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Introduction: Since the beginning of the pandemic, factors associated with mortality in patients with corona virus infection disease 2019 (COVID-19) have been investigated. Comorbidities and increased age have been frequently reported to be associated with mortality. We aimed to evaluate the factors associated with unfavorable outcome of patients with COVID-19 at an early period of the pandemic. Methodology: This single center, retrospective, observational study was conducted among laboratory confirmed COVID-19 patients hospitalized between March 11 and May 5, 2020, at Umraniye Training and Research Hospital, Istanbul, Turkey. The effects of the severity of illness, comorbidities, symptoms, and laboratory findings on the clinical outcome were evaluated. Factors associated with unfavorable outcome (necessity of mechanical ventilation or death) were examined using Cox proportional hazards models. Results: Out of a total of 728 patients, 53.8% were men and median age 54 years. The 30-day mortality rate was 4.9% among all hospitalized patients. A logistic regression model identified six predictors of unfavorable clinical outcome: age, severity of illness, the numbers of comorbidities, lymphopenia, high levels of C-reactive protein, and procalcitonin. Conclusions: The mortality rate was lower among the patients with COVID-19, hospitalized during the early period of the pandemic. Older age, higher severity score on admission, the numbers of comorbidities, higher levels of C-reactive protein, procalcitonin, and lymphopenia were identified to be associated with unfavorable outcome of the hospitalized patients with COVID-19. Copyright © 2022 Ozel et al.
ABSTRACT
Introduction: Pre-existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID-19). Recent studies have also demonstrated that non-invasive indicators of liver fibrosis , including FIB-4 index and neutrophil to lymphocyte ratio, are associated with poor clinical outcomes in COVID-19. Based on the evidence from these studies, it is rationale to anticipate that patients with fibrosing NAFLD could be more prone to more severe COVID-19. Aims & Methods: We aimed to confirm this hypothesis by investigating the associations of liver stiffness measurement (LSM) determined via vibration-controlled transient elastography (VCTE);which is a simple, reliable and non-invasive ultrasound-based procedure to assess the severity of liver fibrosis, with disease severity and clinical outcomes. We prospectively recruited consecutive hospitalised adult patients with COVID-19 in a 3-month period. Demographic, laboratory, clinical and vibrationcontrolled transient elastography (VCTE) features were recorded at entry. LSM and controlled-attenuation parameter (CAP) levels were measured by VCTE. Hepatic steatosis was defined for CAP values higher than 274, and NAFLD was diagnosed in the presence of hepatic steatosis with the exclusion of other liver diseases. Severe liver fibrosis was defined for patients with LSM value higher than 9.6 kPA. COVID-19 disease severity was determined using World Health Organization COVID-19 Disease Severity scale. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes. Results: Out of 98 eligible patients with COVID-19, 12 (12.2%) cases had severe liver fibrosis. Forty-one patients were diagnosed with NAFLD. Patients with severe liver fibrosis had higher baseline disease severity (p=0.022), more commonly required oxygen treatment at entry (p=0.010) and had intensive-care unit (ICU) requirements during the 6 (1-39)-day median follow-up time (p=0.017). Only two (2.0%) patients died in the follow-up. The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR): 7.685, 95% confidence interval (CI): 1.435-41.162, p=0.017) and ICU requirement (OR: 46.656, 95% CI: 2.144-1015.090, p=0.014). LSM was correlated with alanine aminotransferase levels (p=0.005, r: 0.283), but not with other markers of acute hepatic injury or inflammation including ferritin, c-reactive protein, fibrinogen or aspartate aminotransferase. Conclusion: Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicenter prospective studies are required to validate our results.
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Objective: This study aimed to identify the effect of tocilizumab (TCZ) on clinical outcomes in severe COVID-19 patients. Material and Methods: We included hospitalized COVID-19 patients with an initial WHO scale >= 4. We matched the patients with baseline characteristics by using propensity scores. Then, we selected patients with C-reactive protein levels above 30 and showing an upward trend. We assessed the effect of TCZ in patients on clinical outcomes by using Mann - Whitney U and Chi-square tests. Results: Of 200 patients who had an initial WHO scale >= 4, 42 (21%) were given it? in addition to standard of care (SOC). Twenty-five patients (50%) needed mechanical ventilation (MV) in the TCZ group, compared with 35 (21%) of 158 patients with SOC (p<0.01). Nineteen (45%) and 37 (23%) patients died in 30 days in these groups, respectively (p <0.01). The secondary infection rate was significantly higher in the TCZ group (p=0.004). However, no difference was observed in all these parameters in the propensity score-matched cohort (14 patients in ICZ and 14 in the SOC group) (p=0.45, 0.45, 1.0 respectively). Conclusions: Tocilizumab does not provide a beneficial effect on MV requirement and mortality in severe COVID-19, and it does not increase the risk of secondary bacterial infection.
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Objective: We aimed to analyse the positivity rate and cycle threshold values indicating viral loads for SARS CoV-2 among different respiratory specimens and also to evaluate the diagnostic efficacy of saliva samples. Materials and Methods: We included combined oropharyngeal and nasopharyngeal swab (cONS), sputum, and tracheal aspirate (TA) specimens of patients. Unpreserved saliva samples were collected prospectively from hospitalized patients within 72 hours of admission. SARS CoV-2 RNA was extracted by using Bio-Speedy viral nucleic acid buffer than RT-PCR was performed with Bio-Speedy COVID-19 qPCR detection kit. Results: Retrospective evaluation revealed SARS CoV-2 RNA in 19.66% of cONS (n: 5819), 30.77% of sputum (n: 39), 29.41% of TA samples (n: 34) from 4812 patients. In the majority (86.72%) of the samples, the first cONS sample was positive. Consecutive cONS and sputum/TA samples were investigated in 52 patients of whom 11 were positive with either of these samples. Saliva positivity was detected in 60% of cONS positive (n: 20) and 30% of cONS negative (n: 12) patients. Conclusion: Although, cONS samples show the greatest diagnostic guidance, repeated sampling from multiple sites of the respiratory tract increases the possibility of COVID-19 diagnosis. Saliva samples might be considered as an alternative specimen. © 2021 Marmara University Press, All Rights Reserved.