ABSTRACT
OBJECTIVE: To explored whether initial laboratory data and symptoms predict further clinical outcome. MATERIALS AND METHODS: Retrospective cohort study. Clinical records from March to September 2020 were revised to extract clinical-demographic characteristics, laboratory data and outcomes from patients with SARS-CoV-2 pneumonia, admitted to Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City. RESULT(S): One thousand three patients were evaluated at the Emergency-Triage, diagnosed with SARS-CoV-2 and received further in-hospital medical attention. Most of the patients were younger than 65 years-old, male and showed co-morbid conditions, such as obesity, hypertension or diabetes mellitus. After standard therapy, 389 cases (39%) required mechanical ventilation, vasopressor agents or showed fatal outcome. Higher values of C-reactive protein, D-dimer, procalcitonin and low O2 saturation at triage significantly predicted mechanical ventilation (p <0.05) and mortality (p <0.05);while presenting symptoms like fever, myalgia, cough and ageusia showed a particular association with longer hospital stage (p < 0.05). CONCLUSION(S): Laboratory values and presenting symptoms, both evaluated at hospital admission, showed different ability to predict clinical severity, mortality and longer hospitalization time in patients with COVID-19 pneumonia. These results could be useful in possible future pandemic waves of SARS-CoV-2.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
ABSTRACT
The clinical course of COVID-19 may show severe presentation, potentially involving dynamic cytokine storms and T cell lymphopenia, which are leading causes of death in patients with SARS-CoV-2 infection. Plasma exchange therapy (PLEX) effectively removes pro-inflammatory factors, modulating and restoring innate and adaptive immune responses. This clinical trial aimed to evaluate the impact of PLEX on the survival of patients with severe SARS-CoV-2 and the effect on the cytokine release syndrome. Hospitalized patients diagnosed with SARS-CoV-2 infection and cytokine storm syndrome were selected to receive 2 sessions of PLEX or standard therapy. Primary outcome was all-cause 60-days mortality; secondary outcome was requirement of mechanical ventilation, SOFA, NEWs-2 scores modification, reduction of pro-inflammatory biomarkers and hospitalization time. Twenty patients received PLEX were compared against 40 patients receiving standard therapy. PLEX reduced 60-days mortality (50% vs 20%; OR 0.25, 95%CI 0.071-0.880; p = 0.029), and this effect was independent from demographic variables and drug therapies used. PLEX significantly decreased SOFA, NEWs-2, pro-inflammatory mediators and increased lymphocyte count, accompanied with a trend to reduce affected lung volume, without effect on SatO2/FiO2 indicator or mechanical ventilation requirement. PLEX therapy provided significant benefits of pro-inflammatory clearance and reduction of 60-days mortality in selected patients with COVID-19, without significant adverse events.