ABSTRACT
Although coronavirus disease 2019 (COVID-19) mainly involves the lungs, it also affects many systems. The hypothalamic/pituitary axis is vulnerable to hypoxia, hypercoagulation, endothelial dysfunction and autoimmune changes induced by COVID-19 infection. Given that there is no extensive investigation on this issue, we investigated the pituitary functions three to seven months after acute COVID-19 infection. Forty-three patients after diagnosis of COVID-19 infection and 11 healthy volunteers were included in the study. In addition to the basal pituitary hormone levels, growth hormone (GH) and hypothalamo-pituitary adrenal (HPA) axes were evaluated by glucagon stimulation test (GST) and low-dose adrenocorticotropic hormone (ACTH) stimulation test, respectively. The peak cortisol responses to low-dose ACTH test were insufficient in seven (16.2%) patients. Twenty (46.5%) and four (9.3%) patients had inadequate GH and cortisol responses to GST, respectively. Serum insulin-like growth factor-1 (IGF-1) values were also lower than age and sex-matched references in four (9.3%) patients. The peak GH responses to GST were lower in the patient group when compared to the control group. Other abnormalities were mild thyroid-stimulating hormone elevation in four (9.3%) patients, mild prolactin elevation in two (4.6%) patients and central hypogonadism in four (9.3%) patients. Mean total testosterone values were lower in male patients when compared to male controls; however, the difference was not significant. These findings suggest that COVID-19 infection may affect pituitary functions, particularly the HPA and GH axes. These insufficiencies should be kept in mind in post-COVID follow-up. Long-term data are needed to determine whether these deficiencies are permanent or not.
Subject(s)
COVID-19 , Pituitary Diseases , Pituitary Gland , Adrenocorticotropic Hormone , COVID-19/complications , Growth Hormone , Human Growth Hormone , Humans , Hydrocortisone , Hypothalamo-Hypophyseal System , Male , Pituitary Diseases/diagnosis , Pituitary Gland/physiopathology , Pituitary-Adrenal SystemABSTRACT
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.
Subject(s)
COVID-19/complications , COVID-19/mortality , Respiratory Insufficiency/mortality , Respiratory Insufficiency/virology , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , Critical Care , Critical Illness , Female , Follow-Up Studies , Humans , Intensive Care Units , Male , Middle Aged , Prognosis , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Retrospective Studies , Risk Factors , Survival Analysis , Turkey/epidemiologySubject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Lower Extremity/blood supply , Peripheral Arterial Disease/diagnostic imaging , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Thrombosis/diagnostic imaging , Aged , Angiography , COVID-19 , Female , Humans , Male , Pandemics , Peripheral Arterial Disease/virology , SARS-CoV-2 , Thrombosis/virology , Tomography, X-Ray Computed , Ultrasonography, DopplerABSTRACT
Objective: The main objective of this study is to evaluate the frequency of acute kidney injury (AKI) in COVID-19 infected patients who are hospitalized in the intensive care unit (ICU). Materials and Methods: This study was performed retrospectively on patients above 18 years of age who had a positive polymerase chain reaction (PCR), a typical chest computed tomography (CT) for COVID-19 disease. The patients were hospitalized in the medical ICU and kidney disease improving global outcomes (KDIGO) criteria was used for AKI classification. Results: We included 16 patients. The median age was 75 years and 88% were male. The most common co-morbid diseases were hypertension (HT) (56%) and cardiovascular disease (CVD) (44%). The median acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were 26 (19-32) and 7 (4-9) respectively. Patients median serum blood urea nitrogen (BUN) and creatinine levels were 27.8 (19.2-44.7) mg/dL, 1.32 (0.97-2.81) mg/dL respectively. According to the KDIGO classification: there was no AKI in 25% of the patients while, 19% stage 1, 12% stage 2 and 44% stage 3 AKI was observed. AKI developed in 75% of the patients. Conclusion: In this study we detected a high frequency of AKI in SARS-CoV2 infected patients hospitalized in the ICU.