Relationship between kalemia and intensive care unit admission or death in hospitalized COVID-19 patients: A cohort study.

BACKGROUND: SARS-CoV-2 uses Angiotensin-Converting Enzyme 2 as a viral gateway to the cell and could interact with the renin-angiotensin-aldosterone system. Other studies have shown kalemia abnormalities in patients with severe forms of coronavirus disease 2019. Our goal was to assess the prognosis value of kalemia within ten days of symptom offset in the COVID-19 hospitalized population. METHODS: We analyzed data from a prospective cohort that included 65 patients with COVID-19, admitted between March 15, 2020, and March 21, 2020. The study aimed at determining the relationship between baseline kalemia and the admission to an intensive care unit (ICU) or death. RESULTS: The median age of the patients was 65 [54-79] years old, and 66.2% of the patients were men. Baseline kalemia under 3.8mmol/l occurred in 31 patients (48%), including 11 patients (35.5%) who were admitted to an ICU and one patient (3.2%) who died before ICU admission. In the primary end-point analysis, the adjusted hazard ratios for admission to an ICU or death were 3.52 [95% confidence interval (CI), 1.12 to 11.04] among patients with low baseline kalemia. CONCLUSION: Our study suggests that low kalemia levels within ten days of the first symptom onset might be associated with an increased risk of intensive care unit admission or death. The future perspective should be to better understand this relationship.

Relationship between kalemia and ICU admission or death in hospitalized COVID-19 patients: A monocentric cohort study

Introduction: Coronavirus disease 2019 (COVID-19) use Angiotensin-Converting Enzyme 2 (ACE-2) as a viral gateway and could have interactions with the RAA system. Other studies have found kalemia abnormalities associated with severe forms of COVID-19.Our goal was to assess the prognosis value of kalemia in severe COVID-19 hospitalized population. Methods: We analyzed data from a monocentric prospective observational cohort that included 65 patients PCR-confirmed positive for COVID-19 who were admitted at HEGP in Paris, between 15 to 21 March, 2020. The study aimed to determine the relationship between baseline kalemia and the primary composite outcome defined as admission to an intensive care unit (ICU) or death. Baseline kalemia was defined as the presence of a kalemia under 3.8 mmol/L within 10 days of the first symptom onset. Results: We included 65 patients with PCR COVID-19 positive test. Median age was 65 years old and 66.2% were male. Baseline kalemia under 3.8 mmol/l occurred in 31 patients (48%) including 11 patients (35.5%) who were hospitalized in ICU and 1 patient (3.2%) who died before ICU admission. In the primary end-point analysis based on multiple imputations for missing data, the adjusted hazard ratios for admission to ICU or death were 3.52 [95%(CI), 1.12 to 11.04] among patients who presented a kalemia under 3.8 mmol/L within 10 days of the first symptom onset. Moreover, we did find an adjusted association between baseline kalemia and the minimum hemoglobin level presented by the patients during the hospital stay (odds ratio, 0.80;95% CI, 0.64 to 0.99) (Fig. 1). Conclusion: Our study suggests that the presence of a kalemia under 3.8 mmol/L within 10 days of the first symptom onset might be associated with an increased risk of intensive care unit or death, and the minimum hemoglobin level presented by the patients during the hospital stay. Future intervention studies aimed for correcting this hypokalemia with ARBs to improve prognosis are ongoing.

Unusual arterial thrombotic events in Covid-19 patients.

INTRODUCTION: COVID-19 infection is commonly complicated with pro-thrombotic state and endothelial dysfunction. While several studies reported a high incidence of venous thromboembolic events. The occurrence of arterial thromboses are yet rarely described and could be underestimated. OBJECTIVES: To describe the clinical and biological characteristics of COVID-19 patients presenting with an associated arterial thromboembolic event. MATERIAL AND METHODS: We performed a retrospective multicentric study in 3 centers between France and Italy. All patients with a confirmed SARS-CoV-2 infection and arterial thromboembolic events were included in the analysis. RESULTS: From March 8th to April 25th 2020, we identified 20 patients (24 events) with arterial thromboembolic events over 209 admitted patients (9.6%) with severe COVID-19 infection. Arterial thrombotic events included acute coronary occlusions (n = 9), stroke (n = 6), limb ischemia (n = 3), splenic infarcts (n = 3), aortic thrombosis (n = 2) and occlusive mesenteric ischemia (n = 1). At the time of the event, 10/20 (50%) of patients received thromboprohylaxis, 2/20 (10%) were receiving treatment dose anticoagulation and 5/20 (25%) were receiving antiplatelet therapy. CONCLUSION: Our observations suggest that serious arterial thrombotic events might occur in Covid-19 patients. However, the exact incidence of such events and the best way to prevent them yet remains to be investigated.

Large vessel stroke in six patients following SARS-CoV-2 infection: a retrospective case study series of acute thrombotic complications on stable underlying atherosclerotic disease.

BACKGROUND AND PURPOSE: Ischaemic stroke has been described in association with COVID-19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS-CoV-2 infection and underlying atherosclerotic lesions. METHODS: A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS-CoV-2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île-de France area, France. RESULTS: The median age was 52 years, median body mass index was 29.5 kg/m2 . All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID-19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non-stenosing atheroma, after an etiological workup based on angio-computed tomography or magnetic resonance imaging and/or cervical echography. CONCLUSION: Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID-19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.