ABSTRACT
COVID-19 treatment includes both antiviral agents and immunosuppressive and immunomodulatory medication for moderate and severe disease, which decrease systemic inflammation. Our objective was to evaluate tocilizumab, anakinra and corticosteroid effectiveness in a cohort of COVID-19 patients hospitalized in a tertiary care unit from Bucharest, Romania, during the second and third SARS-CoV-2 pandemic waves, by assessing the prediction variables for the length of hospital stay (LHS). We enrolled 330 consecutive patients, with a mean age of 58.2 +/- 14.8 years, 119 females (mean age 61.4 +/- 14.1 years) and 211 males (mean age 56.4 +/- 15 years). The prediction parameters for LHS were the treatment approach, older age and the presence of COPD, but were not associated with other significant comorbidities for COVID-19, such as obesity, diabetes, chronic renal failure or active malignancy. We found a significant difference in the mean LHS between patients who received tocilizumab and standard of care and patients treated with anakinra plus standard of care. Still, this difference was only seen in patients who required high concentration oxygen therapy (more than 5 L O-2/min). We suggest that, especially in non-critically-ill patients with a high oxygen therapy requirement, the administration of tocilizumab and standard of care is associated with a reduced length of hospital stay compared to the anakinra standard of care regimen.
ABSTRACT
The novel Severe Acute Respiratory Syndrome Coronavirus-2 has put an enormous pressure on health systems around the world. The large number of severe cases that had symptoms seemingly unrelated to the respiratory system, continues to create confusion. The digestive tract is not spared either. The most commonly reported digestive symptoms are nausea, vomiting, anorexia, diarrhea and, less frequently but with significant impact, gastrointestinal bleeding. The elderly population is the one more likely to develop severe anemia clinically expressed by hematemesis, melena or hematochezia. From our experience and as we concluded from literature, men confirmed with COVID-19 have a higher risk of developing digestive haemorrhage. The upper gastro-intestinal tract, defined as the digestive segment above the Treitz angle, is more often affected. The gastro-duodenal ulcers are the main cause found in COVID-19 patients with digestive bleeding. In addition, the patients with SARS-COV2 infection and gastro-intestinal bleeding most commonly associate with other comorbidities such as hypertension and diabetes.
ABSTRACT
Background: The severe manifestations of the coronavirus disease 2019 (COVID-19) are linked to viral hyper-inflammation, cytokine release syndrome and subsequent coagulation disturbances. The most common coagulation abnormality observed in COM-19 patients is the elevation of the plasma levels of D-dimers. The aim of this study was to evaluate the characteristics of COVID-19-associated inflammatory syndrome and coagulopathy, in correlation with disease severity. Methods: We performed a cross-sectional study, enrolling all consecutive COVID-19 patients treated in the Adulti 3 Department of the Prof Dr. Matei Bals National Institute of Infectious Diseases, Bucharest, Romania, between 1st march and 30th September 2020. We recorded clinical and epidemiological characteristics, inflammatory markers, coagulation abnormalities and lymphocyte count. The severity of lung involvement was assessed using native Computed Tomography examination. Results: We included 106 patients with SARS-COV2 infection, 50 males (47.2%) and 56 females (52.8%), age range 14-91 years. All markers of inflammation were increased in our study in patients with severe disease, as were lactate dehydrogenase, monocyte distribution width, and neutrophil-to-lymphocyte ratio. An elevated level of serum D-dimers was observed in approximately half of our subjects and was associated with disease severity. Our best linear regression model for predicting COVID-19 coagulopathy (manifested as abnormal D-dimer levels) included age, fibrinogen, and lymphocyte count. Conclusion: Our findings emphasize the association between COVID-19 coagulopathy and the presence of systemic inflammation. A significant proportion of patients with moderate and severe disease had coagulation abnormalities and these were linked with the presence of inflammation and older age..