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Acute pulmonary embolism (PE) and coronavirus disease -2019 (COVID-19) are life-threatening diseases associated with significant morbidity and mortality. Yet little is known about their co-existence.This study explored clinical and laboratory differences between PE patients who tested positive with real-time reverse-transcription polymerase chain reaction (PCR+) and those who tested negative (PCR-) for SARS-CoV-2. Also, to determine whether ferritin D-dimer ratio (FDR) and platelet D-dimer ratio (PDR) can be used to predict COVID-19 in patients with PE. Files of 556 patients who underwent a computed tomography pulmonary angography (CTPA) examination were retrospectively investigated. Out of them, 197 were tested positive and 188 negative for SARS-CoV-2. One hundred thirteen patients (57.36%) in the PCR+ group and 113 (60.11%) in the PCR- group had a diagnosis of PE. Complaints, respiratory rate, and oxygen saturation level in the blood (SpO2) were recorded at the first admission. Monocyte and eosinophil levels remained low, whereas FDR and PDR were higher in the PCR+ group. No difference was detected in ferritin, D-dimer levels, comorbidities, SpO2, and death rates between the two groups. Cough, fever, joint pain, and higher respiratory rate were more common in the PCR+ group. A decrease in white blood cell, monocyte, and eosinophil levels, whereas an increase in FDR and PDR levels may predict COVID-19 in patients with PE. PE patients complaining of cough, fever, and fatigue should undergo PCR testing as common symptoms. COVID-19 does not seem to increase the risk of mortality in patients with PE.
Subject(s)
COVID-19 , Pulmonary Embolism , Humans , COVID-19/complications , COVID-19/diagnosis , SARS-CoV-2 , Retrospective Studies , Cough , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Real-Time Polymerase Chain Reaction , Acute Disease , COVID-19 TestingABSTRACT
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19), which started in China in December 2019 and spread all over the world, is more progressive in patients who are elderly and with chronic diseases. Especially, kidney involvement affects the survival of patients. In this study, we analysed COVID-19 patients who developed acute kidney injury treated in our unit, retrospectively. METHOD The clinical and laboratory data of 610 patients who were hospitalized due to COVID-19 pandemic between 1 June 2020 and 30 June 2021 in the intensive care and other clinics of our hospital were evaluated from the records, retrospectively. A total of 140 patients were diagnosed with AKI according to the criteria of Kidney Disease Global Outcomes (KDIGO). The patients were divided into two groups as KDIGO stages 1 and 2 and 3. RESULTS The median age in both groups was 70 (35–92) and 73 (35–90) years. Approximately 70% of them were >65 years old. Almost all of the patients had hypertension. Most of the patients were using angiotensin converting enzyme inhibitors (ACE inh) or angiotensin receptor blockers (ARB) (84%). AKI was present at the time of admission (61.9%) in the KDIGO 1 group and at the time of hospitalization (64.3%) in the KDIGO 2, 3 groups. The mortality rate was higher in stage 2–3 AKI patients (35.7%). Ferritin and fibrinogen levels were high in the KDIGO 2, 3 group, while lymphocyte levels were low. CONCLUSION AKI can be seen at the time of admission and during treatment in patients who are hospitalized and treated due to COVID-19. COVID-19 is more mortal in patients with advanced AKI.Table 1. Characteristics and laboratuary findings in both groupsKDIGO stage 1 (n = 112)KDIGO stage 2 and 3 (n = 28)PAge, median (min–max)70 (35–92)73 (35–90).630Age ≥ 65, n (%)76 (67.9)76 (67.9)1Diabetes mellitus, n (%)44 (39.3)8 (28.6).294Hypertension, n (%)109 (97.3)27 (96.4).800Chronic kidney disease, n (%)26 (23.2)6 (21.4).840Obesity, n (%)2 (1.8)1 (3.6).491Chronic obstructive pulmonary disease, n (%)16 (14.3)3 (10.7).765Coronary artery disease, n (%)46 (41.1)11 (39.3).863Heart failure, n (%)33 (29.5)4 (14.3).103Cerebrovascular disease, n (%)6 (5.4)3 (10.7).383Malignity, n (%)13 (11.6)7 (25).126Chronic liver disease, n (%)2 (1.8)0 (0).476Medications-ACE inh, n (%)-ARB, n (%)-CCB, n (%)-BB, n (%)-Insulin, n (%)-OAD, n (%)-Antiagregan, n (%)-Anticoagulan, n (%)54 (48.2)41 (36.6)42 (37.5)72 (64.3)32 (28.6)13 (11.6)78 (69.6)9 (8)13 (46.4)10 (35.7)10 (35.7)13 (46.4)3 (10.7)5 (17.9)16 (57.1)2 (7.1).866.930.861.084.051.359.208.875Duration of acute kidney injury, n (%)5 (2–25)(n = 39)7 (2–25)(n = 16).386Acute renal failure-during hospitalization, n (%)-at admission, n (%)38 (33.9)69 (61.9)18 (64.3)10 (35.7).003.013AKI on CKD26 (23.2)6 (21.4).626AKI progression, n (%)10 (8.9)11 (39.3)<.001Mortality, n (%)9 (8)10 (35.7).001Duration of intensive care unit, median (min–max)8 (2–45)6 (1–21).546Ferritin (µg/L)304.10 (23.40–2000)517.50 (74.10–2000).042Lenfosit (10
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Amaç: Koronavirüs hastalığı-2019 (COVID-19), şiddetli akut solunum yolu sendromu koronavirüsü 2’nin neden olduğu pandemik bir enfeksiyondur. Hafif üst solunum yolu enfeksiyonu semptomlarından ölüme kadar giden farklı klinik seyri olabilmektedir. Kritik hastalarda organ fonksiyonlarının değerlendirilmesi prognozu tahmin etmeye yardımcı olabilir. Fizyolojik skorlama sistemleri yoğun bakıma (YB) kabul edilen hastaların tanımlanması, mortalite ve morbidite olasılıklarının belirlenmesi, tedavi uygulamalarının kalitesinin takibi gibi amaçlarla geliştirilmişlerdir. Akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE) II ve ardışık organ yetmezliği değerlendirme (SOFA) skorları YB’de yaygın olarak kullanılmaktadır. APACHE II skoru çoklu organ yetmezliğini öngöremez. Bu nedenle çoklu organ fonksiyon bozukluğunu tanımlamak için SOFA skoru daha uygun bir seçenektir. Çalışmamızda YB yatış APACHE II ve SOFA skorlarının kritik COVID-19 hastalarında prognozu öngörmedeki etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya, COVID-19 tanısı gerçek zamanlı polimeraz zincir reaksiyonu testi ile doğrulanmış, ağır pnömoni kriterlerini taşıyan, invaziv mekanik ventilasyon uygulanan erişkin (>18 yaş) hastalar dahil edildi. Veriler retrospektif olarak tarandı. Hastalar yaşayan (Grup 1) ve ölen (Grup 2) olarak iki gruba ayrılarak YB yatış APACHE II ve SOFA skorları, demografik, klinik ve laboratuvar verileri karşılaştırıldı. Bulgular: Çalışmaya toplam 212 hasta dahil edildi. Demografik veriler iki grupta da benzerdi. APACHE II ve SOFA skorları arasında da fark saptanmadı (sırasıyla;p=0,393, p=0,957). Laboratuvar verilerinden YB yatış sırasındaki C-reaktif protein (CRP) değerleri Grup 2’de anlamlı olarak yüksekti (p=0,001). YB tedavileri döneminde Grup 2’de trakeal aspirat ve kan kültürlerinde üreme oranları da yüksekti (sırasıyla;p=0,023, p=0,034) (Tablo 1). Sonuç: Kritik hastalarda APACHE II, mortaliteyi öngördüğü kabul edilen bir skorlama sistemidir. Ancak mevcut bulgularımız sonucunda YB’ye kabul edilen COVID-19 tanılı hastalarda mortaliteyi öngörmede etkili olmadığını düşünmekteyiz. SOFA skoru da bu hastalarda ilk YB yatışta prognozu öngörmede etkili değildir, yatış sürecinde günlük olarak değerlendirilmesi uygun olacaktır. Çalışmamızda yüksek CRP ve sekonder enfeksiyonlar mortalite ile ilişkili idi. Klinik uygulamalarda rutinde kullanılan skorlama sistemleri COVID-19 hastalarında kullanılacak ise bu skorlara prognostik önemi olan belirteçlerin de eklenmesinin uygun olabileceğini düşünmekteyiz. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI 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.)
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INTRODUCTION: This study aimed to investigate the impact of home quarantine in older patients without COVID-19 hospitalized due to neurological disorders. METHODS: We consecutively enrolled 255 elderly patients(median age: 75 years, female: 54%), including 180 (70%) in the pre-home quarantine period and 75 (30%) home quarantine period from January to May 2020 (ten weeks before and ten weeks after the March 21, 2020, lockdown for older patients in Turkey) in a tertiary referral neurological center. RESULTS: In the home quarantine period, we documented a fall in the number of neurological admissions by 58.3%, but an increased need for intensive care in older patients. Patients in the home quarantine period were younger [73 (65-91) vs 76 (65-95), p = 0.005], had worse Glasgow Coma Scores (12.3 ± 3.6 vs 13.7 ± 2.5, p = 0.007), higher in-hospital mortality rate (21.3% vs. 6.7%, p = 0.001), had a lower prevalence of comorbidities such as diabetes mellitus, hypertension, and cardiovascular disease, and chronic neurologic disease, albeit had a higher prevalence of the acute cerebrovascular disease (hemorrhagic/ ischemic stroke)(90.7% vs 78.9, p = 0.025). In this period, even there was an increase in the proportion of the patients undergoing reperfusion therapy, it wasn't statistically significant (20.3% vs. 10.1%, p: 0.054). Multivariate analysis revealed that high NIHSS (The National Institutes of Health Stroke Scale) score (OR=1.25; p < 0.001) and hospitalization in the home quarantine period (OR=3.21; p = 0.043) were independently associated with in-hospital mortality. CONCLUSION: Our study indicated that during the COVID-19 home quarantine period, despite a significantly fewer number of patients admitted to the hospitalization, there was a higher percentage of those hospitalized needing intensive care and an overall worse prognosis.