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1.
Medicina ; 58(8):1093, 2022.
Article in English | MDPI | ID: covidwho-1987886

ABSTRACT

Background and Objectives: SARS-CoV-2 has an extensive tissue tropism due to its ability to attach to the surfaces of cells through different receptors, leading to systemic complications. In this article, we aim to present the prevalence of pericardial effusions in patients with severe COVID-19, to identify the risk factors/predictors for pericardial involvement, and to evaluate its impact on overall mortality. Materials and Methods: We enrolled 100 patients with severe COVID-19 in our observational cohort study and divided them in two groups: Group A (27 patients with pericardial effusion) and Group B (73 patients without pericardial effusion). We recorded demographic and lifestyle parameters, anthropometric parameters, clinical parameters, inflammation markers, respiratory function parameters, complete blood count, coagulation parameters, and biochemical serum parameters. All patients were evaluated by computer tomography scans within 48 h of admission. Results: The median age was 61 years in both groups and the male/female ratio was 3.5 vs. 2.8 in Group A vs. Group B. We identified mild pericardial effusion (3–4 mm) in 62.9% patients and moderate pericardial effusion (5–9 mm) in 37.1% patients, with a median value of 4 [3;6] mm. The patients with pericardial effusion presented with higher percentages of obesity, type-2 diabetes mellitus, arterial hypertension, and congestive heart failure, without statistical significance. Increased values in cardiac enzymes (myoglobin, CK, CK-MB) and LDH were statistically associated with pericardial effusion. The overall mortality among the participants of the study was 24% (24 patients), 33.3% in Group A and 20.8% in Group B. Conclusions: Pericardial effusion has a high prevalence (27%) among patients with severe forms of COVID-19 and was associated with higher mortality. Pericardial effusion in our study was not associated with the presence of comorbidities or the extent of lung involvement. Overall mortality was 60% higher in patients with pericardial effusion.

2.
Medicina (Kaunas) ; 58(7)2022 Jul 18.
Article in English | MEDLINE | ID: covidwho-1938901

ABSTRACT

Background and Objectives: The severe forms of SARS-CoV-2 pneumonia are associated with acute hypoxic respiratory failure and high mortality rates, raising significant challenges for the medical community. The objective of this paper is to present the importance of early quantitative evaluation of radiological changes in SARS-CoV-2 pneumonia, including an alternative way to evaluate lung involvement using normal density clusters. Based on these elements we have developed a more accurate new predictive score which includes quantitative radiological parameters. The current evolution models used in the evaluation of severe cases of COVID-19 only include qualitative or semi-quantitative evaluations of pulmonary lesions which lead to a less accurate prognosis and assessment of pulmonary involvement. Materials and Methods: We performed a retrospective observational cohort study that included 100 adult patients admitted with confirmed severe COVID-19. The patients were divided into two groups: group A (76 survivors) and group B (24 non-survivors). All patients were evaluated by CT scan upon admission in to the hospital. Results: We found a low percentage of normal lung densities, PaO2/FiO2 ratio, lymphocytes, platelets, hemoglobin and serum albumin associated with higher mortality; a high percentage of interstitial lesions, oxygen flow, FiO2, Neutrophils/lymphocytes ratio, lactate dehydrogenase, creatine kinase MB, myoglobin, and serum creatinine were also associated with higher mortality. The most accurate regression model included the predictors of age, lymphocytes, PaO2/FiO2 ratio, percent of lung involvement, lactate dehydrogenase, serum albumin, D-dimers, oxygen flow, and myoglobin. Based on these parameters we developed a new score (COV-Score). Conclusions: Quantitative assessment of lung lesions improves the prediction algorithms compared to the semi-quantitative parameters. The cluster evaluation algorithm increases the non-survivor and overall prediction accuracy.COV-Score represents a viable alternative to current prediction scores, demonstrating improved sensitivity and specificity in predicting mortality at the time of admission.


Subject(s)
COVID-19 , Pneumonia , Respiratory Distress Syndrome , Adult , Humans , L-Lactate Dehydrogenase , Myoglobin , Oxygen , Retrospective Studies , SARS-CoV-2 , Serum Albumin
3.
J Clin Med ; 11(11)2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1884237

ABSTRACT

It is well known that during the coronavirus disease 2019 (COVID-19) pandemic, antibiotics were overprescribed. However, less is known regarding the arguments that have led to this overuse. Our aim was to understand the factors associated with in-hospital antibiotic prescription for COVID-19, and the rationale behind it. We chose a convergent design for this mixed-methods study. Quantitative data was prospectively obtained from 533 adult patients admitted in six hospitals (services of internal medicine, infectious diseases and pneumology). Fifty-six percent of the patients received antibiotics. The qualitative data was obtained from interviewing 14 physicians active in the same departments in which the enrolled patients were hospitalized. Thematic analysis was used for the qualitative approach. Our study revealed that doctors based their decisions to prescribe antibiotics on a complex interplay of factors regarding the simultaneous appearance of consolidation on the chest computer tomography together with a worsening of clinical conditions suggestive of bacterial infection and/or an increase in inflammatory markers. Besides these features which might suggest bacterial co-/suprainfection, doctors also prescribed antibiotics in situations of uncertainty, in patients with severe disease, or with multiple associated comorbidities.

4.
J Pers Med ; 12(6)2022 May 26.
Article in English | MEDLINE | ID: covidwho-1869681

ABSTRACT

BACKGROUND: Since the beginning of the COVID-19 pandemic, empiric antibiotics (ATBs) have been prescribed on a large scale in both in- and outpatients. We aimed to assess the impact of antibiotic treatment on the outcomes of hospitalised patients with moderate and severe coronavirus disease 2019 (COVID-19). METHODS: We conducted a prospective multicentre cohort study in six clinical hospitals, between January 2021 and May 2021. RESULTS: We included 553 hospitalised COVID-19 patients, of whom 58% (311/553) were prescribed antibiotics, while bacteriological tests were performed in 57% (178/311) of them. Death was the outcome in 48 patients-39 from the ATBs group and 9 from the non-ATBs group. The patients who received antibiotics during hospitalisation had a higher mortality (RR = 3.37, CI 95%: 1.7-6.8), and this association was stronger in the subgroup of patients without reasons for antimicrobial treatment (RR = 6.1, CI 95%: 1.9-19.1), while in the subgroup with reasons for antimicrobial therapy the association was not statistically significant (OR = 2.33, CI 95%: 0.76-7.17). After adjusting for the confounders, receiving antibiotics remained associated with a higher mortality only in the subgroup of patients without criteria for antibiotic prescription (OR = 10.3, CI 95%: 2-52). CONCLUSIONS: In our study, antibiotic treatment did not decrease the risk of death in the patients with mild and severe COVID-19, but was associated with a higher risk of death in the subgroup of patients without reasons for it.

5.
J Clin Med ; 11(9)2022 May 07.
Article in English | MEDLINE | ID: covidwho-1847358

ABSTRACT

(1) Background: We aimed to describe the clinical and imaging characteristics of patients diagnosed with pulmonary artery thrombosis (PAT) despite receiving anticoagulation with low-molecular-weight heparin (LMWH). (2) Methods: We retrospectively studied all hospitalized COVID-19 adult patients diagnosed with PAT between March 2020 and December 2021, who received LMWH for ≥72 h until the diagnosis of PAT. Acute PAT was confirmed by a CT pulmonary angiogram. (3) Results: We included 30 severe and critical COVID-19 patients. Median age was 62 (54-74) years, with 83.3% males, and comorbidities seen in 73.3%. PAT was diagnosed despite prophylactic (23.3%), intermediate (46.6%) or therapeutic (30%) doses of LMWH for a median time of 8 (4.7-12) days. According to their Wells score, 80% of patients had a low probability of pulmonary embolism diagnosis. PAT was localized in the lower lobes of the lungs in 76.6% of cases with 33.3% having bilateral involvement, with the distal, peripheral arteries being the most affected. At the PAT diagnosis we found a worsening of respiratory function, with seven patients progressing to mechanical ventilation (p = 0.006). The in-hospital mortality was 30%. (4) Conclusions: PAT should be considered in patients with severe and critical COVID-19, mainly in elderly male patients with comorbidities, irrespective of Wells score and LMWH anticoagulation.

6.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-335464

ABSTRACT

Purpose: to present the importance of quantitative evaluation of radiological changes in SARS-CoV-2 pneumonia, including an alternative way to evaluate the lung involvement using normal density clusters. Based on these elements we have developed a more accurate new predictive score which includes quantitative radiological parameters. The current evolution models used in the evaluation of severe cases of COVID-19 include only qualitative or semi-quantitative evaluations of pulmonary lesions which lead to a less accurate prognosis and assessment of pulmonary involvement. Methods We performed a retrospective observational cohort study that included 100 adult patients admitted with confirmed severe COVID19. The patients were divided into two groups: group A (76 survivors) and group B (24 non-survivors). Results We found associated with higher mortality a lower percentage of normal lung densities, PaO2/FiO2 ratio, lymphocytes, platelets, hemoglobin and serum albumin, respectively a higher percentage of interstitial lesions, oxygen flow, FiO2, Neutrophils/lymphocytes ratio, lactate dehydrogenase, creatine kinase MB, myoglobin, and serum creatinine. The most accurate regression model included as predictors: age, lymphocytes, PaO2/FiO2 ratio, and percent of lung involvement, lactate dehydrogenase, serum albumin, D-dimers, oxygen flow, and myoglobin. Based on these parameters we developed a new score (COV-Score).Conclusion COV-Score represents a viable alternative to current prediction scores, demonstrating a better sensitivity and specificity in predicting a poor outcome at the time of admission. Quantitative assessment of lung lesions improves the prediction algorithms compared to the semi-quantitative parameters. The cluster evaluation algorithm increases the non-survivor and overall accuracy prediction.

7.
J Clin Med ; 11(5)2022 Feb 25.
Article in English | MEDLINE | ID: covidwho-1715440

ABSTRACT

(1) Background: We aimed to analyze the characteristics associated with the in-hospital mortality, describe the early CT changes expressed quantitatively after tocilizumab (TOC), and assess TOC timing according to the oxygen demands. (2) Methods: We retrospectively studied 101 adult patients with severe COVID-19, who received TOC and dexamethasone. The lung involvement was assessed quantitatively using native CT examination before and 7-10 days after TOC administration. (3) Results: The in-hospital mortality was 17.8%. Logistic regression analysis found that interstitial lesions above 50% were associated with death (p = 0.01). The other variables assessed were age (p = 0.1), the presence of comorbidities (p = 0.9), the oxygen flow rate at TOC administration (p = 0.2), FiO2 (p = 0.4), lymphocyte count (p = 0.3), and D-dimers level (p = 0.2). Survivors had a statistically significant improvement at 7-10 days after TOC of interstitial (39.5 vs. 31.6%, p < 0.001), mixt (4.3 vs. 2.3%, p = 0.001) and consolidating (1.7 vs. 1.1%, p = 0.001) lesions. When TOC was administered at a FiO2 ≤ 57.5% (oxygen flow rate ≤ 13 L/min), the associated mortality was significantly lower (4.3% vs. 29.1%, p < 0.05). (4) Conclusions: Quantitative imaging provides valuable information regarding the extent of lung damage which can be used to anticipate the in-hospital mortality. The timing of TOC administration is important and FiO2 could be used as a clinical predictor.

8.
Blood ; 136(Supplement 1):13-13, 2020.
Article in English | PMC | ID: covidwho-1338942

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. The pathogenic mechanism of COVID-19 pneumonia involved excessive immune reaction in the host - a "cytokine storm", that determined extensive tissue damage associated with coagulation abnormalities. Severity of this disease is associated with comorbidities such as hypertension, obesity, pulmonary disease or age. Thrombotic complications are reported during COVID-19 evolution even with prophylaxis.OBJECTIVE: In this study, we evaluate hematological and coagulation parameters in order to obtain predictors for an unfavourable evolution of the patient. DESIGN AND SETTING: We performed a prospective study that included all patients admitted in our hospital in Hematology, Pneumology, and Intensive Care Unit (ICU) Department at Colentina Clinical Hospital during April - July 2020. The study group included 144 patients that were split into ICU and non-ICU patients. All patients were SARS-CoV-2-positive by molecular test. The distribution according to gender was as follows: 67 male with median age: 61 (min 22, max 88) and 77 female with median age: 57 (min 17, max 92).RESULTS: Age is an important risk factor for the severity;50 patients admitted in ICU with median age 67 (min 34, max 92) and 94 non-ICU patients with median age 52.5 (min 17, max 92), p=0.00003. Associated comorbidities were important and were present in both groups. In ICU patients, we obtained lower level of lymphocytes compared with non ICU group median: 1 x 103/L (min 0.04 x 103/L max 3.28 x 103/L) vs 1.57 x 103/L (min 0.39 x 103/L max 23.35 x 103/L), p=0.0001. There are no significant differences between groups for the rest of hematological parameters. The neutrophil/lymphocytes ratio (NLR) is with statistical difference between ICU and non-ICU groups: 2.34 (min 1.06, max 31.90) vs 7.94 (min 2.18, max 90.04), p<0.000001. This indicator seems to be predictor for severe evolution;a high correlation with IL-6 level (r=0.73, p<0.001) was obtained. NLR in association with IL-6, CRP and ferritin level are important factors in severe evolution of COVID-19 (severe pneumonia-more than 50% of lung evaluated by CT-scan and presence of any complications during COVID-19 evolution), coefficient of determination-R2 =0.69, R2 - adjusted 0.67, p<0.0001). The ICU patients with unfavourable evolution had a higher level of D-Dimers at the admission in hospital compared with ICU patients who were discharged from the hospital (3.42 mg/ml FEU vs 1.09 mg/ml FEU, p=0.01). Patients with thrombosis (stroke, myocardial infarction, deep venous thrombosis, thromboembolism) during COVID-19 evolution have higher level of D Dimers compared with patients without thrombotic complications (7.35 mg/ml FEU vs 0.82 mg/ml FEU), p=0.0001. There are no difference for another coagulation tests (APTT, Quick time) or Protein C, Protein S and Antithrombin III level.CONCLUSIONS: We conclude that NLR in association with feritin, CRP and IL-6 assessment are important to be evaluated in COVID-19 patient in order to expect a severe evolution of the disease. D- Dimer should be an important parameter to be evaluated for all COVID-19 patients in order to identify COVID-19 patients with high risk of thrombotic complications.

9.
Viruses ; 13(7)2021 06 26.
Article in English | MEDLINE | ID: covidwho-1289024

ABSTRACT

The number of serological assays for SARS-CoV-2 has skyrocketed in the past year. Concerns have been raised regarding their performance characteristics, depending on the disease severity and the time of the analysis post-symptom onset (PSO). Thus, independent validations using an unbiased sample selection are required for meaningful serology data interpretation. We aimed to assess the clinical performance of six commercially available assays, the seroconversion, and the dynamics of the humoral response to SARS-CoV-2 infection. The study included 528 serum samples from 156 patients with follow-up visits up to six months PSO and 161 serum samples from healthy people. The IgG/total antibodies positive percentage increased and remained above 95% after six months when chemiluminescent immunoassay (CLIA) IgG antiS1/S2 and electro-chemiluminescent assay (ECLIA) total antiNP were used. At early time points PSO, chemiluminescent microparticle immunoassay (CMIA) IgM antiS achieved the best sensitivity. IgM and IgG appear simultaneously in most circumstances, and when performed in parallel the sensitivity increases. The severe and the moderate clinical forms were significantly associated with higher seropositivity percentage and antibody levels. High specificity was found in all evaluated assays, but the sensitivity was variable depending on the time PSO, severity of disease, detection method and targeted antigen.


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing/methods , COVID-19 Serological Testing/standards , COVID-19/diagnosis , COVID-19/immunology , Reagent Kits, Diagnostic/standards , SARS-CoV-2/immunology , Adult , COVID-19/blood , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Longitudinal Studies , Luminescent Measurements , Male , Middle Aged , Prospective Studies , Romania , Sensitivity and Specificity , Time Factors
10.
Rom J Intern Med ; 59(4): 409-415, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1247777

ABSTRACT

Introduction. Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic. Methods. We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018. Results. We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days). Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment - mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group. Conclusions. The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.


Subject(s)
COVID-19 , Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Cephalosporins/therapeutic use , Clostridium Infections/drug therapy , Cross Infection/drug therapy , Delivery of Health Care , Humans , Pandemics , Retrospective Studies , Risk Factors , Romania/epidemiology , SARS-CoV-2 , Tertiary Care Centers
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