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Ann Med ; 54(1): 1906-1907, 2022 12.
Article in English | MEDLINE | ID: covidwho-1921960

COVID-19 , Humans , Prognosis
Biochem Med (Zagreb) ; 32(2): 020901, 2022 Jun 15.
Article in English | MEDLINE | ID: covidwho-1798676


Introduction: Several laboratory tests are characteristically altered in Coronavirus Disease 2019 (COVID-19), but are not totally accurate in predicting the disease outcome. The long pentraxin 3 (PTX3) is quickly released directly at inflammation sites by many immune cell types. Previous studies have shown that PTX3 correlated with disease severity in various inflammatory conditions. Our study investigated the use of PTX3 as a potential marker of COVID-19 severity and compared its performance in detecting a more severe form of the disease with that of routine laboratory parameters. Materials and methods: Stored serum samples of RT-PCR confirmed COVID-19 cases that had been obtained at hospital admission were retrospectively analysed. Intensive care unit (ICU) stay was considered a surrogate endpoint of severe COVID-19. Pentraxin 3 was measured by a commercial enzyme-linked immunosorbent assay. Results: A total of 96 patients were recruited from May 1st, 2020 to June 30th, 2020; 75/96 were transferred to ICU. Pentraxin 3 was higher in ICU vs non-ICU patients (35.86 vs 10.61 ng/mL, P < 0.001). Univariate and multivariate logistic regression models demonstrated that the only significant laboratory predictor of ICU stay was PTX3 (OR: 1.68 (1.19-2.29), P = 0.003), after controlling for comorbidities. The Receiver Operator Characteristic curve analysis showed that PTX3 had a higher accuracy compared to C-reactive protein (CRP), lactate dehydrogenase (LD), ferritin in identifying ICU patients (AUC of PTX3 = 0.98; CRP = 0.66; LD = 0.70; ferritin = 0.67, P < 0.001). A cut-off of PTX3 > 18 ng/mL yielded a sensitivity of 96% and a specificity of 100% in identifying patients requiring ICU. Conclusion: High values of PTX3 predict a more severe COVID-19.

COVID-19 , Biomarkers , C-Reactive Protein/metabolism , COVID-19/diagnosis , Ferritins , Humans , ROC Curve , Retrospective Studies , Serum Amyloid P-Component
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-304746


Background: The early detection of COVID-19 patients with interstitial pneumonia at high risk of dismal outcome is necessary to deliver proper care and optimize management of limited resources. Objective: The aim of this study was to analyse the performance of pre-existing scores in predicting in-hospital mortality and ICU transfer at admission in an Acute Medical Unit. Methods: 106 consecutive patients with acute respiratory failure due to COVID-19 interstitial pneumoni admitted to Acute Medical Unit were enrolled. The performances of NEWS, SIRS, RAPS, REMS, qSOFA, APACHE II, CURB-65 and PSI were analysed by the Area Under the Receiver Operator Characteristic (AUROCs) and standard indices of accuracy. Results: Considering in-hospital mortality PSI and APACHE II had the higher AUROCs, 0.83 (95% CI 0.75-0.91) and 0.80 (95% CI 0.71-0.88), followed by REMS, 0.77 (95% CI 0.67-0.86), and CURB-65, 0.73 (95% CI 0.63-0.82), whereas the AUROCs of the other scores were < 0.7. PSI and APACHE II had good sensitivity (0.92 and 0.97), negative predictive value (0.96 and 0.97) and negative likelihood ratio (0.1 and 0.1), accurately identifying patients at low risk to die. However, the low specificity (0.70 and 0.47) and positive likelihood ratio (3.1 and 1.8) could limit their usefulness in predicting in-hospital mortality. Considering ICU admissions all the scores, except NEWS, SIRS and qSOFA, showed a worse performance. Conclusions: PSI and APACHE II showed good prognostic results in predicting in-hospital mortality but no pre- existing score validated for acute care settings was totally satisfactory to predict adverse outcomes in COVID-19 interstitial pneumonia after admission to Acute Medical Unit. The application setting and selected outcome criteria should always be considered to evaluate and compare scoring systems’ performance analysis.

Resuscitation ; 166: 83-84, 2021 09.
Article in English | MEDLINE | ID: covidwho-1322337

COVID-19 , Humans , SARS-CoV-2
Auton Neurosci ; 229: 102734, 2020 12.
Article in English | MEDLINE | ID: covidwho-778433


We describe clinical and laboratory findings in 35 patients tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction on nasopharyngeal swab experiencing one or multiple syncope at disease onset. Clinical neurologic and cardiologic examination, and electrocardiographic findings were normal. Chest computed tomography showed findings consistent with interstitial pneumonia. Arterial blood gas analysis showed low pO2, pCO2, and ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) indicating hypocapnic hypoxemia. Patients who presented with syncope showed significantly lower heart rate as compared to 68 SARS-CoV-2 positive that did not. Such poorer than expected compensatory heart rate increase may have led to syncope based on individual susceptibility. We speculate that SARS-CoV-2 could have caused angiotensin-converting enzyme-2 (ACE2) receptor internalization in the nucleus of the solitary tract and other midbrain nuclei, impairing baroreflex and chemoreceptor response, and inhibiting the compensatory tachycardia during acute hypocapnic hypoxemia.

COVID-19/complications , Syncope/virology , Adult , Aged , Aged, 80 and over , Female , Heart Rate/physiology , Humans , Hypocapnia/virology , Hypoxia/virology , Male , Middle Aged , SARS-CoV-2