ABSTRACT
Transmission prevention is important to prevent the spread of COVID-19. Although most cases are transmitted through droplets and aerosols, several studies have shown the possibility of transmission through fecal material. It is important to identify which patients are more likely to shed SARS-CoV-2 to raise awareness of the virus transmission via their feces. This study aims to determine the association of clinical and laboratory characteristics of COVID-19 patients with the SARS-CoV-2 detection in feces. From May to December 2020, fecal specimens from confirmed COVID-19 patients were collected, processed, and tested for the SARS-CoV-2 RNA presence. Clinical and laboratory parameters were compared between patients with and without SARS-CoV-2 RNA in their feces. Categorical variables were analyzed using Chi-square or Fisher's Exact test, whereas non-categorical variables were analyzed using Independent T test and Mann-Whitney U test. From 51 COVID-19 patients of whom fecal specimen were collected, SARS-CoV-2 RNA was found in the feces of 26 (50.9%). The SARS-CoV-2 presence in the feces was associated with cough (p=0.002), dyspnea (p=0.017), bilateral pneumonia (p=0.011), lower SARS-CoV-2 CT-values in nasopharyngeal and oropharyngeal swabs (p=0.015), and clinical severity (p=0.0023). In conclusion, several clinical characteristics contributing to the COVID-19 severity and higher SARS-CoV-2 viral load in the respiratory tract were associated with the SARS-CoV-2 RNA detection in feces. © 2023 by SPC (Sami Publishing Company).
ABSTRACT
Patients with severe and critical COVID-19 may exhibit sepsis and mortality resulting from multi-organ failure. Neutrophil-lymphocyte-ratio (NLR) values, C-reactive protein (CRP) levels, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE-II) scores were used to assess the risk of mortality in sepsis patients resulting from severe COVID-19 infection. The adequacy of NLR, CRP, SOFA, and APACHE-II scores were evaluated as predictors of mortality in septic COVID-19 patients at Dr. Kariadi Hospital Semarang, Indonesia, between August 2021 and July 2022. The subjects included severe and critical COVID-19 patients who fulfilled the WHO interim guidelines and Sepsis-3 criteria. A total of 211 patients were included, which were divided into survivor (n = 116) and non-survivor (n = 95) groups. NLR values, CRP levels, SOFA, and APACHE-II scores were measured within 24 hours of patient admission. Univariate and multivariate logistic regression analyses were used to identify the risk factors for COVID-19 mortality. Receiver operating characteristic curve analysis was used to predict the mortality of severe COVID-19 patients. The results indicated that the APACHE-II score was an independent predictor of mortality in sepsis patients resulting from severe and critical COVID-19. © 2023 by SPC (Sami Publishing Company).
ABSTRACT
BACKGROUND: Most coronavirus disease 2019 (COVID-19) patients are still experiencing persistent clinical symptoms even after being discharged from the hospital. The previous studies have reported the remaining symptoms in 29–93% of patients. This condition can have a major impact on a patient’s ability to perform daily activities and have a deleterious effect on their quality of life (QoL). AIM: This study aimed to evaluate persistent symptoms and QoL of COVID-19 patients 3 months after discharge from Dr. Kariadi Hospital Semarang, Central Java, Indonesia. METHODS: Confirmed COVID-19 patients were enrolled in this prospective cohort study after discharge from Dr. Kariadi Hospital Semarang from March 1, 2021, to May 15, 2021. Telephone interviews were conducted each week in the 1st month, and every 2 weeks in the 2nd and 3rd months regarding persistent symptoms. EQ-5D-5L questionnaires were completed and evaluated every month for 3 months after hospital discharge. RESULTS: Of the 104 patients enrolled, 52.9% were male, with a mean age of 48.96 years. The incidence of persistent symptoms in the 1st, 2nd, and 3rd months was 49%, 31.7%, and 25%, respectively. The most common persistent symptoms were fatigue, cough, shortness of breath, and nausea. The characteristics of the patients included being overweight/obese, having one or more comorbidities, having five or more symptoms classified as moderate COVID-19, and requiring supplemental oxygen during hospitalization. Based on the EQ-5D questionnaire, most patients reported worsening in the quality of their ability to perform usual activities, feelings of pain/discomfort, and anxiety/depression. The total values of the EQ-5D and EQ-VAS indices were lower than those of the Indonesian general population, indicating a decrease in QoL. CONCLUSION: The patients developed persistent symptoms and decreased quality of life during the 3-month following hospital discharge.
ABSTRACT
Introduction: The historical treatment of convalescent plasma was successful against RNA viruses. However, the significance of COVID-19 convalescent plasma therapy has not been clinically proven consistently in most studies and the available data showed contradictory results so far. Our study aims to evaluate the role of convalescent plasma therapy as an adjunctive treatment for severe and critically ill COVID-19 patients. Methods: This study was an open-label, non-randomized comparative clinical trial that was conducted at Dr. Kariadi Hospital, Semarang, Indonesia. This study sample are hospitalized severe and critically ill COVID-19 patients were assigned with a 2:1 ratio to receive convalescent plasma and local standard of care. The primary outcome was the clinical status 30 days after the intervention Results: A total of 73 patients received convalescent plasma and 38 patients received local standards of care. Both of the groups had similar clinical ordinal scales (median was 5, p=0.65), while patients in the study groups had significantly higher SOFA scores and P/F ratio. The control group had a worse overall mortality rate (61.1% vs 18.4%) with a hazard ratio of 3.5 (95%CI, 2.1-5.9) compared to the study group. From the subgroup analysis, we found that patients in the study group without mechanical ventilation support had the best survival rate compared to other groups HR: 0.0047 (95%CI, 0.01-0.19). The clinical outcome 7 days after convalescent plasma infusion was also significantly improved in the study group (median baseline & day-7, 5 & 3, p<0.001). From the multivariate analysis of therapeutic variables, convalescent plasma was the most significant variable for survival outcome (OR=0.089, 95%CI, 0.029-0.27;p<0.001). There was one case of anaphylactic shock and was excluded. Conclusions: The convalescent plasma administration significantly improved clinical outcomes and overall survival rates compared to those who received local standards of care.