The impact of daily Troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients

Background and Aim:The aim of this study is to analyse the daily Troponin-I and D-dimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients. Method(s): 206 patients who were hospitalized between March 20, 2020-May 5, 2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analysed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days. Result(s): Average age was higher in mortality group compared to non-mortality group (respectively 67.79 +/- 14.9, 56.87 +/- 18.15, p<0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p:0.003, p:0.004, p:0.045, p:0.02, p:0.003, p:0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p<0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin-I value on the 7th day >=16.05 pg/mL was related with need for intensive care (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p<0.001). Troponin-I value >=30.25 pg/mL on the 9th day was related with mortality (AUC: 0.920, sensitivity: %89.5, specificity: %89.3, p<0.001). D-dimer value >=878 hg/mL on the 2nd day was associated with intensive care need (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p<0.001). D-dimer value >=1106 hg/mL on the 10th day was associated with mortality (AUC: 0.817, sensitivity: %68.4, specificity: %65.2, p<0.001). It was observed that hospitalization periods >=9.5 days were associated with mortality (AUC: 0.738, sensitivity: %68.4, specificity: %65.9, p<0.001). Conclusion(s): We showed that hospitalizations >=9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration.

Evaluation of electrocardiographic changes in patients under COVID-19 treatment regimes

Background and Aim: Awareness of electrocardiographic (ECG) changes is crucial in patients who receive coronavirus disease 2019 (COVID-19) treatment. In this study, we aimed to evaluate ECG parameters in patients under COVID-19 therapy and their relationship with the severity of lung involvement and the disease on the basis of thoracic computerized tomography (TCT) findings and laboratory parameters. Material(s) and Method(s): Of 350 patients hospitalized due to COVID-19 between March 2020 and June 2020, 300 patients with available data were retrospectively analyzed. Blood analysis, electrocardiographic, and clinical findings were evaluated. Six-month follow-up data were also recorded. Result(s): The patients were categorized into two groups: Survivor (n = 206, 68.7%, Group 1) and nonsurvivor patients (n = 94, 31.3%, Group 2). The mean total follow-up period was 125.39 +/- 73.09 days. The mean age was similar in both groups. In multivariate regression analysis that aimed to predict COVID-19 disease severity, it was found that besides increased C-reactive protein and D-dimer levels, and >=50% lung involvement in TCT, which are well known as bad prognostic factors, the corrected QT interval duration (QTc) prolongation >=60 miliseconds (msn) during hospitalization was associated with worse prognosis in COVID-19 patients during follow-up. Conclusion(s): Our study is the first study that demonstrated that the presence of >=60 msn QTc prolongation during hospital stay was found to be the most valuable ECG parameter to predict the prognosis and had a significant association with >=50% lung involvement in TCT in patients under anti-COVID therapy. Close monitoring of this ECG parameter is important both in terms of treatment planning and interpretation of disease progression. Copyright © 2022 Society of Cardiovascular Academy. All rights reserved.

In Silico Screening and Testing of FDA-Approved Small Molecules to Block SARS-CoV-2 Entry to the Host Cell by Inhibiting Spike Protein Cleavage.

The COVID-19 pandemic began in 2019, but it is still active. The development of an effective vaccine reduced the number of deaths; however, a treatment is still needed. Here, we aimed to inhibit viral entry to the host cell by inhibiting spike (S) protein cleavage by several proteases. We developed a computational pipeline to repurpose FDA-approved drugs to inhibit protease activity and thus prevent S protein cleavage. We tested some of our drug candidates and demonstrated a decrease in protease activity. We believe our pipeline will be beneficial in identifying a drug regimen for COVID-19 patients.

In Silico Screening and Testing of FDA-Approved Small Molecules to Block SARS-CoV-2 Entry to the Host Cell by Inhibiting Spike Protein Cleavage

The COVID-19 pandemic began in 2019, but it is still active. The development of an effective vaccine reduced the number of deaths;however, a treatment is still needed. Here, we aimed to inhibit viral entry to the host cell by inhibiting spike (S) protein cleavage by several proteases. We developed a computational pipeline to repurpose FDA-approved drugs to inhibit protease activity and thus prevent S protein cleavage. We tested some of our drug candidates and demonstrated a decrease in protease activity. We believe our pipeline will be beneficial in identifying a drug regimen for COVID-19 patients.

X-linked agammaglobulinemia presenting with pseudomonas skin abscesses: A case report

Introduction : The skin may be involved in inborn errors of immunity (IEI) and serve as important clues for diagnosis. We report a boy presented with subcutaneous abscesses caused by Pseudomonas aeruginosa and diagnosed as X-linked agammaglobulinemia (XLA). Case Report : A 13-months-old boy patient was referred to our immunology clinic with a history of recurrent fever and skin lesions resistant to conventional therapies on his limbs and cyclic neutropenia. He was the first child of consanguineous parents. His past medical history revealed that he had been suffering from recurrent otitis media, sinopulmonary infections, and conjunctivitis since the age of four months. He was hospitalized with a diagnosis of otitis media, and his fever persisted despite the given antibiotic treatment. Skin abscesses on his extremities occurred and were drained. On physical examination, there were a total of 16 erythematous, hemorrhagic subcutaneous nodules with central black eschar. His tonsils were rudimentary. Peripheral blood sampling showed a white blood cell count 41.3 × 109 /L with 52.3 × 109 /L neutrophils, 33.1 × 109 /L lymphocytes, %2.6 × 109 /L eosinophils, hemoglobin 9.9 g/L, and a platelet count of 397 × 109 /L. Sedimentation 18 mm/h. COVID-19 real-time PCR was negative. His immunological screening revealed that agammaglobulinemia and absence of B cells, consistent with X-linked agammaglobulinemia (Table 1). BTK gene sequence analysis showed the presence of a BTK:c.404-406delACA and BTK:c.407-408insCTTTA hemizygous mutations. To our knowledge, it has never been described before that the compound heterozygosity of these mutations causes X-linked agammaglobulinemia. These variants were classified as likely pathogenic according to the ACMG guidelines and confirmed as XLA. His mother is the carrier. Pseudomonas aeruginosa was isolated in his abscess cultures. Abscess lesions on the right and left leg were drained again, but they repeated. Hereby, the abscess lesions and subcutaneous nodules were evacuated by plastic surgery, and the daily dressing was done with silver material. In the follow-up, the skin lesions improved gradually. The patient was discharged with immunoglobulin replacement therapy and prophylactic antibiotic. Conclusion : Pseudomonas skin infection is common among IEIs, especially patients with neutropenia. XLA should be kept in mind in the evaluation of unexplained cyclic neutropenia and skin abscess resistance to therapy. (Table Presented).

The impact of daily troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients

Introduction: Coronavirus Disease 2019 (COVID-19) caused by that infection resulted in a very high morbidity and mortality rates globally. Purpose: The aim of this study is to analyses the daily Troponin-I and Ddimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients. Methods: 206 patients who were hospitalized between 20.03.2020- 05.05.2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analyzed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days. Results: Average age was higher in mortality group compared to nonmortality group (respectively 67.79±14.9, 56.87±18.15, p:<0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p:0.003, p:0.004, p:0.045, p:0.02, p:0.003, p:0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p<0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin- I value on the 7th day ≥16.05 pg/ml was related with need for intensive care (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p<0.001). Troponin-I value ≥30.25 pg/ml on the 9th day was related with mortality (AUC: 0.920, sensitivity: %89.5, specificity: %89.3, p<0.001). D-dimer value ≥878 hg/ml on the 2nd day was associated with intensive care need (AUC: 0.896, sensitivity: %78.6, specificity %78.3, p<0.001). D-dimer value ≥1106 hg/ml on the 10th day was associated with mortality (AUC: 0.817, sensitivity: %68.4, specificity: %65.2, p<0.001). It was observed that hospitalization periods ≥9.5 days were associated with mortality (AUC: 0.738, sensitivity %68.4, specificity: %65.9, p<0.001). Conclusion: We observed that hospitalizations ≥9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration.