ABSTRACT
Background: COVID-19 severity has been linked to an increased production of inflammatory mediators called "cytokine storm". Available data is mainly restricted to the first international outbreak and reports highly variable results. This study compares demographic and clinical features of patients with COVID-19 from Córdoba, Argentina, during the first two waves of the pandemic and analyzes association between comorbidities and disease outcome with the "cytokine storm", offering added value to the field. Methods: We investigated serum concentration of thirteen soluble mediators, including cytokines and chemokines, in hospitalized patients with moderate and severe COVID-19, without previous rheumatic and autoimmune diseases, from the central region of Argentina during the first and second infection waves. Samples from healthy controls were also assayed. Clinical and biochemical parameters were collected. Results: Comparison between the two first COVID-19 waves in Argentina highlighted that patients recruited during the second wave were younger and showed less concurrent comorbidities than those from the first outbreak. We also recognized particularities in the signatures of systemic cytokines and chemokines in patients from both infection waves. We determined that concurrent pre-existing comorbidities did not have contribution to serum concentration of systemic cytokines and chemokines in COVID-19 patients. We also identified immunological and biochemical parameters associated to inflammation which can be used as prognostic markers. Thus, IL-6 concentration, C reactive protein level and platelet count allowed to discriminate between death and discharge in patients hospitalized with severe COVID-19 only during the first but not the second wave. Conclusions: Our data provide information that deepens our understanding of COVID-19 pathogenesis linking demographic features of a COVID-19 cohort with cytokines and chemokines systemic concentration, presence of comorbidities and different disease outcomes. Altogether, our findings provide information not only at local level by delineating inflammatory/anti-inflammatory response of patients but also at international level addressing the impact of comorbidities and the infection wave in the variability of cytokine and chemokine production upon SARS-CoV-2 infection.
Subject(s)
COVID-19 , Humans , Cytokines/metabolism , SARS-CoV-2/metabolism , Argentina , Chemokines , Cytokine Release Syndrome , PandemicsABSTRACT
Introduction: COVID-19 disease shows a marked heterogeneity in its clinical course, with descriptions of some factors associated with a worse prognosis. Knowledge of the disease behavior in the local scenario is relevant to allow a better approach. Methods: Retrospective study in two hospitals in the city of Córdoba, Argentina, with patients aged 18 years or more, hospitalized for active SARS-CoV-2 infection, from March to October, 2020. Results: 448 patients were included, of which 95.75% corresponded to COVID-19 pneumonia. Most of the episodes occurred in men (63.6%), the median age was 63 years (IQR: 53-75), and the most frequent comorbidities were arterial hypertension (55.1%), obesity (31.7%) and diabetes mellitus (28.1%). 162 patients (36.2%) needed admission to the intensive care unit and 66 (14.7%) were placed on mechanical ventilation. 67 patients (15%) died within the first 30 days of follow-up. In the multivariate analysis, the only independent variable predictive of mortality at 30 days was age (adjusted Odds ratio [aOR] = 1.08, 95% CI = 1.04-1.11, p <0.001). The 4C-Score and CALL-Score prognostic scores showed good discrimination (Area under the curve [AUC] = 0.766, 95% CI = 0.72-0.80 and AUC = 0.785, 95% CI = 0.70-0.85 respectively) and the predicted percentages of mortality were quite close to what was observed in the present study. Conclusions: Most of the patients hospitalized with SARS-CoV-2 infection presented comorbidities and were admitted with pneumonia, associated with high mortality. The prognostic scores with the best performance to predict complications were the 4C-score and the CALL-score.
Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habiéndose descripto algunos factores que se asocian un peor pronóstico. El conocimiento del comportamiento de la enfermedad en el escenario local es de gran relevancia para permitir un mejor abordaje. Métodos: Estudio retrospectivo en dos hospitales de la ciudad de Córdoba, Argentina, de pacientes de 18 años o más hospitalizados por infección activa por SARS-CoV-2, desde marzo a octubre del año 2020. Resultados: Se incluyeron 448 pacientes, de los cuales el 95.75% correspondieron a neumonía COVID-19. La mayoría de los episodios ocurrieron en hombres (63.6%), la mediana de edad fue 63 años (RIC:53-75), y las comorbilidades más frecuentes fueron hipertensión arterial (55.1%), obesidad (31.7%) y diabetes mellitus (28.1%). Requirieron ingreso a unidad de cuidados intensivos 162 pacientes (36.2%) y 66 (14.7%), asistencia respiratoria mecánica. Fallecieron 67 pacientes (15%) dentro de los primeros 30 días de seguimiento. En el análisis multivariado la única variable independiente predictora de mortalidad a los 30 días fue la edad (Odds ratio ajustado [ORa]=1.08, IC95%=1.04-1.11, p<0.001). Los scores pronósticos 4C-Score y CALL-Score presentaron muy buena discriminación (Área bajo la curva [ABC]=0.766, IC95%=0.72-0.80 y ABC=0.785, IC95%=0.70-0.85, respectivamente) y los porcentajes predichos de mortalidad se aproximaron bastante a lo observado en el presente estudio. Conclusiones: La mayoría de los pacientes hospitalizados por infección por SARS-CoV-2 presentaban comorbilidades y se presentaron como neumonía, asociada a una elevada mortalidad. Los scores pronósticos con mejor rendimiento para predecir complicaciones fueron el 4C-Score y el CALL score.
Subject(s)
COVID-19 , SARS-CoV-2 , Argentina , Hospitals , HumansABSTRACT
Introduction: COVID-19 disease is an acute viral pneumonia caused by SARS-CoV-2. Its main means of transmission is from person to person through respiratory droplets. It presents as a febrile condition with respiratory symptoms and high transmissibility rate. There is no vaccine, so the clinical suspicion and immediate isolation of the patient are essential Objective: The purpose of this work is to report the first confirmed case of COVID-19 disease in Córdoba (Argentina), highlighting telemedicine as a novel form of outpatient management. Methodology: We describe the first confirmed case of COVID-19 disease in Córdoba (Argentina), which presented in a patient without comorbidities in good clinical condition, and therefore ambulatory management using telemedicine was decided, which was satisfactory. Results: Outpatient management using telemedicine turned out to be optimal, avoiding the use of beds and the transmission of the virus within the hospital through management at home. Conclusion: Outpatient management of selected patients avoids virus transmission within the hospital and saturation of beds. Telemedicine is an effective and novel strategy for this situation.
Introducción: La enfermedad COVID-19 es una neumonía viral aguda causada por el SARS-CoV-2. Su principal medio de transmisión es de persona a persona a través de gotas respiratorias. Se presenta como un cuadro febril con síntomas respiratorios con una alta tasa de transmisibilidad. No existe vacuna, por lo que la sospecha y aislamiento inmediato del enfermo son primordiales. Objetivo: El propósito de este trabajo es informar el primer caso de enfermedad COVID-19 confirmado en Córdoba (Argentina), destacando a la telemedicina como una novedosa forma de manejo ambulatorio. Metodología: Se describe el primer caso confirmado de enfermedad COVID-19 en Córdoba (Argentina), en un paciente sin comorbilidades, con buen estado clínico, manejándose el mismo mediante telemedicina. Resultados: El manejo ambulatorio mediante telemedicina resultó ser óptimo, evitando la utilización de camas y la transmisión del virus intrahospitalaria mediante el manejo en su domicilio. Conclusión: El manejo ambulatorio de pacientes seleccionados evita la transmisión del virus dentro del hospital y la saturación de camas. La telemedicina es una estrategia efectiva y novedosa para esta situación.