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Pucci G, D'Abbondanza M, Curcio R, Alcidi R, Campanella T, Chiatti L, Gandolfo V, Veca V, Casarola G, Leone MC, Rossi R, Alberti A, Sanesi L, Cavallo M, Vaudo G. Handgrip strength is associated with adverse outcomes in patients hospitalized for COVID-19-associated pneumonia. Intern Emerg Med 2022; 17:1997-2004. [PMID: 35930184 PMCID: PMC9362345 DOI: 10.1007/s11739-022-03060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/18/2022] [Indexed: 12/25/2022]
Abstract
Handgrip strength (HGS), a simple tool for the evaluation of muscular strength, is independently associated with negative prognosis in many diseases. It is unknown whether HGS is prognostically relevant in COVID-19. We evaluated the ability of HGS to predict clinical outcomes in people with COVID-19-related pneumonia. 118 patients (66% men, 63 ± 12 years), consecutively hospitalized to the "Santa Maria" Terni University Hospital for COVID-19-related pneumonia and respiratory failure, underwent HGS measurement (Jamar hand-dynamometer) at ward admission. HGS was normalized to weight2/3 (nHGS) The main end-point was the first occurrence of death and/or endotracheal intubation at 14 days. Twenty-two patients reached the main end-point. In the Kaplan-Meyer analysis, the Log rank test showed significant differences between subjects with lower than mean HGS normalized to weight2/3 (nHGS) (< 1.32 kg/Kg2/3) vs subjects with higher than mean nHGS. (p = 0.03). In a Cox-proportional hazard model, nHGS inversely predicted the main end-point (hazard ratio, HR = 1.99 each 0.5 kg/Kg2/3 decrease, p = 0.03), independently from age, sex, body mass index, ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio), hypertension, diabetes, estimated glomerular filtration rate and history of previous cardiovascular cardiovascular disease. These two latter also showed independent association with the main end-point (HR 1.30, p = 0.03 and 3.89, p < 0.01, respectively). In conclusion, nHGS measured at hospital admission, independently and inversely predicts the risk of poor outcomes in people with COVID-19-related pneumonia. The evaluation of HGS may be useful in early stratifying the risk of adverse prognosis in COVID-19.
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Affiliation(s)
- Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy.
- COVID Unit, Terni University Hospital, Terni, Italy.
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Lorenzo Chiatti
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Vito Veca
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Maria Comasia Leone
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Alessio Alberti
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Leandro Sanesi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Massimiliano Cavallo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
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Curcio R, Gandolfo V, Alcidi R, Giacomino L, Campanella T, Casarola G, Rossi R, Chiatti L, D'abbondanza M, Commissari R, Gresele P, Pucci G, Vaudo G. VACCINE-INDUCED MASSIVE PULMONARY EMBOLISM AND THROMBOCYTOPENIA FOLLOWING A SINGLE DOSE OF JANSSEN AD26.COV2.S VACCINATION. Int J Infect Dis 2022; 116:154-156. [PMID: 34986404 PMCID: PMC8720302 DOI: 10.1016/j.ijid.2021.12.345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 12/01/2022] Open
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) has emerged as a rare side effect of adenoviral vector-based vaccines against Coronavirus disease 2019 (COVID-19), and it is most frequently reported after Vaxzevria (AstraZeneca) vaccine. We described a case of severe thrombocytopenia associated with massive pulmonary embolism and portal vein thrombosis, occurring 13 days after the administration of the single dose adeno viral vector-based vaccine Ad26.COV2.S (Janssen vaccines, Leiden, Netherlands). Based on an early clinical suspect, the patient quickly received treatment with corticosteroids and intravenous immunoglobulins, followed by a rapid increase in platelet count that allowed full dose anticoagulation to be timely administered. Treatment with intravenous immunoglobulins, however, could mask the ability of anti-PF4-heparin antibodies to bind and activate platelets in the presence of heparin, leading to false negative results at the immunoassay functional test. Therefore, if VITT is suspected, blood samples for diagnostic confirmation should be collected prior to any treatment to improve diagnostic performance.
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Affiliation(s)
- Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Luciano Giacomino
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Emergency, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Lorenzo Chiatti
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Marco D'abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Rita Commissari
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Emergency, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy.
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
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Casarola G, D'Abbondanza M, Curcio R, Alcidi R, Campanella T, Rossi R, Fusaro J, Gandolfo V, Di Giuli C, Laoreti C, Veca V, Leone MC, Pucci G, Vaudo G. Efficacy of convalescent plasma therapy in immunocompromised patients with COVID-19: A case report. Clin Infect Pract 2021; 12:100096. [PMID: 34490417 PMCID: PMC8408049 DOI: 10.1016/j.clinpr.2021.100096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Management of immunocompromised COVID-19 patients is the object of current debate. Accumulating evidence suggest that treatment with high-titer COVID-19 convalescent plasma (CCP) may be effective in this characteristic clinical scenario. CASE REPORT A 52-years old immunocompromised female patient, previously treated with rituximab for low grade B-cell lymphoma, showed prolonged SARS-CoV-2 shedding and a long-term course of signs of severe COVID-19. A first cycle of treatment with remdesivir, a nucleotide analogue prodrug effective in inhibiting SARS-CoV-2 replication, did not provide fully and sustained clinical remission. A second hospitalization was deemed necessary after 10 days from the first hospital discharge due to recrudescence of symptoms of severe COVID-19 and the evidence of bilateral interstitial pneumonia at the chest-CT scan. Clinical and radiological findings completely disappeared after CCP administration. The viral culture confirmed the absence of SARS-CoV-2-related cytopathic effect. The clinical evaluation, performed two months after hospital discharge, was unremarkable. RESULTS Findings from our case report suggest that the host T-cell specific response to SARS-CoV-2 is not sufficient to reduce viral load in the absence of neutralizing antibodies. Acquired immune antibodies and/or related components passively infused with CCP might help in boosting the plasma recipient response to the virus and promoting complete viral clearance. CONCLUSIONS Independently from negative results in immunocompetent individuals, the potential effectiveness of CCP infusion in selected cohorts of patients with primary or secondary impaired immune response should be tested. Further research about mechanisms of host response in immunocompromised patients with SARS-CoV-2 infection is required.
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Affiliation(s)
- Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Jessica Fusaro
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,Unit of Internal Medicine, “S.Maria della Misericordia” University Hospital, Perugia
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Cinzia Di Giuli
- Clinical Infectious Disease, Terni University Hospital, Terni, Italy
| | - Chiara Laoreti
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,Unit of Internal Medicine, “S.Maria della Misericordia” University Hospital, Perugia
| | - Vito Veca
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Maria Comasia Leone
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy,Corresponding author at: Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano di Joannuccio, 1, IT-05100 Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
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