Pulmonary function and functional capacity at 3, 6 and 12 months in COVID-19 patients and effect of physical activity on recovery

BACKGROUND: Long-term sequelae due to Coronavirus disease 2019 (COVID-19) are now under investigation. Aim of this study was to evaluate the one-year clinical impact of COVID-19 on respiratory function and relation with physical activity. METHOD(S): One hundred four patients were evaluated 3, 6 and 12 months after SARS-CoV-2 diagnosis. Clinical conditions, symptomatology, 6-minute walking test (6MWT), pulmonary function test with spirometry and diffusing capacity of carbon monoxide (DLCO) were analyzed. RESULT(S): Eighty-six (82.7%) patients referred at least one symptom at 3 months, 46 (44.2%) at 6 months and 24 (23.1%) at 12 months. At the 3-months visit, patients with moderate COVID showed a slight decrease of distance at the 6MWT, with an improvement at 12 months (P=0.04). Patients with severe COVID-19 showed a recovery of SpO2 at rest (P<0.001), DLCO (P=0.001), DLCO/VA (P=0.002), forced vital capacity (P=0.01) and 6MWT distance (P=0.002) at 6 and 12 months. Patients with critical COVID-19 showed a remarkable reduction of DLCO at 3 months (65+/-21%). Then a subsequent gradual improvement of DLCO was recorded (78+/-18% at 6 months, 85+/-16% at 12 months, P=0.01). Patients with DLCO<80% of predicted at 12 months were older (P=0.02), with higher prevalence of cardio-vascular disease (P=0.006), diabetes (P=0.01) and critical COVID-19 (P=0.003). The improvement of 6MWT distance and DLCO during the three visits did not correlate with physical activity. CONCLUSION(S): Patients with COVID-19 lung involvement showed a progressive improvement in respiratory function and physical performance at 6 and 12 months after acute disease.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Comparison of scoring systems' mortality prediction ability in COVID-19 intensive care patients over 80 years of age

Aim: In this study, we aimed tto compare the 30-day mortality prediction abilities of the acute physiology and chronic health evaluation II (APACHE II), CURB-65, pneumonia severity index (PSI), A-DROP, Infectious Diseases Society of America/American Thoracic Society severity criteria, and I-ROAD scores in patients aged over 80 years admitted to the intensive care unit with COVID-19 pneumonia. Material(s) and Method(s): The study was conducted with a single-center retrospective observational design and included patients aged 80 years and older who were admitted to the intensive care unit due to COVID-19 pneumonia between March 2020 and August 2021. Patient demographic data, imaging findings, blood test results, discharge status, length of stay in the intensive care unit, duration of mechanical ventilation, inotropic drug administration status, presence/ absence of mortality and vital signs at the time of admission were obtained from the hospital automation system. Then, the above-mentioned scores were calculated and compared statistically. Result(s): The study was completed with 119 patients, 60 (50.4%) women and 59 (49.6%) men. The mean age of all patients was 84 (80-98) years, and the mortality rate was 84.03% (n=100). Among the scoring systems, I-ROAD had the highest area under the curve (AUC) value (0.703), APACHE II had the highest specificity (94%), and A-DROP had the highest sensitivity (64%). Discussion(s): According to our results, the I-ROAD scoring system is an effective tool that can be used in the prediction of mortality related to COVID-19 pneumonia among intensive care patients aged >=80.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) remains one of the most frequent causes of death worldwide, and the most common infection requiring hospitalization. Worldwide CAP is the leading infectious disease cause of death and the fourth leading cause of death overall and the leading cause of death in children. While most of the literature on CAP is on patients who become ill enough to require admission to hospital, less severe disease that is treated in the outpatient setting is also exceptionally common. © 2022 Elsevier Ltd. All rights reserved

The role of alveolo-arterial oxygen gradient and pneumonia severity index in predicting mortality in patients with COVID-19 pneumonia

Purpose of the study is to determine the success rates of alveolo-arterial oxygen gradient (AaDO2) and the pneumonia severity index (PSI) in predicting mortality for the patients diagnosed with COVID-19 pneumonia. This retrospective study included patients who were treated with the diagnosis of COVID-19 pneumonia in the ICUs. Demographic characteristics, arterial blood gas values, radiological images and laboratory data of the patients were used through the hospital database and patient files. Group I patients consist of alive and Group II patients consist of deceased persons. 150 of 263 patients included in this study are in Group I and 113 are in Group II. RT-PCR test was positive in 20.9% of the patients. The most common symptom was dyspnea with 76.5% and the most common additional disease was hypertension with 58.1%.65% of patients had radiological involvement in both lungs, and the most common finding was the ground-glass opacity at 71.5%. In predicting mortality, PSI value was 135 in group I and 174 in group II (p<0.001);AaDO2 value was 154.88 mmHg in group I, 177.13 mmHg in group II (p<0.001), and this rate was different between the groups. Sensitivity is found at 84.1% and specificity at 67.3% for PSI, whereas sensitivity is found at 49.6% and specificity at 82.7% for the AaDO2 variable. It is important to estimate the mortality risk earlier for the patients with COVID-19 pneumonia who are also followed up in intensive care units. PSI is beneficial in detecting mortality risk whereas AaDO2 is valuable in determining the surviving patients. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Specificities of Correlation Indicators of the Hemostasis System and Leukocytic Index of Intoxication in Patients with Out-of-Hospital Pneumonia on the Background of COVID-19

Foreword: Pneumonia remains an important medical and social problem at the beginning of the 21st century as well. This is due to its high prevalence, fairly high rates of disability and mortality, as well as significant economic expenditures for treatment. The incidence of pneumonia in different regions of the world ranges from 3.5 to 15 cases per 1 thousand population. The mortality rate from pneumonia in different countries of the world ranges from 2-3 to 25%. Pneumonia takes the first place among the causes of lethality and mortality from infectious diseases and the sixth one - among all the causes of death and the fourth - among causes of death in patients older than 65 years. Objective of research: Find out the peculiarities of correlation indicators of the hemostasis system and leukocytic index of intoxication in patients with out-of-hospital pneumonia on the background of COVID-19. Materials and methods of research: Based on NMMCC MMCH, a retrospective review analyzed 66 maps of inpatients with out-of-hospital pneumonia associated with COVID-19. The average age of the patients included in the study was 38.9 ± 0.7 years for males [66% (n = 37)] and 39.3 ± 0.83 for females [44% (n = 29)]. The leukocyte intoxication index (LII) was calculated and the severity of pneumonia was assessed according to the PSI scale (Pneumonia Severity Index, 2004). Results of the personal research: After dividing the patients according to the level of LII and PSI stratification class, we identified three groups of patients: with mild intoxication (n = 30, LII - 2.13 ± 0.09), which corresponded to class II on PSI (61.5 ± 6, 5);with intoxication of moderate severity (n = 31, LII - 4.83 ± 0.29), which corresponded to class III for PSI (79.4 ± 7.4);with severe intoxication (n = 5, LII - 10.11 ± 0.53), which corresponded to class IV PSI (110.4 ± 11.4). Assessing the severity of pneumonia on the PSI and LII scale [in the first group (LII - 2.13 ± 0.09, PSI - 61.5 ± 6.5), in the second group (LII - 4.83 ± 0.29, PSI - 79.4 ± 7.4), and in the third group (LII - 10.11 ± 0.53, PSI - 110.4 ± 11.4)], we found a direct strong credible Pearson's correlation (r = 0.56;p < 0.05) between the level of leukocyte intoxication index and the level of PSI. In addition, it was found that the increasing degree of intoxication significantly increases the value of LII (p < 0.05). When assessing changes in the coagulogram of patients depending on LII (in the first group of LII - 2.13 ± 0.09, PI,% - 91.3 ± 0.86, APTT, c - 33.38 ± 0.2, fibrinogen A, g\L - 3.37 ± 0.08, fibrinogen B, qualitatively - 1.6 ± 0.14, activated plasma recalcification time, c - 84.5 ± 1.64, in the second group of LII - 4.83 ± 0.29, PI,% - 84.6 ± 0.98, APTT, c - 31.96 ± 0.19, fibrinogen A, g\L - 3.69 ± 0.05, fibrinogen B, qualitatively - 2.48 ± 0.13, activated plasma recalcification time, c - 94.19 ± 1.31, in the third group LII - 10.11 ± 0.53, PI,% - 83 ± 2.0, APTT, c - 31, 42 ± 0.26, fibrinogen A, g\L - 3.93 ± 0.11, fibrinogen B, qualitatively - 3.0 ± 0.31, activated plasma recalcification time, c - 97.0 ± 4.63), it was found that with increasing degree of intoxication PI and APTT indicators decreased, while levels of fibrinogen A and B raised, as well as the rate of activated plasma recalcification (a significant difference between the data of groups I and II with p < 0.01;I and II with p < 0.001;I and III with p < 0.05;I and III with p < 0.001 was defined). Conclusion: (1) In assessment, the severity of pneumonia on the PSI scales and leukocyte intoxication index, we found a direct strong veracious correlation by Pearson's method (r = 0.56;p <0.05) between the level of leukocyte intoxication index and the level of PSI. (2) Characteristic features of changes in the leukocyte index of intoxication in patients with community-acquired pneumonia are the following: with increasing degree of intoxication, the value of leukocyte index of intoxication increases significantly (p < 0.05). (3) When assessing changes in the coagulogram depending on LII and PSI scale, it was found that with increasing degree of intoxication PI and APTT indicators decreased but the levels of fibrinogen A and B increased, as well as the rate of the activated plasma recalcification.

Prognostic Role of Different Severity Indexes in COVID-19 Pneumonia: A Retrospective Study

Aim and background: Approximately 50% of the COVID-19 patients require intensive care due to pneumonia and respiratory failure. The CURB-65,3 CRB-654, A-DROP5 score, and Pneumonia Severity Index (PSI) scoring systems are established prognostic tools for community-acquired pneumonia (CAP). Similarly, the qSOFA score is a prognostic tool for critically ill patients. However, the utility of these scoring systems in the context of COVID-19 is yet to be established as a predictive tool for triage by means of rapid decision-making and preventive measures to combat the ongoing pandemic. Materials and methods: This observational, retrospective cohort study was conducted AIIMS, New Delhi during May to June, 2021 after obtaining institutional ethical committee approval (IEC-860/4.9.2020). Only the RT-PCR-proven patients >18 years among the institutionalized patients with severe acute respiratory infections (SARI) were included. Results: Out of the 235 included patients, 27.2% of patients required mechanical ventilation, and the overall period of hospital stay was 9 (5-13) days. While the SMART COP score with an AUC of 0.812 (95% CI 0.752-0.871), the PSI score with an AUC of 0.819 (95% CI 0.762- 0.877) obtained significant results for mortality, the A drop score with an AUC of 0.92 (0.897-0.954), and both the PSI (AUC of 0.964;95% CI 0.928-1.000), and the SMART COP (AUC of 0.925;95% CI 0.887-0.962) acquired the best result for intubation and thereby requirement of mechanical ventilation. Conclusion: Although the outcome of COVID-19 depends upon multiple factors the SMART COP, PSI, and A-drop scoring systems seem to be promising predictive tools for morbidity and mortality.

Sinus bradycardia in patients with severe CoViD-19

Aim of the study: Aim of this study was to analyse the relations between SB and severe CoViD-19 pneumonia (Pneumonia Severity Index >90). Materials and Methods: An observational retrospective study was performed by analyzing clinical, laboratory and instrumental features from 155 hospitalized patients for CoViD-19 pneumonia in our General Medicine and Semi-intensive Care Units. Results: Bradycardia (heart rate <60 bpm) was found in the 32.2% of the study population, as described in literature. Neither clinical and laboratory characteristics of myocardial damage, thyroid impairment or electrolytes abnormalities were diagnosed among these patients. This cohort of population had only a higher amount of smokers (p=0.001) and blood neutrophils count (p=0.032) without anymore differences compared to the cohort with normal heart rate. The incidence of bradycardia was same in patients treated by remdesivir or not (p=0.495). When viral nucleic acid tests turned negative, the SB disappears. Conclusions: Therefore we speculated that the inhibitory effect of SARS-CoV-2 on sinus node activity was the main cause of sinus bradycardia in these patients.

Clinical Features of the 60 Years and Older Patients Infected with 2019 Novel Coronavirus: Can We Predict Mortality Earlier?

INTRODUCTION: The novel coronavirus (COVID-19), which has affected over 100 countries in a short while, progresses more mortally in elderly patients with comorbidities. In this study, we examined the epidemiological, clinical, and laboratory characteristics of the patients aged 60 and over who had been infected with COVID-19. METHODS: The data of the patients admitted to the hospital within 1 month from May 8, 2020 onwards and hospitalized for COVID-19 pneumonia were obtained from the hospital medical records, and the epidemiological, clinical, and laboratory parameters of the patients during the admission to the emergency department were examined. Patients were divided into 2 groups regarding the criteria of having in-hospital mortality (mortality group) and being discharged with full recovery (survivor group). The factors, which could have an impact on the mortality, were investigated using a univariate and multivariate logistic regression analysis. RESULTS: This retrospective study included 113 patients aged 60 years and older, with a confirmed diagnosis of COVID-19 pneumonia. The mean age of the patients was 70.7 ± 7.9, and 64.6% (n = 73) of them were male. The mortality rate was 19.4% (n = 22). Among the comorbid illnesses, only renal failure was significant in the mortality group (p = 0.04). A CURB-65score ≥3 or pneumonia severity index (PSI) class ≥4 manifested a remarkable discrimination ability to predict 30-day mortality (p < 0.001). When the laboratory parameters were considered, the value of neutrophil to lymphocyte ratio (NLR) was significant in predicting mortality in univariate and multivariate analysis (odds ratio [OR] = 1.11; 95% confidence interval [95% CI], 1.03-1.21; p = 0.006, and OR = 1.51; 95% CI, 1.11-2.39; p = 0.044, respectively). CONCLUSION: In our study, NLR was determined to be an independent marker to predict in-hospital mortality among patients with COVID-19. PSI and CURB-65 revealed a considerably precise prognostic accuracy for the patients with COVID-19 in our study as well. Moreover, thanks to that NLR results in a very short time, it can enable the clinician to predict mortality before the scoring systems are calculated and hasten the management of the patients in the chaotic environment of the emergency room.

Predicting severe COVID-19 in the Emergency Department.

BACKGROUND: COVID-19 may lead to severe disease, requiring intensive care treatment and challenging the capacity of health care systems. The aim of this study was to compare the ability of commonly used scoring systems for sepsis and pneumonia to predict severe COVID-19 in the emergency department. METHODS: Prospective, observational, single centre study in a secondary/tertiary care hospital in Oslo, Norway. Patients were assessed upon hospital admission using the following scoring systems; quick Sequential Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome criteria (SIRS), National Early Warning Score 2 (NEWS2), CURB-65 and Pneumonia Severity index (PSI). The ratio of arterial oxygen tension to inspiratory oxygen fraction (P/F-ratio) was also calculated. The area under the receiver operating characteristics curve (AUROC) for each scoring system was calculated, along with sensitivity and specificity for the most commonly used cut-offs. Severe disease was defined as death or treatment in ICU within 14 days. RESULTS: 38 of 175 study participants developed severe disease, 13 (7%) died and 29 (17%) had a stay at an intensive care unit (ICU). NEWS2 displayed an AUROC of 0.80 (95% confidence interval 0.72-0.88), CURB-65 0.75 (0.65-0.84), PSI 0.75 (0.65-0.84), SIRS 0.70 (0.61-0.80) and qSOFA 0.70 (0.61-0.79). NEWS2 was significantly better than SIRS and qSOFA in predicating severe disease, and with a cut-off of5 points, had a sensitivity and specificity of 82% and 60%, respectively. CONCLUSION: NEWS2 predicted severe COVID-19 disease more accurately than SIRS and qSOFA, but not significantly better than CURB65 and PSI. NEWS2 may be a useful screening tool in evaluating COVID-19 patients during hospital admission. TRIAL REGISTRATION: : ClinicalTrials.gov Identifier: NCT04345536. (https://clinicaltrials.gov/ct2/show/NCT04345536).

Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19.

OBJECTIVE: The aim of the study was to analyze the usefulness of CURB-65 and the pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19, and to identify other factors associated with higher mortality. METHODS: A retrospective study was performed in a pandemic hospital in Istanbul, Turkey, which included 681 laboratory-confirmed patients with COVID-19. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Receiver operating characteristic analysis was used to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality. RESULTS: Higher CRP levels were associated with an increased risk for mortality (OR: 1.015, 95% CI: 1.008-1.021; p < 0.001). The PSI performed significantly better than CURB-65 (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.88, 95% CI: 0.85-0.90; p = 0.01), and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.92, 95% CI: 0.89-0.94; p = 0.29). CONCLUSION: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.