ABSTRACT
Several studies have shown that the plasma RNA of SARS-CoV-2 seems to be associated with a worse prognosis of COVID-19. In the present study, we investigated plasma RNA in COVID-19 patients treated with low-dose radiotherapy to determine its prognostic value. Data were collected from the IPACOVID prospective clinical trial (NCT04380818). The study included 46 patients with COVID-19 pneumonia treated with a whole-lung dose of 0.5 Gy. Clinical follow-up, as well as laboratory variables, and SARS-CoV-2 serum viral load, were analyzed before LDRT, at 24 h, and one week after treatment. The mean age of the patients was 85 years, and none received any of the SARS-CoV-2 vaccine doses. The mortality ratio during the course of treatment was 33%. RT-qPCR showed amplification in 23 patients. Higher mortality rate was associated with detectable viremia. Additionally, C-reactive protein, lactate dehydrogenase, and aspartate aminotransferase were significant risk factors associated with COVID-19 mortality. Our present findings show that detectable SARS-CoV-2 plasma viremia 24 h before LDRT is significantly associated with increased mortality rates post-treatment, thus downsizing the treatment success.
ABSTRACT
Background: To determine risk factors of death in diagnosed patients with COVID-19 who were aged ≥60 years and could not benefit from intubation and mechanical ventilation. Methods: Retrospective multicentre study including all patients with COVID-19 admitted to four medium-stay centres in Catalonia (March-June 2020). At the multivariate level, we calculated hazard ratios (HR) with 95% confidence intervals (CI) to determine risk factors associated with mortality. Results: 683 patients were included, of whom 227 died (case fatality rate of 33%, reaching 42% in patients of more than 90 years). Mean survival was 21.92 (20.98–22.86) days. Factors associated with death were fever (HR:1.5 (1.06–2.13)), malaise (HR:1.4 (1.04–1.99)), dyspnoea (HR:1.98 (1.41–2.79)) and atrial fibrillation (HR:1.45 (1.03–2.05)), while coughing (HR: 0.66 (0.46–0.94)), diarrhoea (HR:0.46 (0.23–0.92)), dyslipidaemia (HR:0.47 (0.28–0.82)), and receiving antithrombotic treatment (HR:0.56 (0.40–0.78)) had a protective effect. The analysis by age group showed that other factors were uniquely associated with each age group, such as chronic obstructive pulmonary disease at 60–74 years and polypharmacy at 75–90 years, among other factors. Conclusions: Case fatality in COVID-19 patients who could not benefit from intubation and mechanical ventilation was exceptional. Clinical manifestations such as fever, malaise, dyspnoea and atrial fibrillation helped to identify patients at higher risk of mortality, while antithrombotic treatment had a protective effect. Although some symptoms are very general regarding COVID-19, in the context of the first wave without vaccination, when not much was known about the disease, such symptoms could be useful.
ABSTRACT
The aim of our study was to investigate the changes produced by low-dose radiotherapy (LDRT) in the circulating levels of the antioxidant enzyme paraoxonase-1 (PON1) and inflammatory markers in patients with COVID-19 pneumonia treated with LDRT and their interactions with clinical and radiological changes. Data were collected from the IPACOVID prospective clinical trial (NCT04380818). The study included 30 patients treated with a whole-lung dose of 0.5 Gy. Clinical follow-up, as well as PON1-related variables, cytokines, and radiological parameters were analyzed before LDRT, at 24 h, and 1 week after treatment. Twenty-five patients (83.3%) survived 1 week after LDRT. Respiratory function and radiological images improved in survivors. Twenty-four hours after LDRT, PON1 concentration significantly decreased, while transforming growth factor beta 1 (TGF-ß1) increased with respect to baseline. One week after LDRT, patients had increased PON1 activities and lower PON1 and TGF-ß1 concentrations compared with 24 h after LDRT, PON1 specific activity increased, lactate dehydrogenase (LDH), and C-reactive protein (CRP) decreased, and CD4+ and CD8+ cells increased after one week. Our results highlight the benefit of LDRT in patients with COVID-19 pneumonia and it might be mediated, at least in part, by an increase in serum PON1 activity at one week and an increase in TGF-ß1 concentrations at 24 h.
ABSTRACT
Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.