ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a newly emerging disease caused by the SARS-CoV-2 virus resulting in a global crisis. Activation of the cytokine cascades plays a crucial role in the pathophysiology of severe pneumonia caused by COVID-19. Several treatments targeting pro-inflammatory cytokines have been introduced, however, their efficacy remains controversial. We aimed to demonstrate the comparative efficacy between hemoperfusion and tocilizumab in the reduction of mortality from severe COVID-19 pneumonia. Method(s): A multicentered, ambispective study was conducted on adult patients who were diagnosed with COVID-19 pneumonia between January 1st, 2020, and December 31th, 2021. Clinical parameters including the specific therapy with hemoperfusion (Hemoadsorption cartridge, HA330 JACFRON) or tocilizumab were collected for analysis. Univariable and multivariable regression analyses were performed to determine the association between the specific therapy and the 28-day mortality. Result(s): A total of 92 patients with COVID-19 pneumonia were eligible for analyses (25 patients received hemoperfusion and 67 patients received tocilizumab). The 28-day mortality in the hemoperfusion and tocilizumab groups were 64.0% and 25.4% respectively (p=0.001). However, receiving Tocilizumab was not associated with mortality rate, compared to hemoperfusion in the multivariable analysis [OR 0.56 (95%CI 0.13 -2.39);p=0.428]. Receiving invasive mechanical ventilator (%), duration of hospitalization, and successful withdrawal of invasive mechanical ventilation was not different between the two groups. Inflammatory marker (CRP) was significantly reduced with hemoperfusion and tocilizumab -46.2 (-88.37, -24.9) (p=0.013) and -45.1 (-54.6, -26.15) (p=<0.001). Conclusion(s): The 28-day mortality of COVID-19 pneumonia patients receiving hemoperfusion and tocilizumab were comparable.
ABSTRACT
Pneumonia in patients with COVID-19 is sometimes severe and life-threatening, and currently there is no specific effective drug approved for COVID-19 treatment. Favipiravir is a pyrazine analog inhibiting RNA virus RNA dependent RNA polymerase with antiviral activity against SARS-CoV-2. An observational study was conducted in confirmed COVID-19 pneumonia patients admitted to a university hospital in Thailand on effectiveness and safety of favipiravir prescribed on a compassionate-use basis. Among COVID-19 patients with pneumonia (n = 37), 54 and 46% had severe and non-severe pneumonia, respectively. Mean +/- SD age was 48 +/- 3 years, 62% were male and diabetes mellitus and hypertension were the most common comorbidities. Median period from initiation of favipiravir treatment to clinical improvement of patients with severe and non-severe pneumonia was 17 days (95% confidence interval (CI): 9-25) and 9 days (95% CI: 7-11) respectively. Ninety-five percent of patients completely recovered and were discharged within 39 days following admittance;unfortunately, the remaining patients succumbed to severe acute respiratory distress syndrome and multi-organ failure. In conclusion, favipiravir holds promise as a potential drug for treatment of COVID-19 pneumonia, but a larger randomized trial is warranted to confirm its efficacy.
ABSTRACT
Clinical spectrum of coronavirus disease 2019 (COVID-19) encompasses asymptomatic to severe pneumonia. Clinical characteristics of pneumonia and severe pneumonia in patients with confirmed COVID-19 infection admitted to a university hospital in Thailand were recorded and factors predicting pneumonia and severe pneumonia were determined using a Cox-regression analysis. Of 144 patients, mean +/- SD age was 39 +/- 13 years, with 42% males. Following admission, 51% of patients developed pneumonia within median period of 7 days from onset of illness, among whom 27% progressed to severe pneumonia. Multivariate analysis showed age >= 40 years, body mass index >= 25 kg/m(2), absolute lymphocyte count <1500 cells/mm(3), and serum lactate dehydrogenase (LDH) level >= 200 U/l at admission were significant factors associated with pneumonia, while severe pneumonia was associated with male gender, room- air oxygen saturation <97% and serum LDH level >= 300 U/l at admission. These findings should be of assistance in predicting COVID-19 patients at risk of developing pneumonia and those progressing to the severe form, allowing preparation for close monitoring and prompt management of such patients.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak of coronavirus disease 2019 (COVID-19) caused a major global pandemic. Recent studies showed an increased risk of acute kidney injury during COVID-19 infection. This study aims to determine the rate and predicting factors of acute kidney injury in patients with COVID-19. Methods: A cohort study was conducted among patients with confirmed COVID-19 admitted to a university hospital in Thailand, between March 12th and April 30th, 2020. AKI was defined by KDIGO criteria. Factors associated with AKI in COVID-19 patients were determined using multivariate logistic regression analysis. Results: Of 148 patients diagnosed with confirmed COVID-19, the mean age was 39.0 ± 13.0 years and 58.1% of patients were females. At admission, mean serum creatinine levels was 0.81 ± 0.23 mg/dL and 16.9% of patients had serum creatinine levels >1.0 mg/dL. During admission, 13 (8.8%) patients were diagnosed AKI. The median onset of AKI was 11 (6-20) days after onset of illness. In multivariate analysis, AKI was associated with severe pneumonia (Odds ratio, OR 8.81, 95% confidence interval, CI 1.60-48.3, P = 0.012), diabetes (OR 9.74, 95%CI 1.38-68.67, P = 0.022) and serum creatinine levels >1.0 mg/dL at admission (OR 14.43, CI 2.53-82.40, P = 0.003). Conclusion: Incidence of AKI in patients diagnosed COVID-19 was high. Almost patients were diagnosed AKI between second and third week after onset of illness. Severe pneumonia, underlying diabetes, and serum creatinine levels >1.0 mg/dL at admission date were potential factors associated with developing AKI in COVID-19 patients.
ABSTRACT
Background: Acute kidney injury (AKI) is common in patients with coronavirus disease 2019 (COVID-19). Pathogenesis of AKI and mechanism of renal recovery in COVID-19 are multifactorial. Data of recovery from AKI after COVID-19 remains sparse. This study aims to elucidate natural history of recovery from AKI in COVID-19 patients. Method: A prospective cohort study included all COVID-19 patients with diagnosed AKI during admission in a university hospital in Thailand, between March 12, 2020 and April 30, 2020. AKI and stage of AKI were defined by KDIGO criteria. Recovery of AKI describes serum creatinine turn to baseline of kidney function within 7 days of the initiating event. Acute kidney disease (AKD) was defined as loss of kidney function for a duration of between 7 and 90 days after exposure to an AKI initiating event. Result: A total of 148 patients with confirmed COVID-19, 13 (8.8%) patients diagnosed AKI were studied. Of these 13 patients, the median age was 44.6 (range, 23.5-68.7) years and 69.2% of patients were males. Ten (76.9%) patients had pneumonia. Five (38.4%) patients had acute respiratory distress syndrome. The median duration of AKI period was 10 (range, 3-68) days. Ten (76.9%) patients were classified as stage 1 and the other three as stage 3. For patients with AKI stage 1, 5 (50%) had a recovery of AKI, and the rest recovered from AKI within 2 months. Whereas patients with AKI stage 3, 2 (66.6%) died and the other developed AKD. Conclusion: AKI in COVID-19 may develop early during hospitalization. The severity of AKI in COVID-19 patients contribute to renal outcome and recovery. Our work may be useful for better care optimization and prognostication of patients with COVID-19.