Evaluation of Vitamin D binding protein and 25-hydroxy Vitamin D metabolites in COVID-19 patients

Objectives: The immunomodulatory roles of Vitamin D and Vitamin D binding protein (VDBP) are in interest with incidence or outcome of coronavirus disease-2019 (COVID-19). This study aimed to investigate the association between the severity of COVID-19 with VDBP, total 25-hydroxy Vitamin D (25(OH)D), and its metabolites free Vitamin D (VDfree) and bioavailable Vitamin D (VDbio). Methods: Study group consisted of 68 COVID-19 patients and 20 healthy subjects. Patients were subgrouped as asymptotic, mild/moderately pneumonia, or severe pneumonia. Plasma total 25(OH)D was quantitated by liquid chromatography with mass spectrometry and serum VDBP by a polyclonal sandwich enzyme immunoassay. In addition, routinely used laboratory parameters in follow-up were recorded. VDfree and VDbio were calculated using total 25(OH)D, VDBP, and albumin levels. Results: Plasma total 25(OH)D (13.3±5.7 vs. 30.3±13.3 ng/dL), VDfree (2.18 [1.52–3.44] vs. 4.34 [3.74–6.48] pg/mL), and VDbio (1.86 [1.09–2.81] vs. 4.28 [3.45–6.34] nmol/L) levels were lower in COVID-19 patients (p<0.001). Despite the insignificance of 25(OH)D and metabolites between COVID-19 severity subgroups, serum VDBP was highest in mild/ moderately pneumonia (601.8±278.6 ng/mL) and lowest in severe pneumonia (427.9±147.2 ng/mL) (p<0.001). In addition, VDBP was positively correlated with lymphocyte counts (B:87.9, r2=0.068, p=0.031) and negatively correlated with D-Dimer levels (B:−0.024, r2=0.081, p=0.032). Conclusion: COVID-19 patients have lower plasma 25(OH)D levels and lower 25(OH)D metabolites VDfree, VDbio which are physiologically active. In addition, serum VDBP concentrations significantly decrease in critically ill patients which needs further studies to be associated in the etiopathogenesis of the disease severity. [ FROM AUTHOR] Copyright of International Journal of Medical Biochemistry is the property of KARE Publishing 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.)

The course of COVID-19 in patients with hematological malignancies and risk factors affecting mortality: A cross-sectional study.

Objective: This study aimed to determine the clinical outcomes and risk factors affecting mortality in patients with COVID-19 following hematological malignancy (HM). Methods: Patients diagnosed with HM and hospitalized for COVID-19 were included in this retrospective study. The age, demographic and clinical characteristics, prognosis and treatment of surviving and non-surviving patients were compared. Results: A total of 49 patients were included in this study, 17 (34.6%) of whom died within 28 days of being diagnosed with COVID-19. Older age (p = 0.001), diabetes (p = 0.001), chronic obstructive pulmonary disease (p = 0.002), secondary infection (p < 0.001) and secondary bacterial infection (p = 0.005) were statistically significantly higher in non-survivors. The remission status of HM was higher in surviving patients (p < 0.001). In multivariate regression analysis, age (OR: 1.102, p = 0.035) and secondary infection (OR: 16.677, p = 0.024) were risk factors increasing mortality, the remission status of HM (OR: 0.093, p = 0.047) was a protective factor from mortality. Conclusion: The older age, the remission status of HM and secondary infection due to COVID-19 were determined as prognostic factors predicting mortality in HM patients with following COVID-19.

Quick COVID-19 Severity Index, CURB-65 and Quick SOFA Scores Comparison in Predicting Mortality and Risk Factors of COVID-19 Patients.

BACKGROUND: This study aimed to investigate CURB-65, quick COVID-19 Severity Index (qCSI) and quick Sepsis Related Organ Failure Assessment (qSOFA) scores in predicting mortality and risk factors for death in patients with COVID-19. METHODS: We retrospectively analyzed a total of 1919 cases for whom the rRT-PCR assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. For mortality risk factors, univariate and multivariate logistic regression analyses were used. Receiver operator characteristics (ROC) analysis and Kaplan-Meier survival analysis were performed for CURB-65, qCSI and qSOFA scores. RESULTS: The patients' average age was 45.7 (21.6) years. Male patients accounted for 51.7% (n=992). In univariate analysis, some clinical variables including age over 65 years and comorbid diseases such as hypertension, chronic kidney disease, malignancy, lymphopenia, troponin, lactate dehydrogenase (LDH) and fibrinogen elevation were associated with the mortality rate. In multivariate logistic regression analysis: Neutrophil lymphocyte ratio (NLR) 3.3 and above (OR, 9.1; 95% CI, 1.9-42), C-reactive protein (CRP)30 mg/L and above (OR, 4.1; 95% CI, 1.2-13.6), D-dimer 1000 ng/mL and above (OR, 4; 95% CI, 1.5-10.7) and age (OR, 1.11; 95% CI, 1.04-1.18-year increase) were identified as risk factors for mortality among COVID-19 patients. The CURB-65 and qCSI scores exhibited a high degree of discrimination in mortality prediction (AUC values were 0.928 and 0.865, respectively). Also, the qSOFA score had a moderate discriminant power (AUC value was 0.754). CONCLUSION: CURB-65 and qSCI scores had a high discriminatory power to predict mortality. Also, this study identified CURB-65, qCSI and qSOFA scores, NLR, CRP, D-dimer level, and annual age increase as important mortality risk factors.

Remdesivir treatment for patients with moderate to severe COVID-19.

BACKGROUND: Remdesivir, which was first developed for the treatment of Ebola disease but failed to meet expectations, has become hope in the fight against the COVID-19 pandemic. This study aimed to evaluate risk factors for mortality and prognosis of adult moderate/severe COVID-19 patients treated with remdesivir, and safety and tolerability of 5 days of remdesivir treatment. METHODS: This multicenter prospective observational study was conducted in 14 centers in Turkey. Pregnancy or breastfeeding, multiorgan failure, or usage of vasopressors for septic shock, ALT > 5 × the upper limit of the normal range, or eGRF <30 mL/min or dialysis and receiving favipiravir were the exclusion criteria of the study. RESULTS: Among 500 patients, 494 patients were included in the study. On admission, 392 (79.3%) patients had moderate and 102 (20.6%) patients had severe COVID-19. The 28-day mortality was 10.1%. The median of the scores of the seven-category ordinal scale assessed on days 0, 3, 5, 7 were 4 and 3 on day 14. When the survival status of the patients was evaluated according to the time between the remdesivir start date and the end date of the symptoms, no statistically significant difference was found between the medians of the groups (p = 0.404). In multivariable analysis, age (OR, 1.05; 95%CI, 1.02-1.08; p = 0.003), SpO2 level on admission (OR, 3.03; 95%CI, 1.35-6.81; p = 0.007), heart rate (OR, 2.48; 95%CI, 1.01-6.07; p = 0.047), follow-up site at the hospital (clinic/ICU) (OR, 26.4; 95%CI, 11.6-60.17; p < 0.001) were independently associated with increased mortality. Grade 3 adverse event (AE) was observed in 4 (0.8%) patients. None of the patients experienced grade 4 or 5 AEs. DISCUSSION: Remdesivir is a safe and well-tolerated drug and older age, low SpO2 level on admission, tachycardia, and ICU admission are independently associated with increased mortality among patients with moderate/severe COVID-19 receiving remdesivir treatment.

The clinical characteristics of 541 fully vaccinated hospitalized COVID-19 patients in a Tertiary Care Hospital in Turkey (preprint)

Purpose: We aimed to examine the characteristics of Turkish patients hospitalized with COVID-19 despite being fully vaccinated. Method A retrospective, single-center study was conducted in fully vaccinated patients with inactivated whole virion (CoronaVac) and or BNT162b2 mRNA (Pfizer-BioNTech) vaccines and admitted to the hospital. We evaluated the hospitalized patients regarding the intensive care unit admission and death. Results We conducted the study with 541 patients. The mean age was 70.2, and 52.1% of the patients were women. 73.6% of the patients were 65 years or older. The most common comorbidities were hypertension, diabetes mellitus, and COPD. The rate of the alpha variant was 54.3%, and the delta variant was 29.4%. The mortality rate was 45.8%, and the ICU admission rate was 55.3%. In our study, the delta variant had higher ICU admission, and the alpha variant had a higher mortality rate. Patients vaccinated with two-dose Sinovac-CoronaVac had a higher mortality rate. There was no difference between the time between the last vaccination dose to hospitalization, ICU admission, and mortality. LOS in the hospital was longer in ICU and mortality patients. Conclusion Our results suggest administering a third and fourth dose of mRNA vaccine to subjects vaccinated primarily with two doses of CoronaVac.

COVID-19 Tedavisinde Kullanılan Ílaçların Yan Etki Sıklığının Değerlendirilmesi: Bir Retrospektif Araştırma: Turkiye Klinkeri Journal of Medical Sciences

 Objective: It is aimed to determine the frequency of side effects seen in the use of antiviral, antibacterial and immunomodulatory drugs used in the treatment of coronavirus disease-2019 (COVID-19) in combination or monotherapy. Material and Methods: In this retrospective study, patients with a diagnosis of COVID-19 who received hydroxychloroquine, macrolide, and favipiravir treatments in combination or monotherapy were evaluated in terms of the development of side effects. Demographic and clinical data of the patients, other treatments they received and the side effects that occurred were recorded. Results: During the study period, data from 337 patients were analyzed. The median age of the patients was 56 (19-94), and 184 (54.6%) were male. Hypertension was the most common comorbidity (29.9%). Diffuse infiltration was detected in 210 (62.3%) of 272 (80.7%) patients with pneumonia. Eighteen (5.3%) patients received only hydroxychloroquine, 86 (25.5%) had only macrolide, 193 (57.3%) had hydroxychloroquine and macrolide, and 40 (11.9%) had hydroxychloroquine, macrolide and favipiravir triple combination. Side effects were observed in 2 (11.1%) patients receiving hydroxychloroquine monotherapy, 4 (4.7%) patients receiving macrolide monotherapy, 55 (28.5%) patients receiving hydroxychloroquine-macrolide combination, and 4 (10.0%) patients receiving hydroxychloroquine-macrolidefavipiravir combination. It was observed that the most common (12.9%) side effect in the group receiving the combination of hydroxychloroquine and macrolide was QT prolongation. The most common (7.3%) side effect of the gastrointestinal system was found to be nausea. Conclusion: The frequency of side effects increases when antiviral, antibacterial and immunomodulatory drugs used for the treatment of COVID-19 are used in combination. 

Low-dose tocilizumab is associated with improved outcome and a low risk of secondary infection in severe COVID-19 pneumonia.

BACKGROUND: Respiratory failure and death are the leading causes of severe Coronavirus disease 2019 (COVID-19). Hyper-inflammation and cytokine storm cause lung damage. This study aimed to compare the low-dose and high-dose effects of tocilizumab, an IL-6 receptor antagonist. METHOD: Patients with severe pneumonia and hyper-inflammation signs because of COVID-19 were included in this retrospective study. Patients receiving tocilizumab <200 mg intravenously were classified as the low-dose group, and receiving ≥200 mg as the high-dose group, and those not treated with tocilizumab as the control group. Demographic and clinical data of patients who died and survived in both low-high dose and control patients were compared. According to symptom day and radiological infiltration, patients with tocilizumab were also evaluated in two groups as early and late periods at tocilizumab administration time. RESULTS: A total of 160 patients were included in the study; 70 were treated with a low dose and 50 with high-dose tocilizumab. Forty patients were in the control group. Age, comorbidity and clinical features were similar in the control, low-dose tocilizumab and high-dose tocilizumab groups. The mortality rate (12.9%, 30.0%, 37.5, P = .008) was less in the low-dose tocilizumab group. The secondary infection rate was higher in the high-dose group than in the low-dose tocilizumab and control groups (44.0%, 10.0%, 10.0%, P < .001). Distinguishing between those patients who died and survived, age (OR: 1.1589, P < .001), higher APACHE II scores (OR: 1.225, P = .001) and needs for non-invasive mechanical ventilation (OR: 14.469, P < .001) were the most critical risk factors. Low-dose tocilizumab was associated with a lower mortality rate (OR: 0.244, P = .012). CONCLUSION: The use of tocilizumab at a low dose is associated with lower secondary infections and mortality.

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units.

BACKGROUND: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. AIMS: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. STUDY DESIGN: Retrospective, observational cohort. METHODS: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. RESULTS: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). CONCLUSION: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Retrospective analysis on efficacy of convalescent plasma in acute respiratory distress syndrome due to COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nineteen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.

Investigation of the relationship between inherited thrombophilia and novel coronavirus pneumonia

Aim: This study aimed to investigate the relationship between severe novel coronavirus pneumonia (NCP) and hypercoagulable conditions that predispose patients to thrombosis such as the prothrombin gene ( F2) rs1799963 (G20210A), factor V Leiden ( F5) rs6025 (G1691A) and PAI-1 (rs1799768). Patients: NCP-diagnosed 62 previously healthy patients were enrolled for the investigation of the thrombophilia-related polymorphisms. Materials &methods: The frequency of genotypes were compared with healthy control group frequencies from other studies. Results: There were no statistically significant differences between the severe patient group and the healthy population regarding the investigated single nucleotide polymorphisms (SNPs). Conclusion: This study is the first to rule out the relationship of rs1799963, rs6025 and rs1799768 with severe NCP.

Evaluation of Health Care Workers With COVID-19.

Objective: In this study, we aimed to determine the contact risk levels of infected health care workers for patients with COVID- 19 and to evaluate their disease status. Methods: Health care workers with COVID-19 were analyzed, retrospectively. Close contact with patients was classified as high, medium, low-risk or risk-free contact according to the use of personal protective equipment, and transmission levels were evaluated. Symptoms and disease severity after infection were determined. Results: A total of 82 health care workers were infected during the study period, and only 2% had high-risk contact status. There was risk-free contact in 71% of the patients. Community/ family-borne contaminations were detected as the main source of transmission. 82% of the infected health care workers have developed at least one symptom. Fever (65%) and dry cough 54%) were more common symptoms. According to their clinical severity, 66% of them had mild illness. Only one had severe illness. All the health care workers with COVID-19 recovered and were discharged. Conclusions: Health care workers are at increased risk of COVID- 19 transmission. In addition to the use of appropriate personal protective equipment, masks and social distance rules should be followed in social settings. (English) [ABSTRACT FROM AUTHOR] Amaç: Bu çalışmada COVID-19 hastalarına bakan infekte sağlık çalışanlarının temas risk durumlarının belirlenmesi ve hastalık durumlarının değerlendirilmesi amaçlanmıştır. Yöntemler: COVID-19 geçiren sağlık çalışanları retrospektif olarak değerlendirilmiştir. Hastalarla olan yakın temasları, kişisel koruyucu ekipman kullanımlarına göre yüksek, orta, düşük riskli veya risksiz temas olarak sınıflandırılmış ve bulaşma düzeyleri değerlendirilmiştir. Ínfekte olduktan sonra gelişen semptomlar ve hastalığın ağırlığı belirlenmiştir. Bulgular: Çalışma süresi boyunca toplam 82 sağlık çalışanı infekte olmuştur ve sadece %2'sinde yüksek riskli temas vardı. Risksiz temas ise %71'inde saptanmıştır. Başlıca bulaşma kaynağı olarak ise toplum/aile kaynaklı bulaşma saptanmıştır. Ínfekte sağlık çalışanlarının %82'sinde en az bir semptom gelişmiştir. Ateş (%65) ve kuru öksürük (%54) en sık görülen semptomlardı. Klinik ağırlıklarına göre %66'sı, hastalığı hafif şekilde atlatmıştı. Yalnızca bir sağlık çalışanı ağır hastalık tablosu gösterdi. COVID-19 saptanan sağlık çalışanlarının tamamı iyileşerek taburcu edilmiştir. Sonuçlar: Sağlık çalışanlarına COVID-19 bulaşması riski artmıştır. Uygun kişisel koruyucu ekipman kullanımının yanında, sosyal ortamlarda da maske ve sosyal mesafe kurallarına uyulmalıdır. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Klimik Journal / Klimik Dergisi is the property of Turkish Society of Clinical Microbiology & Infectious Diseases 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 abstract 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 abstract. (Copyright applies to all Abstracts.)