Antigenemia Is Associated to Viral Sepsis and Mortality in COVID-19 (preprint)

Background: Severe COVID-19 has been proposed to represent a form of viral sepsis. The prevalence of sepsis due to this disease has not been evaluated. Some patients with severe COVID-19 present SARS-CoV-2 antigenemia. Whether antigenemia constitutes a factor associated to viral sepsis and fatal outcome in these patients is unknown. Methods: This study recruited 400 patients hospitalized with COVID-19. Prevalence of sepsis in the first 24 hours following hospitalization was determined using the SEPSIS-3 criteria. Prevalence and concentration of SARS-CoV-2 N-antigenemia was determined in plasma at hospitalization using the Panbio® COVID-19 Ag Rapid Test from Abbott and the COV-QUANTO® ELISA from AAZ. Findings: The prevalence of sepsis due to SARS-CoV-2 infection at hospitalization was of 54%, affecting mostly to the respiratory, renal and coagulation function. Antigenemia was present in the 53% of the patients, and constituted an independent risk factor of sepsis in the multivariate analysis (OR [CI95%], p): presence of N-antigenemia (Panbio®): (1·6 [1·1 - 2·5],0·023); concentration of N-antigen >575 pg/mL (COV-QUANTO®): (1·9 [1·0 - 3·5], 0·043). Antigenemia was associated with a reduction in the survival mean time of 9·42 and 9·33 days in the 90 first days following hospitalization, based on the PANBIO® and the COV-QUANTO® tests respectively. Interpretation: Half of the COVID-19 patients needing of hospitalization fulfill the criteria of sepsis. Antigenemia is strongly linked to the presence of this condition, and confers a higher risk of mortality. Monitoring the presence of antigenemia at the earlier moments of COVID-19 could help to identify those patients at risk of deterioration. Clinical Trial Registration Details: This was a sub-study of the CIBERES-UCI-COVID project, registered at Clinicaltrials.gov with the identification NCT04457505. Funding Information: Instituto de Salud Carlos III (COV20/00110; CP20/00041; FI20/00278), Fundació La Marató de TV3 (473/C/2021).Declaration of Interests: AT, JME, FB, RA and JFBM have a patent application on SARS-CoV-2 antigenemia. The remainder authors declare no conflicts of interest regarding this work.Ethics Approval Statement: Written or oral informed consent was obtained directly from all patients, or their legal representative, before enrolment. Scientific and ethical approval of the study protocol was obtained from the respective scientific committees for clinical research of the participant hospitals.

ICU-Acquired Pneumonia is a Risk Factor of a Poor Health Post-Covid-19 Syndrome (preprint)

Background: . Some patients who had previously presented with COVID-19 have been reported to develop persistent COVID-19 symptoms. Whilst this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the prevalence and risk factors and characteristics of persistent COVID_19 . On other hand these patients have very often intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence in the poor health post-Covid 19 syndrome in ICU discharged patients Methods: This prospective, multicentre and observational study was done across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1,255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP) Patients requiring invasive mechanical ventilation had persistent, post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, and development of ICUAP were independent risk factors for persistent poor health post-COVID-19. Conclusions: : Persistent, post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay and the onset of ICUAP comprised all independent risk factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-Covid 19