ABSTRACT
Sustainable Urban Development Observatory of Thessaloniki (SUDOTh) started operating in the first semester of 2020 with the objective to promote territorial evidence in policy making in urban governance. SUDOTh was developed as part of the Sustainable Urban Development Strategy 2016-2023 of Thessaloniki Metropolitan Area to address the need to obtain, observe and monitor how complex urban functions interact, at a territorial level, with product development (or lagging) effects. In the first year of operation, the Observatory had to set, test and evaluate the system of indicators and indexes it uses. Initially the system was formed in 4 basic sections: 1. Territorial Development and Urban renewal, 2. Urban Mobility, 3. Environmental Conditions and 4. Social Conditions. An extra set of indicators for Urban Governance was also developed. The process of data collection, test and evaluation of indicators was eventually coincided with the COVID-19 pandemic. This situation influenced deeply several urban functions as well as the data collection methodology. The first results and conclusions from the first year of the operation of SUDOTh are presented and discussed further in this paper.
ABSTRACT
Objective: A critical role in coronavirus disease 2019 (COVID-19) pathogenesis is played by immune dysregulation that leads to a generalized uncontrolled multisystem inflammatory response, caused by overproduction of proinflammatory cytokines, known as "a cytokine storm" (CS), strongly associated with a severe course of disease. The aim of this study is to identify prognostic biomarkers for CS development in COVID-19 patients and integrate them into a prognostic score for CS-associated risk applicable to routine clinical practice. Materials and Methods: The authors performed a review of 458 medical records from COVID-19 patients (241 men and 217 women aged 60.0 ± 10.0) who received treatment in the St. Petersburg State Budgetary Institution of Healthcare City Hospital 40 (City Hospital 40, St. Petersburg), from Apr. 18, 2020 to Nov. 21, 2020. The patients were split in two groups: one group included 100 patients with moderate disease symptoms; the other group included 358 patients with progressive moderately severe, severe, and extremely severe disease. The National Early Warning Score (NEWS) score was used alongside with clinical assessment, chest computed tomographic (CT) scans, electrocardiography (ECG), and lab tests, like ferritin, C-reactive protein (CRP), interleukin (IL)-6, lactate dehydrogenase (LDH), and D-dimer. Results: The basic risk factors for cytokine storms in COVID-19 patients are male gender, age over 40 years, positive test result for replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, absolute lymphocyte count, dynamics in the NEWS score, as well as LDH, D-dimer, ferritin, and IL-6 levels. These clinical and instrumental findings can be also used as laboratory biomarkers for diagnosis and dynamic monitoring of cytokine storms. The suggested prognostic scale (including the NEWS score dynamics; serum IL-6 greater than 23 pg/ml; serum CRP 50 mg/L or greater; absolute lymphocyte count less than 0.72 × 109/L; positive test result for replicative coronavirus (SARS-CoV-2) RNA; age 40 years and over) is a useful tool to identify patients at a high risk for cytokine storm, requiring an early onset of anti-inflammatory therapy.