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1.
Frontiers in Medicine ; JOUR, 9 (no pagination).
Article in English | EMBASE | ID: covidwho-2089851

ABSTRACT

The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5-24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) number of symptoms of 5.7 +/- 4.6, and 61.3% met the criteria for post-COVID syndrome at 1 year. During the follow-up, 46 patients were discharged, and 16 were transferred to other consultations. Other conditions, such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%), and lung cancer (1%) were identified. A high use of health care resources is observed in the first year. In conclusion, one-third of critically ill COVID-19 patients need to continue follow-up beyond 1 year, due to abnormalities on DLCO, chest CT, or persistent symptoms. Copyright © 2022 Gonzalez, Zuil, Benitez, de Gonzalo-Calvo, Aguilar, Santisteve, Vaca, Minguez, Seck, Torres, de Batlle, Gomez, Barril, Moncusi-Moix, Monge, Gort-Paniello, Ferrer, Ceccato, Fernandez, Motos, Riera, Menendez, Garcia-Gasulla, Penuelas, Labarca, Caballero, Barbera, Torres and Barbe.

4.
Hepatology ; 74(SUPPL 1):325A-326A, 2021.
Article in English | EMBASE | ID: covidwho-1508711

ABSTRACT

Background: The new coronavirus-19 (COVID-19) disease has been associated with a persistent symptomatic state after the acute phase, called Long COVID-19. This study aimed to find liver effects and their association with pro-inflammatory cytokines and percentage (%) of neutrophil extracellular traps (NETosis) in this stage Methods: Prospective, observational study including symptomatic subjects four months after COVID-19 diagnosis. Clinical, demographic, anthropometry data, and blood samples were collected at enrollment time. Non-contrast computed tomography of chest and abdomen was performed, and fatty liver was defined as liver attenuation <40 Hounsfield units. Alanine aminotransferase [ALT], aspartate aminotransferase [AST], glycemic and insulin blood levels were obtained. Interleukine (IL)-1β, IL-6, IL-8, IL-12, and Tumor necrosis factor (TNF-a) levels were measured in blood samples using flow cytometry. % of vital NETosis was measured in freshly isolated neutrophils using SYTOX and LIVE/DEAD dye correlated, ex vivo, with circulating cytokine levels. Continuous variables were analyzed by U de Mann-Whitney and nominal variables by Fisheŕs test. A logistic regression model analyzed the clinical association between liver attenuation. We evaluated the correlation between ALT, AST, cytokines, and NETosis using a linear model Results: 60 subjects were enrolled. The age average was 46.4 years old (standard deviation[SD]±13.1), and 32/60 (53.3%) were male. 25/60 (41.6%) reported severe COVID-19 during the acute phase. The prevalence of fatty liver was 17/60 (28.3%). 6 out of these 17 subjects had fatty liver before their COVID-19 diagnosis. Fatty liver was associated with high body mass index (p=0.02), waist circumference (p=0,01), insulin resistant (p=0,003), severe COVID-19 during acute phase (p=0,04), higher ALT (p<0.01), AST (p<0.01), IL-6 (p=0.02) and IL-12 (p=0.03). 12/60 (20%) patients had ALT elevation, although most of them, 8/12 (66.6%), did not have fatty liver. Both ALT and AST were correlated to IL-8 levels (R2=0.158, p<0.01), and IL-8 levels were significant correlated with % vital NETosis (R2=0.068, p=0.04) Conclusion: Fatty liver is prevalent and associated with severe COVID-19 during the acute phase and associated with high ALT, AST, IL-6, and IL-12 levels during the long COVID-19 phase. However, the ALT, AST and IL-8 elevations in the long COVID-19 might not be necessarily related to fatty liver. Therefore, the association between IL-8 and vital NETosis could be a possible pathway.

5.
Revista Medica de Chile ; 148(5):689-696, 2020.
Article in Spanish | GIM | ID: covidwho-1431447

ABSTRACT

Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.

7.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277044

ABSTRACT

Background More than 20% of hospitalized patients with coronavirus disease 2019 (COVID-19) develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. The long-term respiratory sequelae in ICU survivors remain unclear. Aim: To perform a detailed characterization of the long-term pulmonary sequelae in critical COVID-19 survivors. Study Design and Methods Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-minute walking test (6MWT)) and chest computed tomography (CT). Results 125 ICU patients with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%), and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The mean distance in the 6MWT was 401±93 mts. CT scans were abnormal in 70.2% of patients, showing reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT had worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT were age and prone position during the ICU stay. Interpretation Pulmonary structural abnormalities and functional impairment are highly prevalent in surviving ICU patients with ARDS secondary to COVID-19 3 months after hospital discharge. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months post discharge.

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