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1.
Exp Gerontol ; 170: 111998, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2086199

ABSTRACT

PURPOSE: While the definitive diagnosis of COVID-19 relies on PCR confirmation of the virus, the sensitivity of this technique is limited. The clinicians had to go on with the clinical diagnosis of COVID-19 in selected cases. We aimed to compare PCR-positive and PCR-negative patients diagnosed as COVID-19 with a specific focus on older adults. METHODS: We studied 601 hospitalized adults. The demographics, co-morbidities, triage clinical, laboratory characteristics, and outcomes were noted. Differences between the PCR (+) and (-) cases were analyzed. An additional specific analysis focusing on older adults (≥65 years) (n = 184) was performed. RESULTS: The PCR confirmation was present in 359 (59.7 %). There was not any difference in terms of age, sex, travel/contact history, hospitalization duration, ICU need, the time between first symptom/hospitalization to ICU need, ICU days, or survival between PCR-positive and negative cases in the total study group and older adults subgroup. The only symptoms that were different in prevalence between PCR-confirmed and unconfirmed cases were fever (73.3 % vs. 64 %, p = 0.02) and fatigue/myalgia (91.1 % vs. 79.3 %, p = 0.001). Bilateral diffuse pneumonia was also more prevalent in PCR-confirmed cases (20 % vs. 13.3 %, p = 0.03). In older adults, the PCR (-) cases had more prevalent dyspnea (72.2 % vs. 51.4 %, p = 0.004), less prevalent fatigue/myalgia (70.9 % vs. 88.6 %, p = 0.002). CONCLUSION: The PCR (+) and (-) cases displayed very similar disease phenotypes, courses, and outcomes with few differences between each other. The presence of some worse laboratory findings may indicate a worse immune protective response in PCR (-) cases.


Subject(s)
COVID-19 , Pneumonia , Humans , COVID-19/diagnosis , SARS-CoV-2 , Myalgia , Hospitalization , Polymerase Chain Reaction , Outcome Assessment, Health Care , Fatigue
2.
The American journal of the medical sciences ; 2022.
Article in English | EuropePMC | ID: covidwho-2033769

ABSTRACT

Background The coronavirus disease 2019 (COVID-19) has had a great impact on patients’ physical problems as well as psychological status. However, there is limited data about the impact of psychological problems on cardiac function during the COVID-19 pandemic. In this study, we aimed to investigate the relationship between mental health disorders and subclinical early myocardial systolic dysfunction by left ventricular global longitudinal strain (LVGLS) imaging in patients recovered from COVID-19. Methods Of the 108 participants, 71 patients had recovered from COVID-19;the members of the study group were prospectively recruited to the study after COVID-19 recovery. Comparisons were made with a risk-factor matched control group (n=37). The psychological status of the subjects, namely, Depression, Anxiety and Stress Scale-21 (DASS-21), and the Impact of Events Scale (IES-R) at follow-up visits, were assessed via questionnaire forms. The relationship between the psychological parameters and LVGLS values was subsequently evaluated. Results Overall, 45.0% of patients with COVID-19 had some degree of anxiety after recovery. A significant negative correlation was found between LVGLS and DASS-21 total score, DASS-21 anxiety subscale score, IES-R total score, and IES-R intrusion subscale score (r= -0.251, p=0.02;r= -0.285, p=0.008;r= -0.291, p=0.007;and r= -0.367, p=0.001, respectively). Furthermore, the DASS-21 total score was identified as an independent predictor of LVGLS (β= -0.186, p=0.03). Conclusions Patients who suffered from the COVID-19 disease may have experienced psychological distress symptoms due to COVID-19, which may be associated with silent impairment in myocardial systolic functions measured by global longitudinal strain analysis.

3.
Exp Gerontol ; 167: 111907, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-2031280

ABSTRACT

BACKGROUND: While there are substantial reports on the acute phase of Covid-19, the data on post-Covid phase are limited. AIM: To report the data on older post-Covid patients comparatively with the young adults. STUDY DESIGN: Retrospective, single-center study in post-Covid outpatient clinic. Clinical characteristics, laboratory examination, chest imagings were examined. RESULTS: 665 patients were included (median age, 46; 53 %, male; 10.5 %, aged ≥65). We assessed patients at 47th day (median) after recovery. 43.6 % were suffering from one or more ongoing symptomatology. The prevalence of symptoms or physical examination findings were not different between older and younger groups. Most prevalent ongoing symptom was dyspnea (14.3 % and 11.8 % older and younger group, respectively). Most common laboratory abnormality was high pro-BNP (12.2 %, in both age groups). Despite there was no differences regarding imaging findings at acute-phase, there were higher rates of control imaging abnormalities in older subgroup (35.7 % vs 19.4 %; p = 0.006). On admission 28.4 % younger patients had normal imaging, of whom 12.4 % developed some form of sequela; however, in older group, 40.0 % had normal imaging, of whom 25.0 % developed sequela. CONCLUSION: Complaints related to Covid-19 persisted in about half of the patients at about 1.5 months after Covid. More than 1/3 older post-Covid patients displayed pulmonary sequela in the post-acute period which was more prevalent than those in younger adults. Hence, compared to the younger counterparts, the clinicians should be alert in follow-up of older adults for subsequent pulmonary sequela, even among those that had normal imaging finding on initial presentation.


Subject(s)
COVID-19 , Aged , Female , Humans , Lung/diagnostic imaging , Male , Retrospective Studies , SARS-CoV-2
4.
Clin Lab ; 68(6)2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1893325

ABSTRACT

BACKGROUND: The purpose of this study is to evaluate the prognostic roles of hemostatic tests including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, and antithrombin III in the progression of disease, monitorization of severe, mild and moderate cases, and also to show their relationship with inflammatory markers including C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6). METHODS: The study comprised 604 patients (360 men and 244 women) with confirmed SARS-CoV-2 infection admitted to Emergency Department of Istanbul Faculty of Medicine between March 15 and April 15, 2020. The variations in the concentration of coagulation tests and inflammatory markers were observed from the admission to hospital to the 10th day with three-day periods. RESULTS: PT level and PT activity of severe cases were significantly different compared to mild cases (p = 0.012, p = 0.010, respectively). Similarly, aPTT and D-dimer levels in severe cases were significantly higher compared to the mild cases. However, fibrinogen levels of mild cases were significantly lower compared to either moderate or severe cases (p < 0.001, for both). The PT, PT activity, aPTT, and D-Dimer levels in severe cases were significantly different compared with the mild cases. However, fibrinogen level was the highest in severe cases, and higher than either mild or moderate cases. CONCLUSIONS: Our findings reveal the vital importance of measuring coagulation parameters at the time of admission and monitoring them at regular intervals in clinical monitoring of COVID-19 patients, in determining the severity of the disease in terms of the patient's prognosis, and in choosing and applying the appropriate treatment at the right time.


Subject(s)
COVID-19 , Biomarkers , COVID-19/diagnosis , Female , Fibrin Fibrinogen Degradation Products , Fibrinogen/analysis , Humans , Male , Partial Thromboplastin Time , Prognosis , Prothrombin Time , SARS-CoV-2
5.
Glob Med Genet ; 9(2): 185-188, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1886253

ABSTRACT

Mannose-binding lectin 2 (MBL2) is a serine protease which is believed to be an important factor in the inherited immune system. In this article, we present a coronavirus disease 2019 (COVID-19) family of five patients: a 56-year-old father, a 51-year-old mother, two sons aged 23 and 21 years, and a 15-year-old daughter. According to the results of MBL2 rs1800450 variant analysis performed, the father had homozygous mutant, the mother had homozygous normal, and the three children had heterozygous mutant genotype. When we compared the clinical parameters and genotypes, MBL2 gene polymorphism plays a very important role in COVID-19 susceptibility and severe disease. The family, which makes up our study, is the proof of this situation, and it contains important implications for host factors and COVID-19.

6.
Int Urol Nephrol ; 54(5): 1097-1104, 2022 May.
Article in English | MEDLINE | ID: covidwho-1782900

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) in COVID-19 patients is associated with poor prognosis. However, the incidence, risk factors and potential outcomes of AKI in hospitalized patients are not well studied. MATERIALS AND METHODS:  This is a retrospective cohort study conducted in two major university hospitals. Electronic health records of the patients, 18 years or older, hospitalized between 13 April and 1 June 2020 with confirmed COVID-19 were reviewed. We described the incidence and the risk factors for AKI development in COVID-19 patients. Furthermore, we investigated the effects of AKI on the length of hospital and intensive care unit (ICU) stay, the admission rates to ICU, the percentage of patients with cytokine storm and in-hospital mortality rate. RESULTS: Among 770 hospitalized patients included in this study, 92 (11.9%) patients developed AKI. The length of hospitalized days (16 vs 9.9, p < 0.001) and days spent in the hospital until ICU admission (3.5 vs. 2.5, p = 0.003) were higher in the AKI group compared to patients without AKI. In addition, ICU admission rates were also significantly higher in patients with AKI (63% vs. 20.7%, p < 0.001). The percentage of patients with AKI who developed cytokine storm was significantly higher than patients without AKI (25.9% vs. 14%, p = 0.009). Furthermore, the in-hospital mortality rate was significantly higher in patients with AKI (47.2% vs. 4.7%, p < 0.001). CONCLUSIONS: AKI is common in hospitalized COVID-19 patients. Furthermore, we show that AKI increases the admission rates to ICU and in-hospital mortality. Our findings suggest that AKI should be effectively managed to prevent the adverse outcomes in COVID-19 patients.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , COVID-19/complications , Cytokine Release Syndrome , Hospital Mortality , Humans , Intensive Care Units , Retrospective Studies , Risk Factors
7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316822

ABSTRACT

Objective: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults. Design: Retrospective;observational study Setting: Istanbul Faculty of Medicine hospital, Turkey Participants: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020. Measurements: The demographic information;associated comorbidities;presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses. Results: : The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%;mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001). Conclusion: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk.

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-310079

ABSTRACT

Background: There is some evidence from case reports and a few studies in China that critically ill COVID-19 patients may benefit from treatment with intravenous immunoglobulins (IVIG). We compared clinical outcomes and biomarkers in a Turkish cohort of patients with severe COVID-19 who were treated with the institution's standard of care (SOC), either alone or in combination with IVIG. Methods: : Data from COVID-19 patients treated in two intensive care units at the University hospital of Istanbul was analyzed retrospectively. Patients received preliminary SOC according to the institution's treatment algorithm, to which Octagam 5% at 30 g/day for 5 days was added in one of the two wards. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers (C-reactive protein=CRP, ferritin, procalcitonin, interleukin-6, D‑dimer, leukocytes). Imbalance in baseline APACHE II scores was addressed by propensity-score-matching;otherwise Kaplan-Meier and multiple logistic regression models were used. Results: : Data from 93 patients was analyzed, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index (BMI) and blood group distribution. IVIG-treated patients were younger (means 65 vs. 71 years) and had slightly lower baseline disease scores (APACHE II: 20.6 vs. 22.4;SOFA: 5.0 vs. 7.0). Overall survival (OS) was 61% in the IVIG and 38% in the control group. After controlling for imbalances at baseline, there was still a trend for better OS (OR: 2.2, 95%CI: 0.9-5.4, p=0.091) and a significantly longer median survival time with IVIG (68 vs. 18 days, p=0.014). IVIG significantly reduced CRP levels, but had no relevant effect on other inflammation markers. Conclusion: Adjunct treatment with IVIG might add to the COVID-19 armamentarium, but results need to be confirmed in a randomized, controlled trial.

9.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-306532

ABSTRACT

Background: The novel coronavirus infection (COVID-19) disease has spread rapidly and posed a great threat to global public health. The laboratory parameters and clinical outcomes of the disease in discharged patients remain unknown. In this study, we aimed to investigate the laboratory and echocardiographic findings of patients with COVID-19 after discharge and the relation between left ventricular global longitudinal strain (LVGLS) and inflammatory parameters in discharged patients. Methods A total of 75 patients recovering from COVID-19 as the study group were prospectively recruited from the COVID-19 outpatient clinic for their follow-up visits at a median 6 months after discharge. Patients were classified into groups according to pneumonia severity and impairment in LVGLS. Laboratory findings of patients both at admission and after discharge were evaluated and the relation with pneumonia severity at admission and LVGLS after discharge were analyzed. Results Serum ferritin, lactate dehydrogenase (LDH) and prohormone B-type natriuretic peptide (pro-BNP) levels after discharge were significantly higher in the study group than the control group (n = 44). Ferritin was found to be related to pneumonia severity. Serum ferritin and LDH values after discharge were significantly higher in patients with impaired LVGLS than those with preserved. There was a significant correlation between LVGLS, serum ferritin and LDH values after discharge (r = -0.252, p = 0.012;r = -0.268, p = 0.005, respectively). Conclusions Clinicians should pay close attention to the serum ferritin and LDH levels in discharged patients for predicting the severity of COVID-19 disease and early identification of subclinical left ventricular myocardial dysfunction.

11.
Curr Med Sci ; 41(6): 1075-1080, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1482282

ABSTRACT

OBJECTIVE: Corona Virus Disease-2019 (COVID-19) has been among the major infectious events of the century. In today's literature where COVID-19 and host factor effects are frequently examined, we aimed to examine another factor: Circadian Clock Protein PERIOD 3 (PER3). There is a significant correlation between PER3 gene polymorphism and circadian rhythm disturbances and immune system dysregulation. METHODS: In our study, we recruited 200 patients diagnosed with COVID-19 in our hospital between April-June 2020, and 100 volunteers without known comorbidities to create a healthy control group. After comparing the initial gene polymorphisms of the patients with healthy controls, three separate clinical subgroups were formed. Gene polymorphism distribution and statistical significance were examined in the formed patient groups. RESULTS: No significant difference was found between the patient group and the healthy controls (P>0.05, for all). When patients were divided into two separate clinical subgroups as exitus/alive according to their last condition during their 28-day follow-up, the 4R/5R genotype was significantly more common in patients with a mortal course (P=0.007). The PER3 4R/5R genotype was found at a significantly higher rate in the group of patients with the need for intensive care (P=0.034). CONCLUSION: The 4R/5R genotype may be associated with the need for intensive care and mortality in COVID-19 patients. These important results will be a guide for future studies.


Subject(s)
COVID-19/genetics , Pandemics , Period Circadian Proteins/genetics , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Case-Control Studies , Female , Genotype , Humans , Male , Middle Aged , Minisatellite Repeats , Patient Acuity , Polymorphism, Genetic , Turkey/epidemiology , Young Adult
12.
Pharmaceutics ; 13(11)2021 Oct 22.
Article in English | MEDLINE | ID: covidwho-1480917

ABSTRACT

In COVID-19-induced acute respiratory distress syndrome, the lungs are incapable of filling with sufficient air, leading to hypoxemia that results in high mortality among hospitalized patients. In clinical trials, low-molecular-weight heparin was administered via a specially designed soft-mist inhaler device in an investigator initiated, single-center, open-label, phase-IIb clinical trial. Patients with evidently worse clinical presentations were classed as the "Device Group"; 40 patients were given low-molecular-weight heparin via a soft mist inhaler at a dose of 4000 IU per administration, twice a day. The Control Group, also made up of 40 patients, received the standard therapy. The predetermined severity of hypoxemia and the peripheral oxygen saturation of patients were measured on the 1st and 10th days of treatment. The improvement was particularly striking in cases of severe hypoxemia. In the 10-day treatment, low-molecular-weight heparin was shown to significantly improve breathing capability when delivered via a soft-mist inhaler.

13.
Pathog Glob Health ; 116(3): 178-184, 2022 05.
Article in English | MEDLINE | ID: covidwho-1437790

ABSTRACT

For COVID-19 (Coronavirus Disease-2019) cases, detecting host-based factors that predispose to infection is a very important research area. In this study, the aim is to investigate the MBL2 and NOS3 gene polymorphisms in COVID-19 patients with lung involvement, whose first nasopharyngeal PCR results were negative. Seventy-nine patients diagnosed with COVID-19 between April-June 2020 who were admitted to a university hospital, and 100 healthy controls were included. In the first statistical analysis performed between PCR-positive, CT-negative and PCR-negative, CT-positive patients; the AB of MBL2 genotype was significantly higher in the first group (p = 0.049). The B allele was also significantly higher in the same subgroup (p = 0.001). The absence of the AB genotype was found to increase the risk of CT positivity by 6.9 times. The AB genotype of MBL2 was higher in healthy controls (p = 0.006). The absence of the AB genotype was found to increase the risk of CT positivity; also, it can be used for early detection and isolation of patients with typical lung involvement who had enough viral loads, but whose initial PCR results were negative.


Subject(s)
COVID-19 , Mannose-Binding Lectin , COVID-19/diagnosis , Genetic Predisposition to Disease , Genotype , Humans , Mannose-Binding Lectin/genetics , Nitric Oxide Synthase Type III/genetics , Polymerase Chain Reaction/methods
14.
Int J Cardiovasc Imaging ; 37(8): 2387-2397, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1173934

ABSTRACT

Myocardial injury caused by COVID-19 was reported in hospitalized patients previously. But the information about cardiac consequences of COVID-19 after recovery is limited. The aim of the study was comprehensive echocardiography assessment of right ventricular (RV) in patients recovered from COVID-19. This is a prospective, single-center study. After recovery from COVID-19, echocardiography was performed in consecutive 79 patients that attended follow-up visits from July 15 to November 30, 2020. According to the recovery at home vs hospital, patients were divided into two groups: home recovery (n = 43) and hospital recovery (n = 36). Comparisons were made with age, sex and risk factor-matched control group (n = 41). In addition to conventional echocardiography parameters, RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS) were determined using 2D speckle-tracking echocardiography (2D STE). Of the 79 patients recovered from COVID-19, 43 (55%) recovered at home, while 36 (45%) required hospitalization. The median follow-up duration was 133  ±  35 (87-184) days. In patients recovered from hospital, RV-GLS and RV-FWS were impaired compared to control group (RV-GLS: -17.3  ±  6.8 vs. -20.4  ±  4.9, respectively [p = 0.042]; RV-FWS: -19.0  ±  8.2 vs. -23.4  ±  6.2, respectively [p = 0.022]). In subgroup analysis, RV-FWS was impaired in patients severe pneumonia (n = 11) compared to mild-moderate pneumonia (n = 28), without pneumonia (n = 40) and control groups (-15.8  ±  7.6 vs. -21.6  ±  7.6 vs. -20.8  ±  7.7 vs. -23.4  ±  6.2, respectively, [p = 0.001 for each]) and RV-GLS was impaired compared to control group (-15.2  ±  6.9 vs. -20.4  ±  4; respectively, [p = 0.013]). A significant correlation was detected between serum CRP level at hospital admission and both RV-GLS and RV-FWS (r = 0.285, p = 0.006; r = 0.294, p = 0.004, respectively). Age (OR 0.948, p = 0.010), male gender (OR 0.289, p = 0.009), pneumonia on CT (OR 0.019, p = 0.004), and need of steroid in treatment (OR 17.424, p = 0.038) were identifed as independent predictors of impaired RV-FWS (> -18) via multivariate analysis. We demonstrated subclinic dysfunction of RV by 2D-STE in hospitalized patients in relation to the severity of pneumonia after recovery from COVID-19. 2D-STE supplies additional information above standard measures of RV in this cohort and can be used in the follow-up of these patients.


Subject(s)
COVID-19/physiopathology , Heart Ventricles/diagnostic imaging , Severity of Illness Index , Ventricular Dysfunction, Right/physiopathology , Age Factors , Case-Control Studies , Echocardiography , Female , Glucocorticoids/therapeutic use , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Sex Factors
15.
Int J Cardiovasc Imaging ; 37(8): 2451-2464, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1171328

ABSTRACT

BACKGROUND: The novel coronavirus infection (COVID-19) disease has spread rapidly and posed a great threat to global public health. The laboratory parameters and clinical outcomes of the disease in discharged patients remain unknown. In this study, we aimed to investigate the laboratory and echocardiographic findings of patients with COVID-19 after discharge and the relation between left ventricular global longitudinal strain (LVGLS) and inflammatory parameters in discharged patients. METHODS: A total of 75 patients recovering from COVID-19 as the study group were prospectively recruited from the COVID-19 outpatient clinic for their follow-up visits at a median 6 months after discharge. Patients were classified into groups according to pneumonia severity and impairment in LVGLS. Laboratory findings of patients both at admission and after discharge were evaluated and the relation with pneumonia severity at admission and LVGLS after discharge were analyzed. RESULTS: Serum ferritin, lactate dehydrogenase (LDH) and prohormone B-type natriuretic peptide (pro-BNP) levels after discharge were significantly higher in the study group than the control group (n = 44). Ferritin was found to be related to pneumonia severity. Serum ferritin and LDH values after discharge were significantly higher in patients with impaired LVGLS than those with preserved. There was a significant correlation between LVGLS, serum ferritin and LDH values after discharge (r = -0.252, p = 0.012; r = -0.268, p = 0.005, respectively). CONCLUSIONS: Clinicians should pay close attention to the serum ferritin and LDH levels in discharged patients for predicting the severity of COVID-19 disease and early identification of subclinical left ventricular myocardial dysfunction.


Subject(s)
COVID-19/physiopathology , Heart Ventricles/diagnostic imaging , Ventricular Dysfunction, Left/physiopathology , Adult , Echocardiography , Female , Ferritins/blood , Follow-Up Studies , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Prospective Studies , Severity of Illness Index
16.
Curr Med Res Opin ; 37(4): 543-548, 2021 04.
Article in English | MEDLINE | ID: covidwho-1081490

ABSTRACT

OBJECTIVES: To evaluate the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIG) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients. METHODS: Data from a single center was analyzed retrospectively. Patients had received preliminary standard intensive care (SIC) according to a local treatment algorithm, either alone or along with IVIG 5% at 30 g/day for 5 days. The two groups were compared regarding baseline characteristics, survival and changes in inflammation markers. Imbalance in baseline APACHE II scores was addressed by propensity score matching. Otherwise, Kaplan-Meier and multiple logistic regression models were used. RESULTS: Out of 93 patients, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index and AB0 blood type distribution. IVIG-treated patients were younger (mean 65 ± 15 versus 71 ± 15 years, p = .066) and had slightly lower baseline disease scores (APACHE II: 20.6 versus 22.4, p = .281; SOFA: 5.0 versus 7.0, p = .006). Overall survival was 61% in the SIC + IVIG and 38% in the SIC only group (odds ratio: 2.2, 95% confidence interval: 0.9-5.4, p = .091 after controlling for baseline imbalances). IVIG significantly prolonged median survival time (68 versus 18 days, p = .014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, p = .049). CONCLUSION: Clinically relevant benefits through adjunct IVIG treatment in COVID-19 need to be confirmed in a randomized, controlled trial.


Subject(s)
COVID-19/drug therapy , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2 , APACHE , Aged , Aged, 80 and over , COVID-19/mortality , Female , Humans , Male , Middle Aged , Retrospective Studies
17.
Infect Genet Evol ; 89: 104717, 2021 04.
Article in English | MEDLINE | ID: covidwho-1051857

ABSTRACT

BACKGROUND/OBJECTIVES: COVID-19 followed a mortal course in some young patients without any underlying factors, however, it followed a very benign course in some very older individuals with multiple comorbidities. These observations question if some genetic factors may be related to the vulnerability and poor prognosis of the disease. In this study, we aimed to investigate whether MBL2 gene B variant at codon 54 (rs1800450) were related to the variabilities in clinical course of this infection. METHODS: 284 PCR-confirmed COVID-19 patients and 100 healthy controls were included in the study. COVID-19 patients were subdivided according to the clinical features and clinical characteristics were analyzed. DNAs of all patients and controls were examined for the codon 54 A/B (gly54asp: rs1800450) variation in exon 1 of the MBL2 gene. RESULTS: In univariate analysis, BB genotype of MBL2 gene was more common among COVID-19 cases compared with controls (10.9% vs 1.0%, respectively; OR = 12.1, 95%CI = 1.6-90.1, p = 0.001). Multivariate analyses, adjusted for age, sex and MBL genetic variants, revealed that when compared with the COVID-19 patients that had AA genotype (reference), the patients that had BB or AB genotypes suffered from a higher risk for severe disease (for BB genotype, odds ratio (OR) = 5.3, p < 0.001; for AB genotype, OR = 2.9, p = 0.001) and for ICU need (for BB genotype, OR = 19.6, p < 0.001; for AB genotype, OR = 6.9, p = 0.001). On the other hand, there was not any significant difference between the genotype variants in terms of mortality at 28 days or development of secondary bacterial infection. CONCLUSION: The B variants of MBL2 gene at codon 54, which were associated with lower MBL2 levels, were related to a higher risk for a more severe clinical course of COVID-19 infection in some respects. Our findings may have potential future implications, e.g. for use of MBL protein as potential therapeutics or prioritize the individuals with B variants during vaccination strategies.


Subject(s)
COVID-19/genetics , COVID-19/pathology , Mannose-Binding Lectin/genetics , Mutation, Missense , Adult , Aged , Aged, 80 and over , COVID-19/virology , Case-Control Studies , Comorbidity , Female , Genetic Predisposition to Disease , Humans , Male , Mannose-Binding Lectin/metabolism , Middle Aged , Protein Interaction Maps , SARS-CoV-2/isolation & purification , Severity of Illness Index , Young Adult
18.
Am J Med Sci ; 361(5): 591-597, 2021 05.
Article in English | MEDLINE | ID: covidwho-973807

ABSTRACT

BACKGROUND: The information on electrocardiographic features of patients with coronavirus disease 2019 (COVID-19) is limited. Our aim was to determine if baseline electrocardiographic features of hospitalized COVID-19 patients are associated with markers of myocardial injury and clinical outcomes. METHODS: In this retrospective, single center cohort study, we included 223 hospitalized patients with laboratory-confirmed COVID-19. Clinical, electrocardiographic and laboratory data were collected and analyzed. Primary composite endpoint of mortality, need for invasive mechanical ventilation, or admission to the intensive care unit was assessed. RESULTS: Forty patients (17.9%) reached the primary composite endpoint. Patients with the primary composite endpoint were more likely to have wide QRS complex (>120 ms) and lateral ST-T segment abnormality. The multivariable Cox regression showed increasing odds of the primary composite endpoint associated with acute respiratory distress syndrome (odds ratio 7.76, 95% CI 2.67-22.59; p < 0.001), acute cardiac injury (odds ratio 3.14, 95% CI 1.26-7.99; p = 0.016), high flow oxygen therapy (odds ratio 2.43, 95% CI 1.05-5.62; p = 0.037) and QRS duration longer than >120 ms (odds ratio 3.62, 95% CI 1.39-9.380; p = 0.008) Patients with a wide QRS complex (>120 ms) had significantly higher median level of troponin T and pro-BNP than those without it. Patients with abnormality of lateral ST-T segment had significantly higher median level of troponin T and pro-BNP than patients without. CONCLUSIONS: The presence of QRS duration longer than 120 ms and lateral ST-T segment abnormality were associated with worse clinical outcomes and higher levels of myocardial injury biomarkers.


Subject(s)
COVID-19 , Electrocardiography , Heart Injuries , Natriuretic Peptide, Brain/blood , Respiration, Artificial , SARS-CoV-2/metabolism , Troponin T/blood , Acute Disease , Adult , Aged , Biomarkers , COVID-19/blood , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Disease-Free Survival , Female , Heart/physiopathology , Heart Injuries/blood , Heart Injuries/mortality , Heart Injuries/physiopathology , Heart Injuries/therapy , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate
19.
Cardiovasc J Afr ; 32(2): 79-86, 2021.
Article in English | MEDLINE | ID: covidwho-916532

ABSTRACT

AIM: The purpose of this article was to report the low rates of intensive care unit admission and mortality in intermediate- and high-risk COVID-19 patients, and to share our clinical approach with other colleagues. In addition, we sought to reveal the relationship between myocardial injury and clinical outcomes such as death, intensive care unit uptake and hospital stay, and the relationship between inflammatory parameters and cardiac biomarkers in a cardiovascular perspective. METHODS: Patients admitted to the emergency department in the Department of Internal Medicine, Faculty of Medicine, Istanbul University, with laboratory or clinically and radiologically confirmed COVID-19 were included in this retrospective cross-sectional study, which was conducted from 11 March to 10 April 2020. The demographic (age and gender) and clinical (symptoms, co-morbidities, treatments, complications and outcomes) characteristics, laboratory findings, and results of cardiac examinations (cardiac biomarkers and electrocardiography) of patients during hospitalisation were collected from their medical records by two investigators. Data were analysed using SPSS version 25.0 (IBM). A two-sided p < 0.05 was considered statistically significant. Analysis began on 11 April 2020. RESULTS: Mortality and intensive care unit admission rates were statistically significantly higher in patients with cardiac injury than in those without. There was a positive correlation between levels of high-sensitivity TNT and fibrinogen, D-dimer, ferritin, procalcitonin and C-reactive protein (r = 0.24, p < 0.01; r = 0.37, p < 0.01; r = 0.25, p < 0.01, r = 0.34, p < 0.01; r = 0.31, p < 0.01). CONCLUSIONS: The first general data of our 309 patients regarding low mortality and intensive care admission rates, and particular treatment algorithms specific to our centre should be helpful in determining better treatment strategies in the future. Our study emphasises the importance and frequency of cardiovascular outcomes, and the significance of some cardiac biomarkers in predicting COVID-19 prognosis.


Subject(s)
COVID-19/mortality , Cardiovascular System/virology , Critical Care , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Cross-Sectional Studies , Hospitalization/statistics & numerical data , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Middle Aged , Retrospective Studies
20.
Angiology ; 72(2): 187-193, 2021 02.
Article in English | MEDLINE | ID: covidwho-792871

ABSTRACT

Thrombotic and embolic complications in the cardiovascular system are evident and associated with worse prognosis in coronavirus disease 2019 (COVID-19) patients. Endothelial-specific molecule 1 (endocan) plays a role in vascular pathology. We hypothesized serum endocan levels on admission are associated with primary composite end point (mortality and intensive care unit hospitalization) in COVID-19 patients. Patients (n = 80) with laboratory, clinical, and radiological confirmed COVID-19 were included in this cross-sectional study. Ten milliliter of peripheral venous blood were drawn within 24 hours of admission to estimate serum endocan levels. Data were analyzed using SPSS version 26.0 (IBM). Patients with the primary composite end point had significantly higher serum endocan levels than patients without (852.2 ± 522.7 vs 550.2 ± 440.8 ng/L, respectively; P < .01). In the logistic regression analysis, only increased serum endocan levels and increase in age were independent predictors of the primary composite end point (P < .05). In the receiver operating characteristics curve analysis, we found that a serum endocan level of 276.4 ng/L had a 97% sensitivity and 85% specificity for prediction of the primary composite end point. Baseline serum endocan levels may prove useful as a prognostic factor in patients hospitalized for COVID-19.


Subject(s)
COVID-19/blood , COVID-19/mortality , Neoplasm Proteins/blood , Proteoglycans/blood , Adult , Aged , Cross-Sectional Studies , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Pilot Projects , Prognosis , Retrospective Studies
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