MS, Mohamed YG, Cetinkaya O, Fiidow OA. Prevalence of Acute Kidney Injury in Covid-19 Patients- Retrospective Single-Center Study. Infect Drug Resist 2022; 15:1555-1560. [PMID: 35411159 PMCID: PMC8994562 DOI: 10.2147/idr.s357997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Aim Methods Results Conclusion
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Affiliation(s)
- Ahmed Muhammad Bashir
- Department of Internal Medicine, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Ahmed Muhammad Bashir, Department of Internal Medicine, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia, Tel +252612527061, Email
| | - Mahad Sadik Mukhtar
- Department of Pulmonology, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia
| | - Yahye Garad Mohamed
- Department of Radiology, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia
| | - Osman Cetinkaya
- Department of Emergency Medicine, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia
| | - Osman Abubakar Fiidow
- School of Public Health and Research, Somali National University, Mogadishu, Somalia
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Mendonça MM, da Cruz KR, Pinheiro DDS, Moraes GCA, Ferreira PM, Ferreira-Neto ML, da Silva ES, Gonçalves RV, Pedrino GR, Fajemiroye JO, Xavier CH. Dysregulation in erythrocyte dynamics caused by SARS-CoV-2 infection: possible role in shuffling the homeostatic puzzle during COVID-19. Hematol Transfus Cell Ther 2022; 44:235-245. [PMID: 35098037 PMCID: PMC8786672 DOI: 10.1016/j.htct.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The evolving COVID-19 pandemic became a hallmark in human history, not only by changing lifestyles, but also by enriching scientific knowledge on viral infection and its consequences. Objective Although the management of cardiorespiratory changes is pivotal to a favorable prognosis during severe clinical findings, dysregulation of other systems caused by SARS-CoV-2 infection may imbalance erythrocyte dynamics, such as a bidirectional positive feedback loop pathophysiology. Method and Results Recent evidence shows that SARS-CoV-2 is capable of affecting the genetics and dynamics of erythrocytes and this coexists with a non-homeostatic function of cardiovascular, respiratory and renal systems during COVID-19. In hypothesis, SARS-CoV-2-induced systematical alterations of erythrocytes dynamics would constitute a setpoint for COVID-19-related multiple organ failure syndrome and death. Conclusion The present review covers the most frequent erythrocyte-related non-homeostatic findings during COVID-19 capable of providing mechanistic clues of SARS-CoV-2-induced infection and inspiring therapeutic-oriented scientific evidence.
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Affiliation(s)
| | - Kellen Rosa da Cruz
- Instituto de Ciências Biológicas da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | | | | | - Patricia Maria Ferreira
- Instituto de Ciências Biológicas da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Marcos Luiz Ferreira-Neto
- Instituto de Ciências Biomédicas da Universidade Federal de Uberlândia (ICBIM UFU), Uberlândia, MG, Brazil
| | | | | | | | - James O Fajemiroye
- Instituto de Ciências Biológicas da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Carlos Henrique Xavier
- Instituto de Ciências Biológicas da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
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Martínez-Salazar B, Holwerda M, Stüdle C, Piragyte I, Mercader N, Engelhardt B, Rieben R, Döring Y. COVID-19 and the Vasculature: Current Aspects and Long-Term Consequences. Front Cell Dev Biol 2022; 10:824851. [PMID: 35242762 PMCID: PMC8887620 DOI: 10.3389/fcell.2022.824851] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/20/2022] [Indexed: 12/11/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was first identified in December 2019 as a novel respiratory pathogen and is the causative agent of Corona Virus disease 2019 (COVID-19). Early on during this pandemic, it became apparent that SARS-CoV-2 was not only restricted to infecting the respiratory tract, but the virus was also found in other tissues, including the vasculature. Individuals with underlying pre-existing co-morbidities like diabetes and hypertension have been more prone to develop severe illness and fatal outcomes during COVID-19. In addition, critical clinical observations made in COVID-19 patients include hypercoagulation, cardiomyopathy, heart arrythmia, and endothelial dysfunction, which are indicative for an involvement of the vasculature in COVID-19 pathology. Hence, this review summarizes the impact of SARS-CoV-2 infection on the vasculature and details how the virus promotes (chronic) vascular inflammation. We provide a general overview of SARS-CoV-2, its entry determinant Angiotensin-Converting Enzyme II (ACE2) and the detection of the SARS-CoV-2 in extrapulmonary tissue. Further, we describe the relation between COVID-19 and cardiovascular diseases (CVD) and their impact on the heart and vasculature. Clinical findings on endothelial changes during COVID-19 are reviewed in detail and recent evidence from in vitro studies on the susceptibility of endothelial cells to SARS-CoV-2 infection is discussed. We conclude with current notions on the contribution of cardiovascular events to long term consequences of COVID-19, also known as “Long-COVID-syndrome”. Altogether, our review provides a detailed overview of the current perspectives of COVID-19 and its influence on the vasculature.
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Affiliation(s)
- Berenice Martínez-Salazar
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Melle Holwerda
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Chiara Stüdle
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Indre Piragyte
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Nadia Mercader
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Institute of Anatomy, University of Bern, Bern, Switzerland.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Bern Center of Precision Medicine BCPM, University of Bern, Bern, Switzerland
| | | | - Robert Rieben
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.,Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Extracellular Oxidative Stress Markers in COVID-19 Patients with Diabetes as Co-Morbidity. Clin Pract 2022; 12:168-176. [PMID: 35314591 PMCID: PMC8938798 DOI: 10.3390/clinpract12020021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/05/2023] Open
Abstract
COVID-19 patients have a higher risk of developing inflammatory responses associated with serious and even fatal respiratory diseases. The role of oxidative stress in exacerbating manifestations in COVID-19 pathogenesis is under-reported.This study aimed touseserum levels of superoxide dismutase (SOD3) and glutathione-S-transferase (GSTp1) by ELISA, zinc (ErbaChem5), ferritin and free iron (VitrosChemistry, Ortho Clinical Diagnosis, Raritan, NJ, USA) at the first encounter of randomly selected RT-PCR-positive COVID-19 patients, for assessing disease severity. The parameters which helped in identifying the severity, leading to poor prognosis, were neutrophil:lymphocyte higher than 4, high CRP, low SOD3 values and high GSTp1 values, and diabetes mellitus as a co-morbidity. Higher zinc levels correlated with high GSTp1 and low SOD3, indicating the protective effect of zinc on ROS. The increased high GSTp1 shows an anticipated protective biochemical response, to mitigate the low SOD3 values due to ROS consumption. Decreased SOD3 levels indicate a state of high oxidative stress at cellular levels, and an anticipated increase in GSTp1 levels points to the pathophysiological bases of increasing severity with age, sex, and co-morbidities, such asdiabetes. High levels of initial GSTp1 and zinc levels possibly offer protection to redox reactions at the cellular level in severe COVID-19 infection, preventing deterioration.
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López-Martínez R, Albaiceta GM, Amado-Rodríguez L, Cuesta-Llavona E, Gómez J, García-Clemente M, Vázquez-Coto D, Alvarez V, Coto E. The FCGR2Ars1801274 polymorphism was associated with the risk of death among COVID-19 patients. Clin Immunol 2022; 236:108954. [PMID: 35149195 PMCID: PMC8824710 DOI: 10.1016/j.clim.2022.108954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022]
Abstract
Polymorphisms of Fcγ receptors have been associated with variable responses to infections. We determined the association of functional polymorphisms rs1801274 in the FCGR2A and rs396991 in the FCGR3A with COVID-19 severity. This study involved 453 patients with severe COVID-19, in which the FCGR2A rs1801274 G-allele (131-Arg) was significantly associated with death (p = 0.02, OR = 1.47). This effect was independent of age and increased IL6 and D-Dimer levels. This study suggests that the FCGR2A gene might be associated with the risk of death among COVID-19 patients. Our study has several limitations, mainly the limited number of patients and the inclusion of a single population. It is thus necessary to confirm this result in larger cohorts from different populations.
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Affiliation(s)
| | - Guillermo M Albaiceta
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain; Universidad de Oviedo, Oviedo, Spain; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Laura Amado-Rodríguez
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Elías Cuesta-Llavona
- Genética Molecular, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain
| | - Juan Gómez
- Genética Molecular, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain
| | - Marta García-Clemente
- Neumología, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain
| | | | - Victoria Alvarez
- Inmunología, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain
| | - Eliecer Coto
- Genética Molecular, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado deAsturias, ISPA, Oviedo, Spain; Universidad de Oviedo, Oviedo, Spain.
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Role of Polypeptide Inflammatory Biomarkers in the Diagnosis and Monitoring of COVID-19. Int J Pept Res Ther 2022; 28:59. [PMID: 35095356 PMCID: PMC8785374 DOI: 10.1007/s10989-022-10366-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 01/08/2023]
Abstract
The COVID-19 (coronavirus disease 2019) pandemic that took over the world in December 2019 has had everlasting devastating impacts on the lives of people globally. It manifests a huge symptom spectrum ranging from asymptomatic to critically ill patients with an unpredictable outcome. Timely diagnosis and assessment of disease severity is imperative for effective treatment. Possibilities exist that by the time symptoms appear the viral load might increase beyond control. However, it is advisable to get adequately diagnosed as soon as the first symptom appears. There is an immediate requirement of reliable biomarkers of COVID-19 manifesting an early onset for effective clinical management, stratification of high risk patients and ensuring ideal resource allocation. In this review, we attempt to explore and describe important polypeptide inflammatory biomarkers, namely C-reactive protein, Procalcitonin, Ferritin, Lactate Dehydrogenase, Serum amyloid A, Interleukin-6, Tumor necrosis factor-alpha and LIGHT used in the detection and management of COVID-19. Viral pathogenesis and the role of these inflammatory biomarkers is highlighted, based on the evidences available till date. An integrative data monitoring along with their correlation with the natural disease progression is of utmost importance in the management of COVID-19. So further research and in-depth analysis of these biomarkers is warranted in the present scenario.
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Mechanisms of the Effects of Short-Term Inhalations of Xe and O 2 Gas Mixture in the Rehabilitation of Post-COVID Ventilation Failure. Bull Exp Biol Med 2022; 172:364-367. [PMID: 35001305 PMCID: PMC8743161 DOI: 10.1007/s10517-022-05393-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 11/15/2022]
Abstract
The article presents a theoretical rationale and a clinical case of relief of post-COVID ventilation failure by inhalation of Xe and O2 gas mixture. Pneumonitis of coronavirus etiology transforms saturated phospholipids of surfactant into a solid-ordered phase, which disrupts surface tension, alveolar pneumatization, and alveolar-capillary gas exchange. Using molecular modeling (B3LYP/lanl2dz; GAUSSIAN09), we demonstrated that Xe atom due to the van der Waals dispersion interaction increases the distance between the phospholipid acyl chains providing a phase transition from the solid-ordered to liquid phase and restored the surface-active monolayer surfactant film. A clinical case confirmed that short-term inhalations of the Xe and O2 gas mixture relieved manifestations of ventilation insufficiency and increased SpO2 and pneumatization of the terminal parts of the lungs.
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The analysis of Fe-dependent serum enzymes in severe COVID-19 with a pulmonary thrombotic event. Cent Eur J Immunol 2022; 47:293-298. [PMID: 36817400 PMCID: PMC9901253 DOI: 10.5114/ceji.2022.124076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/25/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction COVID-19 patients in critical condition requiring ICU admission are more likely to experience thromboembolic complications, especially pulmonary embolism. Since the outbreak of coronavirus disease 2019 (COVID-19), clinicians have struggled with the attempt to diagnose and manage the severe and fatal complications of COVID-19 appropriately. Several reports have described significant procoagulatory events, including life-threatening pulmonary embolism, in these patients. The aim of the study was to analyze the results of selected serum enzymes in patients with a radiologically confirmed pulmonary thrombotic event based on the pulmonary tissue involvement assessed in a computed tomography (CT) scan. Material and methods The retrospective study covered a group of 226 COVID-19 patients. Groups were divided based on the degree of lung tissue involvement in CT examinations, including patients with confirmed pulmonary embolism. The analyzed group consisted of 136 men and 90 women with mean age of 70 years. Results The group consisted of patients with < 50% of lung volume changes who had higher parameter values in each analyzed parameter, except red blood cells (RBC) (p < 0.05). Especially, the level of ferritin was much higher in the first group (p = 0.000008). Elevated ferritin levels were observed in all patients with lung tissue involvement. Discussion This line of research is critical in order to assess the predisposing conditions for pulmonary embolism occurrence in COVID-19, which can be used as a predictive factor for course of the disease. The conducted research will resolve whether there is a relationship between the selected laboratory parameters and the occurrence of pulmonary embolism in patients with COVID-19. Conclusions The study demonstrated that elevated levels of several inflammatory and thrombotic parameters such as ferritin, D-dimer, C-reactive protein (CRP) as well as hemoglobin do not correlate with the degree of lung tissue involvement in the computed tomography image.
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Acute Mesenteric Ischemia in COVID-19 Patients. J Clin Med 2021; 11:jcm11010200. [PMID: 35011941 PMCID: PMC8745985 DOI: 10.3390/jcm11010200] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 01/08/2023] Open
Abstract
Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.
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Low Transferrin Levels Predict Heightened Inflammation in COVID-19 Patients: New Insights. Int J Infect Dis 2021; 116:74-79. [PMID: 34952211 PMCID: PMC8688186 DOI: 10.1016/j.ijid.2021.12.340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Mounting evidence links hyperinflammation in gravely ill patients to low serum iron levels and hyperferritinemia. However, little attention has been paid to other iron-associated markers such as transferrin. The aim of this study was to investigate the association of different iron parameters in severe COVID-19 and their relation to disease severity. Subjects and methods This study involved 73 hospitalized patients with positive test results for SARS-CoV-2. Patients were classified into two groups according to symptom severity: mild and severe. Blood levels of anti–SARS-CoV-2 antibodies, interleukin 6 (IL-6), C-reactive protein (CRP), and iron-related biomarkers were measured. Results The results revealed a significant increase in IL-6, CRP, and ferritin levels and decreased transferrin and iron levels in severe COVID-19. Transferrin negatively predicted variations in IgM and IgG levels (P < 0.001), as well as 34.4% and 36.6% increase in IL-6 and CRP levels, respectively (P < 0.005). Importantly, transferrin was the main negative predictor of ferritin levels, determining 22.7% of serum variations (P < 0.001). Conclusion Reduced serum transferrin and iron levels, along with the increased CRP and high ferritin, were strongly associated with the heightened inflammatory and immune state in COVID-19. Transferrin can be used as a valuable predictor of increased severity and progression of the disease.
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Singh V, Kamaleswaran R, Chalfin D, Buño-Soto A, San Roman J, Rojas-Kenney E, Molinaro R, von Sengbusch S, Hodjat P, Comaniciu D, Kamen A. A deep learning approach for predicting severity of COVID-19 patients using a parsimonious set of laboratory markers. iScience 2021; 24:103523. [PMID: 34870131 PMCID: PMC8626152 DOI: 10.1016/j.isci.2021.103523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
The SARS-CoV-2 virus has caused tremendous healthcare burden worldwide. Our focus was to develop a practical and easy-to-deploy system to predict the severe manifestation of disease in patients with COVID-19 with an aim to assist clinicians in triage and treatment decisions. Our proposed predictive algorithm is a trained artificial intelligence-based network using 8,427 COVID-19 patient records from four healthcare systems. The model provides a severity risk score along with likelihoods of various clinical outcomes, namely ventilator use and mortality. The trained model using patient age and nine laboratory markers has the prediction accuracy with an area under the curve (AUC) of 0.78, 95% CI: 0.77–0.82, and the negative predictive value NPV of 0.86, 95% CI: 0.84–0.88 for the need to use a ventilator and has an accuracy with AUC of 0.85, 95% CI: 0.84–0.86, and the NPV of 0.94, 95% CI: 0.92–0.96 for predicting in-hospital 30-day mortality. Algorithm using 9 laboratory markers & age may predict severity in patients with COVID-19 Model was trained and tested on a multicenter sample of 10,937 patients Algorithm can predict ventilator use (NPV, 0.86) and mortality (NPV, 0.94) High NPV suggests utility as an adjunct to aid in triaging of patients with COVID-19
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Affiliation(s)
- Vivek Singh
- Siemens Healthineers, Digital Technology and Innovation, 755 College Road East, Princeton, NJ 08540, USA
| | - Rishikesan Kamaleswaran
- Emory University School of Medicine WMB, 1010 Woodruff Circle, Suite 4127, Atlanta, GA 30322, USA
| | - Donald Chalfin
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA.,Jefferson College of Population Health of Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, USA
| | - Antonio Buño-Soto
- Department of Laboratory Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Janika San Roman
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Edith Rojas-Kenney
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Ross Molinaro
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Sabine von Sengbusch
- Siemens Healthineers, Laboratory Diagnostics, 511 Benedict Avenue, Tarrytown, NY 10591, USA
| | - Parsa Hodjat
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
| | - Dorin Comaniciu
- Siemens Healthineers, Digital Technology and Innovation, 755 College Road East, Princeton, NJ 08540, USA
| | - Ali Kamen
- Siemens Healthineers, Digital Technology and Innovation, 755 College Road East, Princeton, NJ 08540, USA
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Parimoo A, Biswas A, Baitha U, Gupta G, Pandey S, Ranjan P, Gupta V, Barman Roy D, Prakash B, Wig N. Dynamics of Inflammatory Markers in Predicting Mortality in COVID-19. Cureus 2021; 13:e19080. [PMID: 34868744 PMCID: PMC8629097 DOI: 10.7759/cureus.19080] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction A cytokine storm is an important cause of morbidity and mortality in patients with coronavirus disease 2019 (COVID-19). The objective of the study was to determine the prognostic significance of pro-inflammatory cytokines with the overall final outcome of patients with COVID-19. Methods We conducted a retrospective study of 142 patients admitted with COVID-19 in the Department of Medicine at All India Institute of Medical Sciences, New Delhi, from May 2021 to June 2021. We obtained their demographic, clinical, and biochemical characteristics at baseline and 48-72 hours prior to the terminal event (survival/death). The data were analyzed to determine the prognostic significance of these markers on the final outcome. Results Higher levels of inflammatory markers were associated with a worse final outcome (ferritin p-value <0.001, c-reactive protein (CRP) p-value <0.001, interleukin 6 (IL-6) p-value 0.007, procalcitonin p-value 0.005, and lactic acid p-value 0.004). Optimal probability cut-offs for these markers for predicting mortality were: ferritin: 963 ng/mL (sensitivity - 67.35%, specificity - 67.50%), CRP: 66.3 mg/L (sensitivity - 78.43%, specificity - 74.12%), IL-6: 46.2 pg/mL (sensitivity - 59.26%, specificity - 59.57%), procalcitonin: 0.3ng/mL (sensitivity - 65.38 %, specificity - 66.67%), lactic acid: 1.5 mg/dL (sensitivity - 59.26%, specificity - 58.57%). Multivariate logistic regression analysis was done, which showed that pre-terminal event CRP was associated with a statistically significant higher risk of mortality (Unadjusted OR 18.89, Adjusted OR 1.008, p=0.002, 95% CI 6.815 - 47.541). Conclusion Inflammatory markers have a prognostic significance in patients with COVID-19, with higher levels being associated with worse outcomes.
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Affiliation(s)
- Aditi Parimoo
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, IND
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Vandana Gupta
- Division of Periodontics, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Bindoo Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, IND
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In Silico Identification and Clinical Validation of a Novel Long Non-Coding RNA/mRNA/miRNA Molecular Network for Potential Biomarkers for Discriminating SARS CoV-2 Infection Severity. Cells 2021; 10:cells10113098. [PMID: 34831321 PMCID: PMC8625524 DOI: 10.3390/cells10113098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/23/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: The coronavirus (COVID-19) pandemic is still a major global health problem, despite the development of several vaccines and diagnostic assays. Moreover, the broad symptoms, from none to severe pneumonia, and the various responses to vaccines and the assays, make infection control challenging. Therefore, there is an urgent need to develop non-invasive biomarkers to quickly determine the infection severity. Circulating RNAs have been proven to be potential biomarkers for a variety of diseases, including infectious ones. This study aimed to develop a genetic network related to cytokines, with clinical validation for early infection severity prediction. (2) Methods: Extensive analyses of in silico data have established a novel IL11RA molecular network (IL11RNA mRNA, LncRNAs RP11-773H22.4 and hsa-miR-4257). We used different databases to confirm its validity. The differential expression within the retrieved network was clinically validated using quantitative RT-PCR, along with routine assessment diagnostic markers (CRP, LDH, D-dimmer, procalcitonin, Ferritin), in100 infected subjects (mild and severe cases) and 100 healthy volunteers. (3) Results: IL11RNA mRNA and LncRNA RP11-773H22.4, and the IL11RA protein, were significantly upregulated, and there was concomitant downregulation of hsa-miR-4257, in infected patients, compared to the healthy controls, in concordance with the infection severity. (4) Conclusion: The in-silico data and clinical validation led to the identification of a potential RNA/protein signature network for novel predictive biomarkers, which is in agreement with ferritin and procalcitonin for determination of COVID-19 severity.
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Effect of Age on Innate and Adaptive Immunity in Hospitalized COVID-19 Patients. J Clin Med 2021; 10:jcm10204798. [PMID: 34682920 PMCID: PMC8538457 DOI: 10.3390/jcm10204798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022] Open
Abstract
An effective but balanced cellular and inflammatory immune response may limit the severity of coronavirus disease (COVID-19), whereas uncontrolled inflammation leads to disease progression. Older age is associated with higher risk of COVID-19 and a worse outcome, but the underlying immunological mechanisms for this age-related difference are not clear. We investigated the impact of age on viral replication, inflammation, and innate and adaptive cellular immune responses in 205 hospitalized COVID-19 patients. During the early symptomatic phase of COVID-19, we found that patients above 65 years had significantly higher viral load, higher levels of proinflammatory markers, and inadequate mobilization and activation of monocytes, dendritic cells, natural killer cells, and CD8 T cells compared to those below 65 years. Our study points toward age-related deficiencies in the innate immune cellular response to SARS-CoV-2 as a potential cause of poorly controlled viral replication and inflammation during the early symptom phase and subsequent disease progression.
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