Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil

Abstract INTRODUCTION: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. METHODS: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. CONCLUSIONS: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.

Estudo dos mediadores inflamatórios e de coagulação na epidemia 2013 pelo DENV-4 / Evaluation of inflammatory and coagulation mediators in 2013 dengue virus type 4 outbreak

A dengue se tornou a arbovirose mais difundida no mundo, atingindo mais de 100 países. O sorotipo DENV-4 foi reintroduzido no Brasil em 2010, se espalhou para as diferentes regiões brasileiras sendo responsável por uma das maiores epidemias de dengue relatadas no país em 2013. O objetivo deste estudo foi avaliar o perfilclínico-laboratorial, citocinas/quimiocinas inflamatórias e mediadores da coagulação em pacientes infectados pelo DENV durante esta epidemia. Para isto, foram avaliados 265 casos confirmados de dengue atendidos nos centros de saúde dos estados do RJ e MS no ano de 2013. Os pacientes foram classificados de acordo com a nova classificação da OMS, 2009 nos grupos: 158 (70,2 por cento) dengue sem sinais de alarme (DSSA), 65 (28,9 por cento) dengue com sinais de alarme (DCSA) e 2 (0,9 por cento)dengue grave. Os sinais de alarme mais frequentes foram dor abdominal persistente(61,5 por cento) e sangramento de mucosas (32,3 por cento). O DENV-4 foi o sorotipo de maior incidência e 85,2 por cento dos pacientes apresentaram infecção secundária. Pacientes DCSA/DG apresentaram baixa contagem de leucócitos totais, de plaquetas e altos níveis séricos de AST/TGO e ALT/TGP quando comparados aos pacientes DSSA e aqueles ODF (outras doenças febris). A quantificação dos mediadores inflamatórios por ensaios imunoenzimáticos indicou: (i) níveis aumentados de citocinas (TNF-alfa, IL-6 e IL-10) e quimiocinas (IL-8/CXCL8, IP-10/CXCL10 e MCP-1/CCL2) nos pacientes DSSA e DCSA/DG quando comparados com o grupo controle; (ii) níveis aumentados de IL-10 e IL-6 nos pacientes DCSA/DG enquanto que IL-8/CXCL8 foimaior nos pacientes DSSA...

Dengue has become the most widespread arbovirus in the world, reaching more than100 countries. The DENV-4 serotype was reintroduced in Brazil in 2010, and spreadto the different Brazilian regions being responsible for one of the largest epidemics ofdengue reported in the country in 2013. The objective of this study was to evaluatethe clinical and laboratory profile, and inflammatory cytokines/chemokines andcoagulation mediators in patients infected with DENV during this epidemic. For this,were evaluated 265 confirmed cases of dengue attended at health centers in thestates of RJ and MS in the year 2013. Patients were classified according to the newWHO classification, 2009 in groups: 158 (70.2 percent) dengue without warning signs(DwoWS), 65 (28.9 percent) dengue with warning signs (DwWS) and 2 (0.9 percent) severedengue (SD). The most frequent warning signals were persistent abdominal pain(61.5 percent) and mucosal bleeding (32.3 percent). The DENV-4 was the most prevalentserotype and 85,2 percent of dengue patients showed secondary infection. DwWS/SDpatients showed lower white blood cell and platelet counts, and higher AST and ALTserum levels compared to DwoWS and other febrile illnesses patients. Quantificationof inflammatory mediators by immunoassays indicated: (i) increased levels ofcytokines (TNF-alpha, IL-6 and IL-10) and chemokines (IL-8/CXCL8, IP-10/CXCL10 andMCP-1/CCL2) in DwoWS and DwWS patients compared with healthy individuals; (ii)increased levels of IL-10 and IL-6 in DwWS/SD patients while IL-8/CXCL8 wasincreased in DSSA patients; In respect to coagulation parameters: (iii) DwoWS andDwWS/SD patients showed lower levels of sTF and higher of TFPI compared withthe control group; (iv) Lower levels of fibrinogen were found in DwWS/SD patientsand higher levels of thrombomodulin in patients between 4-7 days of illness...