Le syndrome post COVID-19 : un mythe ou une réalité ?

Le concept de post COVID-19 a été adopté par l'Organisation mondiale de la santé et d'autres sociétés savantes suite à la description de symptômes et de séquelles persistants pendant au moins deux mois, au-delà de 3 mois d'évolution après une COVID-19 aiguë. La prévalence, les caractéristiques cliniques et évolutives du Post COVID-19 méritent d'être étudiées. Nous avons mené une enquête monocentrique descriptive prospective à travers la mise en place d'un questionnaire en ligne où les patients ayant eu une infection COVID-19 confirmée par un test antigénique ou une PCR ont été sollicités pour renseigner cette fiche technique standardisée. Parmi 269 patients sollicités, 206 ont renseigné le questionnaire en ligne. Les patients étaient répartis en 106 femmes et 100 hommes dont 145 (70 %) avaient moins de 60 ans. 84 % des patients avaient des symptômes persistants au-delà de 4 semaines alors que 75 % des patients avaient un syndrome Post COVID-19 authentique. Les signes cliniques rapportés sont : l'asthénie (55,7 %), l'anxiété (25 %), les arthralgies (28 %), l'anosmie (27,5 %), l'agueusie (22,1 %), les céphalées (26 %), les vertiges (26,7 %), les acouphènes (9,2 %), hypoacousie, les troubles mnésiques (22 %), la toux (22,9 %), la dyspnée (22,1 %), les douleurs thoraciques (19,8 %), palpitations récurrentes (17,6 %), les troubles du sommeil (20,6 %), la vision flou (6,9 %), la dépression (19,1 %), l'alopécie (17,6 %), la sècheresse cutanée (9,9 %), la fièvre (17,6 %), les diarrhées (13,7 %), les nausées et vomissements (10,7 %) et les aphtes buccaux (6,1 %). Le retentissement sur la qualité de vie a été rapporté par 85 % des femmes, 66 % des hommes et 78 % des sujets de plus de 60 ans. L'asthénie, l'anxiété, les arthralgies, la dyspnée et les troubles mnésiques sont les symptômes les plus rapportés en Post COVID-19. Le retentissement du syndrome post COVID-19 sur la qualité de vie semble plus important chez les femmes et le sujet âgé. Les questionnaires dédiés au syndrome post COVID-19, à l'asthénie, l'anxiété et la dépression pourraient aider à mesurer et à mettre en évidence le syndrome post COVID-19. Une prise en charge multidisciplinaire est nécessaire pour améliorer la qualité de vie de ces patients, détecter des séquelles post COVID-19 relevant d'une prise en charge spécialisée et éliminer un diagnostic différentiel notamment une dyspnée d'origine cardiaque, post embolique ou une pneumopathie interstitielle d'une autre origine. (French) [ FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Increased levels of factor VIII on admission, predict intensive care unit transferal and mortality in hospitalized COVID-19 patients

Background: Despite the necessity, there is no reliable biomarker to predict disease severity and prognosis of patients with COVID-19. Factor VIII is a procoagulant factor that is stored in endothelial cells and is released during inflammation. COVID-19 is clearly an inflammatory and thromboembolic disease, especially in its severe forms. That is why we hypothesized that FVIII could be a potential prognostic marker in this disease. Method A prospective observational cohort study was performed from 1 September 2020 to 31 August 2021. This study cohort included 91 consecutive patients admitted to the Military University Hospital of Oran (Algeria), with COVID-19 confirmed by the PCR. All these patients underwent FVIIIc assay at the admission. The primary end-point was transferal from respiratory intermediate care unit (RICU) to intensive care unit (ICU) and in-hospital mortality. Objectives To assess the prognostic value of FVIIIc, in the prediction of the transferal to ICU during the first days of hospitalization as well as in the prediction of mortality in patients with COVID-19. Results: Ninety-one patients with a confirmed COVID-19 were enrolled in this study, with a mean age of 58.5 years [CI: 55-62];67 men (73.6%) and 24 women (26.4%) with a sex ratio of 2.79. Thirty-six patients (39.6%) were admitted with moderate acute respiratory distress syndrome (ARDS), 47 (51.6%) with severe and eight (8.8%) with critical ARDS. Among these patients, 20 (22.0%) were transferred to the ICU. Eighteen (19.8%) died, of whom 3 (16.7%) died in the RICU and 15 (83.3%) died in the ICU. FVIIIc levels in patients transferred to ICU were significantly higher, compared to those who were not: 408% [CI: 334-483] vs. 261% [CI: 234-289] respectively ( p = 0.001). Same for those who died in which we found a significant increase in FVIIIc levels, compared to survivors: 409% [CI: 335-483] vs. 265% [237-294] respectively ( p = 0.001). By using the ROC curves, we established the predictive threshold values. The value of 371% for FVIIIc, predicted the risk of transfer to ICU with a sensitivity (Se) of 65% and a specificity (Sp) of 83.1%. Beyond this threshold value, patients were more likely to see their condition worsen and to be transferred to the ICU with an odds ratio of 8.29 [CI: 2.76-24.85]. While for the prediction of mortality, we had two cutoff values: 341% (Se = 72.2%;Sp = 78.1%;PPV = 44.9%;NPV = 91.9%) and 520% (Se = 27.8%;Sp = 98.6%;PPV = 83.4%;NPV = 84.7%). Using these two threshold values, we created three prognostic groups: group 1 (FVIIIc < 341%), group 2 (341% ≤ FVIIIc < 520%) and group 3 (FVIIIc ≥ 520%). Using Kaplan-Meier model, we found that these three groups had a highly different survival probability. The best survival probability for the group 1 (88.2% after 15 days of hospitalization). This probability decreased in the group 2, only 51% with a Hazard ratio (HR) of 5.11 [CI: 1.58-16.47], meaning that these patients had a higher risk of dying compared to those of the group 1. The worst survival probability was recorded in the group 3, only 15.6% with a HR = 11.22 [CI: 1.96-64.36]. Conclusion Factor VIII can predict the need for transfer from the RICU to the ICU and also mortality in patients with COVID-19. This biomarker could be a valuable one for better clinical stratification by early and meaningful profiles in patients admitted to the RICU who are at risk of transferal to the ICU..

Fibrinogen and D-dimer are significantly associated with severity of COVID-19 disease

Background : Since the emergence of COVID-19 pandemic, a growing evidence showed that this disease is associated with disturbances in hemostatic components, defining a COVID-19 associated coagulopathy. This is reflected in the lab tests with an increase in D-dimer and Fibrinogen, which correlate with severity and outcomes of disease. Aims : To assess the association between elevation of fibrinogen and d-dimer with worsening of COVID-19 disease, as well as the prognostic value of these two markers. Methods : We conducted a prospective single-center study, including patients with confirmed COVID-19 consecutively admitted over a period of 05 months. Fibrinogen and D-Dimer were tested and the correlation with clinical stages, and prognosis were studied. Results : 131 patients with confirmed COVID-19 (Mean age 47 years;13% with severe and critical cases;73.3% male) were included in this study. The most frequent comorbidities were : high blood pressure 27.9% and diabetes 23.5%. Levels of D-Dimer and Fibrinogen increased considerably in severe and critical cases compared to mild, moderate and asymptomatic cases. For Fibrinogen: 4.81 gr/L [CI 4.40 -5.22] Vs 3.53 gr/L [CI 3.28 -3.77] ( P 0.026). For D-Dimer 1308 μg/ml [CI 703 -1913] Vs 820 μg/ml [CI 338 -1302] ( P 0.0001). The results from ROC analyses for predicting severe and critical cases showed that the AUC of Fibrinogen the AUC was at 0.75 also with two cut-off values : 4.46 gr/L (Se : 67.9% , Sp : 78.2% ) and 5.49 gr/L (Se : 34% , Sp : 97.4% ). For D-Dimer AUC was 0.7, with two cutoff values : 750 μg/ml (Se : 56.8% , Sp : 78.72% ) and 1790 μg/ml (Se : 24.32% , Sp : 95.7%). Conclusions : Fibrinogen and D-dimers in patients with COVID-19 should be used as prognostic markers for warning of severe cases.