Comparison of COVID-GRAM, 4C Mortality, qSOFA, SIRS, NEWS, and MEWS in Predicting Mortality in COVID-19

Objective: Mortality prediction methods are still controversial about coronavirus disease-2019 (COVID-19) pneumonia. This study aimed to compare the efficacy of the the quick Sequential Organ Failure Assessment, systemic inflammatory response syndrome (SIRS), Modified Early Warning score (MEWS), National Early Warning score, 4C mortality, and COVID-GRAM critical illness risk score (COVID-GRAM), scoring systems in predicting 28-day mortality in adult patients with COVID-19.Methods: This single-center, retrospective, observational cohort study included patients presenting to a pandemic hospital between November 2021 and December 2021. Inclusion criteria were patients aged 18 years or older, patients with positive reverse transcription-polymerase chain reaction test, and thoracic computed tomography imaging. The receiver operating characteristic analysis was performed to examine the diagnostic accuracy of the investigated scoring systems in predicting 28-day mortality. Statistical analyses were performed using the SPSS and MedCalc software packages. A p-value of <0.5 was considered statistically significant.Results: The study was conducted in 846 patients. The median age of the patients included in the study was 49 (36-75) years, and the rate of male patients was 46.3% (n=392). The rate of pneumonia detection was 85.1% (n=720). The hospitalization rate was 49.6% (n=420), the admission rate to the intensive care unit was 7.4% (n=63), and the 28-day mortality rate was 5.7% (n=48). The highest area under the curve (AUC) values for 28-day mortality prediction was obtained from COVID-GRAM (AUC: 0.935) and 4C mortality (AUC: 0.922) scores, while the lowest AUC values were calculated in SIRS (AUC: 0.756) and MEWS (AUC: 0.805).Conclusion: According to our results, COVID-GRAM may be the first-choice scoring system in the emergency department for predicting the 28-day mortality associated with COVID-19.

Efficacy of anticytokine treatments added to corticosteroids in patients with COVID-19-associated pneumonia and hyperinflammation: a single center experience.

OBJECTIVE: Pneumonia and hyperinflammatory state related to COVID-19 infection are fatal clinical conditions without definite treatment modalities. Interleukin-6 and Interleukin-1 targeted therapies have been proposed as treatment options. This study was conducted to investigate the efficacy of anakinra and tocilizumab added to corticosteroids in patients with COVID-19-associated pneumonia and hyper-inflammatory syndrome in our tertiary clinical center. PATIENTS AND METHODS: Patients with COVID-19-associated pneumonia and hyperinflammatory state who did not respond to initial treatments, including corticosteroids, were included in the study. The patients' electronic records were reviewed retrospectively and recorded according to a standardized data table. Univariate and multivariate regression analyses were used to identify risk factors associated with intubation. RESULTS: 388 patients were included in the study. 197 patients were intubated and most of them died (n=194/197, 98%). 67 patients received tocilizumab, and 97 patients received anakinra. Anakinra [OR: 0.440, 95% CI=0.244-0.794, p=0.006] and tocilizumab [OR: 0.491, 95% CI=0.256-0.943, p=0.033] were both associated with a decreased risk for intubation. However, having a neutrophil/lymphocyte ratio ≥ 10 [OR: 2.035, 95% CI=1.143-3.623, p=0.016], serum lactate dehydrogenase (LDH) level ≥ 400 [OR: 3.160, 95% CI=1.937-5.156, p<0.001] and age ≥ 50 [OR: 4.048, 95% CI=2.037-8.043, p < 0.001] was associated with an increased risk for intubation. CONCLUSIONS: Both anakinra and tocilizumab, added to initial standard COVID-19 treatments (including glucocorticoids) reduced the need for intubation in patients with COVID-19-associated severe pneumonia and hyperinflammatory syndrome. Given the high mortality rate of intubated patients with COVID-19, both treatments may have added benefits on mortality.

Evaluation of the frequency and intensity of COVID-19 in patients with ankylosing spondylitis under anti-TNF therapy

BACKGROUND: The underlying pathogenetic mechanisms of Sjögren syndrome (SjS) have not been elucidated yet [1]. Leptin is a glycosylated peptide structurally similar to some cytokines [2]. Leptin has proinflammatory effects via various mechanisms. It has been previously reported that serum leptin levels increase in some autoimmune diseases and that leptin levels are also associated with disease activity [3, 4]. In addition, leptin and its receptor in the salivary glands stimulate epithelial proliferation and modulate the local immune system with their autocrine effects [5]. In this study, we assessed the presence of leptin in minor salivary glands (MSG) of the patients with and without SjS. Additionally, we evaluated the association between leptin staining intensity and disease activity among patients with SjS. We included patients who underwent MSG biopsy with the suspicion of SjS between 2013 and 2014. Among these patients, those who met the 2012 American College of Rheumatology Sjögren's syndrome classification criteria (6) and had at least 50 mononuclear cell infiltrates in a 4 mm2 minor salivary gland section were classified as the SjS group. The rest of the patients who underwent MSG biopsy but did not meet the histopathological and/or clinical criteria for SjS were considered the control group. Leptin staining was assessed by immunohistochemistry (Bio-Rad AbDSerotec, Oxford, UK) in the stroma, acinar and ductal epithelium, and staining intensities were graded by a semiquantitative method;no staining (score 0), mild (score 1), moderate (score 2), and diffuse (score 3). Definitions of leptin staining intensities were described as mild;focal staining of few cells in one focus, moderate;mild staining in more than one focus, diffuse;diffuse staining in all assessed sections (Figure 1). The sum of leptin staining in all areas was defined as total leptin staining. The SjS group was divided into 3 groups according to the focus scores (FS) (FS1: FS = 1, FS2: FS = 2, FS3: FS ≥ 3). In addition, patients' disease activities were assessed by EULAR Sjogren's syndrome disease activity index (ESSDAI) [7]. Visual (histograms, probability plots) and analytical methods (Kolmogorov-Smirnov test) were used to analyze the variables' distribution and select the test method. Descriptive analyses were presented as mean or median according to their distribution patterns. A chi-square test was used for univariate analyses to identify variables associated with leptin staining and clinical features. Patients' disease activities were assessed by ESSDAI [9]. The correlations between ESSDAI scores and leptin staining intensities were analyzed using Spearman's test. A p value of 66%, in FS3 group: 100%) areas were higher in the patients with FS3. There was a positive correlation between ESSDAI and leptin staining scores in the acinar area (p < 0.05;r = 0.406) regardless of focus scores. However, the correlations between disease activity and leptin staining in ductal areas (p: 0.1;r: 0.334), in stromal areas (p: 0.1;r: 0.184), and total leptin (p: 0.2;r: 0.268) staining was not significant. We identified that majority of the patients in both groups had leptin staining in acinar (92% and 84%, respectively), ductal (94% and 84%, respectively), and stromal areas (96% and 100%, respectively) of their MSGs. Patients with higher FSs had significantly more intense leptin staining patterns. The possible explanations for the similar staining pattern in patients with an FS of ≤2 was the insufficient number of patients (β error) or absolute indifference. In contrast, a study by Erbasan F et al. argued that leptin has no role in primary SjS due to similar leptin staining patterns among patients with SjS and healthy controls. However, they did not compare patients according to the ESSDAI scores [8]. Thus, we still need more robust data to identify whether leptin has an inciting or prognostic role in pSS. Limitations of our study were the lack of some clinical characteristics and metabolic parameters which may affect leptin metabolism and lack of leptin receptor staining patterns in MSG biopsies, which together with leptin staining could better define the role of leptin. Lack of power analysis was another limitation. In conclusion, leptin staining properties were similar in both SjS and non-SjS groups. Additionally, the only clinical significance of leptin density in the MSG was in the acinar region. RESULTS: The authors have no financial or competing interests. DISCUSSION: All authors declare no conflict of interest We received funding support from Kartal Dr. Lutfi Kirdar City Hospital research assistance department. Authors contributed to writing this study and have approved the final version. Ethical approval: This article does not contain any studies with human participants performed by any of the authors. The study protocol was approved by the Local Ethics Committee of Dr Lutfi Kirdar Kartal City Hospital.

Investigation of descriptive characteristics of randomized controlled trials of COVID-19 vaccines

INTRODUCTION: The aim of this study was to examine the descriptive characteristics of randomized controlled trials published in PubMed on COVID-19 vaccines until May 30, 2021. METHODS: Seventy three articles reached by scanning the keywords "vaccine" and "COVID 19" in the PubMed database were reviewed by researchers, 33 randomized controlled trials (RCTs) related to COVID 19 vaccines were included in the study. According to the 17-item questionnaire created by the researchers, the descriptive features of included studies were examined. RESULTS: The total number of investigative authors in 33 RCT articles published in approximately one and a half years from the outbreak of the pandemic was 946, and the average number of authors per article was 28.67+or-18.56.39.3% of the articles were published in The Lancet and 27.2% in The New England Journal of Medicine. Of the vaccines used in the studies, 36.3% mRNA vaccine, 21.2% Inactivated vaccine, 18.1% Recombinant adenovirus vaccine, 12.1% Chimpanzee adenovirus-based vector vaccine, 6% BCG vaccine. 22.5% of vaccines are Phase 1, 12.9% Phase 2, 19.3% Phase 3, 3.2% Phase 4, 32.3% Phase 1-2, 9%,6 of them are Phase 2-3 studies. DISCUSSION AND CONCLUSION: The majority of randomized controlled trials on COVID-19 vaccines are phase 1 and phase 2 trials for mRNA vaccines and inactivated vaccines. Studies have generally been conducted on the adult age group and studies are needed to evaluate the effect of vaccines on the pediatric age group. In studies, the safety of vaccines has been examined more, and there is limited information on efficacy and effectiveness of vaccines.

The Impact of Left Ventricle Geometry Patterns on Length of Hospital Stay in COVID-19 Patients

Objective: The coronavirus disease 2019 (COVID-19) has placed huge strains on medical systems. Therefore, it is essential to determine the predictors of the long hospital stay. We sought to investigate whether alterations in left ventricular (LV) geometry in COVID-19 patients are associated with the length of stay (LoS) and a long hospital stay. Materials and Methods: 108 consecutive hospitalized COVID-19 patients were incorporated in the study and 89 patients remained for statistical analysis. All participants underwent standard two-dimensional (2D) and Doppler echocardiographic examinations. Patients were classified according to LV geometry characteristics namely normal geometry (NG), concentric remodeling, concentric hypertrophy and eccentric hypertrophy. Results: Multiple binary logistic regression model adjusted for clinical and laboratory variables yielded significant and independent association of LV mass index (LVMI) (OR: 1.12, 95% CI: 1.06-1.19, p<0.001), 10 g/m(2) increase in LVMI (OR: 3.63, 95% CI: 2.00-6.59, p<0.001), LV geometry patterns (OR: 2.92, 95% CI: 1.46-5.34, p=0.002), and altered geometric patterns compared to NG (OR: 3.97, 95% CI: 1.08-14.5, p=0.037) with long hospital stay. Correlation analysis of LVMI and LoS demonstrated significant and moderate correlation (rho=0.58, p<0.001). Conclusion: LVMI and LV geometric patterns independently predict long hospital stays in COVID-19 patients. The significant correlation between LoS and LVMI underlies the significance of LV geometry in this infection.

The relationship between disease severity and CRP/albumin levels in cases with COVID-19 pneumonia

Background: To determine disease severity in the COVID-19 pandemic, it is necessary to monitor several clinical and laboratory parameters. Non-invasive and objective inflammatory markers can be a practical and objective route in the determination of disease activity. The C-reactive protein/albumin ratio (CAR) is an inflammatory marker thought to have prognostic value for most diseases, primarily sepsis. The aim of this study was to evaluate the diagnostic performance of CAR in determining the clinical severity of COVID-19 disease.

Experiences of providers and simulated patients with using a novel proning and repositioning device

INTRODUCTION/HYPOTHESIS: Proning critically ill patients presents risk to both patient and healthcare provider. In response to challenges with proning COVID-19 patients, the Apparatus and Method for Moving a Patient (AMMP) device was developed to facilitate the proning of patients while minimizing risk to the patient or the healthcare team. Using healthy participants as patient volunteers, this study sought to determine if the AMMP makes it easier, quicker, and safer to prone patients compared to using the standard approach. METHODS: In this preclinical feasibility study, healthy participants were recruited to participate as patient volunteers at 2 ICUs in Nova Scotia (QEII Health Sciences Centre, Cape Breton Regional Hospital). Education on how to use the AMMP was provided prior to performing the movements. Healthcare providers in the ICUs including physicians, nurses, and respiratory therapists used the AMMP to move participants from supine to prone and vice versa, up/ down and/or to lateral position. Paper-based surveys were administered to patient volunteers and healthcare providers upon completion of the movements. RESULTS: In all, 10 patient volunteers and 23 healthcare providers completed surveys. The majority of volunteers were aged 18-35 years (7/10;70%) and weighed 61-90 kg (6/10;60%). None of the volunteers reported being injured while being repositioned using the AMMP, and none of the providers reported any strain or injury to a volunteer or to a team member. Among providers, 91.3% (21/23) felt the AMMP was easy to apply to patients, 100% (23/23) found it easy to adjust strap length, and 100% (23/23) found it was easy to remove after the movement was completed. Compared to prone positioning using the standard approach, 100% (23/23) providers felt that using the AMMP was safer for the healthcare team and 96% (22/23) felt it was safer for the patient. All providers (23/23;100%) agreed physical demands were reduced using the AMMP, and 96% (22/23) agreed it took less time to complete prone positioning and required fewer providers to prone and reposition the patient volunteers. CONCLUSIONS: Volunteers felt comfortable and secure being proned and repositioned in the AMMP. Healthcare providers in the ICU found the AMMP easier to use and less physically demanding compared to their standard approach to proning.

Assessing humoral immune response after two doses of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthcare workers.

OBJECTIVES: During COVID-19 pandemic, the absence of immunity in the population left them susceptible to infection with SARS-CoV-2; healthcare workers (HCWs) being in the highest risk group. This study intends to assess and follow up the humoral immunity in HCWs vaccinated with an inactive virus vaccine (CoronaVac). STUDY DESIGN: This is a prospective observational study. METHODS: A total of 1072 HCWs were investigated for the presence of immunoglobulin G antibodies to the receptor-binding domain of the S1 subunit of the spike protein of SARS-CoV-2 after vaccination. Blood samples were obtained after 28 days of the first dose, 21 days of the second dose, and 3 months after the second dose. Detection of antispike antibodies was performed by the chemiluminescent microparticle immunoassay method (SARS-CoV-2 IgG II Quant, Abbott, Ireland). The results greater than or equal to the cutoff value of 50.0 AU/mL were reported as positive. RESULTS: Four weeks after the first dose of vaccine, antispike antibodies were detected in 834/1072 (77.8%) of HCWs. Seropositivity was higher among females (84.6%) than males (70.6% p < 0.001) and was found to be highest in both women and men between the ages of 18-34 years. Antispike antibodies were detected in 1008 of 1012 (99.6%) after 21 days of the second dose and in 803 of 836 (96.1%) after 3 months of the second dose. CONCLUSIONS: CoronaVac was found to be highly immunogenic after two consecutive doses performed 28 days apart to HCWs; however, the immunogenicity declined significantly (p < 0.001) after 3 months following the second dose of vaccine.

Subacute thyroiditis during the COVID-19 pandemic: a prospective study.

PURPOSE: Subacute thyroiditis(SAT) is a destructive thyroiditis associated with viral infections. Several SAT cases associated with SARS-CoV-2 infection/vaccination were recently reported. We aimed to evaluate prospectively all cases applied to our tertiary center and their relationship with SARS-CoV-2 during 16 months of the pandemic. Cases during similar pre-pandemic period were recorded for numeric comparison. METHODS: Prospective study took place between March 2020 and July 2021. SAT was diagnosed by classical criteria. Swabs for SARS-CoV-2 and a wide respiratory viral panel (RV-PCR) were taken. Previous COVID-19 was assessed by SARS-CoV-2 IgM&IgG levels. Study group was divided into three as: CoV-SAT, patients who had or still have COVID-19, Vac-SAT, patients diagnosed within three months after SARS-CoV-2 vaccination and NonCoV-SAT, those not associated with COVID-19 or vaccination. RESULTS: Out of 64 patients, 18.8% (n = 12) was classified as CoV-SAT, 9.3% (n = 6) as Vac-SAT and 71.9% as (n = 46) NonCoV-SAT. SARS-CoV-2 RT-PCR tests on the diagnosis of SAT were negative in all, but two patients tested positive five days later, in second testing, performed upon clinical necessity. CoV-SAT and NonCoV-SAT groups were similar in terms of clinical, laboratory, and treatment characteristics. However, symptoms were milder and treatment was easier in Vac-SAT group (p = 0.006). CONCLUSIONS: Total number of SAT cases during the pandemic period was comparable to pre-pandemic period. However, a considerable rate of SARS-CoV-2 exposure in SAT patients was established. COVID-19 presented with SAT, as the first manifestation in three cases. Vaccine-related cases developed in a shorter time period, clinical presentation was milder, and only a few required corticosteroids.

Antibody production against COVID-19 in hemodialysis patients

Introduction: Dialysis patients may have a very high prevalence and death rate for COVID-19. The aim of this study is to show the level of antibody against SARS-CoV-2 in hemodialysis and staff working in the same dialysis center. Methods: Anti-SARS-CoV-2 IgG antibodies were studied in 156 hemodialysis patients and 27 staff. After a 5-minute resting period, blood pressure was measured and then subsequent to an approximately 12-hour fasting period, blood sample were drawn for biochemistry parameters and anti-SARS-CoV-2 IgG antibodies. Results: Three of hemodialysis patients were diagnosed with COVID-19 in March and their PCR tests were positive. The symptoms of these patients were extreme fatigue and muscle weakness. Anti-SARS-CoV-2 IgG antibodies tests were performed on all patients and staff in July. In total, 13/156 ( 8.3%) patients were diagnosed as COVID-19 based on anti-SARS-CoV-2 antibodies. The other 10 patients were asymptomatic. The staff and 143 hemodialysis patients had IgG (-). Hemodialysis patients who had anti-SARS-CoV-2 IgG (+) antibodies had decreased level of haemoglobin and high levels of C-reactive protein and alkaline phosphatase. Conclusions: Antibody tests are particularly important for detecting people with COVID-19 who have few or no symptoms. It has also been seen that the spread of infection in the dialysis center can be prevented by very strict precautions.

Comparison of Differences of the Hand Area Anatomic and Anthropometric Parameters of the Isokinetic Muscle Functions of the Healthcare Workers Who Work in Different Units during the Covid-19 Pandemic Process

The hand grip strength of neurology physiotherapists working with neurological patients who have impaired control of agonist and antagonist muscles due to nerve injuries or accidents, and intensive care nurses and nursing staff working with second and third level immobile patients are at risk. Wrist grip level decreases over time in both professions;due to the damage to the anatomical structures of the wrist, for reasons such as positioning the patient, exercising, etc. Our aim in this study is to ensure that the aforementioned similar sub divisional health workers;to reveal the occupational difference rates between hand grip strength and forearm flexion extension strength losses. In our study, only male participants were included in the study in order to eliminate gender-related muscle strength differences. 20 male neurology physiotherapists and 20 male intensive care workers were determined as the research sample. Wrist circumference and Body Mass Index (BMI) of the groups were calculated for the anthropometric measurement evaluations in both groups included in the study. The wrist grip strength of both hands of the participants was evaluated with jamar dynamometer and flexion and extension strengths with an Electronic Push/Pull Dynamometer (EPPD). The data obtained were evaluated with SPSS22. In the analysis of the data, "Independent samples t" test was applied for parameters such as age, height, weight, and dominant hand preference, duration of work, flexion, extension and left jamar average values. "Mann Whitney U" test, one of the non-parametric tests, was applied for variables that do not show normal distribution. In the light of the data obtained as a result, there are statistically significant differences between the two groups for height, time spent in the profession/month and left hand extension values and right hand jamar average values in both occupational groups (P<0,05).

Analysis of ACE2 gene coding variants by direct whole exome sequencing in the Turkish Population

Objective: Due to the rapid spread of a novel coronavirus (SARS-CoV-2) globally, the WHO declared the situation as a pandemic. ACE2 is crucial for SARS-CoV-2 attachment onto the host cells. The expression levels and variations of ACE2 may facilitate or slow down the entrance of the SARS-CoV-2 virus into host cells. This might explain the variability of infection through individuals and populations. Materials-Methods: In this study, a retrospective comparative WES analysis of the ACE2 variants was conducted to 584 individuals around Turkey. Allele frequencies of all variants were calculated and filtered to remove variants with allele frequencies lower than 0.003. Results: The variants that showed a susceptibility to SARS-CoV-2 transmission in the literature were compared with our data. The most frequent variant, ACE2 N720D, and the second most frequent variant, ACE2 K26R that alters ACE2 protein and enhances its affinity for SARS-CoV-2 are not frequent in the Turkish population. Conclusion: The main ACE variants that has susceptibility effect to SARS-CoV-2 were not determined. It shows that the Turkish genetic makeup lacks any ACE2 variant that increases susceptibility for SARS-CoV-2 infection. Overall, this study will contribute to the formation of a national variation database and may also contribute to further studies of SARS-CoV-2 infection.

Epicardial fat volume predicts clinical severity of COVID-19

Background and Aim: The inflammatory response plays a critical role in coronavirus disease 2019 (COVID-19) and inflammatory cytokine storm increases the severity of COVID-19. Epicardial adipose tissue serves as a source of inflammatory cytokines and mediators. This study aimed to investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19. Methods: This retrospective study included 101 patients hospitalized with COVID-19 between March 11 and April 21, 2020. Laboratory findings, treatment and complications were recorded. The serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomographic images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to intensive care unit (ICU) or death. Results: The primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died (mean age 71.9±14.3, 6 male). EFV (115.1±44.0 cm3 vs 94.3±45.5 cm3, respectively, p=0.037), CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation between EFV and CRP (r=0.494, p<0.001), PCT (r=.287, p=0.005), ferritin (r=0.265, p=0.01) and IL-6 (r=0.311, p=0.005) was determined. At receiver operating characteristic analysis, patients with EFV >102 cm3 were more likely to have severe complications. Conclusions: Epicardial fat volume and the serum levels of CRP, IL-6, PCT and ferritin can effectively assess disease severity and predict outcome in patients with COVID-19.