ABSTRACT
Introduction: Acute kidney injury (AKI) appears to be prevalent in ICU COVID-19 patients. Nevertheless, there are few data in comparison with non-COVID-19 patients. The aim of our study was to compare the prevalence of AKI in COVID-19 and non-COVID-19 critically ill patients. Method(s): We performed a retrospective single-center study including all consecutively COVID-19 critically ill mechanically ventilated patients admitted from 03/2020 to 11/2021 to our ICU and all consecutively critically ill mechanically ventilated patients from 08/2020 to 01/2021 and from 03/2021 to 08/2021 admitted to our non-COVID-19 ICU. Patients' demographics, comorbidity including Charlson Comorbidity Index (CCI), outcome, as well as, admission, maximum and minimum creatinine blood values, as well as KDIGO stage were recorded. Two patient groups, i.e., COVID-19 and non-COVID-19 patients were compared in terms of AKI. Result(s): The study included 333 patients (183 COVID-19, 150 non- COVID-19), of an average age 66.3 +/- 14.36 years-old. Between the two patient groups there was no difference in age or sex. COVID-19 patients had a lower CCI score (84% had a score of < 5 compared to 68.8%, p = 0.004). COVID-19 patients had a lower admission creatinine (1.13 +/- 0.78 mg/dl vs 1.49 +/- 1.33 mg/dl, p 0.003), nevertheless, developed more often AKI (74.3% vs 54%, p 0001) during their ICU hospitalization. Among COVID-19 ICU patients that developed AKI 54.4% were stage 1, 18.8% stage 2 and 26.8% stage 3, while 10.27% (19/185) of patients underwent CRRT. Twenty-eight-day mortality was high in COVID-19 patients (66.18%, 90/136). There was no difference in KDIGO stage percentage among the two groups. Conclusion(s): COVID-19 critically-ill patients develop more often AKI compared to non-COVID-19 patients. More studies are required to assess this phenomenon, focusing also on the long-term follow-up of the kidney function of these patients.
ABSTRACT
INTRODUCTION The novel Severe Acute Respiratory Syndrome Coronavirus-2, which causes the coronavirus disease COVID-19, is a highly infectious viral pathogen that is responsible for the ongoing pandemic. The aim of the present study was to illustrate the pre-hospitalization baseline characteristics and comorbidities of patients admitted with COVID-19 and their association with patient outcomes. METHODS This was a retrospective observational study of consecutive patients who were admitted to the COVID-19 departments of the University General Hospital of Ioannina, Greece (March 2020 - August 2021). Patients' demographic data, chronic disease medication use, and comorbidities were recorded upon their admission. RESULTS A total of 627 patients were hospitalized with mean age 62.5 years, 65.2% with at least one comorbidity, and 43.1% female. The median hospitalization duration was 11 days;554 (88.4%) of the patients were discharged and the mortality rate was 11.6%. Older age, admission during the second pandemic wave, arterial hypertension, and diabetes mellitus were associated with longer hospitalization. In multivariate analyses, cardiovascular disease was an independent predictor of hospitalization length (OR=1.834;95% CI: 1.039-3.228), whereas age (HR=1.079;95% CI: 1.045-1.115), history of malignancy (HR=1.246;95% CI: 1.002-1.595), and a diagnosis of COPD (HR=1.989;95% CI: 1.025-7.999) remained the independent mortality predictors. CONCLUSIONS Our data highlight the effect of COPD and malignancy on mortality risk in COVID-19 patients and the association of cardiovascular disease with a longer hospitalization.
ABSTRACT
Introduction: Annualized relapse rate (ARR) is routinely used as the primary outcome measure in MS clinical trials and is important in service planning. Most disease modifying therapies (DMTs) are prescribed in people with relapsing remitting MS (RRMS) and the ARR of secondary progressive MS (SPMS) and RRMS has not been accurately described in a modern clinical cohort. Recent treatment advances have led to more people with MS being effectively managed with early intensive medications, reducing the frequency of reported relapse rates in RRMS. Aims: To facilitate MS service planning and improve the feasibility estimations for clinical trials in MS. Objectives: To establish a current estimated ARR observed in a contemporary MS clinic in the UK. Methods: A retrospective cohort study examined all relapses recorded in a university hospital serving the local MS population. A random sample of 812 MS Nottingham patients from our database were reviewed for reported relapses from April 1 to June 30, 2020 and the same period in 2019, to account for potential reporting bias during the COVID-19 pandemic. The MS clinical database, nurse and admin registries, medical and telephone records for those individuals were reviewed at the end of 2020 for possible relapses during the study periods. Results: Among MS patients followed up in clinic, 60% had RRMS, 23% SPMS, 14% PPMS and 4% CIS. We identified 30 clinician confirmed relapses during the study period equating to an ARR of 0.15 for all MS patients treated and untreated. 70% of RRMS and 18% of SPMS were on DMTs. The ARR in RRMS and SPMS were the same (0.15). Validating this with pre-pandemic 2019 records found similar results. Conclusions: This contemporary UK-based study reports halving of the ARR previously reported in 2 similar studies in the UK 8 years ago. While relapse prevention has been achieved in RRMS, there appears to be significant unappreciated relapses occurring in the SPMS (pre-siponimod) cohort.
ABSTRACT
Beta interferons (IFN-ß) are pleiotropic cytokines with antiviral properties. They play important roles in the pathogenesis of multiple sclerosis (MS), an incurable immune-mediated disorder of the central nervous system. The clinical expression of MS is heterogeneous, with relapses of neuroinflammation and with disability accrual in considerable part unrelated to the attacks. The injectable recombinant IFN-ß preparations are the first approved disease-modifying treatments for MS. They have moderate efficacy in reducing the frequency of relapses, but good long-term cost-efficacy and safety profiles, so are still widely used. They have some tolerability and adherence issues, partly mitigated in recent years by the introduction of a PEGylated formulation and use of 'smart' autoinjector devices. Their general impact on long-term disability is modest but could be further improved by developing accurate tools for identifying the patient profile of best responders to IFN-ß. Here, we present the IFN-ß-based immunomodulatory therapeutic approaches in MS, highlighting their place in the current coronavirus disease (COVID-19) pandemic. The potential role of IFN-ß in the treatment of COVID-19 is also briefly discussed.