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Objectives: Patients with systemic lupus erythematosus (SLE) present greater severity of SARS-CoV-2 infection compared to the general population, particularly those with glomerulonephritis and who are treated with glucocorticoids. Likewise, high disease activity and some immunosuppressants have been associated with worse outcomes. The aim of this study was to describe the characteristics of SARS-CoV-2 infection in patients with SLE in Argentina from the SAR-COVID registry and to establish factors associated with a worse outcome. Method(s): Observational study. Patients diagnosed with SLE with confirmed SARS-CoV-2 infection (RT-PCR and/or positive serology) from the SAR-COVID registry were included. Data were collected from August 2020 to March 2022. The outcome of the infection was measured using the World Health Organization-ordinal scale (WHO-OS). Severe COVID-19 was defined as an WHO-OS value >=5. Descriptive analysis, Student's t , Mann Whitney U, ANOVA, Chi2 and Fisher's tests. Multivariable logistic regression. Result(s): A total of 399 patients were included, 93%female, with a mean age of 40.9 years (SD 12.2), 39.6% had at least one comorbidity. At the time of infection, 54.9% were receiving glucocorticoids, 30.8% immunosuppressants, and 3.3% biological agents. SARS-CoV-2 infection was mild in most cases, while 4.6% had a severe course and/or died. The latter had comorbidities, used glucocorticoids, and had antiphospholipid syndrome (APS) more frequently and higher disease activity at the time of infection. In the multivariate analysis, high blood pressure (OR 5.1, 95% CI 1.8-15.0), the diagnosis of APS (4.7, 95% CI 1.2-15.8), and the use of glucocorticoids (10 mg/day or more: OR 5.5, 95% CI 1.6-20.5) were associated with severe hospitalization and/or death from COVID-19 (WHO-EO >= 5). Conclusion(s): In this cohort of SLE patients with confirmed SARS-CoV-2 infection, most had a symptomatic course, 22.1% were hospitalized, and 5% required mechanical ventilation. Mortality was close to 3%. The diagnosis of APS, having high blood pressure, and the use of glucocorticoids were significantly associated with severe COVID-19.
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Introduction: Endothelial dysfunction and coagulopathy have been reported as the basis of severe Acute Kidney Injury (AKI) associated with COVID-19. Endothelial biomarkers can detect kidney damage early and allow the adoption of efficient measures to prevent the progression of the disease and its complications. This finding could facilitate the follow-up of patients at higher risk, as well as provide early diagnosis strategies and promote the rational use of resources. The aim of this study is to assess the role of vascular biomarkers to predict the need for hemodialysis in critically ill patients with COVID-19. Method(s): This is a prospective study with 58 patients critically ill due to COVID-19 infection admitted to a tertiary hospital in Fortaleza, Northeast Brazil, from 2020 to 2021. General laboratory tests and vascular biomarkers such as VCAM-1, Syndecan-1, ACE-2, ICAM-1, Angiopoietin-1 and Angiopoietin-2 were quantified on admission to the intensive care unit (ICU). Result(s): There was a 40% mortality rate. VCAM and the Ang-2/Ang-1 ratio at ICU admission were associated with the need for hemodialysis. Vascular biomarkers (VCAM-1, Syndecan-1, angiopoietin-2/anogiopoietin-1 ratio) and thrombocytopenia were predictors of dialysis, and their cutoff values were useful to stratify patients with worse prognosis in the Kaplan-Meier analysis. In the cox multivariate regression analysis with models adjusted according to the presence or absence of platelets, VCAM-1 [O.R. 1.13 (95% CI: 1.01 - 1.27);p=0.034] was an independent predictor of dialysis in all models, and the Ang-2/Ang-1 ratio [O.R. 4.87 (95% C.I.: 1.732 - 13.719);p=0.003] was associated with the need for dialysis in the model without platelet input. Conclusion(s): Vascular biomarkers, mainly VCAM-1 and Ang-2/Ang-1 ratio, and coagulation disorders showed important predictive value for the need for hemodialysis in critically ill patients with COVID-19. No conflict of interestCopyright © 2023
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La infección por el virus SARS-CoV-2, denominada COVID-19 (COronaVIrus Disease 19), fue detectada inicialmente en China en diciembre 2019, y posteriormente se ha diseminado rápidamente por todo el mundo, hasta el punto de que el 11 de marzo la Organización Mundial de la Salud declaró que el brote podría definirse como pandemia. La COVID-19 presenta un cuadro que oscila desde episodios leves seudogripales a otros graves e incluso potencialmente mortales debido, sobre todo, a insuficiencia respiratoria aguda. Es frecuente el ingreso de estos pacientes en nuestros servicios de Medicina Intensiva en relación con un síndrome de distrés respiratorio agudo. La falta de un tratamiento con evidencia científica ha llevado al empleo de diferentes pautas terapéuticas, en muchas ocasiones, con modificaciones rápidas de los protocolos. Recientes revisiones en revistas de prestigio han destacado la falta de terapias probadas y la necesidad de ensayo clínicos que permitan establecer pautas de tratamiento claras y objetivas. Este documento tiene por objeto ofrecer una actualización de la terapia que se está aplicando en la actualidad, y una ayuda en la asistencia diaria, sin pretender sustituir los protocolos adoptados en cada centro.
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Background: Questions emerged about safety renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs)) in patients diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our objective was to evaluate the safety of this treatment in a Spanish cohort during 2020 pandemic. Methods: Observational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, since March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. Primary end-point (PE) was the combined of all-cause death or need for orotracheal intubation until 30 days of infection symptoms onset. To assess the effect of RAS inhibitors, we performed a double statistical approach, with multivariate logistic regression and propensity-score matching. Results: We included 704 patients (table). Median age was 61 years old (IQR 52.9-72.9);52.7% were female. 34.7% and 12.6% had hypertension (HTA) and diabetes (DM) respectively. 92 patients (13.1%) and 87 patients (12.4%) were taking ACEI and ARB respectively. Baseline characteristics of both subgroups are shown in the table. Patients on RAS inhibitors treatment had a worse clinical profile: were older, more males and with higher prevalence of HTA, DM, dyslipemia, ischemic heart disease and heart failure. There were no differences in terms of respiratory nor neoplasic disease. After 30 days, 112 patients (15.9%) had died, 148 (21.4%) had died or had required invasive mechanical ventilation (PE);390 patients (55.4%) had needed hospital admission. PE was reached in 33.3% patients under ACEI treatment (vs. 19.6% in control group, p=0.005) and in 41.9% patients under ARB treatment (vs. 18.5% in control group, p<0.001). In the analysis to estimate the effect of ACEI no differences between groups were found (OR 1.01 [0.55-1.85], p=0.973). Likewise, in terms of ARB treatment, there were no differences among both groups (OR 1.66 [0.91-3.03], p=0.097). Using a propensity-score approach 79 patients under ACEI treatment and 72 patients under ARB treatment were matched 1:1 with control patients (characteristics of matched population are described in the table) Logistic binary regression showed no significant differences on incidence of the PE in patients under ACEI treatment (OR 0.84, 95% CI [0.43-1.63], p=0.613) nor ARB treatment (OR 1.82, 95% CI [0.92-3.60], p=0.085). Nevertheless, there was a trend towards worse prognosis in ARB patients. Kaplan-Meier curves of survival free of death or need for mechanical ventilation in matched population (ACEI and ARB treatment) are shown in the figure. Conclusions: We have not found any correlation between the severity of the disease and the treatment with ACEI nor ARB. We do not recommend the withdrawal of these drugs during the current epidemic situation. Further studies are needed to assess this finding.
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Background: High incidence of cardiovascular events has been described among patients with COVID-19 and since the beginning of the pandemic concerns have been expressed with medical treatments for cardiovascular disease, as they could contribute to the severity of illness in patients with COVID-19. We aim to analyze the effect of chronic treatment with calcium channel blockers and beta-blockers on COVID 19 severity in a Spanish cohort during the 2020 pandemic. Methods: Observational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, from March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. The Primary end-point (PE) was all-cause death and the secondary end-point (SE) was the combined of death or the need for orotracheal intubation until 30 days of infection symptoms onset. Results: We included 704 patients in our study. Baseline characteristics of the overall cohort can be seen in the table. Median age was 61 years old (IQR 52.9-72.9);52.7% were female. 34.7% and 12.6% had hypertension and diabetes respectively. After a median follow-up of 111.5 days, 58 patients (8.2%) needed orotracheal intubation and 133 patients (18.9%) died. Secondary endpoint (all-cause death or need for orotracheal intubation) was reached by 164 patients (23.3%). The table described clinical differences between survivors and deceased patients. After multivariate Cox modeling, age, male gender, diabetes, previous lung disease, BMI and the chronic intake of calcium channel blockers (HR 1.74, 95% CI (1.11-2.75), p=0.016) and beta-blockers (HR 1.71, 95% CI (1.07-2.76), p=0.026) were independently related with mortality. Other cardiovascular drugs (Antiplatelets, anticoagulants, diuretics, mineralcorticoid-receptor antagonists, angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors and statins) did not influence survival after SARS-CoV 2 infection (Figure). The secondary outcome was reached by 164 patients (23.3%) and chronic treatment with calcium channel blockers remains as an independent predictor of mortality (HR 1.55, 95% CI (1.01-2.37), p=0.044). Conclusions: Chronic treatment with calcium channel blockers and betablockers are independent predictors of mortality after SARS-CoV-2 infection. Further studies are needed to confirm these results.
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Background: On January 2020, the first patient with coronavirus 2 (SARSCoV- 2) was detected in Spain. Since then, 3 280 000 cases have been confirmed and 75.305 people have died. We aimed to clarify the epidemiological and clinical characteristics related with poor short-term prognosis in patients diagnosed with SARS-CoV-2. Methods: Observational, retrospective single-center study including consecutive patients (≥40yo) diagnosed with SARS-CoV-2 through PCR, since March 2nd to 20th 2020 in our center in Spain. The primary endpoint (PE) was the combined of all-cause death or need for orotracheal intubation within the first 30 days of infection symptoms. Results: 704 patients were included (table). A follow-up period of thirtydays was fully completed in 692 of 704 patients (98.3%). At the end of this period, 148 patients (21.4%) met the PE;they were older, more frequently male, obese and smokers. Patients who met the PE had a higher prevalence of hypertension, diabetes, dyslipidemia, ischemic heart disease, heart failure, peripheral and cerebrovascular disease, cancer and lung pathologies. They received more frequently therapies with reninangiotensin system inhibitors, betablockers, calcium channel blockers and statins, as well as antiplatelet and anticoagulant therapies Multivariate analysis showed that age (OR 1.99 for every 10 years, 95% CI [1.637-2.4], p<0.001), female sex (OR 0.49, [0.30-0.80], p=0.004), diabetes (OR 2.09, [1.17-3.71], p=0.012), lung disease (OR 1.99, [1.14- 3.44], p=0.014) and body mass index (OR 1.33 for each 5 kg/m2 increased, [1.05-1.68], p=0.017) were predictors of the PE. Hypertension was not significantly related to the PE (OR 1.55, [0.93-2.60], p=0.09) Conclusion: In our group of patients with SARS-CoV-2, age, male sex, diabetes, lung disease and obesity were found to be independent predictors of the combined of all case death or need for orotracheal intubation within the first 30 days of infection symptoms. Larger studies are needed to confirm these results. (Figure Presented).
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BACKGROUND: During the current COVID-19 pandemic there are studies that have suggested a negative impact of the pandemic on the mental health of patients with multiple sclerosis (PwMS). In this sense, several factors may be related to the increase in experiences of anxiety and depression in PwMS during the current pandemic. OBJECTIVE: In this study we first explored the reactions of anxiety, depression and fear to COVID-19 in a group of PwMS that belong to the Ibero-American region. Besides, we explored whether having been positive to COVID-19, fear of COVID-19, the obstacles to attend medical appointments during the outbreak and subjective experience of MS progression, could predict the anxiety and depression reactions in our PwMS sample. MATERIALS AND METHODS: An online cross-sectional survey was conducted on 202 MS patients from six countries (Argentina, Mexico, Spain, Dominican Republic, Venezuela and Cuba). For comparisons between variables an independent-samples t-test and one-way analysis of variance were used. Multiple linear regression was used to evaluate the effects of potential predictor variables over emotional reactions. RESULTS: Our results showed that PwMS who were positive for COVID-19 reported higher levels of fear of COVID-19 (p<.001) and also higher levels of anxiety (p<.001) compared to non-positive patients. Those patients who had difficulties attending their medical appointments during the outbreak showed higher levels of depression (p=.03) and anxiety (p=.019). Levels of anxiety (p<.001) and depression (p=.006) were also higher among patients with the subjective experience of MS disease progression. The reactions of fear of COVID-19, having been positive to COVID-19, problems attending medical appointments, and subjective experience of MS disease progression showed a high association with the negative impact of the pandemic on mental health of PwMS. CONCLUSIONS: Our results show that the situation generated by the COVID-19 pandemic has had a negative impact on the mental health of PwMS in our sample. Our results also alert to the importance of offering psychological care to patients with multiple sclerosis during the current outbreak, regardless of whether they have been positive for COVID-19.
Subject(s)
COVID-19 , Multiple Sclerosis , Anxiety/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Disease Progression , Fear , Humans , Multiple Sclerosis/complications , Multiple Sclerosis/epidemiology , Pandemics , SARS-CoV-2ABSTRACT
Infection by the SARS-CoV-2 virus, known as COVID-19 (COronaVIrus Disease-19) was initially detected in China in December 2019, and has subsequently spread rapidly throughout the world, to the point that on March 11 the World Health Organization (WHO) reported that the outbreak could be defined as a pandemic. COVID-19 disease ranges from mild flu-like episodes to other serious and even life-threatening conditions, mainly due to acute respiratory failure. These patients are frequently admitted to our Intensive Care Units in relation to acute respiratory distress syndrome (ARDS). The lack of a treatment based on scientific evidence has led to the use of different management guidelines, in many cases with rapid changes in the applied protocols. Recent reviews in reputed journals have underscored the lack of proven therapies and the need for clinical trials to establish clear and objective treatment guidelines. The present study provides an update on the currently applied treatment, and intends to offer help in relation to daily care, without seeking to replace the protocols adopted in each individual center. Resumen La infección por el virus SARS-CoV-2, denominada COVID-19 (COronaVIrus Disease 19), fue detectada inicialmente en China en diciembre 2019, y posteriormente se ha diseminado rápidamente por todo el mundo, hasta el punto de que el 11 de marzo la OMS declaró que el brote podría definirse como pandemia. La COVID-19 presenta un cuadro que oscila desde episodios leves pseudogripales a otros graves e incluso potencialmente mortales debido, sobre todo, a insuficiencia respiratoria aguda. Es frecuente el ingreso de estos pacientes en nuestros Servicios de Medicina Intensiva en relación con un Síndrome de Distrés Respiratorio Agudo (SDRA). La falta de un tratamiento con evidencia científica ha llevado al empleo de diferentes pautas terapéuticas, en muchas ocasiones, con modificaciones rápidas de los protocolos. Recientes revisiones en revistas de prestigio han destacado la falta de terapias probadas y la necesidad de ensayo clínicos que permitan establecer pautas de tratamiento claras y objetivas. Este documento tiene por objeto ofrecer una actualización de la terapia que se está aplicando en la actualidad, y una ayuda en la asistencia diaria, sin pretender sustituir los protocolos adoptados en cada centro.
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Infection by the SARS-CoV-2 virus, known as COVID-19 (COronaVIrus Disease-19) was initially detected in China in December 2019, and has subsequently spread rapidly throughout the world, to the point that on March 11 the World Health Organization (WHO) reported that the outbreak could be defined as a pandemic. COVID-19 disease ranges from mild flu-like episodes to other serious and even life-threatening conditions, mainly due to acute respiratory failure. These patients are frequently admitted to our Intensive Care Units in relation to acute respiratory distress syndrome. The lack of a treatment based on scientific evidence has led to the use of different management guidelines, in many cases with rapid changes in the applied protocols. Recent reviews in reputed journals have underscored the lack of proven therapies and the need for clinical trials to establish clear and objective treatment guidelines. The present study provides an update on the currently applied treatment, and intends to offer help in relation to daily care, without seeking to replace the protocols adopted in each individual center.
Subject(s)
COVID-19 Drug Treatment , SARS-CoV-2 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/therapy , Disease Progression , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunoglobulins, Intravenous/therapeutic use , Immunomodulation , Interferon-beta/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Lopinavir/therapeutic use , Nitriles , Protein Kinase Inhibitors/therapeutic use , Pyrazoles/therapeutic use , Pyrimidines , Ritonavir/therapeutic use , COVID-19 SerotherapyABSTRACT
Introduction: A correlational type investigation was carried out evaluating 145 patients with COVID-19 sepsis. Objectives: To determine whether hypoalbuminemia is a predictor of mortality and to identify the serum albumin value most frequently related to lethality. Method: Patients older than or equal to 18 years seen at Hospital II Chocope during May to August 2020 were included. Patients with oncological pathologies and incomplete medical records were excluded. The documentary analysis technique was used, by reviewing medical records. Results: There was a statistically significant association between hypoalbuminemia and mortality (p=0.014), patients with hypoalbuminemia had 3 times the risk of dying. (OR=3.97 95% CI of 1,24-12,74). Likewise, the highest sensitivity and specificity of the test was when the cut-off point for hypoalbuminemia was 1.38 g / dl. Finally, the most frequent comorbidity was arterial hypertension. Conclusions: Hypoalbuminemia can be a predictor of mortality in patients with sepsis due to COVID-19 at the Hospital de Chocope because it has a statistically significant association, with three times the risk of death. The highest sensitivity and specificity was obtained with an albuminemia cutoff of 1.38 g / dL. The most frequent comorbidity in patients with sepsis due to COVID-19 who died was arterial hypertension.