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Background Elevated transaminases (AST, ALT) have been seen with COVID-19, especially in severely sick patients. It is unclear whether SARS-CoV-2 directly causes hepatic injury. Other reasons can be hepatotoxic drugs (tocilizumab, remdesivir), sepsis, cytokine induced damage and hypoxic liver injury. Liver histopathology reports have shown macrovesicular steatosis, mild acute hepatitis, mild portal inflammation and sinusoidal microthrombi. Viral RNA using PCR of liver tissue was identified in 55% of patients in a study. Association of transaminitis with all-cause mortality in COVID-19 needs further research. Methods In this single center study, adult patients with confirmed SARS-CoV-2 infection by nasopharyngeal RT-PCR who were hospitalized from March 1st to August 20, 2020, were included. Data were manually extracted using the hospital electronic medical record retrospectively after IRB approval. Patients were divided into two cohorts: survivors (n=182) and non survivors (n=41). Categorical variables were compared by conducting a chi-square test or Fisher's exact test while continuous ones were compared by conducting a median two-sample test. Multivariate logistic regression analysis was done including age, gender, baseline and peak transaminases (AST, ALT). Statistical analysis was done with SAS software. Missing values were adjusted using f variance. Results A total of 223 patients were included in the study. Of 233 patients, 182 were discharged alive from the hospital and 41 were non survivors. Median liver function tests (AST, ALT, ALP, Albumin, INR) and inflammatory markers (LDH, CRP, Ferritin, D-dimer) on admission and peak values during hospitalization are presented in table-1. It showed that LDH value varied significantly between two cohorts similar to ferritin and D-dimer. Treatment options like remdisivir and tocilizumab were used more commonly in cohort 2 which could have led to higher peak ALT and AST during hospitalization, however, there was no statistical significance. Further, multivariate analysis (adjusted for age and sex) showed that higher ALT and AST on admission was not associated with higher odds of all cause mortality in hospitalized COVID-19 patients. Conclusion Our data revealed that transaminitis (elevation in ALT and AST) on admission is not an independent risk factor for all cause mortality in COVID-19. (Table presented.)
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Background: While a common phenomenon in other viral illnesses, data regarding coinfection/superinfections in Coronavirus Disease 2019 (COVID-19) is limited and emerging. Superinfections may contribute to the overall high mortality in those suffering from severe COVID19. We aimed to study the rate of coinfections and secondary bacterial/fungal infections among SARS-CoV-2 positive cases in a community hospital. Methods: This is a single-centre IRB approved, retrospective observational study. Adult patients with laboratory-confirmed SARS-CoV-2 by Real-Time Reverse Transcriptase-Polymerase Chain Reaction assay of nasopharyngeal swabs admitted from March 1st to April 20th 2020 were included. Relevant clinical and laboratory data were manually collected from electronic medical records. Results: A total of 129 patients were included in the study. 91 patients had a respiratory pathogen panel PCR on admission. This panel includes testing for influenza, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, rhinovirus, Bordetella pertussis, Bordetella parapertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae. Only one patient was positive for coinfection with the parainfluenza virus. None of them was found to be positive for bacterial coinfection at admission. Thirteen patients (10.1%) had secondary bacterial or fungal infections that developed during their respective hospital stays, 12 of them were critically ill. The mean duration from admission to the onset of secondary infection was 13 days. Positive Blood Cultures Positive Lower Respiratory Tract Cultures Conclusion: Our data revealed that the rate of viral coinfection was 1.1 % and bacterial coinfection was 0% at admission. Study timing can play a role as upper respiratory virus infection rate is low in the population during March and April. Secondary infections were found to be common in patients admitted to the ICU. Potential explanations for this include compromised immunity in severely ill patients, extended ICU stay, central venous catheters and endotracheal intubation. It is evident that with severe COVID-19 illness, an extended hospital course often ensues, leading to increased risk of secondary infections and contributing to the overall high mortality of these patients.
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SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: A high mortality rate (up to 97%) has been observed in intubated Coronavirus Disease 2019 (COVID-19) patients;advanced age, high SOFA score, and elevated inflammatory markers are common risk factors. Data are scarce regarding the predictors of successful extubation in these patients. The purpose of our study is to compare inflammatory markers including lactate dehydrogenase (LDH), ferritin, D-dimer, interleukin-6 levels (IL-6) in successfully extubated patients with the non-survivors. Patients 65 years or older were excluded. Puja Mehta et al. suggested that patients with severe COVID-19 have cytokine storm syndrome associated with poor prognosis. The clinical judgement regarding successful extubation in COVID-19 patients is still evolving. We hypothesized that the successfully extubated patients would have lower levels of inflammatory markers. METHODS: This is a single-centre, retrospective observational study approved by the institutional review board (IRB). SARS-CoV-2 confirmed intubated patients (n=12) with age <65 years were included. Data were manually extracted from electronic medical records. We compared patients who were successfully extubated (Group A) and those who died (Group B). Group A had six male patients, while group B had six patients with a male to female ratio of 2:1. To investigate the association of inflammatory markers with successful extubation, statistical analysis was performed using the Wilcoxon two-sample test. RESULTS: Mean values of LDH max, ferritin max, D-dimer max during hospitalization, and IL-6 level on admission in group A were 793 IU/L, 1266.8 ng/ml, 3.6 FEU, and 69.37 pg/ml respectively. Mean values of LDH max, ferritin max, D-dimer max during the hospitalization, and IL-6 level on admission in group B were 1693.8, 6136.6, 4.2, and 10606.86 respectively. Group B had higher mean values as compared to group A. The mean values of ferritin max and IL-6 on admission showed a statistically significant difference in both groups ( p-values 0.008, 0.03 respectively). However, the difference in mean values of LDH max and D-dimer max (p-value 0.17, 0.45 respectively) were not significant. CONCLUSIONS: Higher values of inflammatory markers were seen in COVID-19 patients who died as compared to patients who successfully got extubated. Our data indicate that patients who were successfully weaned off the invasive mechanical ventilation had lower levels of ferritin and IL-6 as compared to patients who died. However, statistical significance could not be established for LDH and D-dimer. Limitations of our study include small sample size and single-centre data. CLINICAL IMPLICATIONS: Higher mean values of inflammatory markers (ferritin and IL-6) can correlate with the severity of the illness and failed extubation. Replicative studies with larger sample size will define the clinical impact of our findings. DISCLOSURES: No relevant relationships by Denise Lauren Dalmacion, source=Web Response No relevant relationships by Kenneth Granet, source=Web Response No relevant relationships by Ali Jaffery, source=Web Response No relevant relationships by Ikwinder Preet Kaur, source=Web Response No relevant relationships by Violet Kramer, source=Web Response No relevant relationships by Mohsin Mughal, source=Web Response No relevant relationships by Chandler Patton, source=Web Response