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1.
Vaccines (Basel) ; 10(7)2022 Jul 18.
Article in English | MEDLINE | ID: covidwho-1939062

ABSTRACT

Information on the efficacy and safety of molnupiravir in daily clinical practice is very scarce. We aimed to describe the clinical characteristics and outcomes of fully vaccinated patients with mild to moderate breakthrough COVID-19 treated with molnupiravir between January 2022 and February 2022. Overall, 145 patients were enrolled. Their median age was 71.0 years, and 60.7% were males. The most common underlying condition was a severe cardiovascular disease (37.2%), followed by primary or acquired immunodeficiency (22.8%), and oncological/onco-hematological disease in the active phase (22.1%). At 30 days after breakthrough COVID-19 diagnosis, only 4 out of 145 patients (2.7%) required hospital admission. No patients developed severe COVID-19, were admitted to the ICU, or died during the follow-up period. Adverse events, mild in intensity, occurred in 2 patients (1.4%). Our results support the current evidence establishing positive clinical and safety outcomes of molnupiravir in fully vaccinated patients with mild or moderate breakthrough COVID-19.

2.
J Community Health ; 2022 Jun 21.
Article in English | MEDLINE | ID: covidwho-1899237

ABSTRACT

Diagnosing people living with chronic viral hepatitis is challenging due to the absence of symptoms as long as liver decompensated cirrhosis come out. The aim of this retrospective study was to evaluate the prevalence of HBV and/or HCV infections in a non-selected population, hospitalised for SARS-CoV-2 infection in a tertiary care hospital in Northern Italy. During the study period 1,429 patients were admitted to hospital for SARS-CoV-2 infection, serologic tests for HBV and/or HCV were available for 382 (27%) patients and 3 were excluded due to their previous known serologic status. Among 379 patients, 235 (62%) were male, median age was 70 years (range 21-103), 360 (95%) were Caucasian. Among them, 372/379 (98%) were screened for HBsAg, 320/379 (84%) for HBcAb. HBsAg was positive in 2/372 (0.5%, 95% CI 0.0006-0.02) patients (only in one HBV-DNA was performed that was negative), while HBcAb was found positive in 55/320 (17%, 95% CI 0.13-0.22). Among 370/379 (98%) patients screened for HCV, 11/370 (3%, 95% CI 0.02-0.05) had positive HCV-Ab. Five out of 11 (45%) were tested for HCV-RNA that resulted positive in two patients (0.5%, 95% CI 0.0006-0.02). Considering this data, even though the screening was performed in only 27% of study population, a tailored screening in people with known risk factors for hepatitis might be preferable to universal screening in low prevalence areas. Also a prompt diagnostic workout should begin in case of clinical or laboratory suspicion of hepatitis and in those starting immunosuppressive treatments.

3.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-337875

ABSTRACT

Patients with severe SARS-CoV-2 infection have an overwhelming inflammatory response characterized by remarkable organs monocyte infiltration. We performed an immunophenotypic analysis on circulating monocytes in 19 COVID-19 patients in comparison with 11 naïve HIV-1 patients and 10 healthy subjects. Reduced frequency of classical monocytes and increased frequency of intermediate monocytes characterized COVID-19 patients with respect to both HIV naïve patients and healthy subjects. Intensity of C-C motif chemokine receptor 2 (CCR2) monocyte expression highly correlated with parameters of kidney dysfunction. Our data indicate that highly activated monocytes of COVID-19 patients may be pathogenically associated to the development of renal disease.

4.
Ther Adv Infect Dis ; 9: 20499361221095732, 2022.
Article in English | MEDLINE | ID: covidwho-1854735

ABSTRACT

SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being one of the most significant challenges of health care systems worldwide. Bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 (COVID-19) are uncommon but consumption of antibiotics and antifungals has increased dramatically during the ongoing pandemic resulting in increased selective pressure for global antimicrobial resistance. Nosocomial bacterial superinfections appear to be more frequent than community-acquired coinfections, particularly among patients admitted to the intensive care unit (ICU) and those receiving immunosuppressive treatment. Fungal infections associated with COVID-19 might be missed or misdiagnosed. Existing and new antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19 pandemic and are urgently needed to contain the high rates of misdiagnosis and antimicrobial prescription. The aim of this review is to describe the role of bacterial and fungal infections and possible strategies of AMS to use in daily practice for optimal management of COVID-19.

5.
Infect Dis Ther ; 11(3): 1149-1160, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1783017

ABSTRACT

INTRODUCTION: Candida auris (C. auris) is an emerging nosocomial pathogen, and a sharp rise in cases of colonization and infection has been registered in intensive care units (ICUs) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The unfavorable resistance profile of C. auris and the potential high mortality of C. auris infections represent an important challenge for physicians. METHODS: We conducted a single-center retrospective study including all patients admitted to ICUs with isolation of C. auris in any non-sterile body site between February 20, 2020, and May 31, 2021. The primary aim of the study was to assess the cumulative incidence of C. auris candidemia in colonized patients. The secondary aim was to identify predictors of C. auris candidemia in the study population. RESULTS: During the study period, 157 patients admitted to ICUs in our hospital became colonized with C. auris; 59% of them were affected by COVID-19. Overall, 27 patients (17%) developed C. auris candidemia. The cumulative risk of developing C. auris candidemia was > 25% at 60 days after first detection of C. auris colonization. Seven patients with C. auris candidemia (26%) also developed a late recurrent episode. All C. auris blood isolates during the first occurring episode were resistant to fluconazole and susceptible to echinocandins, while 15 (56%) were resistant to amphotericin B. During late recurrent episodes, emergent resistance to caspofungin and amphotericin B occurred in one case each. In the final multivariable model, only multisite colonization retained an independent association with the development of C. auris candidemia. CONCLUSION: Candida auris candidemia may occur in up to one fourth of colonized critically ill patients, and multisite colonization is an independent risk factor for the development of candidemia. Implementing adequate infection control measures remains crucial to prevent colonization with C. auris and indirectly the subsequent development of infection.

6.
Respir Physiol Neurobiol ; 301: 103889, 2022 07.
Article in English | MEDLINE | ID: covidwho-1747608

ABSTRACT

PURPOSE: To describe the effects of timing of intubation in COVID-19 patients that fail helmet continuous positive airway pressure (h-CPAP) on progression and severity of disease. METHODS: COVID-19 patients that failed h-CPAP, required intubation, and underwent chest computed tomography (CT) at two levels of positive end-expiratory pressure (PEEP, 8 and 16 cmH2O) were included in this retrospective study. Patients were divided in two groups (early versus late) based on the duration of h-CPAP before intubation. Endpoints included percentage of non-aerated lung tissue at PEEP of 8 cmH2O, respiratory system compliance and oxygenation. RESULTS: Fifty-two patients were included and classified in early (h-CPAP for ≤2 days, N = 26) and late groups (h-CPAP for >2 days, N = 26). Patients in the late compared to early intubation group presented: 1) lower respiratory system compliance (median difference, MD -7 mL/cmH2O, p = 0.044) and PaO2/FiO2 (MD -29 mmHg, p = 0.047), 2) higher percentage of non-aerated lung tissue (MD 7.2%, p = 0.023) and 3) similar lung recruitment increasing PEEP from 8 to 16 cmH2O (MD 0.1%, p = 0.964). CONCLUSIONS: In COVID-19 patients receiving h-CPAP, late intubation was associated with worse clinical presentation at ICU admission and more advanced disease. The possible detrimental effects of delaying intubation should be carefully considered in these patients.


Subject(s)
COVID-19 , Continuous Positive Airway Pressure , COVID-19/therapy , Humans , Intubation, Intratracheal , Retrospective Studies , Tomography, X-Ray Computed
7.
Mycoses ; 65(3): 362-373, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1700157

ABSTRACT

OBJECTIVES: (1) To describe the incidence, clinical characteristics, treatment and outcome of Aspergillus Endocarditis (AE) in a nationwide multicentric cohort (GAMES). (2) To compare the AE cases of the GAMES cohort, with the AE cases reported in the literature since 2010. (3) To identify variables related to mortality. METHODS: We recruited 10 AE cases included in the GAMES cohort (January 2008-December 2018) and 51 cases from the literature published from January 2010 to July 2019. RESULTS: 4528 patients with infectious endocarditis (IE) were included in the GAMES cohort, of them 10 (0.2%) were AE. After comparing our 10 cases with the 51 of the literature, no differences were found. Analysing the 61 AE cases together, 55.7% were male, median age 45 years. Their main underlying conditions were as follows: prosthetic valve surgery (34.4%) and solid organ transplant (SOT) (19.7%). Mainly affecting mitral (36.1%) and aortic valve (29.5%). Main isolated species were as follows: Aspergillus fumigatus (47.5%) and Aspergillus flavus (24.6%). Embolisms occurred in 54%. Patients were treated with antifungals (90.2%), heart surgery (85.2%) or both (78.7%). Overall, 52.5% died. A greater mortality was observed in immunosuppressed patients (59.4% vs. 24.1%, OR = 4.09, 95%CI = 1.26-13.19, p = .02), and lower mortality was associated with undergoing cardiac surgery plus azole therapy (28.1% vs. 65.5%, OR = 0.22, 95%CI = 0.07-0.72, p = .01). CONCLUSIONS: AE accounts for 0.2% of all IE episodes of a national multicentric cohort, mainly affecting patients with previous valvular surgery or SOT recipients. Mortality remains high especially in immunosuppressed hosts and azole-based treatment combined with surgical resection are related to a better outcome.


Subject(s)
Aspergillosis , Endocarditis , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillus , Aspergillus fumigatus , Endocarditis/drug therapy , Endocarditis/therapy , Humans , Male , Middle Aged
8.
The New Microbiologica ; 44(4):245, 2021.
Article in English | ProQuest Central | ID: covidwho-1696108

ABSTRACT

This retrospective study describes demographics and outcomes of adult patients with SARS-CoV-2 infection admitted to our ward during the first wave (from February 25 to May 30, 2020) and during the second wave (from August 5 to November 30, 2020). The primary study objective was to evaluate overall in-hospital mortality, which was 21.1% (60/285) vs 10.3% (27/261) (p=.0006). This study seems to corroborate and expand the concept that the second wave of COVID-19 was less deadly than the first. Despite some limitations, the clinical and managerial experience gained during the first wave trained us to handle and control the second one.

9.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322195

ABSTRACT

Background: Some patients affected by COVID-19 present a life-threatening hyperinflammatory state known as cytokine storm syndrome (CSS) associated with a high mortality rate. Our hypothesis is that a eucaloric ketogenic diet (EKD) may be a safe and efficacious treatment option to reduce CSS and consequently to reduce the need for CPAP, ICU admission and COVID-19 mortality.Aim of the study: The primary objective is to explore the effect of an EKD on mortality, admission to the ICU and the need for NIV in hospitalized patients with COVID-19 in comparison to a eucaloric standard diet (ESD). The secondary objectives are to collect data about the safety and feasibility of an EKD during hospitalization and to evaluate the effect of the diet on biological and inflammatory parameters, particularly interleukin-6 (IL-6).Patients and methods: The study is a retrospective explorative analysis of 34 patients fed with an EKD during hospitalization for COVID-19 in comparison to 68 patients fed an ESD selected and matched using propensity score one-to-two to avoid the confounding effect of interfering variables. Results: A trend of reduced 30-day mortality (HR 0.416, 95% CI 0.122 – 1.413, P = 0.160) and a trend regarding the need for ICU admission (HR 0.357, 95% CI 0.045 – 2.847, P = 0.331) were observed in subjects treated with the EKD compared to patients fed with the standard diet. No significantly different risks in the need for CPAP (HR 0.968, CI 0.289 – 3.242, P = 0.958 for EKD) or the composite endpoint (HR 0.674, CI 0.233 – 1.949, P = 0.446 for EKD) were detectable between the two groups of dietary patterns.Furthermore, IL-6 concentrations between t 0 and t 7 (seven days after the beginning of the diet) in the ketogenic nutrition group showed a median difference of -26.0 ȵg/mL and a mean difference of -164 ȵg/mL (data from 23 of the 34 pairs) compared to controls, with a trend toward significance (P = 0.062). EKD was safe and no adverse events were observed in patients fed an EKD.Discussion and conclusions: These preliminary data on the clinical results for mortality, need for ICU admission and the effect on the IL-6 concentration during EKD feeding, collected in a retrospective way during the most aggressive period of the COVID-19 pandemic, suggest a favorable role of this dietary treatment in COVID-19 clinical management. The EKD was safe and well accepted by patients during hospitalization and seems to be an interesting tool in controlling COVID-19 CSS. The results of the prospective controlled randomized trial, currently underway with a large number of subjects, are necessary to confirm these preliminary data.

10.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316572

ABSTRACT

Background: Increases in cardiac troponin (cTn) in coronavirus disease 2019 (COVID-19) have been associated with worse prognosis. Nonetheless, data about the significance of cTn in elderly subjects with COVID-19 are lacking. Methods: : From a registry of consecutive patients with COVID-19 admitted to a hub hospital in Italy from 25/02/2020 to 03/07/2020, we selected those ≥60 year-old and with cTnI measured within 3 days from the molecular diagnosis of SARS-CoV-2 infection. When available, a second cTnI value within 48 hours was also extracted. The relationship between increased cTnI and all-cause in-hospital mortality was evaluated by a Cox regression model and restricted cubic spline functions with three knots. Results: : Of 343 included patients (median age 75.0 (68.0-83.0) years, 34.7% men), 88 (25.7%) had cTnI above the upper-reference limit (0.046 µg/L). Patients with increased cTnI had more comorbidities, greater impaired respiratory exchange and higher inflammatory markers on admission than those with normal cTnI. Furthermore, they died more (73.9% vs. 37.3%, p<0.001) over 15 (6-25) days of hospitalization. The association of elevated cTnI with mortality was confirmed by the adjusted Cox regression model (HR: 1.61, 95%CI: 1.06-2.52, p=0.039) and was linear until 0.3 µg/L, with a subsequent plateau. Of 191 (55.7%) patients with a second cTnI measurement, 49 (25.7%) had an increasing trend, which was not associated with mortality (univariate HR 1.39, 95%CI 0.87-2.22, p=0.265). Conclusions: : In elderly COVID-19 patients, an initial increase in cTn is common and predicts a higher risk of death. Serial cTn testing may not confer additional prognostic information.

11.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-306491

ABSTRACT

Background: The incidence and clinical presentation of neurological manifestations of coronavirus disease 2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: : This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and type of neurological complications in critically ill COVID-19 patients and their effect on survival, as well as on hospital and intensive care unit (ICU) length-of-stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial doppler (TCD), optic nerve sheath diameter (ONSD), and pupillometry. Results: : Ninety-four patients with COVID-19 receiving mechanical ventilation and admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 47/94 patients (50%), with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8±25.1 vs. 19.4±16.9 days, p <0.001) and ICU (31.5±22.6 vs. 11.5±10.1 days, p <0.001) stay. The duration of mechanical ventilation was independently associated with risk of developing neurological complications (OR 1.100, 95%CI 1.046-1.175, p=0.001). Patients with increased intracranial pressure (ICP) measured by ONSD (19% of the overall population) had longer ICU stays. Conclusions: : In conclusion, neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length-of-stay. Multimodal noninvasive neuromonitoring systems are useful tools for early detection of cerebrovascular changes in COVID-19. Registration number: 163/2020

12.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-309368

ABSTRACT

Background: To describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of critically ill COVID-19 patients requiring invasive mechanical ventilation;the secondary outcome is to describe BALF findings between survivors vs non-survivors. Materials and Methods Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed. Results Sixty-four patients were enrolled, median age of 64 years (IQR 58–69). The majority cells in the BALF were neutrophils (70%, IQR 37.5–90.5) and macrophages (27%, IQR 7–49) while a minority were lymphocytes, 1%, TCD3 + 92% (IQR 82–95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014–1.759, p = 0.039). Conclusions In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.

13.
Mycoses ; 65(4): 411-418, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1685386

ABSTRACT

BACKGROUND: The diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is challenging, and the role of Aspergillus-PCR in bronchoalveolar lavage (BAL) is unknown. OBJECTIVES: This study evaluated diagnostic accuracy of Aspergillus-PCR in BAL in IPA in three different cohorts: ICU-admitted patients with COVID-19, ICU-admitted patients without COVID-19 and immunocompromised patients. METHODS: All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius® ). IPA was diagnosed according to appropriate criteria for each patient group. RESULTS: We included 111 BAL samples from 101 patients: 52 (51%) patients admitted to ICU for COVID-19, 24 (24%) admitted to ICU for other reasons and 25 (25%) immunocompromised. There were 31 cases of IPA (28%). Aspergillus-PCR sensitivity was 64% (95% CI 47-79) and specificity 99% (95% CI 93-100). Aspergillus-PCR sensitivity was 40% (95%CI 19-64) in ICU COVID-19, 67% (95% CI 21-93) in non-COVID-19 ICU patients and 92% (95%CI 67-98) in the immunocompromised. The concordance between positive BAL-GM and BAL-PCR in patients with and without IPA was significantly lower in ICU patients (32%; 43% in COVID-19, 18% in non-COVID-19) than in the immunocompromised (92%), p < .001. CONCLUSIONS: Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Aspergillus/genetics , Bronchoalveolar Lavage , Bronchoalveolar Lavage Fluid , COVID-19/diagnosis , Critical Illness , Galactose , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Mannans/analysis , Polymerase Chain Reaction , Sensitivity and Specificity
14.
Curr Opin Infect Dis ; 35(2): 149-162, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1672443

ABSTRACT

PURPOSE OF REVIEW: Some patients with coronavirus disease 2019 (COVID-19) may develop pulmonary bacterial coinfection or superinfection, that could unfavorably impact their prognosis. RECENT FINDINGS: The exact burden of methicillin-resistant Staphylococcus aureus (MRSA) lung infection in peculiar populations such as patients with COVID-19 remains somewhat elusive, possibly because of wide heterogeneity in methods and endpoints across studies. SUMMARY: There was important heterogeneity in the retrieved literature on the epidemiology of MRSA lung infection in patients with COVID-19, both when considering all other bacteria as the denominator (relative prevalence ranging from 2% to 29%) and when considering only S. aureus as the denominator (relative prevalence ranging from 11% to 65%). Overall, MRSA is among the most frequent causative agents of pulmonary infection in patients with COVID-19. Improving our ability to rapidly reach etiological diagnosis of bacterial lung infection in COVID-19 patients remains fundamental if we are to improve the rates of appropriate antibiotic therapy in patients with COVID-19 and concomitant/superimposed MRSA infection, at the same time avoiding antibiotic overuse in line with antimicrobial stewardship principles.


Subject(s)
COVID-19 , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Humans , Lung , SARS-CoV-2 , Staphylococcal Infections/complications , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcus aureus
15.
Curr Opin Infect Dis ; 35(2): 88-94, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1650791

ABSTRACT

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) is a well established respiratory tract illness. Recent studies in adults and children have shown an increasing number of patients reporting polymorphic cutaneous manifestations during COVID-19, including different types of rashes, from maculopapular, vascular, vesicular to atypical forms. RECENT FINDINGS: Although pathogenesis of skin manifestations is still not fully understood, it has been proposed that cutaneous involvement during COVID-19 may be the results of the activation of the immune response against severe acute respiratory syndrome coronavirus-2, the reactivation or co-infection of herpesviruses or drug hypersensitivity. SUMMARY: According to available literature, skin manifestations in patients with COVID-19 may be categorized on the basis of their clinical presentations as follows: erythematous rashes, lesions of vascular origin, vesicular rash, urticarial rash and acute generalized exanthematous pustulosis (AGEP), erythema multiforme and other polymorphic erythema/atypical reactions. Prompt recognition of these cutaneous manifestations represents a crucial point to facilitate diagnosis and management of COVID-19 patients.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Child , Humans , SARS-CoV-2 , Skin/pathology
17.
J Clin Med ; 10(20)2021 Oct 13.
Article in English | MEDLINE | ID: covidwho-1470899

ABSTRACT

Monoclonal antibodies, such as bamlanivimab and etesevimab combination (BEC), have been proposed for patients with mild or moderate coronavirus disease 2019 (COVID-19). However, few studies have assessed the factors associated with the early administration of BEC or the impact of early BEC treatment on the clinical evolution of the patients. We conducted a retrospective cohort study of all adults with COVID-19 who received BEC at three institutions in the Liguria region. The primary endpoint was to investigate the clinical variables associated with early BEC infusion. Secondary endpoints were 30-day overall mortality and the composite endpoint of requirement of hospital admission or need for supplemental oxygen during the 30-day follow-up period. A total of 127 patients (median age 70 years; 56.7% males) received BEC. Of those, 93 (73.2%) received BEC within 5 days from symptoms onset (early BEC). Patients with a higher Charlson comorbidity index were more likely to receive early treatment (odds ratio (OR) 1.60, 95% confidence interval (CI) 1.04-2.45; p = 0.03) in contrast to those reporting fever at presentation (OR 0.26, 0.08-0.82; p = 0.02). Early BEC was associated with lower likelihood of hospital admission or need for supplemental oxygen (OR 0.19, 0.06-0.65; p = 0.008). Five patients who received early BEC died during the follow-up period, but only one of them due to COVID-19-related causes. Early bamlanivimab and etesevimab combination was more frequently administered to patients with a high Charlson comorbidity index. Despite this, early BEC was associated with a lower rate of hospital admission or need for any supplementary oxygen compared to late administration. These results suggest that efforts should focus on encouraging early BEC use in patients with mild-moderate COVID-19 at risk for complications.

18.
Crit Care ; 25(1): 214, 2021 06 21.
Article in English | MEDLINE | ID: covidwho-1440944

ABSTRACT

BACKGROUND: Critically ill COVID-19 patients have pathophysiological lung features characterized by perfusion abnormalities. However, to date no study has evaluated whether the changes in the distribution of pulmonary gas and blood volume are associated with the severity of gas-exchange impairment and the type of respiratory support (non-invasive versus invasive) in patients with severe COVID-19 pneumonia. METHODS: This was a single-center, retrospective cohort study conducted in a tertiary care hospital in Northern Italy during the first pandemic wave. Pulmonary gas and blood distribution was assessed using a technique for quantitative analysis of dual-energy computed tomography. Lung aeration loss (reflected by percentage of normally aerated lung tissue) and the extent of gas:blood volume mismatch (percentage of non-aerated, perfused lung tissue-shunt; aerated, non-perfused dead space; and non-aerated/non-perfused regions) were evaluated in critically ill COVID-19 patients with different clinical severity as reflected by the need for non-invasive or invasive respiratory support. RESULTS: Thirty-five patients admitted to the intensive care unit between February 29th and May 30th, 2020 were included. Patients requiring invasive versus non-invasive mechanical ventilation had both a lower percentage of normally aerated lung tissue (median [interquartile range] 33% [24-49%] vs. 63% [44-68%], p < 0.001); and a larger extent of gas:blood volume mismatch (43% [30-49%] vs. 25% [14-28%], p = 0.001), due to higher shunt (23% [15-32%] vs. 5% [2-16%], p = 0.001) and non-aerated/non perfused regions (5% [3-10%] vs. 1% [0-2%], p = 0.001). The PaO2/FiO2 ratio correlated positively with normally aerated tissue (ρ = 0.730, p < 0.001) and negatively with the extent of gas-blood volume mismatch (ρ = - 0.633, p < 0.001). CONCLUSIONS: In critically ill patients with severe COVID-19 pneumonia, the need for invasive mechanical ventilation and oxygenation impairment were associated with loss of aeration and the extent of gas:blood volume mismatch.


Subject(s)
Blood Volume/physiology , COVID-19/diagnostic imaging , COVID-19/metabolism , Lung/diagnostic imaging , Lung/metabolism , Pulmonary Gas Exchange/physiology , Aged , Blood Gas Analysis/methods , COVID-19/epidemiology , Cohort Studies , Critical Illness/epidemiology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Respiration, Artificial/methods , Retrospective Studies , Tomography, X-Ray Computed/methods
19.
Eur J Intern Med ; 94: 39-44, 2021 12.
Article in English | MEDLINE | ID: covidwho-1377703

ABSTRACT

OBJECTIVES: The hypothesis of this study is that tocilizumab should affect common signs of infection due to its immunosuppressive properties. Primary aim of the study was to investigate whether the administration of tocilizumab to critically ill patients with COVID-19, led to a different clinical presentation of infectious complications compared to patients who did not receive tocilizumab. Secondary aim was investigating differences in laboratory parameters between groups. METHODS: Single-centre retrospective study, enrolling COVID-19 patients who developed a microbiologically confirmed infectious complication [ventilator associated pneumonia or bloodstream infection] after intensive care unit [ICU] admission and either treated with tocilizumab or not [controls]. RESULTS: A total of 58 patients were included, 25 treated with tocilizumab and 33 controls. Median time from tocilizumab administration to infection onset was 10 days [range 2-26]. Patients were 78% male, with median age 65 years [range 45-79]. At first clinical presentation of the infectious event, the frequency of hypotension [11/25, 44% vs. 11/33, 33%], fever [8/25, 32% vs. 10/33, 30%] or hypothermia [0/25,0%, vs. 2/33, 6%], and oxygen desaturation [6/25, 28% vs 4/33, 12%], as well as the frequency of SOFA score increase of ≥ 2 points [4/25, 16%,vs. 4/33, 12%] was similar in tocilizumab treated patients and controls [p>0.1 for all comparisons]. Among laboratory parameters, C-Reactive Protein elevation was reduced in tocilizumab treated patients compared to controls [8/25, 32% vs. 22/33, 67%, p=0.009]. CONCLUSION: The clinical features of infectious complications in critically ill patients with COVID-19 admitted to ICU were not affected by tocilizumab.


Subject(s)
COVID-19 , Aged , Antibodies, Monoclonal, Humanized , COVID-19/drug therapy , Female , Humans , Intensive Care Units , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Standard of Care
20.
J Med Virol ; 93(9): 5608-5613, 2021 09.
Article in English | MEDLINE | ID: covidwho-1363674

ABSTRACT

In this observational study, 13 patients with severe COVID-19 and 10 healthy controls were enrolled. The data concerning the analysis of circulating T cells show that, in severe COVID-19 patients, the expansion of these cell compartments is prone to induce antibody response, inflammation (CCR4+ and CCR6+ TFH) and regulation (CD8+ Treg). This pathogenic mechanism could lead us to envision a possible new form of biological target therapy.


Subject(s)
Antibodies, Viral/biosynthesis , CD8-Positive T-Lymphocytes/immunology , COVID-19/immunology , SARS-CoV-2/immunology , Adaptive Immunity , Adult , Aged , Aged, 80 and over , Antibodies, Viral/immunology , CD4-Positive T-Lymphocytes/immunology , Case-Control Studies , Female , Fluorescent Antibody Technique , Humans , Male , Middle Aged , Receptors, CCR4 , Receptors, CCR6
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