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Lucijanic M, Krecak I, Busic I, Atic A, Stojic J, Sabljic A, Soric E, Veic P, Marevic S, Derek L, Mitrovic J, Luksic I. Estimated plasma volume status in COVID-19 patients and its relation to comorbidities and clinical outcomes. J Thromb Thrombolysis 2024; 57:50-57. [PMID: 37572182 DOI: 10.1007/s11239-023-02882-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
Blood plasma is a large reservoir of circulating mediators of inflammation and its expansion has been associated with unfavorable outcomes in patients with inflammatory and cardiovascular diseases. The aim of this study was to determine clinical and prognostic value of estimated plasma volume status (ePVS) in hospitalized patients with COVID-19. We retrospectively investigated 5871 consecutive COVID-19 patient hospitalized in our tertiary-level institution in period 3/2020-6/2021. ePVS was determined using the Strauss-derived Duarte formula and was correlated with clinical characteristics and unwanted outcomes. Median ePVS was 4.77 dl/g with interquartile range 4.11-5.74. Higher ePVS was significantly associated with older age, female sex, higher comorbidity burden, worse functional status, less severe COVID-19 clinical presentation with lower severity and longer duration of symptoms, but more pronounced inflammatory profile with higher C-reactive protein, interleukin-6 and D-dimer levels (P < 0.05 for all analyses). In the multivariate regression analysis U shaped relationship of ePVS with mortality was revealed, present independently of age, sex, COVID-19 severity and comorbidity burden. In addition, higher ePVS was independently associated with higher tendency for mechanical ventilation, intensive care unit treatment, venous thromboembolism, major bleeding and bacteriemia and lower ePVS was independently associated with tendency for arterial thrombotic events. Higher ePVS, indicative of plasma volume expansion and inflammatory cytokine accumulation, may predispose respiratory deterioration and venous thromboembolism, despite less severe initial clinical presentation. Lower ePVS, indicative of hemoconcentration, may predispose arterial thrombotic events. Both may be associated with higher mortality in hospitalized COVID-19 patients.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, Croatia.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Ivan Krecak
- Internal medicine department, General hospital of Sibenik-Knin county, Sibenik, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Iva Busic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Armin Atic
- Nephrology Department, University Hospital Center Zagreb, Zagreb, Croatia
| | - Josip Stojic
- Gastroenterology, Hepatology and Clinical Nutrition Department, University Hospital Dubrava, Zagreb, Croatia
| | - Anica Sabljic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, Croatia
| | - Ena Soric
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, Zagreb, 10000, Croatia
| | - Petra Veic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sanja Marevic
- Clinical Department for Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Lovorka Derek
- Clinical Department for Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Josko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Clinical Immunology, Allergology and Rheumatology department, University hospital Dubrava, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivica Luksic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Maxillofacial surgery Department, University Hospital Dubrava, Zagreb, Croatia
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Lucijanic M, Tjesic-Drinkovic I, Piskac Zivkovic N, Pastrovic F, Rob Z, Bacevac M, Sedinic Lacko M, Dzambas E, Medic B, Vukoja I, Busic I, Grgurevic I, Luksic I, Barsic B. Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients. Life (Basel) 2023; 13:1699. [PMID: 37629556 PMCID: PMC10455881 DOI: 10.3390/life13081699] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Thromboprophylaxis is a mainstay of treatment of hospitalized COVID-19 patients, due to the high occurrence of thrombotic events. This increases the risk of bleeding. However, data on bleeding events and associated risk factors are scarce. Thus, we aimed to investigate the incidence, predictors and clinical outcomes associated with major bleeding in hospitalized COVID-19 patients. We retrospectively evaluated a cohort of 4014 consecutively hospitalized COVID-19 patients treated in a tertiary-level institution in the period 3/2020-3/2021. Bleeding of any kind was documented in 322 (8%) and major bleeding in 129 (3.2%) patients. A total of 129 (40.1%) bleeding events were present at the time of hospital admission, and 193 (59.9%) occurred during hospitalization. In the multivariate logistic regression analysis, intensive-care-unit treatment (adjusted odds ratio (aOR) 6.55; p < 0.001), atrial fibrillation (aOR 2.55; p = 0.029), higher white-blood-cell count (WBC) (aOR 1.03; p = 0.021), lower hemoglobin (aOR 0.97; p = 0.002) and history of bleeding (aOR 17.39; p < 0.001) were recognized as mutually independent predictors of major bleeding. Major bleeding was significantly associated with increased in-hospital mortality compared to non-major-bleeding patients (59.7% vs. 34.8%, p < 0.001), especially if occurring during hospitalization. Median time from major bleeding to death was 5 days. Bleeding events are frequent in hospitalized COVID-19 patients, with a significant proportion of patients presenting at the time of hospital admission, and others almost universally exposed to anticoagulant and corticosteroid therapies. Major bleeding is associated with high mortality, especially if occurring during hospitalization. The recognition of patients at risk and implementation of timely interventions are of high clinical importance.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ida Tjesic-Drinkovic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, 10000 Zagreb, Croatia
| | | | - Frane Pastrovic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Zrinka Rob
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Mersiha Bacevac
- Department of Emergency and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | | | - Eleonora Dzambas
- Department of Emergency and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Barbara Medic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Ivan Vukoja
- Gastroenterology and Nephrology Department, General County Hospital Pozega, 34000 Pozega, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Iva Busic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivica Grgurevic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Ivica Luksic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Bruno Barsic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Bjelos M, Curic A, Kuzmanovic Elabjer B, Busic I, Bulat S. Thyroid peroxidase antibodies may induce demyelination and oculomotor neuromyotonia in the absence of thyroid eye disease. Neuro Endocrinol Lett 2022; 43:65-67. [PMID: 35786818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The first report of oculomotor neuromyotonia (ONM) in a child induced by thyroid peroxidase antibodies (anti-TPO) in the absence of thyroid eye disease (TED). CASE 14-year-old girl complained of left eye (LE) paroxysmal upper lid fluttering and ptosis precipitated by hyperventilation or sustained left gaze. On sustained left gaze, right eye (RE) upper lid retraction and LE upper lid fluttering with ptosis ensued. RESULTS Diagnostic work-up revealed markedly elevated anti-TPO (> 600 IU/ml) and no TED. Brain MRI was normal with no signs of tortuous vessels presenting focal demyelination. We hypothesized that anti-TPO directly induced demyelination and set the ground for right ONM with ephaptic transmission between neurons supplying right medial rectus and levator muscle. CONCLUSIONS Plethora of theories try to decode the ONM. TED associated ONM is not reported in children but is the second most common cause of ONM in adults, advocated to be of compressive origin. Conversely, this case holds true for cross talk hypothesis. All extraocular muscles must be tested to determine the triggering one. ONM should not be overlooked due to its positive response to carbamazepine.
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Affiliation(s)
- Mirjana Bjelos
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
| | - Ana Curic
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
| | - Biljana Kuzmanovic Elabjer
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
| | - Iva Busic
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
| | - Stjepan Bulat
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia
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Busic N, Lucijanic T, Barsic B, Luksic I, Busic I, Kurdija G, Barbic L, Kunstek S, Jelic T, Lucijanic M. Vaccination provides protection from respiratory deterioration and death among hospitalized COVID-19 patients: Differences between vector and mRNA vaccines. J Med Virol 2022; 94:2849-2854. [PMID: 35187697 PMCID: PMC9088639 DOI: 10.1002/jmv.27666] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 11/01/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 11/07/2022]
Abstract
Outcomes of 109 hospitalized COVID-19 patients who received at least one vaccine dose 14 or more days prior the disease onset were retrospectively compared to control cohort of 109 age, sex, and Charlson comorbidity index-matched patients chosen among 2990 total hospitalized patients in our tertiary-level institution in a period from January to June 2021. Among 109 vaccinated patients, 84 patients were partially and 25 fully vaccinated. Vaccinated patients experienced significantly lower 30 days mortality (30% vs. 49%; hazard ratio [HR]: 0.56 [0.37-0.85]; p = 0.008), less frequently required high flow oxygen therapy (17% vs. 34%; HR: 0.45 [0.26-0.76]; p = 0.005), and mechanical ventilation (8% vs. 18%; HR: 0.41 [0.20-0.88]; p = 0.027) in comparison to the matched cohort of unvaccinated patients. More favorable survival was observed in patients receiving vector in comparison to messenger RNA (mRNA) vaccine types in unadjusted analysis (30 days mortality 18% vs. 40%; HR: 0.45 [0.25-0.79]; p = 0.034). In the multivariable Cox regression analysis model both mRNA (HR: 0.59 [0.36-0.98]; p = 0.041) and vector vaccine types (HR: 0.30 [0.15-0.60]; p < 0.001) were associated with improved survival in comparison to unvaccinated patients, independently of age (HR: 1.03 [1.01-1.06]; p = 0.011), male sex (HR: 1.78 [1.14-2.76]; p = 0.010), severity of illness (HR: 2.06 [1.36-3.10]; p < 0.001) and functional status on admission (HR: 1.42 [1.07-1.85]; p = 0.013).
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Affiliation(s)
- Nikolina Busic
- Primary Respiratory and Intensive Care CenterUniversity Hospital DubravaZagrebCroatia
| | - Tomo Lucijanic
- Primary Respiratory and Intensive Care CenterUniversity Hospital DubravaZagrebCroatia
- Endocrinology and Clinical Pharmacology DepartmentUniversity Hospital DubravaZagrebCroatia
| | - Bruno Barsic
- Primary Respiratory and Intensive Care CenterUniversity Hospital DubravaZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
| | - Ivica Luksic
- Primary Respiratory and Intensive Care CenterUniversity Hospital DubravaZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
- Maxillofacial Surgery DepartmentUniversity Hospital DubravaZagrebCroatia
| | - Iva Busic
- School of MedicineUniversity of ZagrebZagrebCroatia
| | | | - Ljubo Barbic
- Faculty of Veterinary MedicineUniversity of ZagrebZagrebCroatia
| | - Sanja Kunstek
- Healthcare Quality DepartmentUniversity Hospital DubravaZagrebCroatia
| | - Tea Jelic
- Healthcare Quality DepartmentUniversity Hospital DubravaZagrebCroatia
| | - Marko Lucijanic
- Primary Respiratory and Intensive Care CenterUniversity Hospital DubravaZagrebCroatia
- School of MedicineUniversity of ZagrebZagrebCroatia
- Hematology DepartmentUniversity Hospital DubravaZagrebCroatia
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Bras M, Gregurek R, Milunovic V, Busic I, Kalenic B. Relationship between psychotrauma and multiple sclerosis. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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