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Bakiera J, Strzelec-Pawełczak K, Czarnek K, Osuchowska-Grochowska I, Bogucki J, Markiewicz-Gospodarek A, Górska A, Chilimoniuk Z, Radej S, Szymański M, Portincasa P, Grochowski C. Novel inflammatory markers in patients with severe COVID-19 and a pulmonary thrombotic event. Cent Eur J Immunol 2023; 48:167-173. [PMID: 37901866 PMCID: PMC10604642 DOI: 10.5114/ceji.2023.131382] [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: 01/30/2023] [Accepted: 05/09/2023] [Indexed: 10/31/2023] Open
Abstract
Venous thromboembolism (VTE), clinically manifested as deep vein thrombosis (DVT) or acute pulmonary embolism (PE), is the third most common acute cardiovascular syndrome following myocardial infarction and stroke. The annual incidence of PE is between 39 and 115 per 100,000 inhabitants. The incidence of VTE is almost eight times higher in people aged 80 and older than in the fifth decade of life. We performed a retrospective study of 226 COVID-19 patients and selected group of patients who experienced a pulmonary thrombotic event. The incidence of PE in hospitalized COVID-19 patients was approximately 1.9-8.9%. The retrospective nature of the analyzed cohorts and relatively short observation periods could have led to underestimation of the actual incidence of PE. This study underlines the role of novel inflammatory biomarkers such as neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with a pulmonary thrombotic event in COVID-19. We suggest that these biomarkers may have high assessment value and complement routinely used biomarkers.
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Affiliation(s)
- Jarosław Bakiera
- Department of Laboratory Diagnostics, Coagulation and Microbiology, Stefan Wyszyński Regional Specialist Hospital, Lublin, Poland
| | | | - Katarzyna Czarnek
- Institute of Health Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
| | | | - Jacek Bogucki
- Department of Organic Chemistry, Medical University of Lublin, Lublin, Poland
| | | | - Aleksandra Górska
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | | | - Sebastian Radej
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
- Institute of Health Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Mateusz Szymański
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences & Human Oncology, University of Bari “Aldo Moro” Medical School, Bari, Italy
| | - Cezary Grochowski
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
- Institute of Health Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
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2
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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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Parker S, Mahomed O. Hypoxia and thrombosis in COVID-19: new considerations for air passengers. J Travel Med 2020; 27:5876263. [PMID: 32710617 PMCID: PMC7454775 DOI: 10.1093/jtm/taaa122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Salim Parker
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Rondebosch, Cape Town 7700, South Africa
| | - Ozayr Mahomed
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, 238 Mazisi Kunene Rd, Glenwood, Durban 4041, South Africa
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Thakkar S, Arora S, Kumar A, Jaswaney R, Faisaluddin M, Ammad Ud Din M, Shariff M, Barssoum K, Patel HP, Nirav A, Jani C, Patel K, Savani S, DeSimone C, Mulpuru S, Deshmukh A. A Systematic Review of the Cardiovascular Manifestations and Outcomes in the Setting of Coronavirus-19 Disease. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820977196. [PMID: 33312009 PMCID: PMC7716078 DOI: 10.1177/1179546820977196] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/01/2020] [Indexed: 01/08/2023]
Abstract
The impact of coronavirus disease, 2019 (COVID-19), has been profound. Though COVID-19 primarily affects the respiratory system, it has also been associated with a wide range of cardiovascular (CV) manifestations portending extremely poor prognosis. The principal hypothesis for CV involvement is through direct myocardial infection and systemic inflammation. We conducted a systematic review of the current literature to provide a foundation for understanding the CV manifestations and outcomes of COVID-19. PubMed and EMBASE databases were electronically searched from the inception of the databases through 27 April 2020. A second literature review was conducted to include major trials and guidelines that were published after the initial search but before submission. The inclusion criteria for studies to be eligible were case reports, case series, and observation studies reporting CV outcomes among patients with COVID-19 infection. This review of the current COVID-19 disease and CV outcomes literature revealed a myriad of CV manifestations with potential avenues for treatment and prevention. Future studies are required to understand on a more mechanistic level the effect of COVID-19 on the myocardium and thus provide avenues to improve mortality and morbidity.
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Affiliation(s)
| | - Shilpkumar Arora
- Department of Cardiology, Case Western Reserve University, Cleveland, OH, USA
| | - Ashish Kumar
- Department of Critical Care Medicine, St. John’s Medical College Hospital, Bangalore, India
| | - Rahul Jaswaney
- Department of Internal Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mohammed Faisaluddin
- Department of Medicine, Deccan College of Medical Science, Hyderabad, Telangana, India
| | | | - Mariam Shariff
- Department of Critical Care Medicine, St. John’s Medical College Hospital, Bangalore, India
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Arora Nirav
- MS in Computer Science, Lamar University, TX, USA
| | - Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Kripa Patel
- Department of Medicine, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Sejal Savani
- Department of Public Health, NYU College of Dentistry, NY, USA
| | | | - Siva Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Sakr Y, Giovini M, Leone M, Pizzilli G, Kortgen A, Bauer M, Tonetti T, Duclos G, Zieleskiewicz L, Buschbeck S, Ranieri VM, Antonucci E. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Ann Intensive Care 2020; 10:124. [PMID: 32953201 PMCID: PMC7492788 DOI: 10.1186/s13613-020-00741-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). MAIN TEXT We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic implications of PE in relation to COVID-19. The incidence of PE is reported to be around 2.6-8.9% of COVID-19 in hospitalized patients and up to one-third of those requiring intensive care unit (ICU) admission, despite standard prophylactic anticoagulation. This may be explained by direct and indirect pathologic consequences of COVID-19, complement activation, cytokine release, endothelial dysfunction, and interactions between different types of blood cells. CONCLUSION Thromboprophylaxis should be started in all patients with suspected or confirmed COVID-19 admitted to the hospital. The use of an intermediate therapeutic dose of low molecular weight (LMWH) or unfractionated heparin can be considered on an individual basis in patients with multiple risk factors for venous thromboembolism, including critically ill patients admitted to the ICU. Decisions about extending prophylaxis with LMWH after hospital discharge should be made after balancing the reduced risk of venous thromboembolism (VTE) with the risk of increased bleeding events and should be continued for 7-14 days after hospital discharge or in the pre-hospital phase in case of pre-existing or persisting VTE risk factors. Therapeutic anticoagulation is the cornerstone in the management of patients with PE. Selection of an appropriate agent and correct dosing requires consideration of underlying comorbidities.
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Affiliation(s)
- Yasser Sakr
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - Manuela Giovini
- Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Marc Leone
- Service d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Giacinto Pizzilli
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Andreas Kortgen
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - Michael Bauer
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Gary Duclos
- Service d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Laurent Zieleskiewicz
- Service d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Samuel Buschbeck
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - V. Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Elio Antonucci
- Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
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Yang N, Shen Y, Shi C, Ma AHY, Zhang X, Jian X, Wang L, Shi J, Wu C, Li G, Fu Y, Wang K, Lu M, Qian G. In-flight transmission cluster of COVID-19: a retrospective case series. Infect Dis (Lond) 2020; 52:891-901. [PMID: 32735163 DOI: 10.1080/23744235.2020.1800814] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND No data is available about in-flight transmission of SARS-CoV-2. Here, we report an in-flight transmission cluster of COVID-19 and describe the clinical characteristics of these patients. METHODS After a flight, laboratory-confirmed COVID-19 was reported in 12 patients. Ten patients were admitted to the designated hospital. Data was collected from 25th January to 28th February 2020. Clinical information was retrospectively collected. RESULTS All patients were passengers, and none were flight attendants. The median age was 33 years, and 70% were females. None was admitted to intensive care unit, and no patients died up to 28th February. The median incubation period was 3.0 days and time from onset of illness to hospital admission was 2 days. The most common symptom was fever. Two patients were asymptomatic and had normal chest CT scan during hospital stay. On admission, initial RT-PCR was positive in 9 patients, and initial chest CT was positive in half of the patients. The median lung 'total severity score' of chest CT was 6. 'Crazy-paving' pattern, pleural effusion, and ground-glass nodules were seen. CONCLUSION There is potential for COVID-19 transmission in aeroplanes, but the symptoms were mild in our patients. Passengers and attendants must be protected during flights.
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Affiliation(s)
- Naibin Yang
- Department of Infection and Liver Diseases, Ningbo First Hospital, Ningbo, China.,Department of Infection and Liver Diseases, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuefei Shen
- Department of Infectious Diseases, Xiaoshan First People's Hospital, Xiaoshan, China
| | - Chunwei Shi
- Department of Infectious Diseases, Xiaoshan First People's Hospital, Xiaoshan, China
| | - Ada Hoi Yan Ma
- Nottingham University Business School, University of Nottingham, Ningbo, China
| | - Xie Zhang
- Department of Pulmon.ary and Critical Care Medicine, Yueqing people's Hospital, Yueqing, China
| | - Xiaomin Jian
- Department of Radiology, Beijing Fuxing Hospital, Affiliated to Capital University of Medical Science, Beijing, China
| | - Liping Wang
- Department of Infection and Liver Diseases, Ningbo First Hospital, Ningbo, China
| | - Jiejun Shi
- Department of Infection and Liver Diseases, Ningbo First Hospital, Ningbo, China
| | - Chunyang Wu
- Department of Infection and Liver Diseases, Ningbo First Hospital, Ningbo, China
| | - Guoxiang Li
- Department of Infection and Liver Diseases, Ningbo First Hospital, Ningbo, China
| | - Yuan Fu
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Keyin Wang
- Department of Infection and Liver Diseases, The First Hospital of Jiaxing City, Jiaxing, China
| | - Mingqin Lu
- Department of Infection and Liver Diseases, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China
| | - Guoqing Qian
- Department of General Internal Medicine, Ningbo First Hospital, Ningbo, China
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Larsen K, Coolen-Allou N, Masse L, Angelino A, Allyn J, Bruneau L, Maillot A, Lagrange-Xelot M, Vitry T, André M, Travers JY, Foch E, Allou N. Detection of Pulmonary Embolism in Returning Travelers with Hypoxemic Pneumonia due to COVID-19 in Reunion Island. Am J Trop Med Hyg 2020; 103:844-846. [PMID: 32618261 PMCID: PMC7410458 DOI: 10.4269/ajtmh.20-0597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to evaluate the occurrence of pulmonary embolism in returning travelers with hypoxemic pneumonia due to COVID-19. All returning travelers to Reunion Island with hypoxemic pneumonia due to COVID-19 underwent computed tomography pulmonary angiography (CTPA) and were included in the cohort. Thirty-five patients were returning travelers with hypoxemic pneumonia due to COVID-19 and had recently returned from one of the countries most affected by the COVID-19 outbreak (mainly from France and Comoros archipelago). Five patients (14.3%) were found to have pulmonary embolism and two (5.9%) were incidentally found to have deep vein thrombosis on CTPA. Patients with pulmonary embolism or deep vein thrombosis had higher D-dimer levels than those without pulmonary embolism or deep vein thrombosis (P = 0.04). Returning travelers with hypoxemic pneumonia due to COVID-19 should be systematically screened for pulmonary embolism.
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Affiliation(s)
- Kevin Larsen
- Pneumologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Nathalie Coolen-Allou
- Pneumologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Laurie Masse
- Pneumologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Alexandre Angelino
- Radiologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Lea Bruneau
- Department of Public Health and Research Support, Methodological Support and Biostatistics Unit, University Hospital, Saint Denis, France.,INSERM CIC 1410 Clinical and Epidemiology, University Hospital, Saint Denis, France
| | - Adrien Maillot
- Department of Public Health and Research Support, Methodological Support and Biostatistics Unit, University Hospital, Saint Denis, France
| | - Marie Lagrange-Xelot
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Thierry Vitry
- Radiologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Michel André
- Pneumologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Jean Yves Travers
- Radiologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Emilie Foch
- Pneumologie, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
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8
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Benito N, Filella D, Mateo J, Fortuna AM, Gutierrez-Alliende JE, Hernandez N, Gimenez AM, Pomar V, Castellvi I, Corominas H, Casademont J, Domingo P. Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19. Front Med (Lausanne) 2020; 7:557. [PMID: 32984388 PMCID: PMC7477312 DOI: 10.3389/fmed.2020.00557] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/05/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: We set out to analyze the incidence and predictive factors of pulmonary embolism (PE) in hospitalized patients with Covid-19. Methods: We prospectively collected data from all consecutive patients with laboratory-confirmed Covid-19 admitted to the Hospital de la Santa Creu i Sant Pau, a university hospital in Barcelona, between March 9 and April 15, 2020. Patients with suspected PE, according to standardized guidelines, underwent CT pulmonary angiography (CTPA). Results: A total of 1,275 patients with Covid-19 were admitted to hospital. CTPA was performed on 76 inpatients, and a diagnosis of PE was made in 32 (2.6% [95%CI 1.7-3.5%]). Patients with PE were older, and they exhibited lower PaO2:FiO2 ratios and higher levels of D-dimer and C-reactive protein (CRP). They more often required admission to ICU and mechanical ventilation, and they often had longer hospital stays, although in-hospital mortality was no greater than in patients without PE. High CRP and D-dimer levels at admission (≥150 mg/L and ≥1,000 ng/ml, respectively) and a peak D-dimer ≥6,000 ng/ml during hospital stay were independent factors associated with PE. Prophylactic low molecular weight heparin did not appear to prevent PE. Increased CRP levels correlated with increased D-dimer levels and both correlated with a lower PaO2:FiO2. Conclusions: The 2.6% incidence of PE in Covid-19 hospitalized patients is clearly high. Higher doses of thromboprophylaxis may be required to prevent PE, particularly in patients at increased risk, such as those with high levels of CRP and D-dimer at admission. These findings should be validated in future studies.
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Affiliation(s)
- Natividad Benito
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- *Correspondence: Natividad Benito
| | - David Filella
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jose Mateo
- Thrombosis and Hemostasis Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ana M. Fortuna
- Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Juan E. Gutierrez-Alliende
- Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Nerea Hernandez
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ana M. Gimenez
- Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Virginia Pomar
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ivan Castellvi
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Hector Corominas
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Rheumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Jordi Casademont
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Pere Domingo
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
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