The assessment of ROTEM test in patients with critical form of COVID-19

Background: Patients with comorbidities could have severe COVID-19 outcomes. Thrombosis or hemorrhages were frequently reported during COVID-19 evolution Aims: The study evaluated the role of ROTEM in the identification of patients with a high risk of vascular complications Methods: We analyzed clinical, ROTEM, and laboratory data of 80 patients admitted to the intensive care unit (ICU) Department of our hospital, during 2020-2021. Result(s): Thrombosis was diagnosed in 26 cases (27.96%) and was more frequent in patients with severe pneumonia and ARDS, Chi-squared 3.55, p = 0.05. Hemorrhages were identified in 21 cases (22.58%) and were less frequent in patients with severe ARDS, Chi-squared = 4.67, p = 0.03. ROTEM analyses were focused on ExTEM, InTEM, and FibTEM clotting time (CT), clot amplitudes after five and ten minutes (A5/A10), maximum clot firmness (MCF), and maximum lysis (ML). In the ExTEM median CT (eCT) value was 90.5 (50-207) s in patients with severe ARDS vs 75(58-571) s in patients with mild/ medium ARDS, p = 0.02;A5 44 (16-68) in patient with thrombosis vs. 53 (12-69) in patient without thrombosis;ML 6 (0-104) in patients with sepsis vs 8 (0-15) in patient without sepsis, p = 0.04.The median FibTEM CT (fCT) was 91 (53-7913) s in patients with severe ARDS vs 76 (52-8203) s in patients with mild/medium ARDS, p = 0.009;there were a significant correlation with ferritin level, rho = 0.22, p = 0.05. An increasing value of fCT during COVID-19 evolution was observed especially in the critical form of COVID-19. Lymphopenia was significant in patient with severe ARDS 0.48 x 1000/uL (0.02-8.03) vs 0.67 x 1000/uL (0.14-9.09) identified in patients with mild/medium ARDS, p = 0.05;it was not obtained significant correlations between lab test and ROTEM results. Conclusion(s): The ROTEM test suggests showing hypercoagulability probably due to severe inflammation. Patients with a critical form of COVID-19 developed thrombotic complications more frequently than hemorrhages. We have to check these results in large cohorts of patients.

The importance of the long Covid-19 in the evolution of patients with neoplasms

Background: Patients with comorbidities especially those with oncological diseases could have severe COVID-19 outcomes. OBJECTIVE: The aim of this study was to evaluate the role of prolonged positivity of SARS-Cov2 in evolution of patients with various neoplasia. Methods: We analysed clinical and laboratory (hematological parameters and inflammatory markers: interleukin-6 and ferritin) data of COVID-19 patients admitted in intensive care unit (ICU) Department of our hospital, during 2020-2021 and presented in medical history solid tumors or haematological neoplasia . The cohort of patients included 78 patients with severe and critical form of COVID-19, 31 patients with solid tumors and 47 patients with hematologic malignancies. We consider long COVID-19 all cases with SARS Cov2 positivity more than 14 days. Results: The frequency of long COVID-19 was quite equal between patients groups with solid tumors and hematologic malignancies, incidence rate 1:2, the incidence rate differences was 1:18, p = 0.75. Long COVID-19 was observed in 60% cases with favourable evolution, Chi-squared 5.35%, p = 0.02, these patients had moderate form and was admitted in hospital in 1 or more days after the onset, median value 3 (min 1, max 55) compared with patients with normal duration of positivity of SARS-Cov2 test-median value 2 (min 1, max 8), p = 0.01. The Kaplan Meyer survival analyses indicated long COVID-19 as predictive factor for unfavourable evolution, Chi-squared 17.97, p < 0.0001. Although we have not obtain significant differences, we observed more severe lymphopenia in patient without long COVID-19, probably because a part of these patients group died in the first 14 days of COVID-19 (0.765 (min 0.04, max 297.64) vs. 1.01 (min 0.09, max 254.35), p = 0.09). The rest of hematological and biochemistry parameters was not significant different between groups. Infectious and thrombotic complication was most frequent in patients with long COVID-19, Chi squared 8.6, p = 0.003. Conclusions: Long Covid-19 is predictable for unfavourable evolution and is associated with sepsis and thrombotic complication. This diagnosis is frequent in patients who was admitted in hospital after the onset of COVID-19 symptoms, early treatment of COVID-19 in oncological patients being very important for favourable evolution.

The impact of COVID 19 infection on HCV-induced thyroid disease.

Context: As we progress into the COVID-19 pandemic, it has become apparent that this infection is associated with a multitude of systemic effects, some involving the thyroid gland. The thyroid is also frequently affected in the HCV chronic infection. Objective: The objective of this study is to determine the effects of COVID-19 infection on the presence and severity of thyroid disorders associated with chronic HCV infection, at short and mid-term follow-up. Design: We prospectively evaluated patients with documented HCV- associated thyroid disease (with sustained virologic response after antiviral therapy). Subjects and Methods: The study group consisted of 42 patients with HCV- associated thyroid disease, diagnosed with COVID -19 infection between April and October 2020. We determined serum values of thyroid-stimulating hormone, freeT3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies at one and three months after resolution of infection and compared them to the baseline characteristics of the patient. We also evaluated the changes in thyroid substitution treatments or antithyroid drugs. Results: At baseline, out of the 42 patients, 5 presented hypothyroidism under levothyroxine substitution therapy, while 2 presented hyperthyroidism under methimazole therapy; 37 patients had positive antithyroid antibodies. At one month follow-up, we note an increase in serum values of antibodies, with a decrease in TSH, freeT3 and freeT4 levels, correlated with the severity of COVID-19 infection. Two patients required discontinuation of levothyroxine. At 3 months follow-up, lower levels of antithyroid antibodies were recorded, with an increase in TSH levels. No medication doses were adjusted at this time. Conclusion: Among the systemic effects of COVID-19, the impact of thyroid dysfunction should not be underestimated, especially in the presence of pre-existing conditions, such as HCV infection.

The assessment of thrombotic complication in patients with COVID-19

Background : COVID-19 frequently associated thrombotic complication that could determine severe evolution. Inflammation was proved as important pathogenic mechanism of thrombosis. Aims : The main objective was to evaluate the role of inflammation in increased risk of thrombosis in COVID 19 patients. Methods : Our study was prospective and included all patients diagnosed with COVID 19 between April-September 2020 in Hematology, Pneumology and Intensive Care Unit from Colentina Clinical Hospital (285 patients). The diagnosis was established using molecular test for SARS-Cov2. Results : Thrombotic complication was presented in 56 COVID-19 patients (19, 65%), The higher incidence of thrombosis was observed in severe form of COVID-19: stage 3 (66%) and stage 2 (26.3%), Comorbidities: diabetes mellitus, obesity and arterial hypertension were presented in majority of COVID 19 patients with thrombosis. Acute thrombosis (stroke, myocardial infarction or pulmonary embolism) was diagnosed in 14 patients;all of them were admitted in Intensive care unit due severe form of COVID-19. Inflammatory markers including C reactive protein (CRP), procalcitonin, ferritin are significantly increased in COVID-19 group with acute thrombosis compared with COVID -19 patients with thrombosis in medical history CRP 148.86 mg/L (2.96-386.5) vs. 58.24 mg/L (min 0.25, max 212.98) P = 0.005;procalcitonin 0.93 ng/ml (0.04-784) vs 0.18 (min 0.02, max 14.1) P = 0.02;ferritin 702 ng/ml (min 102, max 4070) vs. 1195 ng/ml (min 358, max 12800) P = 0.03. There is no significant difference between haematological parameters in COVID-19 patients with acute thrombosis or in their medical history. D Dimers are significant increased in patients with acute thrombosis 4.79 ug/ml (0.51-20) vs patients with medical history of thrombosis 2.12 (0.31-20), P = 0.02. The level of protein C, protein S and antitrombine III, antiphospholipid antibodies are not significant modified in the both groups. Conclusions : The assessment of inflammation parameters are very important in COVID-19 patients especially those with a history of thrombosis or who have significant comorbidities (diabetes mellitus, arterial hypertension or obesity).

Evaluation of the impact of Covid-19 infection on the evolution and prognosis of patients with acute leukaemia

Introduciton: COVID19 is one of the largest pandemics. Since December 2019 until now the coronavirus has infected over 131 million people. The mortality rate in the general population varies between 1 to 5%, with a potential of over 30% in patients with neoplasms. Methods: The main objective of the study was to identify some peculiarities of the evolution, complications and treatment of patients with acute leukaemia and COVID-19. The study was retrospective and included 50 patients with acute leukaemia and COVID-19. Results: Recent administration of chemotherapy was identified in 20 patients with acute myeloblastic leukaemia and 4 patients with acute lymphoblastic leukaemia. The newly diagnosed patients or those undergoing intensive chemotherapy, in particular elderly patients, had a severe form of COVID-19 and an unfavourable evolution, and these clinical situations were identified as predictive factors for adverse outcomes. Patients with acute lymphoblastic leukaemia had a shorter survival curve compared to patients with acute myeloblastic leukaemia. Pneumonia was present especially in patients with acute myeloblastic leukaemia, most patients having over 30% of lung fields affected (55.26%). Patients with an unfavourable outcome had significantly increased median values of C-reactive protein, procalcitonin and interleukin6. Conclusions: Patients with acute leukaemia, especially acute myeloblastic leukaemia who have been diagnosed with COVID-19 infection require special attention because they may associate complications and adverse outcomes of COVID-19. The results we obtained require evaluation in a larger group of patients and analysis in the follow-up period after COVID-19.

The assessment of impact of covid-19 in patients with acute leukemia

Background: The severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) was first reported in Wuhan, China in December2019 and represented the pathogen agent that induced COVID-19. The onset and evolution of COVID -19 is severe when is associated with another comorbidities. Patients with acute leukemia present high risk for severe form of COVID-19 Aims: The main objective was to evaluate the particularities of COVID-19 in patients with acute leukemia. Methods: Our study was prospective and included 49 patients with acute leukemia (27 male median age 64 and22 female median age 54,5) who also were SARS CoV2 positive between April2020- February2021 admitted in Hematology and Intensive Care Unit Departments of Colentina Clinical Hospital Bucharest. The diagnosis was established using molecular test for SARS-Cov2 Results: In the group was included 32 patients diagnosed with acute myeloid leukemia (AML), 9 patients with acute lymphoid leukemia (ALL), 6 patients with acut promyelocytic leukemia and2 patients with acute bifenotypic leukemia. Severe form of COVID-19 with ICU addmission was diagnosed in16 patients (32,17%), almost all of them (15 patients) had unfavourable evolution compared with non-ICU patients group with only1 deceased patient, p<0.0001. The recent chemotherapy followed by severe aplasia was the main negative factor that impacted patient evolution (rho=0.508, p=0.0002),13 patients admitted in ICU Department and12 patients in non-ICU. Severe pneumonia (more than 30% lung field) was diagnosed in17 patients with recent chemotherapy and 4 untreated patients. The type of leukemia or refractory status have not any impact of patient evolution. Antiviral therapy - Remdesivir rapidly introduced in patient's therapy was followed by favourable evolution. Summary/Conclusion: Patients with acute leukemia are negatively impacted by intensive chemotherapy during COVID-19 evolution. The key for good prognosis of these patients during COVID-19 are rapid diagnosis and antiviral therapy at the onset of the disease.

CT-365: The Evaluation of Haematological and Biochemistry Parameters in COVID-19 Patients as a Predictive Factor for Unfavourable Evolution

Context: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. Severity of this disease is associated with comorbidities present (hypertension, obesity, pulmonary disease) or with age. Objective: In this study, we evaluate haematological and biochemistry parameters in order to obtain indications for unfavourable evolution of the patient. Design and Setting: We performed a prospective study that included all patients admitted in our hospital in Hematology, Pneumology, and ICU at Department Colentina Clinical Hospital during April and May 2020. Patients or other participants: The study group included 80 patients that was split into ICU and non-ICU patients. All patients were SARS-CoV-2-positive by molecular test. The distribution according to gender was: 47 male with median age: 73 (min 35, max 88) and 33 female with median age: 50 (min 17, max 84). Results: Age is an important risk factor for the severity, as the median age of patients admitted in ICU was 73 (min 43, max 88) compared with non-ICU patients 41 (min 17, max 64), p=0.00004. Comorbidities associated were important but were present in both groups. In ICU patients, we obtained lower level of lymphocytes compared with non ICU group median: 0.87× 103/L (min 0.09 × 103/L max 7.04 × 103/L) vs 2.17 × 103/L (min 0.19 × 103/L max 3.28 × 103/L), p=0.01. There are no significant differences between groups for the rest of haematological parameters. The biochemistry markers ferritin, AST, ALT, LDH, and D Dimers are important in evaluation of COVID-19 patients;there are statistical differences between ICU and non ICU patients (median value: LDH 405.5 UI/l vs 215 U/l, p=0.001;ferritin 1275 ng/ml vs. 161 ng/ml, p=0.002;D Dimers 2.61 mg/ml FEU vs 0.39 mg/ml FEU, p=0.002;AST 70.9 U/l vs. 19.9 U/l, p=0.0003;ALT 50.05 U/l vs. 18.5 U/l, p=0.009). The ICU patients with unfavourable evolution had a higher level of D-Dimers at the admission in hospital compared with ICU patients who was discharged from the hospital (3.42 mg/ml FEU vs 1.09 mg/ml FEU, p=0.01). We did not obtain statistical significance between ICU groups for all haematological and biochemistry parameters. Conclusions: We conclude that lymphocyte count, LDH, AST, ALT, and ferritin at the time of hospital admission is important to evaluate in COVID-19 patient in order to expect a severe evolution of the disease. D-Dimer should be an important parameter to evaluate for all COVID-19 patients. Anti-thrombotic therapy is important to be introduced in COVID-19 patients.

Immunotherapy in cancer patients in COVID-19 era

The coronavirus disease 2019 pandemic is concerning for patients with cancer who are receiving immunotherapy. COVID-19 has had a major impact on cancer and clinical trials, affecting treatment and oncology patients in a number of different ways. Immunotherapy has also been found to have a durable treatment response in patients after just a few courses of therapy, for example in cases where patients can't continue with their treatment. The drugs reveal the cancer to the body's immune system, turning it against the cancer and, when treatment stops, the immune system can continue killing the cancer itself. Uncertainty remains about whether immunotherapies increase the risk of infection with severe acute respiratory syndrome Coronavirus 2 or increase the risk of severe disease and death upon infection.