1
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Mastboim NS, Angel A, Shaham O, Ber TI, Navon R, Simon E, Rosenberg M, Israeli Y, Hainrichson M, Avni N, Reiner E, Feigin P, Oved K, Tadmor B, Singer P, Kagan I, Lev S, Diker D, Jarjou'I A, Kurd R, Ben-Chetrit E, Danziger G, Tegethoff SA, Papan C, Motov S, Shapira M, Stein M, Gottlieb TM, Eden E, Klein A. An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease. Cytokine 2023; 169:156246. [PMID: 37327532 PMCID: PMC10235675 DOI: 10.1016/j.cyto.2023.156246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 patients are oftentimes over- or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Paul Feigin
- Technion-Israel Institute of Technology, Israel
| | - Kfir Oved
- MeMed, Tirat Carmel, Israel; Canopy Immuno-therapeutics, Israel
| | | | | | | | | | | | - Amir Jarjou'I
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Israel
| | - Ramzi Kurd
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Israel
| | - Eli Ben-Chetrit
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Israel
| | | | | | | | | | - Ma'anit Shapira
- Technion-Israel Institute of Technology, Israel; Hillel Yaffe Medical Center, Israel
| | - Michal Stein
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel; Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel
| | | | | | - Adi Klein
- Technion-Israel Institute of Technology, Israel; Hillel Yaffe Medical Center, Israel
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2
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Mang S, Reichert L, Muellenbach RM, Riesner J, Lotz C, Supady A, Mutlak H, Bals R, Rixecker TM, Becker AP, Leitner M, Zeiner C, Danziger G, Meybohm P, Seiler F, Lepper PM. Transfer of Veno-venous Extracorporeal Membrane Oxygenation Patients With COVID-19 Associated Acute Respiratory Distress Syndrome. ASAIO J 2023; 69:789-794. [PMID: 37146598 PMCID: PMC10627394 DOI: 10.1097/mat.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Interhospital transport of acute respiratory distress syndrome (ARDS) patients bears transport-associated risks. It is unknown how interhospital extracorporeal membrane oxygenation (ECMO) transfer of COVID-19 patients by mobile ECMO units affects ARDS mortality. We compared the outcome of 94 COVID-19 patients cannulated in primary care hospitals and retrieved by mobile ECMO-teams to that of 84 patients cannulated at five German ECMO centers. Patients were recruited from March 2020 to November 2021. Twenty-six transports were airborne, 68 were land-based. Age, sex, body-mass-index, Simplified Acute Physiology Score (SAPS) II, days invasively ventilated, and P/F-Ratio before ECMO initiation were similar in both groups. Counting only regional transports (≤250 km), mean transport distance was 139.5 km ± 17.7 km for helicopter (duration 52.5 ± 10.6 minutes) and 69.8 km ± 44.1 km for ambulance or mobile intensive care unit (duration 57.6 ± 29.4 minutes). Overall time of vvECMO support (20.4 ± 15.2 ECMO days for transported patients vs. 21.0 ± 20.5 for control, p = 0.83) and days invasively ventilated (27.9 ± 18.1 days vs. 32.6 ± 25.1 days, p = 0.16) were similar. Overall mortality did not differ between transported patients and controls (57/94 [61%] vs. 51/83 [61%], p = 0.43). COVID-19 patients cannulated and retrieved by mobile ECMO-teams have no excess risk compared with patients receiving vvECMO at experienced ECMO centers. Patients with COVID-19-associated ARDS, limited comorbidities, and no contraindication for ECMO should be referred early to local ECMO centers.
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Affiliation(s)
- Sebastian Mang
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Lena Reichert
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Ralf M. Muellenbach
- Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Jonathan Riesner
- Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Christopher Lotz
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alexander Supady
- Department of Internal medicine, Cardiology, Intensive Care and Emergency Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Haitham Mutlak
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Sana Klinikum Offenbach, Offenbach, Germany
| | - Robert Bals
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Torben M. Rixecker
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - André P. Becker
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Maximilian Leitner
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Carsten Zeiner
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Guy Danziger
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Frederik Seiler
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Philipp M. Lepper
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
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3
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Tegethoff SA, Eisenbeis J, Danziger G, Last K, Geisel J, Rissland J, Krawczyk M, Lepper PM, Becker SL, Smola S, Papan C. Evaluation of the host-response biomarker IP-10 in predicting SARS-CoV-2 infectiousness. J Hosp Infect 2023; 135:201-203. [PMID: 36898433 PMCID: PMC9995295 DOI: 10.1016/j.jhin.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Sina A Tegethoff
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Janina Eisenbeis
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Guy Danziger
- Department of Medicine V: Pneumology, Allergology and Intensiv Care Medicine, ECLS Center Saar, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Katharina Last
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Jürgen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Jürgen Rissland
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Philipp M Lepper
- Department of Medicine V: Pneumology, Allergology and Intensiv Care Medicine, ECLS Center Saar, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany; Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Center for Infection Research (HZI), Saarland University Campus, Saarbrücken, Germany
| | - Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
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4
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Feth M, Zeiner C, Danziger G, Eimer C, Mang S, Kühn S, Villalobos N, Muellenbach RM, Hörsch SI, Lepper PM. [Interhospital critical care transport]. Med Klin Intensivmed Notfmed 2023; 118:73-83. [PMID: 36507960 PMCID: PMC9744043 DOI: 10.1007/s00063-022-00973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Critically ill patients in need of specialized diagnostic or therapeutic procedures, but are being cared for in a hospital without such equipment, have to be transferred to appropriate centers without discontinuation of current critical care (interhospital critical care transfer). These transfers are resource intensive, challenging, and require high logistical effort, which must be managed by a specialized and highly trained team, predeployment planning and efficient crew-resource management strategies. If planned adequately, interhospital critical care transfers can be performed safely without frequent adverse events. Beside routine interhospital critical care transfers, there are special missions (e.g., for patients in quarantine or supported by extracorporeal organ support) that might require adaption of the team composition or standard equipment. This article describes interhospital critical care transport missions including their different phases and special circumstances.
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Affiliation(s)
- Maximilian Feth
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Carsten Zeiner
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
| | - Guy Danziger
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
| | - Christine Eimer
- Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Sebastian Mang
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
| | - Stefan Kühn
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Nick Villalobos
- Dept. of Pneumology, Critical Care and Sleep Medicine, Brooke Army Medical Center, San Antonio, TX USA
| | - Ralf M. Muellenbach
- Klinik für Anästhesiologie, Notfallmedizin, Schmerz- und Intensivmedizin, Klinikum Kassel, Kassel, Deutschland
| | - Sabrina I. Hörsch
- Zentrale Notaufnahme und Klinik für Anästhesiologie, Schmerz- und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg, Deutschland
| | - Philipp M. Lepper
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
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5
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Feth M, Zeiner C, Danziger G, Eimer C, Mang S, Kühn S, Villalobos N, Muellenbach RM, Hörsch SI, Lepper PM. [Interhospital critical care transport]. Notf Rett Med 2023; 26:227-237. [PMID: 37101845 PMCID: PMC10099003 DOI: 10.1007/s10049-023-01148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Critically ill patients in need of specialized diagnostic or therapeutic procedures, but are being cared for in a hospital without such equipment, have to be transferred to appropriate centers without discontinuation of current critical care (interhospital critical care transfer). These transfers are resource intensive, challenging, and require high logistical effort, which must be managed by a specialized and highly trained team, predeployment planning and efficient crew-resource management strategies. If planned adequately, interhospital critical care transfers can be performed safely without frequent adverse events. Beside routine interhospital critical care transfers, there are special missions (e.g., for patients in quarantine or supported by extracorporeal organ support) that might require adaption of the team composition or standard equipment. This article describes interhospital critical care transport missions including their different phases and special circumstances.
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Affiliation(s)
- Maximilian Feth
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Carsten Zeiner
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
| | - Guy Danziger
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
| | - Christine Eimer
- Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Sebastian Mang
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
| | - Stefan Kühn
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Nick Villalobos
- Dept. of Pneumology, Critical Care and Sleep Medicine, Brooke Army Medical Center, San Antonio, TX USA
| | - Ralf M. Muellenbach
- Klinik für Anästhesiologie, Notfallmedizin, Schmerz- und Intensivmedizin, Klinikum Kassel, Kassel, Deutschland
| | - Sabrina I. Hörsch
- Zentrale Notaufnahme und Klinik für Anästhesiologie, Schmerz- und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg, Deutschland
| | - Philipp M. Lepper
- Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
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6
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Mang S, Wengenmayer T, Danziger G, Muellenbach RM, Lepper PM. Extracorporeal Membrane Oxygenation Transport for Severe COVID-19: Why We Can and Should! Am J Respir Crit Care Med 2022; 206:1432-1433. [PMID: 35882064 PMCID: PMC9746865 DOI: 10.1164/rccm.202207-1305le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sebastian Mang
- Saarland University HospitalHomburg/Saar, Germany,Pneumology, Allergology, Critical CareInterdisciplinary COVID-19 CenterHomburg/Saar, Germany
| | | | - Guy Danziger
- Saarland University HospitalHomburg/Saar, Germany,Pneumology, Allergology, Critical CareInterdisciplinary COVID-19 CenterHomburg/Saar, Germany
| | | | - Philipp M. Lepper
- Saarland University HospitalHomburg/Saar, Germany,Pneumology, Allergology, Critical CareInterdisciplinary COVID-19 CenterHomburg/Saar, Germany,Corresponding author (e-mail: philipp.lepper@uks)
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7
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Omlor AJ, Schwärzel LS, Bewarder M, Casper M, Damm E, Danziger G, Mahfoud F, Rentz K, Sester U, Bals R, Lepper PM. Comparison of immersive and non-immersive virtual reality videos as substitute for in-hospital teaching during coronavirus lockdown: a survey with graduate medical students in Germany. Med Educ Online 2022; 27:2101417. [PMID: 35850619 PMCID: PMC9302008 DOI: 10.1080/10872981.2022.2101417] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
As a consequence of the continued Covid-19 lockdown in Germany, in-hospital teaching for medical students was impossible. While lectures and other theoretical training were relatively easily converted into online sessions using platforms such as Moodle, Zoom and Microsoft Teams, this was not the case for practical skills and clinical interventions, such as bronchoscopy or colonoscopy. This study describes a workaround that was implemented at the Saarland University Hospital utilizing virtual reality equipment to convey the impressions of shadowing clinical procedures to the students without physical presence. To achieve this, 3D 180° videos of key clinical interventions of various internal medicine specialities were recorded, cut, and censored. The videos were uploaded to the e-learning YouTube channel of our institution and shared with the students via the private share function. The students could choose whether to use a VR-viewer to watch the videos immersively or to watch them without a viewer on a screen non-immersively. At the end of the course after 1 week, the students completed a questionnaire anonymously focusing on learning-success regarding the presented topics, a self-assessment, and an evaluation of the course. A total of 27 students watched the videos with a VR-Viewer and 74 watched non-immersively. Although the VR-viewer group self-assessed their expertise higher, there was no significant difference between the two groups in the learning-success test score. However, students in the VR-viewer group rated the learning atmosphere, comprehensibility, and overall recommendation of the course significantly higher. They also agreed significantly more to the statement, that they gained a better conception of the presented procedures, and that virtual reality might be an appropriate tool for online teaching. Video-assisted teaching facilitates learning and might be a valuable add-on to conventional teaching.Abbreviations: Covid-19: severe acute respiratory syndrome coronavirus 2; 3D: three-dimensional; 2D: Two-dimensional; VR: virtual reality.
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Affiliation(s)
- Albert J. Omlor
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Leonie S. Schwärzel
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Moritz Bewarder
- Department of Internal Medicine I - Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University Medical Center, Homburg, Germany
| | - Markus Casper
- Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Ellen Damm
- Department of Internal Medicine, Saarland University Medical Center, Homburg, Germany
| | - Guy Danziger
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Katharina Rentz
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Urban Sester
- Department of Internal Medicine IV - Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
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More TH, Mozafari B, Märtens A, Herr C, Lepper PM, Danziger G, Volk T, Hoersch S, Krawczyk M, Guenther K, Hiller K, Bals R. Plasma Metabolome Alterations Discriminate between COVID-19 and Non-COVID-19 Pneumonia. Metabolites 2022; 12:1058. [PMID: 36355140 PMCID: PMC9693035 DOI: 10.3390/metabo12111058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 03/10/2024] Open
Abstract
Pneumonia is a common cause of morbidity and mortality and is most often caused by bacterial pathogens. COVID-19 is characterized by lung infection with potential progressive organ failure. The systemic consequences of both disease on the systemic blood metabolome are not fully understood. The aim of this study was to compare the blood metabolome of both diseases and we hypothesize that plasma metabolomics may help to identify the systemic effects of these diseases. Therefore, we profiled the plasma metabolome of 43 cases of COVID-19 pneumonia, 23 cases of non-COVID-19 pneumonia, and 26 controls using a non-targeted approach. Metabolic alterations differentiating the three groups were detected, with specific metabolic changes distinguishing the two types of pneumonia groups. A comparison of venous and arterial blood plasma samples from the same subjects revealed the distinct metabolic effects of pulmonary pneumonia. In addition, a machine learning signature of four metabolites was predictive of the disease outcome of COVID-19 subjects with an area under the curve (AUC) of 86 ± 10 %. Overall, the results of this study uncover systemic metabolic changes that could be linked to the etiology of COVID-19 pneumonia and non-COVID-19 pneumonia.
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Affiliation(s)
- Tushar H. More
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Bahareh Mozafari
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Andre Märtens
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Christian Herr
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Guy Danziger
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, 66421 Homburg, Germany
| | - Sabrina Hoersch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, 66421 Homburg, Germany
| | - Marcin Krawczyk
- Department of Internal Medicine II-Gastroenterology, Saarland University, 66421 Homburg, Germany
| | - Katharina Guenther
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Karsten Hiller
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, 66123 Saarbrücken, Germany
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Tegethoff SA, Danziger G, Kühn D, Kimmer C, Adams T, Heintz L, Metz C, Reifenrath K, Angresius R, Mang S, Rixecker T, Becker A, Geisel J, Jentgen C, Seiler F, Reichert MC, Fröhlich F, Meyer S, Rissland J, Ewen S, Wagenpfeil G, Last K, Smola S, Bals R, Lammert F, Becker SL, Krawczyk M, Lepper PM, Papan C. TNF-related apoptosis-inducing ligand, interferon gamma-induced protein 10, and C-reactive protein in predicting the progression of SARS-CoV-2 infection: a prospective cohort study. Int J Infect Dis 2022; 122:178-187. [PMID: 35643306 PMCID: PMC9132472 DOI: 10.1016/j.ijid.2022.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/08/2022] [Accepted: 05/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Early prognostication of COVID-19 severity will potentially improve patient care. Biomarkers, such as TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), and C-reactive protein (CRP), might represent possible tools for point-of-care testing and severity prediction. METHODS In this prospective cohort study, we analyzed serum levels of TRAIL, IP-10, and CRP in patients with COVID-19, compared them with control subjects, and investigated the association with disease severity. RESULTS A total of 899 measurements were performed in 132 patients (mean age 64 years, 40.2% females). Among patients with COVID-19, TRAIL levels were lower (49.5 vs 87 pg/ml, P = 0.0142), whereas IP-10 and CRP showed higher levels (667.5 vs 127 pg/ml, P <0.001; 75.3 vs 1.6 mg/l, P <0.001) than healthy controls. TRAIL yielded an inverse correlation with length of hospital and intensive care unit (ICU) stay, Simplified Acute Physiology Score II, and National Early Warning Score, and IP-10 showed a positive correlation with disease severity. Multivariable regression revealed that obesity (adjusted odds ratio [aOR] 5.434, 95% confidence interval [CI] 1.005-29.38), CRP (aOR 1.014, 95% CI 1.002-1.027), and peak IP-10 (aOR 1.001, 95% CI 1.00-1.002) were independent predictors of in-ICU mortality. CONCLUSIONS We demonstrated a correlation between COVID-19 severity and TRAIL, IP-10, and CRP. Multivariable regression showed a role for IP-10 in predicting unfavourable outcomes, such as in-ICU mortality. TRIAL REGISTRATION Clinicaltrials.gov, NCT04655521.
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Affiliation(s)
- Sina A Tegethoff
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Guy Danziger
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Dennis Kühn
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Charlotte Kimmer
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Thomas Adams
- Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Lena Heintz
- Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Carlos Metz
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Katharina Reifenrath
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Rebecca Angresius
- Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Sebastian Mang
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Torben Rixecker
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - André Becker
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Jürgen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Christophe Jentgen
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Frederik Seiler
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Franziska Fröhlich
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Department of General Paediatrics and Neonatology, Saarland University, Homburg, Germany
| | - Sascha Meyer
- Department of General Paediatrics and Neonatology, Saarland University, Homburg, Germany
| | - Jürgen Rissland
- Centre for Infectious Diseases, Institute of Virology, Saarland University Medical Centre, Homburg, Germany
| | - Sebastian Ewen
- Department of Emergency Medicine, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Katharina Last
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Sigrun Smola
- Centre for Infectious Diseases, Institute of Virology, Saarland University Medical Centre, Homburg, Germany; Helmholtz Institute for Pharmaceutical Research Saarland, Helmholtz Centre for Infection Research, Saarland University Campus, Saarbrücken, Germany
| | - Robert Bals
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany; Hannover Medical School (MHH), Hannover, Germany
| | - Sören L Becker
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Philipp M Lepper
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Centre Saar, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
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Mang S, Reyher C, Mutlak H, Natanov R, Lotz C, Gill-Schuster D, Bals R, Danziger G, Meybohm P, Combes A, Kühn C, Lepper PM, Muellenbach RM. Awake Extracorporeal Membrane Oxygenation for COVID-19-induced Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2022; 205:847-851. [PMID: 35044896 PMCID: PMC9836215 DOI: 10.1164/rccm.202105-1189le] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alain Combes
- Hôpital Universitaire Pitié SalpêtrièreParis, France
| | | | - Philipp M. Lepper
- Saarland UniversityHomburg/Saar, Germany,Corresponding author (e-mail: )
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11
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Angel A, Mastboim NS, Shaham O, Ber TI, Navon R, Simon E, Rosenberg M, Israeli Y, Hainrichson M, Avni N, Reiner E, Feigin P, Oved K, Tadmor B, Singer P, Kagan I, Lev S, Diker D, Jarjou’i A, Kurd R, Ben-Chetrit E, Danziger G, Papan C, Motov S, Shapira M, Stein M, Klein A, Gottlieb T, Eden E. 32. Host Immune-Protein Signature Combining TRAIL, IP-10 and CRP for Early and Accurate Prediction of Severe COVID-19 Outcome. Open Forum Infect Dis 2021. [PMCID: PMC8643723 DOI: 10.1093/ofid/ofab466.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Accurately identifying COVID-19 patients at-risk to deteriorate remains challenging. Dysregulated immune responses impact disease progression and development of life-threatening complications. Tools integrating host immune-protein expression have proven useful in determining infection etiology and hold potential for prognosticating disease severity. Methods Adults with COVID-19 were enrolled at medical centers in Israel, Germany, and the United States (Figure 1). Severe outcome was defined as intensive care unit admission, non-invasive or invasive ventilation, or death. Tumor necrosis factor related apoptosis inducing ligand (TRAIL), interferon gamma inducible protein-10 (IP-10) and C-reactive protein (CRP) were measured using an analyzer providing values within 15 minutes (MeMed Key®). A signature indicating the likelihood of severe outcome was derived generating a score (0-100). Description of derivation cohort ![]()
RT-PCR, reverse transcription polymerase chain reaction. Results Between March and November 2020, 518 COVID-19 patients were enrolled, of whom 394 were eligible, 29% meeting a severe outcome. Age ranged between 19-98 (median 61.5), with 59.1% male. Patients meeting severe outcomes exhibited higher levels of CRP and IP-10 and lower levels of TRAIL (Figure 2; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The signature’s area under the receiver operating characteristic curve (AUC) was 0.86 (95% confidence interval: 0.81-0.91). Performance was not confounded by age, sex, or comorbidities and was superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Clinical deterioration proximal to blood draw was associated with higher signature score. Scores of patients meeting a first outcome over 3 days after blood draw were significantly (p < 0.001) higher than scores of non-severe patients (Figure 3). Moreover, the signature differentiated patients who further deteriorated after meeting a severe outcome from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001; Figure 4). TRAIL, IP-10, CRP and the severity signature score are differentially expressed in severe and non-severe COVID-19 infection ![]()
Dots represent patients and boxes denote median and interquartile range (IQR) The signature score of patients meeting a severe outcome on or after the day of blood draw is significantly (p < 0.001) higher than the signature score of non-severe patients. ![]()
Dots represents patients and boxes denote median and IQR Kaplan-Meier survival estimates for signature score bins ![]()
Conclusion The derived signature combined with a rapid measurement platform has potential to serve as an accurate predictive tool for early detection of COVID-19 patients at risk for severe outcome, facilitating timely care escalation and de-escalation and appropriate resource allocation. Disclosures Alon Angel, n/a, MeMed (Employee, Shareholder) Niv Samuel Mastboim, BSc, MeMed (Employee, Shareholder) Oded Shaham, PhD, MeMed (Employee, Shareholder) Tahel Ilan Ber, MD, MeMed (Employee, Shareholder) Roy Navon, MSc, MeMed (Employee, Shareholder) Einav Simon, PhD, MeMed (Employee, Shareholder) Michal Rosenberg, PhD, MeMed (Employee) Yael Israeli, PhD, MeMed (Employee) Mary Hainrichson, PhD, MeMed (Employee, Shareholder) Noa Avni, PhD, MeMed (Employee) Eran Reiner, MD, MeMed (Employee) Kfir Oved, MD, PhD, MeMed (Board Member, Employee, Shareholder) Ilya Kagan, MD, MeMed (Scientific Research Study Investigator) Shaul Lev, M.D, MeMed (Scientific Research Study Investigator) Dror Diker, MD, MeMed (Scientific Research Study Investigator) Amir Jarjou’i, MD, MeMed (Scientific Research Study Investigator) Ramzi Kurd, MD, MeMed (Scientific Research Study Investigator) Guy Danziger, MD, MeMed (Scientific Research Study Investigator) Cihan Papan, MD, MeMed (Scientific Research Study Investigator) Sergey Motov, MD, MeMed (Scientific Research Study Investigator) Maanit Shapira, Ph.D, MeMed (Scientific Research Study Investigator) Tanya Gottlieb, PhD, MeMed (Employee, Shareholder) Eran Eden, PhD, MeMed (Board Member, Employee, Shareholder)
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Affiliation(s)
- Alon Angel
- MeMed, Haifa, Israel, Haifa, Hefa, Israel
| | | | | | | | - Roy Navon
- MeMed Diagnostics, Tirat Carmel, HaZafon, Israel
| | - Einav Simon
- MeMed Diagnostics, Tirat Carmel, HaZafon, Israel
| | | | | | | | - Noa Avni
- MeMed, Haifa, Israel, Haifa, Hefa, Israel
| | | | - Paul Feigin
- Technion-Israel Institute of Technology, Haifa, HaZafon, Israel
| | - Kfir Oved
- MeMed Diagnostics, Tirat Carmel, HaZafon, Israel
| | - Boaz Tadmor
- Rabin Medical Center, Hasharon, Petach Tikva, Israel, Tel Aviv University, Israel, Petach Tikva, HaMerkaz, Israel
| | | | - Ilya Kagan
- Rabin Medical Center, Petah Tikva, HaMerkaz, Israel
| | - Shaul Lev
- Rabin Medical Center, Hasharon, Petach Tikva, Israel, Tel Aviv University, Israel, Petach Tikva, HaMerkaz, Israel
| | - Dror Diker
- Hasharon Hospital-Rabin Medical Center, Petah Tikva, HaMerkaz, Israel
| | - Amir Jarjou’i
- Shaare Zedek Medical Center, Jerusalem, Yerushalayim, Israel
| | - Ramzi Kurd
- Shaare Zedek Medical Center, Jerusalem, Yerushalayim, Israel
| | - Eli Ben-Chetrit
- Shaare Zedek Medical Center, Jerusalem, Yerushalayim, Israel
| | - Guy Danziger
- Saarland University Hospital, Homburg, Saarland, Germany
| | - Cihan Papan
- Saarland University Hospital, Homburg, Saarland, Germany
| | | | | | - Michal Stein
- Hillel Yaffe Medical Center, Hadera, HaZafon, Israel
| | - Adi Klein
- Hillel Yaffe Medical Center, Hadera, HaZafon, Israel
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12
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Herr C, Mang S, Mozafari B, Guenther K, Speer T, Seibert M, Srikakulam SK, Beisswenger C, Ritzmann F, Keller A, Mueller R, Smola S, Eisinger D, Zemlin M, Danziger G, Volk T, Hoersch S, Krawczyk M, Lammert F, Adams T, Wagenpfeil G, Kindermann M, Marcu C, Ataya ZWD, Mittag M, Schwarzkopf K, Custodis F, Grandt D, Schaefer H, Eltges K, Lepper PM, Bals R. Distinct Patterns of Blood Cytokines Beyond a Cytokine Storm Predict Mortality in COVID-19. J Inflamm Res 2021; 14:4651-4667. [PMID: 34552347 PMCID: PMC8451220 DOI: 10.2147/jir.s320685] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/18/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background COVID-19 comprises several severity stages ranging from oligosymptomatic disease to multi-organ failure and fatal outcomes. The mechanisms why COVID-19 is a mild disease in some patients and progresses to a severe multi-organ and often fatal disease with respiratory failure are not known. Biomarkers that predict the course of disease are urgently needed. The aim of this study was to evaluate a large spectrum of established laboratory measurements. Patients and Methods Patients from the prospective PULMPOHOM and CORSAAR studies were recruited and comprised 35 patients with COVID-19, 23 with conventional pneumonia, and 28 control patients undergoing elective non-pulmonary surgery. Venous blood was used to measure the serum concentrations of 79 proteins by Luminex multiplex immunoassay technology. Distribution of biomarkers between groups and association with disease severity and outcomes were analyzed. Results The biomarker profiles between the three groups differed significantly with elevation of specific proteins specific for the respective conditions. Several biomarkers correlated significantly with disease severity and death. Uniform manifold approximation and projection (UMAP) analysis revealed a significant separation of the three disease groups and separated between survivors and deceased patients. Different models were developed to predict mortality based on the baseline measurements of several protein markers. A score combining IL-1ra, IL-8, IL-10, MCP-1, SCF and CA-9 was associated with significantly higher mortality (AUC 0.929). Discussion Several newly identified blood markers were significantly increased in patients with severe COVID-19 (AAT, EN-RAGE, myoglobin, SAP, TIMP-1, vWF, decorin) or in patients that died (IL-1ra, IL-8, IL-10, MCP-1, SCF, CA-9). The use of established assay technologies allows for rapid translation into clinical practice.
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Affiliation(s)
- Christian Herr
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Sebastian Mang
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Bahareh Mozafari
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Katharina Guenther
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV - Nephrology and Hypertension & Translational Cardio-Renal Medicine, Saarland University, Homburg, 66421, Germany
| | - Martina Seibert
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Sanjay Kumar Srikakulam
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Christoph Beisswenger
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Felix Ritzmann
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Andreas Keller
- Clinical Bioinformatics, Saarland University, Homburg, 66421, Germany
| | - Rolf Mueller
- Helmholtz-Institute for Pharmaceutical Science Saarland, Saarbrücken, 66123, Germany
| | - Sigrun Smola
- Institute for Virology, Saarland University, Homburg, 66421, Germany
| | | | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University, Homburg, 66421, Germany
| | - Guy Danziger
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, Homburg, 66421, Germany
| | - Sabrina Hoersch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, Homburg, 66421, Germany
| | - Marcin Krawczyk
- Department of Internal Medicine II - Gastroenterology, Saarland University, Homburg, 66421, Germany
| | - Frank Lammert
- Department of Internal Medicine II - Gastroenterology, Saarland University, Homburg, 66421, Germany
| | - Thomas Adams
- Department of Internal Medicine II - Gastroenterology, Saarland University, Homburg, 66421, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, 66421, Germany
| | - Michael Kindermann
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Caritas Hospital St. Theresia Saarbrücken, Saarbrücken, 66113, Germany
| | - Constantin Marcu
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Caritas Hospital St. Theresia Saarbrücken, Saarbrücken, 66113, Germany
| | - Zuhair Wolf Dietrich Ataya
- Department of Gastroenterology, Internal and Intensive Care Medicine, Caritas Hospital St. Josef Saarbrücken, Saarbrücken, 66125, Germany
| | - Marc Mittag
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Konrad Schwarzkopf
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Florian Custodis
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Daniel Grandt
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Harald Schaefer
- Department of Internal Medicine and Pulmonology, SHG-Hospital Völklingen, Saarbrücken, 66333, Germany
| | - Kai Eltges
- Department of Internal Medicine and Pulmonology, SHG-Hospital Völklingen, Saarbrücken, 66333, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
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13
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Lesan V, Bewarder M, Metz C, Becker A, Mang S, Regitz E, Thurner L, Neumann F, Kos I, Christofyllakis K, Danziger G, Stilgenbauer S, Bals R, Lepper PM, Kaddu-Mulindwa D, Rixecker T. Killer immunoglobulin-like receptor 2DS5 is associated with recovery from coronavirus disease 2019. Intensive Care Med Exp 2021; 9:45. [PMID: 34476598 PMCID: PMC8412971 DOI: 10.1186/s40635-021-00409-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/22/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite numerous advances in the identification of risk factors for the development of severe coronavirus disease 2019 (COVID-19), factors that promote recovery from COVID-19 remain unknown. Natural killer (NK) cells provide innate immune defense against viral infections and are known to be activated during moderate and severe COVID-19. Killer immunoglobulin-like receptors (KIR) mediate NK cell cytotoxicity through recognition of an altered MHC-I expression on infected target cells. However, the influence of KIR genotype on outcome of patients with COVID-19 has not been investigated so far. We retrospectively analyzed the outcome associations of NK cell count and KIR genotype of patients with COVID-19 related severe ARDS treated on our tertiary intensive care unit (ICU) between February and June 2020 and validated our findings in an independent validation cohort of patients with moderate COVID-19 admitted to our tertiary medical center. RESULTS Median age of all patients in the discovery cohort (n = 16) was 61 years (range 50-71 years). All patients received invasive mechanical ventilation; 11 patients (68%) required extracorporeal membrane oxygenation (ECMO). Patients who recovered from COVID-19 had significantly higher median NK cell counts during the whole observational period compared to patients who died (121 cells/µL, range 16-602 cells/µL vs 81 cells/µL, range 6-227 cells/µL, p-value = 0.01). KIR2DS5 positivity was significantly associated with shorter time to recovery (21.6 ± 2.8 days vs. 44.6 ± 2.2 days, p-value = 0.01). KIR2DS5 positivity was significantly associated with freedom from transfer to ICU (0% vs 9%, p-value = 0.04) in the validation cohort which consisted of 65 patients with moderate COVID-19. CONCLUSION NK cells and KIR genotype might have an impact on recovery from COVID-19.
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Affiliation(s)
- Vadim Lesan
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany.
| | - Moritz Bewarder
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Carlos Metz
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
| | - André Becker
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
| | - Sebastian Mang
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
| | - Evi Regitz
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Lorenz Thurner
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Frank Neumann
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Igor Kos
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Konstantinos Christofyllakis
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Guy Danziger
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
| | - Dominic Kaddu-Mulindwa
- Department of Internal Medicine I (Oncology, Hematology, Clinical Immunology, Rheumatology), Saarland University Medical Center, University Hospital, Saarland, 66421, Homburg, Germany
| | - Torben Rixecker
- Department of Internal Medicine V (Pneumology, Allergology and Critical Care Medicine), Interdisciplinary COVID-19 Center, University Hospital, Saarland, Homburg, Germany
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14
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Kermad A, Speltz J, Danziger G, Mertke T, Bals R, Volk T, Lepper PM, Meiser A. Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients-a retrospective chart review. J Anesth 2021; 35:625-632. [PMID: 34169362 PMCID: PMC8225486 DOI: 10.1007/s00540-021-02960-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/06/2021] [Indexed: 02/07/2023]
Abstract
Purpose In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. Results Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h−1; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour−1∙kg−1ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). Conclusion Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.
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Affiliation(s)
- Azzeddine Kermad
- Department of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Hospital Medical Center, Kirrberger Str. 100, 66421, Homburg, Saarland, Germany.
| | - Jacques Speltz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Hospital Medical Center, Kirrberger Str. 100, 66421, Homburg, Saarland, Germany
| | - Guy Danziger
- Department of Internal Medicine V-Pulmonology, Allergology and Intensive Care Medicine, Saarland University Hospital Medical Center, Homburg, Saarland, Germany
| | - Thilo Mertke
- Department of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Hospital Medical Center, Kirrberger Str. 100, 66421, Homburg, Saarland, Germany
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology and Intensive Care Medicine, Saarland University Hospital Medical Center, Homburg, Saarland, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Hospital Medical Center, Kirrberger Str. 100, 66421, Homburg, Saarland, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V-Pulmonology, Allergology and Intensive Care Medicine, Saarland University Hospital Medical Center, Homburg, Saarland, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Hospital Medical Center, Kirrberger Str. 100, 66421, Homburg, Saarland, Germany
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15
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Supady A, Lepper PM, Bracht H, Moerer O, Muellenbach RM, Michels G, Fiedler MO, Kalenka A, Kochanek M, Mutlak H, Danziger G, Muenz S, Lunz D, Hoersch S, Staudacher D, Wengenmayer T, Zotzmann V. Conservative management of COVID-19 associated hypoxaemia. ERJ Open Res 2021; 7:00204-2021. [PMID: 34159186 PMCID: PMC8054352 DOI: 10.1183/23120541.00204-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
With great interest we read the article by Voshaaret al. [1] reporting data from a retrospective analysis of 78 coronavirus disease 2019 (COVID-19) patients treated with or without invasive mechanical ventilation. The authors conclude that avoiding invasive mechanical ventilation by allowing permissive hypoxaemia was superior to current treatment standards and guidelines. Overall mortality in this cohort was 7.7% (six out of 78), but 50% (four out of eight) of the patients supported with invasive mechanical ventilation eventually died [1]. This correspondence argues that data presented previously cannot justify a novel approach for treating hypoxic patients with severe #COVID19https://bit.ly/3dLaPlk
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Affiliation(s)
- Alexander Supady
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany.,Heidelberg Institute of Global Health, University of Heidelberg, Freiburg im Breisgau, Germany
| | - Philipp M Lepper
- Dept of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Hendrik Bracht
- Dept of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Baden-Württemberg, Germany.,Dept of Emergency Medicine, University Hospital Ulm, Baden-Württemberg, Germany
| | - Onnen Moerer
- Dept of Anaesthesiology, University Medical Centre, Georg-August University Göttingen, Göttingen, Germany
| | - Ralf M Muellenbach
- Dept of Anaesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Guido Michels
- Dept of Acute and Emergency Care, St Antonius Hospital Eschweiler, Eschweiler, Germany
| | - Mascha O Fiedler
- Dept of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Kalenka
- Dept of Anaesthesiology and Intensive Care Medicine, Kufstein District Hospital, Kufstein, Austria
| | - Matthias Kochanek
- First Dept of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), University of Cologne, Cologne, Germany
| | - Haitham Mutlak
- Dept of Anaesthesiology, Critical Care Medicine and Pain Medicine, SANA Klinikum Offenbach, Offenbach, Germany
| | - Guy Danziger
- Dept of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Sebastian Muenz
- Dept of Internal Medicine - Cardiology, Pneumology, Angiology and Intensive Care Medicine, SLK-Hospital Heilbronn, Baden-Württemberg, Germany
| | - Dirk Lunz
- Dept of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Sabrina Hoersch
- Dept of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Dawid Staudacher
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tobias Wengenmayer
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Viviane Zotzmann
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
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16
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Mang S, Kaddu-Mulindwa D, Metz C, Becker A, Seiler F, Smola S, Maßmann A, Becker SL, Papan C, Bals R, Lepper PM, Danziger G. Pneumocystis jirovecii Pneumonia and Severe Acute Respiratory Syndrome Coronavirus 2 Coinfection in a Patient With Newly Diagnosed HIV-1 Infection. Clin Infect Dis 2021; 72:1487-1489. [PMID: 32607564 PMCID: PMC7337649 DOI: 10.1093/cid/ciaa906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sebastian Mang
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Dominic Kaddu-Mulindwa
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg/Saar, Germany
| | - Carlos Metz
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
| | - André Becker
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Frederik Seiler
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Sigrun Smola
- Center for Infectious Diseases, Institute of Virology, Saarland University, Homburg/Saar, Germany
| | - Alexander Maßmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University, Homburg/Saar, Germany
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Robert Bals
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Philipp M Lepper
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Guy Danziger
- Department of Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg/Saar, Germany
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17
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Mang S, Kalenka A, Broman LM, Supady A, Swol J, Danziger G, Becker A, Hörsch SI, Mertke T, Kaiser R, Bracht H, Zotzmann V, Seiler F, Bals R, Taccone FS, Moerer O, Lorusso R, Bělohlávek J, Muellenbach RM, Lepper PM. Extracorporeal life support in COVID-19-related acute respiratory distress syndrome: A EuroELSO international survey. Artif Organs 2021; 45:495-505. [PMID: 33590542 PMCID: PMC8014805 DOI: 10.1111/aor.13940] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/03/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 12/18/2022]
Abstract
Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient's recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS.
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Affiliation(s)
- Sebastian Mang
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Armin Kalenka
- Department of Anaesthesiology and Intensive Care Medicine, District Hospital Bergstrasse, University Hospital Heidelberg, Heppenheim, Germany
| | - Lars Mikael Broman
- ECLS Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justyna Swol
- Department of Pneumology, Allergology and Sleep Medicine, and Intensive Care Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Guy Danziger
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - André Becker
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Sabrina I Hörsch
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Anaesthesiology, Critical Care Medicine and Pain Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Thilo Mertke
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Anaesthesiology, Critical Care Medicine and Pain Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Ralf Kaiser
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Hendrik Bracht
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Ulm, Ulm, Germany
| | - Viviane Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frederik Seiler
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Robert Bals
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Onnen Moerer
- Department of Anaesthesiology, University Hospital of Göttingen, Göttingen, Germany
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department-Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Bělohlávek
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital, Prague, Czech Republic
| | - Ralf M Muellenbach
- Department of Anaesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Philipp M Lepper
- Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg, Germany.,Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, University Medical Centre, Saarland University, Homburg, Germany
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18
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Becker A, Seiler F, Muellenbach RM, Danziger G, Kamphorst M, Lotz C, Bals R, Lepper PM. Pulmonary Hemodynamics and Ventilation in Patients With COVID-19-Related Respiratory Failure and ARDS. J Intensive Care Med 2021; 36:655-663. [PMID: 33678052 DOI: 10.1177/0885066621995386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND It has been suggested that COVID-19-associated severe respiratory failure (CARDS) might differ from usual acute respiratory distress syndrome (ARDS) due to failing autoregulation of pulmonary vessels and higher shunt. We sought to investigate pulmonary hemodynamics and ventilation properties in patients with CARDS compared to patients with ARDS of pulmonary origin. METHODS This was a retrospective analysis of prospectively collected data from consecutive adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 patients treated in our ICU in 04/2020 and a comparison of the data to matched controls with ARDS due to respiratory infections treated in our ICU from 01/2014 to 08/2019 for whom pulmonary artery catheter data were available. RESULTS CARDS patients (n = 10) had ventilation characteristics similar to those of ARDS (n = 10) patients. Nevertheless, mechanical power applied by ventilation was significantly higher in CARDS patients (23.4 ± 8.9 J/min) than in ARDS (15.9 ± 4.3 J/min; P < 0.05). COVID-19 patients had similar pulmonary artery pressure but significantly lower pulmonary vascular resistance, as cardiac output was higher in CARDS vs. ARDS patients (P < 0.05). Shunt fraction and dead space were similar in CARDS compared to ARDS (P > 0.05) and were correlated with hypoxemia in both groups. The arteriovenous pCO2 difference (▵pCO2) was elevated (CARDS 5.5 ± 2.8 mmHg vs. ARDS 4.7 ± 1.1 mmHg; P > 0.05), as was the P(v-a)CO2/C(a-v)O2 ratio (CARDS mean 2.2 ± 1.5 vs. ARDS 1.7 ± 0.8; P > 0.05). CONCLUSIONS Respiratory failure in COVID-19 patients seems to differ only slightly from ARDS regarding ventilation characteristics and pulmonary hemodynamics. Our data indicate microcirculatory dysfunction. More data need to be collected to assure these findings and gain more pathophysiological insights into COVID-19 and respiratory failure.
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Affiliation(s)
- André Becker
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Frederik Seiler
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Ralf M Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Guy Danziger
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Maren Kamphorst
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Christopher Lotz
- Department of Anaesthesiology and Critical Care Medicine, 9190University of Würzburg, Würzburg, Germany
| | | | - Robert Bals
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, 39072University Hospital of Saarland and Saarland University, Homburg/Saar, Germany.,Interdisciplinary COVID-19-Center, 39072University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
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19
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Casper M, Lepper P, Danziger G, Reichert M, Seiler F, Bals R, Lammert F, Krawczyk M. Gastrointestinal endoscopy during extracorporeal membrane oxygenation (ECMO) for COVID-19. J Gastrointestin Liver Dis 2020; 29:471-473. [PMID: 32919427 DOI: 10.15403/jgld-2826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Markus Casper
- Department of Medicine II: Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Philipp Lepper
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Center Saar, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Guy Danziger
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Center Saar, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Matthias Reichert
- Department of Medicine II: Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Frederik Seiler
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Center Saar, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Robert Bals
- Department of Medicine V: Pneumology, Allergology and Intensive Care Medicine, ECLS Center Saar, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Frank Lammert
- Department of Medicine II: Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Homburg, Germany.
| | - Marcin Krawczyk
- Department of Medicine II: Gastroenterology, Hepatology and Endocrinology, Saarland University Medical Center, Saarland University, Homburg, Germany.
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20
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Danziger G, Ducza G, Takács J. [Prosthetic rehabilitation of patients with cleft palate]. Fogorv Sz 1985; 78:114-6. [PMID: 3858108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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21
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Lelkes K, Ember E, Danziger G. [Repeated tests for candidiasis in denture wearers]. Fogorv Sz 1982; 75:240-2. [PMID: 6754465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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