Comparison of Cytokine Hemadsorption as an Immunomodulator Therapy in COVID-19 Patients with and without Bacterial Sepsis.

BACKGROUND: In this retrospective study, we aimed to compare the laboratory and clinical results of cytokine hem-adsorption as an immunomodulation therapy in COVID-19 ICU patients with or without sepsis. METHODS: The levels of PCT, CRP, and ferritin were determined as indicators of infection/sepsis; the levels of in-terleukins (IL-6, IL-8 and IL-10, and TNF-α) were determined as indicators of cytokine storm were compared. APACHE score, SOFA score, and mortality rates were compared for the progression of the disease in 23 COVID-19 patients. RESULTS: The therapy was generally successful in reducing the levels of IL-6, IL-8, IL-10, and TNF-α but the levels measured after the procedure did not differ among the patients with or without sepsis, suggesting that the presence of sepsis did not affect the efficacy and function of the cytokine hemadsorption procedure in COVID-19 patients. All parameters were reduced after the procedure except the levels of PCT and ferritin and mortality rates of patients diagnosed with sepsis. The level of PCT was significantly higher in these patients compared with the patients without sepsis while the ferritin and mortality did not show any significant difference between the two groups, suggesting that the cytokine hemadsorption may be safe in the treatment of critical COVID-19 patients. CONCLUSIONS: As a result, the progression of sepsis in COVID-19 may be avoided with cytokine hemadsorption applied as an immunomodulator therapy. However, this therapy should be further explored and validated prior to its introduction to everyday clinical practice when the epidemic conditions end.

Low prevalence of SARS-CoV-2 infection in inflammatory bowel disease.

OBJECTIVE: Treatments used in Inflammatory Bowel Disease (IBD) have been associated with enhanced risk of viral infections and viral reactivation, however, it remains unclear whether IBD patients have increased risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. The aim of the study was to examine the prevalence of SARS-CoV-2 IgG positivity in IBD patients followed at our referral center. The role of treatments for IBD and risk factors for infection were also evaluated. PATIENTS AND METHODS: In a prospective study, all IBD patients followed at our referral centre between May 27th and July 21st, 2020 and fulfilling the inclusion criteria were tested for SARS-CoV-2 IgG. Specific IgG antibodies were evaluated by a commercial ELISA kit and SARS-CoV-2 nasopharyngeal swab was performed in seropositive patients. RESULTS: Two-hundred and eighteen patients, 128 Crohn's disease (CD) and 90 Ulcerative colitis (UC) [age 44, (19-77) years; ongoing biologics in 115 (52.7%)] were enrolled. No patient had major SARS-CoV-2-related symptoms. SARS-CoV-2 IgG were detected in 3 out of 218 (1.37%) patients with IBD (2 CD and 1 UC), all on biologics (2.6%). In all of the 3 seropositive patients, the nasopharyngeal swab was negative. There was no relationship between SARS-CoV-2 seroprevalence and the demographic/clinical characteristics of IBD patients. In contrast, history of recent travel was more frequent in the SARS-CoV-2 seropositive patients (2/3; 66.6%) than in SARS-CoV-2 seronegative patients [7/215 (3.25%); p<0.0001]. CONCLUSIONS: The prevalence of SARS-CoV-2 IgG seropositivity in IBD patients appears to be comparable to the non-IBD population and not influenced by ongoing treatments. Risk factors for infection common to the general non-IBD population should be considered when managing patients with IBD.

Death risk and the importance of clinical features in elderly people with COVID-19 using the random forest algorithm. (Special issue.)

Objectives: train a Random Forest (RF) classifier to estimate death risk in elderly people (over 60 years old) diagnosed with COVID-19 in Pernambuco. A "feature" of this classifier, called feature importance, was used to identify the attributes (main risk factors) related to the outcome (cure or death) through gaining information.

Women with cancer and COVID-19: an analysis of lethality and clinical aspects in Pernambuco. (Special Issue: Transparency in research and publications on COVID-19.)

Objectives: to analyze the lethality and clinical characteristics in Pernambuco women with neoplasia that were infected by SARS-CoV-2.

Death risk and the importance of clinical features in elderly people with covid-19 using the random forest algorithm

Objectives: train a Random Forest (RF) classifier to estimate death risk in elderly people (over 60 years old) diagnosed with COVID-19 in Pernambuco. A "feature" of this classifier, called feature importance, was used to identify the attributes (main risk factors) related to the outcome (cure or death) through gaining information. Methods: data from confirmed cases of COVID-19 was obtained between February 13 and June 19, 2020, in Pernambuco, Brazil. The K-fold Cross Validation algorithm (K=10) assessed RF performance and the importance of clinical features. Results: the RF algorithm correctly classified 78.33% of the elderly people, with AUC of 0.839. Advanced age was the factor representing the highest risk of death. The main comorbidity and symptom were cardiovascular disease and oxygen saturation ≤ 95%, respectively. Conclusion: this study applied the RF classifier to predict risk of death and identified the main clinical features related to this outcome in elderly people with COVID-19 in the state of Pernambuco.