Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. METHODS: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. RESULTS: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p=0.003, 36.6% vs 10.8%, p<0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. CONCLUSION: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Primary spontaneous intracerebral hemorrhage in COVID-19 patients: differences among presentation patterns - A systematic review.

OBJECTIVE: The objective of this study was to determine if there are differences between the presentation patterns of hemorrhagic stroke (HS) associated to COVID-19. METHODS: It was performed a systematic search based on PRISMA guidelines of the cases reported in PUBMED of HS associated to SARS-CoV-2 infection and we added to this sample cases from our own hospital cohort. Patients in the database were separated by groups according to presentation symptoms: if they debuted with neurological symptoms or debuted with pulmonary symptoms. RESULTS: Seventy cases were included in the study. Patients that debuted with pulmonary symptoms accounted for 68.6% of the cases with an interval between the development of symptoms and the presentation of HS of 15.6 days. We found that the use of anticoagulants during hospitalization, multifocal image pattern, and the elevation of D-dimer, Ferritin, and lactate dehydrogenase levels were significantly associated with the group of pulmonary presentation, whereas the presence of hypertension during hospitalization, and a lower hemoglobin level was associated with the group of neurologic symptoms. CONCLUSION: Although HS associated with COVID-19 is a clinical entity with increasing evidence, it is necessary to establish that there are two forms of presentation with their own characteristics.

OBJETIVO: determinar si existen diferencias entre los patrones de presentación de hemorragia intracraneal asociada a COVID-19. PACIENTES Y MÉTODOS: Se realizó una búsqueda sistemática basada en la guía PRISMA de los casos reportados en PUBMED de hemorragia intracraneal asociados a infección por SARS-CoV-2 y se agregaron a esta muestra casos de nuestra propia cohorte hospitalaria. RESULTADOS: se incluyeron 70 casos. Los pacientes que debutaron con síntomas pulmonares representaron el 68.6% de los casos con un intervalo entre el desarrollo de los síntomas y la presentación de la hemorragia intracraneal de 15.6 días. Encontramos que el uso de anticoagulantes durante la hospitalización, el patrón de imagen multifocal y la elevación de los niveles de dímero D, ferritina y deshidrogenasa láctica se asociaron significativamente con el grupo de presentación pulmonar, mientras que la presencia de hipertensión durante la hospitalización, y un nivel de hemoglobina más bajo se asoció con el grupo que debutó con síntomas neurológicos. CONCLUSIÓN: si bien la hemorragia intracraneal asociada a COVID-19 es una entidad clínica con evidencia creciente, es necesario establecer que existen dos formas de presentación con características propias.

HALLAZGOS EN EL PET/CT – PET/RM SECUNDARIOS A LA INFECCION EN EL SISTEMA NERVIOSO CENTRAL Y PERIFERICO POR SARS-CoV-2

Resumen Introducción: La infección por SARS-CoV-2 a nivel mundial ha comprometido cerca de 232,075,351 de personas y provocando al menos 4,752,988 muertes según datos de la OMS. Se ha considerado que el órgano de predilección para la afectación por esta infección es el pulmón, pero según la literatura, el 36.4% de los pacientes han evidenciado compromiso del SNC y el 8.9% del SNP. Materiales y métodos: Se realizo una búsqueda intencionada de la literatura en diferentes bases de datos médicas como Pubmed, Ovid, BMJ, Clinical Key, ScienceDirect, ingresando palabras claves como: COVID-19, brain, SARS-CoV-2 infection, PET/CT, PET/RM encephalopathy, acompañadas de operadores booleanos como AND, OR y NOT. Resultados: Hasta la actualidad se han publicados numerosos reportes de casos, series de casos y estudios observacionales empleando diferentes radiotrazadores PET/CT o PET/RM con diferentes hallazgos. Conclusión: La PET/CT o PET/RM con 2-[18F]FDG o [18F]FDOPA ha mostrado ser una herramienta útil para detectar y comprender el proceso de la enfermedad en aquellos pacientes con neuroinfección por SARS-CoV-2 en caso de imágenes estructurales normales. Introduction: SARS-CoV-2 infection worldwide has affected about 232,075,351 people and caused at least 4,752,988 deaths according to WHO data. It has been considered that the organ of predilection for involvement by this infection is the lung, but according to the literature, 36.4% of patients have evidenced CNS involvement and 8.9% of the SNP. Materials and methods: An intentional search of the literature was carried out in different medical databases such as Pubmed, Ovid, BMJ, Clinical Key, ScienceDirect, entering keywords such as COVID-19, brain, SARS-CoV-2 infection, PET/CT, PET/RM encephalopathy, accompanied by Boolean operators such as AND, OR and NOT. Results: To date, numerous case reports, case series, and observational studies have been published using different PET/CT or PET/MRI radiotracers with different findings. Conclusion: PET / CT or PET/MRI with 2- [18F]FDG or [18F]FDOPA has shown to be a useful tool to detect and understand the disease process in those patients with SARS-CoV-2 neuro-infection in cases of normal structural images.

Characteristics of patients with immune-mediated inflammatory diseases hospitalized for SARS-CoV-2 infection.

BACKGROUND: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. METHODS: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. RESULTS: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. CONCLUSION: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.

Acute hepatitis of unknown origin in children. What is the cause?

The World Health Organization has issued a report on 228 cases of acute hepatitis of unknown cause in children between 1 month and 16 years, 10% of them required liver transplantation and 4 died (3 in Indonesia), another 50 cases are under investigation. The adenovirus type 41 is one of the causative agents of acute gastroenteritis in children, characterized by diarrhea, vomiting and fever, often accompanied by respiratory symptoms. Cases of hepatitis in immunocompromised children have been documented;however, there is no available evidence to indicate that adenovirus type 41 can cause hepatitis in healthy children. Although adenovirus is currently hypothesized as the underlying cause, it does not fully explain the severity of the clinical picture. Given this new situation, we have more questions than answers, the reported cases had no apparent risk factors, most had not received the COVID-19 vaccine. Several hypotheses are being evaluated and it seems that the infectious cause is more solid. The possible role of previous SARS-CoV-2 infection in children reported with acute hepatitis is analyzed. (English) [ FROM AUTHOR]

SARS-CoV-2 and Chlamydia pneumoniae co-infection: A review of the literature.

Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbid-mortality. The prevalence of Chlamydia (C.) pneumoniae infection in patients infected with SARS-CoV-2 has not been sufficiently studied. The objective of the present review was to describe the prevalence of C. pneumoniae in patients with coronavirus disease 2019 (COVID-19). A search in MEDLINE and Google Scholar databases for English language literature published between January 2020 and August 2021 was performed. Studies evaluating patients with confirmed COVID-19 and reporting the simultaneous detection of C. pneumoniae were included. Eleven articles were included in the systematic review (5 case cross-sectional studies and 6 retrospective studies). A total of 18450 patients were included in the eleven studies. The detection of laboratory-confirmed C. pneumoniae infection varied between 1.78 and 71.4% of the total number of co-infections. The median age of patients ranged from 35 to 71 years old and 65% were male. Most of the studies reported one or more pre-existing comorbidities and the majority of the patients presented with fever, cough and dyspnea. Lymphopenia and eosinopenia were described in COVID-19 co-infected patients. The main chest CT scan showed a ground glass density shadow, consolidation and bilateral pneumonia. Most patients received empirical antibiotics. Bacterial co-infection was not associated with increased ICU admission and mortality. Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus 2-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial co-infection. Prospective evidence generation to support the development of an antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic are urgently required.

Cytokine release syndrome in infection due to COVID-19 and administration of tocilizumab as therapeutic option.

The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), causing of coronavirus disease 2019 (COVID-19), is resulting in a worldwide pandemic and has affected more than 200 countries, leading in more than 10 million cases with 508,000 confirmed deaths. The disease spectrum is wide from mild symptoms to severe pneumonia, and some critical conditions be able to produce life-threatening complications, particularly in patients with cytokine release syndrome. This is characterized by dyspnea, hypoxemia and bilateral lung infiltrates on chest radiographic imaging, in case of disease progression invasive mechanical ventilation is needed. The clinical presentation includes hypotension, fever, septic shock with vasopressor therapy, endothelial injury, disseminated intravascular coagulation and multi-organic failure. The most relevant paraclinical parameters associated to cytokine release syndrome are cytopenias, elevated levels of inflammatory cytokines, transaminasemia, coagulation abnormalities and increment in C-reactive protein values. Tocilizumab is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6r), it has been successful administrated in cytokine release syndrome. We propose the blockage with tocilizumab in patients who fulfilled the clinical criteria of cytokine release syndrome based on the literature review as a therapeutic target for COVID-19 infection. (English) [ FROM AUTHOR] La pandemia derivada por el nuevo síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2), agente causal de la enfermedad por coronavirus 2019 (COVID-19), ha afectado a más de 200 países, ocasionando cerca de 10 millones de casos confirmados y 508,000 muertes. El espectro de la enfermedad varía desde casos leves de neumonía hasta el estado crítico que puede poner en peligro la vida, en especial en los pacientes que manifiestan el síndrome de liberación de citocinas. Éste se caracteriza por disnea, hipoxemia e infiltrados bilaterales en la radiografía de tórax que en ocasiones requiere ventilación mecánica;en términos clínicos, los pacientes con síndrome de liberación de citocinas pueden cursar con hipotensión, fiebre elevada, estado de choque con requerimiento de vasopresor, daño vascular, coagulación intravascular diseminada e insuficiencia orgánica múltiple. Entre los parámetros de laboratorio que destacan en los pacientes con síndrome de liberación de citocinas están las citopenias, elevación de citocinas, incremento en las enzimas hepáticas, alteración en los parámetros de coagulación y aumento en la proteína C reactiva. Tocilizumab es un anticuerpo monoclonal humanizado recombinante antagonista del receptor de IL-6 que se ha prescrito en forma exitosa en pacientes con este síndrome. El enfoque orientado hacia el bloqueo de citocinas para contrarrestar la hiperinflamación observada en COVID-19 representa una oportunidad terapéutica. En esta revisión se proponen algunos criterios para la administración de tocilizumab en pacientes con infección por SARS-CoV-2 y síndrome de liberación de citocinas. (Spanish) [ FROM AUTHOR] Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Efficacy and safety of hydroxychloroquine in healthcare professionals with mild SARS-CoV-2 infection: Prospective, non-randomized trial.

OBJECTIVES: To assess the efficacy and safety of hydroxychloroquine (HCQ) compared with no treatment in healthcare workers with mild SARS-CoV-2 infection. METHODS: Prospective, non-randomized study. All health professionals with confirmed COVID-19 between April 7 and May 6, 2020, non-requiring initial hospitalization were asked to participate. Patients who accepted treatment were given HCQ for five days (loading dose of 400mg q12h the first day followed by200mg q12h). Control group included patients with contraindications for HCQ or who rejected treatment. Study outcomes were negative conversion and viral dynamics of SARS-CoV-2, symptoms duration and disease progression. RESULT: Overall, 142 patients were enrolled: 87 in treatment group and 55 in control group. The median age was 37 years and 75% were female, with few comorbidities. There were no significant differences in time to negative conversion of PCR between both groups. The only significant difference in the probability of negative conversion of PCR was observed at day 21 (18.7%, 95%CI 2.0-35.4). The decrease of SARS-CoV-2 viral load during follow-up was similar in both groups. A non significant reduction in duration of some symptoms in HCQ group was observed. Two patients with HCQ and 4 without treatment developed pneumonia. No patients required admission to the Intensive Care Unit or died. About 50% of patients presented mild side effects of HCQ, mainly diarrhea. CONCLUSIONS: Our study failed to show a substantial benefit of HCQ in viral dynamics and in resolution of clinical symptoms in health care workers with mild COVID-19.

Neumomediastino en pacientes con COVID-19: Una serie de 10 casos

Resumen En la actualidad la enfermedad por Coronavirus 2019 (COVID-19) es un problema de salud pública que ha causado más de 100.000 muertes en Colombia y alrededor de 4,13 millones de muertes en todo el mundo. El síndrome de Distress Respiratorio Agudo (SDRA) secundario a esta infección viral, puede llevar a un serie de complicaciones como el neumomediastino, este es poco frecuente pero potencialmente mortal y se encuentra relacionado con la ventilación mecánica. Presentamos una serie de casos de 10 pacientes que ingresaron a la unidad de cuidados intensivos con requerimiento de ventilación mecánica invasiva y que desarrollaron neumomediastino. La serie de casos más grande reportada hasta el momento. Coronavirus disease 2019 (COVID-19) is a current public health problem that has caused more than 100,000 deaths in Colombia and around 4.13 million deaths worldwide. The acute respiratory distress syndrome (ARDS) secondary to this viral infection can lead to a series of complications such as pneumomediastinum, which is rare but potentially fatal and is related to mechanical ventilation. We present a case series of 10 patients who were admitted to the intensive care unit requiring invasive mechanical ventilation and developed pneumomediastinum. Largest case series reported to date

More difficult still: Treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.

Characteristics of Patients With Immune-Mediated Inflammatory Diseases Hospitalized for SARS-CoV-2 Infection. / Características de pacientes con enfermedades inflamatorias inmunomediadas hospitalizados por infección por SARS-CoV-2.

BACKGROUND: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. METHODS: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. RESULTS: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. CONCLUSION: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.

Blood system ABO antigens as risk factor for severity of SARS-CoV-2 infection.

INTRODUCTION: Whether there is an influence of the ABO blood system on SARS-CoV-2 infection is unknown. OBJECTIVE: To analyze if there is an association between the ABO system antigens and susceptibility to and severity of SARS-CoV-2 infection. MATERIAL AND METHODS: The frequency of ABO system antigens was compared in 73 confirmed cases of SARS-CoV-2 infection and 52 clinically healthy donors. Infection severity was assessed by comparing the frequency of antigens by disease severity and mortality. RESULTS: The risk of suffering from SARS-CoV-2 infection increases in subjects with A vs. non-A antigen (OR = 1.45; 95 % CI: 1.061-1.921). Blood phenotype O reduces the risk of SARS-CoV-2 infection (OR = 0.686; 95 % CI: 0.522-0.903). No differences were found regarding disease severity. In critically ill patients, the risk of mortality increased in subjects with A vs. non-A antigen (OR = 3.34; 95 % CI: 1.417-8.159). CONCLUSION: Blood group A is a risk factor for SARS-CoV-2 infection, but not for disease severity, although in critically ill patients it is a risk factor for mortality.

INTRODUCCIÓN: Se desconoce si existe una influencia del sistema sanguíneo ABO en susceptibilidad y gravedad de la enfermedad. OBJETIVO: Analizar si existe una asociación entre los antígenos del sistema ABO y la susceptibilidad y gravedad de la infección por SARS-CoV-2. MATERIAL Y MÉTODOS: Se compararon las frecuencias de los antígenos del sistema ABO en 73 casos confirmados de infección por SARS-CoV-2 y 52 donadores clínicamente sanos. La gravedad de la infección se evaluó comparando la frecuencia de los antígenos por gravedad de la enfermedad y la mortalidad. RESULTADOS: El riesgo de padecer infección por SARS-CoV-2 se incrementa en sujetos con antígeno A vs los no-A (OR=1.45; IC95 %:1.061-1.921). El fenotipo sanguíneo O disminuye el riesgo de padecer infección por SARS-CoV-2 (OR=0.686; IC95 %: 0.522-0.903). No se encontraron diferencias entre la gravedad de la enfermedad. En los pacientes graves, el riesgo de mortalidad se incrementó en sujetos con antígeno A vs los no-A (OR= 3.34; IC95 %: 1.417-8.159). CONCLUSIÓN: El grupo sanguíneo A es un factor de riesgo para padecer infección por SARS-CoV-2, no así en la gravedad de la enfermedad, pero en los pacientes graves fue un factor de riesgo para la mortalidad.

More difficult still: Treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia. / Más difícil todavía: tratar una glomerulonefritis rápidamente progresiva grave en el seno de una neumonía por COVID-19.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.

Efficacy and safety of hydroxychloroquine in healthcare professionals with mild SARS-CoV-2 infection: Prospective, non-randomized trial.

OBJECTIVES: To assess the efficacy and safety of hydroxychloroquine (HCQ) compared with no treatment in healthcare workers with mild SARS-CoV-2 infection. METHODS: Prospective, non-randomized study. All health professionals with confirmed COVID-19 between April 7 and May 6, 2020, non-requiring initial hospitalization were asked to participate. Patients who accepted treatment were given HCQ for five days (loading dose of 400mg q12h the first day followed by200mg q12h). Control group included patients with contraindications for HCQ or who rejected treatment. Study outcomes were negative conversion and viral dynamics of SARS-CoV-2, symptoms duration and disease progression. RESULT: Overall, 142 patients were enrolled: 87 in treatment group and 55 in control group. The median age was 37 years and 75% were female, with few comorbidities. There were no significant differences in time to negative conversion of PCR between both groups. The only significant difference in the probability of negative conversion of PCR was observed at day 21 (18.7%, 95%CI 2.0-35.4). The decrease of SARS-CoV-2 viral load during follow-up was similar in both groups. A non significant reduction in duration of some symptoms in HCQ group was observed. Two patients with HCQ and 4 without treatment developed pneumonia. No patients required admission to the Intensive Care Unit or died. About 50% of patients presented mild side effects of HCQ, mainly diarrhea. CONCLUSIONS: Our study failed to show a substantial benefit of HCQ in viral dynamics and in resolution of clinical symptoms in health care workers with mild COVID-19.