ABSTRACT
Several studies have evaluated the impact of radiological phenotyping in the management of COVID-19 pneumonia (G. Scioscia et al. Arch Bronconeumol (Engl Ed). 2021 Jul 28). Moreover, among the various procedures, the prone position (PP) appears to be effective in improving alveolar gas exchange. Therefore, we have tested the efficacy of PP in different COVID-19 radiological phenotypes (PH). The study was conducted on COVID-19 patients admitted in our Unit between November 2020 and April 2021. The patients with a PaO2/FiO2 (P/F) <= 200 mmHg on blood gas analysis underwent PP cycles. In relation to PP ability, they were divided into two groups (Prone and Supine) and the groups were then compared. We enrolled 60 patients (29 Prone and 22 Supine). Of all patients, we calculated the post-PP P/F gain, resulting in 51.7+/-30.2 mmHg in PH1, 50.3+/-24.2 in PH2 and 55.0+/-19.7 mmHg in PH3. Although there were no significant differences in mortality rates between phenotypes, a post-PP gain >=20% seems to be a safety cut-off of response to PP. Hence, 83.3% PH2, 66.7% PH1 and 55% PH3 were identified as "responders" In conclusion, our findings suggest that PP is a procedure that should be performed;it improves gas exchange even if it shows different efficacy based on the radiological phenotype. Therefore, a gain of >=20% PaO2/FiO2 post-PP could be considered a discriminating marker of efficacy of this therapeutic approach.
ABSTRACT
BACKGROUND: The risk for symptomatic COVID-19 requiring hospitalization is higher in the older population. The course of the disease in hospitalised older patients may show significant variation, from mild to severe illness, ultimately leading to death in the most critical cases. The analysis of circulating biomolecules involved in mechanisms of inflammation, cell damage and innate immunity could lead to identify new biomarkers of COVID-19 severity, aimed to improve the clinical management of subjects at higher risk of severe outcomes. In a cohort of COVID-19 geriatric patients (n= 156) who required hospitalization we analysed, on-admission, a series of circulating biomarkers related to neutrophil activation (neutrophil elastase, LL-37), macrophage activation (sCD163) and cell damage (nuclear cfDNA, mithocondrial cfDNA and nuclear cfDNA integrity). The above reported biomarkers were tested for their association with in-hospital mortality and with clinical, inflammatory and routine hematological parameters. Aim of the study was to unravel prognostic parameters for risk stratification of COVID-19 patients. RESULTS: Lower n-cfDNA integrity, higher neutrophil elastase and higher sCD163 levels were significantly associated with an increased risk of in-hospital decease. Median (IQR) values observed in discharged vs. deceased patients were: 0.50 (0.30-0.72) vs. 0.33 (0.22-0.62) for n-cfDNA integrity; 94.0 (47.7-154.0) ng/ml vs. 115.7 (84.2-212.7) ng/ml for neutrophil elastase; 614.0 (370.0-821.0) ng/ml vs. 787.0 (560.0-1304.0) ng/ml for sCD163. The analysis of survival curves in patients stratified for tertiles of each biomarker showed that patients with n-cfDNA integrity < 0.32 or sCD163 in the range 492-811 ng/ml had higher risk of in-hospital decease than, respectively, patients with higher n-cfDNA integrity or lower sCD163. These associations were further confirmed in multivariate models adjusted for age, sex and outcome-related clinical variables. In these models also high levels of neutrophil elastase (>150 ng/ml) appeared to be independent predictor of in-hospital death. An additional analysis of neutrophil elastase in patients stratified for n-cfDNA integrity levels was conducted to better describe the association of the studied parameters with the outcome. CONCLUSIONS: On the whole, biomarkers of cell-free DNA integrity, neutrophil and macrophage activation might provide a valuable contribution to identify geriatric patients with high risk of COVID-19 in-hospital mortality.
ABSTRACT
OBJECTIVE: The pandemic effects due to the coronavirus SARS-CoV-2 caused a health emergency. We decided to carry out a study with the aim to investigate the changes in patients' tendencies for admission to the emergency department for surgical diseases, and the related hospitalizations and urgent surgery rates. PATIENTS AND METHODS: We carried out a retrospective, observational study on patients who received emergency general surgery consultation at our University Hospital during the two COVID-19 pandemic periods and on the same dates one year before. The patients' demographic characteristics, their hospitalization in surgical department and the data about those who underwent urgent surgery were retrospectively recorded. RESULTS: In the period March-April 2020 there were 95 surgical visits recorded; among these patients, 25% required hospitalization and 12.63% underwent urgent surgery. In the period November-December-January 2020-2021 there were 156 surgical consultations, of which 35.26% required hospitalization and 21.15% underwent urgent surgery. In both considered periods we found that the number of surgical consultations decreased compared to the same periods of the previous year. Moreover, we found a higher rate of hospitalization and need for urgent surgery. CONCLUSIONS: We documented a significant reduction in the overall number of surgical consultations and an increase of hospitalization and urgent surgery rates.
Subject(s)
COVID-19 , Humans , Pandemics , Referral and Consultation , Retrospective Studies , SARS-CoV-2ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 presents symptoms include fever, cough, dyspnoea, myalgia or fatigue. While most patients tend to have a mild illness, a minority of patients develop severe hypoxia, ARDS, requiring hospitalization and mechanical ventilation. The current management of COVID-19 is based generally on supportive therapy and prevention of respiratory failure. There are still no targeted therapeutic options available for SARS-CoV-2, and symptomatic management is the mainstay of treatment in ARDS associated with COVID-19. Case Report: We describe a case series of five patients with severe COVID-19-related pneumonia and respiratory failure who were successfully treated with intravenous short-term high-dose methylprednisolone. These patients improved clinically in about a week and shortly were able to stop oxygen therapy and to be discharged home. We also report a series of 5 patients chosen for confrontation, admitted to our department for severe COVID-19 related pneumonia and respiratory failure who were treated with dexamethasone instead of short-course high-dose methylprednisone. Conclusions: As reported above, after short-term intravenous highdose methylprednisone followed by oral methylprednisone, all the patients showed early clinical and radiological improvement. Finally methylprednisone offers a potential cost-effective therapeutical choice for developing countries and poor-resourced backgrounds.