LATENT CLASS ANALYSIS: AN INNOVATIVE APPROACH FOR IDENTIFICATION OF CLINICAL AND LABORATORY MARKERS OF DISEASE SEVERITY AMONG COVID-19 PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Evidence about the phenotypic profile of COVID-19 ICU patients in sub- Saharan Africa remains insufficient. Our study aimed to identify clinical and laboratory phenotype distribution patterns and their usefulness as prognostic markers in COVID-19 patients admitted to the intensive care unit (ICU) in South Africa. We used a latent class analysis (LCA) model in a prospective cohort study of clinical and laboratory data collected from 343 COVID-19 patients between 27 March 2020 and 10 February 2021. A sub-analysis was performed to determine sub-phenotypes associated with clinical outcomes among COVID-19 patients and their impact on survival. Data from 343 COVID-19 patients were analysed. Two distinct phenotypes 1 and 2, comprising 68.46 % and 31.54% patients respectively, were identified. The phenotype 2 patients were characterized by increased coagulopathy markers (D-dimer, median value 1.73 ng/L vs 0.94 ng/L, p <0.001), end-organ dysfunction (creatinine, median 79 umol/L vs 69.5 umol/L, p <0.003), under-perfusion marker (lactate, median value 1.60 mmol/L, vs 1.20 mmol/L, p <0.001), abnormal cardiac function markers (median N‐terminal pro‐brain natriuretic peptide (NT-proBNP) 314 pg/ml vs 63.5 pg/ml, p <0.001 and median high‐sensitivity cardiac troponin (Hs-TropT) 39 ng/l vs 12 ng/ l, p<0.001) and acute inflammatory syndrome (median neutrophil-to-lymphocyte ratio 15.08 vs value 8.68, p <0.001 and monocyte, median value 0.68 × 109/L vs 0.45 × 109/L, p <0.001). Females in class 2 had lower mean haemoglobin levels than females in class 1 (11.88g/dL vs 12.67g/dL, p = 0.014). In a sub-analysis, mortality and survival were characterized in two sub-phenotypes with increased acute inflammatory syndrome, under-perfusion, end-organ dysfunction, and cardiac function markers in sub-phenotype 2. The identification of COVID-19 phenotypes and sub-phenotypes among ICU patients could be used as prognostic markers in day-to-day management of patients. Future studies are required in sub-Sahara Africa to elucidate pathophysiological mechanisms underlying these phenotypes. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. 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.)

Cardiac Biomarkers in 2022 - A Vital Tool for Emergency Care

The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.

The covid 19 pandemic and the challenge of growing up in children with congenital heart defects and adolescents

Background and Aim: The WHO recommends physical activity (PA-60 min/day) for children and adolescents, also having chronic diseases (CCD). Studies have shown that children and adolescents with congenital heart defects (CHD) exercise regularly and PA can be influenced by health programs (e.g. kidsTUMove). Children and adolescents with/without CCD, are willing to achieve the guidelines recommended by the WHO. Likewise, studies show that life quality (HrQl) in CHD has equally good values than healthy controls. However, the covid 19 pandemic has an impact on children's, adolescents and young adults lives. The aim is to summarize the impact and its measures on healthy children as well as in CHD/CDD and point out possible solutions improving the health of the affected subjects. Method(s): A systematic review regarding HrQl, mental health and PA in children with/without CHD/CDD was conducted. In addition, data was collected at different times of the pandemic using questionnaires (kindl, Kidsscreen, WHO 5) regarding HrQl in children with/without CHD (age: 3-6, 8-16). A second survey was conducted in spring 2021 (age: 3-14) before and after a virtual sports camp (VIC). To have a glimps into adulthood HrQl data in student was evaluated in Dec 2020/Jan 2021. Result(s): The review shows a decrease in PA of children in relation to the COVID-19 pandemic. Mental health (stress, anxiety and depression) was also affected as well as increasing concerns and fears. Result first survey: summer-fall 2020: Age 3-6: HrQLsum20 79% +/- 8.89 vs. HrQLfall20 78.98% +/- 11.21;p gt;0.05;age 8-16 kidsscreen: HrQLsum20 51,63% +/- 7,64 vs. HrQLfall20 51,12% +/- 7,50. HrQl in healthy children remained constant, but HRQoLsum/fall20 in children with CHD was sig-nificant lower (plt;0.005). HrQLspring21 after VIC increased (HrQLpre21 74.50% +/- 11.34 vs HrQLpost21 80.13 % +/- 9.57;plt;0.05). Student WHO5 survey showed that 51.8% felt more burdened by second lockdown 2021. There was a significant worsening of study life balance since the onset of the pan-demic (plt;0.001). Conclusion(s): It is important to provide suitable offers to increase PA, HRQoL, and mental health to minimize adverse health outcomes and prevent future health problems in adulthood in CHD/CDD.

AORTIC STIFFNESS AND INDEXES OF DISEASE SEVERITY IN SUBJECTS WITH PREVIOUS COVID-19 PNEUMONIA: A FOLLOWUP STUDY

Objective: Up to date the possibility of a vascular damage due to COVID-19 pneumonia is a not clarified. We searched for relationships between the carotidfemoral pulse wave velocity (cfPWV) and clinical and biochemical markers of severity of the infectious disease, after hospital discharge, in a group of patients who had been admitted in care units. Design and method: In 69 subjects (age 58 ± 13 years, 36 males), previously admitted in hospital because of COVID-19 pneumonia, we evaluated at the time of hospital admission anthropometric parameters, blood pressure, history of arterial hypertension or other diseases, drugs, smoking and alcohol habit, physical activity level, and indexes of infectious disease severity, such as the SIMEU score, need for invasive oxygen delivery, PaO2, PaCo2, inflammatory markers such as white blood cells count, levels of proadrenomedulline (proADM), reactive C protein, procalcitonin, IL- 6, glomerular filtration rate (GFR), troponin, mioglobin, B natriuretic peptide. After an average 2 months follow-up the cf- PWV was measured. Results: At univariate analysis the cfPWV was significantly and positively related to age (r = 0.454, P < 0.001), body mass index (r = 0.436, P = 0.016), waist circumference (r = 0.345, P = 0.004), levels of plasma glucose (r = 0.430, P = 0.001), proADM (r = 0.456, P = 0.006), IL-6 (r = 0.280, P = 0.037), mioglobin (r = 0.443, P = 0.001) and inversely related to GFR (r = -0.289, P = 0.023). The cfPWV was higher in diabetics subjects than in non-diabetics (P = 0.011), and in patients who had needed invasive oxygen support (P = 0.044). There was no difference in cfPWV in patients with or without history of arterial hypertension or with different blood pressure levels at admission. At multivariate analysis the cfPWV was independently associated with invasive oxygen support (B = 0.168, P = 0.012), body mass index (B = 0.180, P = 0.001), waist circumference (B = 0.162, P = 0.002), GFR (B = 0.078, P = 0.008), and proADM levels (B = 0.161, P = 0.003). Conclusions: In patients who recovered from COVID-19 pneumonia the aortic stiffness is associated with severity of disease and levels of proADM, but not with history of hypertension. Patients with more higher proADM levels in acute phase of the infectious disease could need a longer follow-up evaluation of the CFPWV after the recovering from disease to search for long time vascular damage.

Contemporaneous Evaluation of Kawasaki Disease and Multi-system Inflammatory Syndrome in Children in Northern Virginia

Background. Multi-system inflammatory syndrome in children (MIS-C) can present like Kawasaki disease (KD). After Centers for Disease Control and Prevention guidance was issued in May 2020, we implemented local management strategies emphasizing limited laboratory work up of non-toxic children with suspected MIS-C or KD. We then re-evaluated our management recommendations to ensure appropriate resource utilization for children with MIS-C and KD. Methods. We identified MIS-C and KD cases via convenience sampling of Pediatric Infectious Diseases records at Inova Fairfax Medical Center from May 1, 2020 to February 28, 2021. Manual chart review extracted clinical points of interest and descriptive statistics compared cohorts. Oral changes included edema, erythema, cracking, or strawberry tongue. Abdominal symptoms included pain, emesis, and diarrhea. Respiratory symptoms included shortness of breath, tachypnea, cough, and need for mechanical ventilation. Musculoskeletal symptoms included pain and edema. Neurological symptoms included headache, dizziness, altered mental status, and irritability. Results. We identified 8 KD cases and 29 concurrent MIS-C cases. MIS-C cases tended to be older and have presenting abdominal symptoms (median age 8 years old versus 2 years old, p < 0.01) and hypotension (20 versus 0, p < 0.01), otherwise there was no difference in the frequency of oral changes, rash, conjunctivitis, musculoskeletal symptoms, or neurological symptoms. 7 KD cases and 8 MIS-C cases did not require intensive care. Patients with MIS-C who did not need intensive care still had a lower initial absolute lymphocyte count (ALC) (median 1275/μL, p < 0.01), lower initial platelet count (median 217/μL, p = 0.05), and higher initial C-reactive protein (CRP) (median 18.3 mg/dL, p = 0.06) compared to KD cases;other results were not different between the two cohorts. Conclusion. We observed differences in the initial ALC, platelet count, and CRP between KD and MIS-C cases not requiring intensive care, whereas other labs such as ferritin, troponin, B-natriuretic peptide, and initial echocardiograms did not significantly differ between the two cohorts. Thus, our diagnostic management recommending limited laboratory evaluation for non-toxic patients with suspected KD or MIS-C is reasonable.

Late-Breaking Basic Science Abstracts From the American Heart Association's Scientific Sessions 2021

The proceedings contain 34 papers. The topics discussed include: combinatorial maturation of patient stem cell-derived atrial cardiomyocytes unmasks mechanism of atrial fibrillation induced by NPPA gene mutation;the pathogenesis of Covid-19 myocardial injury: an immunohistochemical study of postmortem biopsies;mitochondrial optogenetic-mediated preconditioning protects cardiomyocytes from stress-induced injury;the aldose reductase inhibitor At-001 improves cardiac efficiency and decreases diastolic dysfunction in an animal model of diabetic cardiomyopathy: comparative and add-on studies versus SGLT-2 inhibition;cardiomyocyte specific deletion Of Trpv4 offers cardio-protection independent of cardiac fibrosis following pressure overload-induced hypertrophy;and sacubitril-valsartan protects against aortic aneurysm progression via regulating neprilysin-induced vascular smooth muscle cell apoptosis.

Multi-marker risk assessment in patients hospitalized with coronavirus disease-2019: Results from the American heart association covid-19 cardiovascular disease registry

Introduction: The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described. Methods: We analyzed data from pts hospitalized with COVID-19 in Jan to Nov, 2020 at 107 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry who had biomarker data for D-Dimer, CRP, ferritin, natriuretic peptides [NP], or cTn at admission. We assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a composite of CV death, myocarditis, AMI, HF, or ischemic stroke. cTn quintiles were indexed to the assay-specific 99 %ile ref limits. Multivariable logistic regression determined the relative prognostic performance of each biomarker. Results: 17,829 (83% of total) had admission values reported for at least 1 of the 5 key biomarkers (n= 2422 with values for all). Each biomarker revealed a gradient of mortality risk from Q1 to Q5: Ddimer 17-35%, CRP 11-30%, ferritin 11-29%, cTn 13-42%, and NPs 7-35% (p for each <0.001;Panel A). After adjustment for all biomarkers, the highest values (Q5) of NP, CRP, and cTn independently identified pts at greater odds of death (Panel B) and the highest values of NP, CRP, cTn and D-dimer identified greater odds of the CV composite. After further adjustment for clinical variables, Q5 values for NPs (OR:4.07, 95% CI: 2.40 to 6.92) and CRP (OR: 2.43, 95% CI:1.62 to 3.66) retained the strongest prognostic value for death;NP (OR:6.79, 95% CI: 3.56 to 12.94) and cTn (OR:4.44, 95% CI:2.75 to 7.18) were associated with the greatest odds of the CV composite. Conclusions: Among pts hospitalized with COVID-19, high levels of NPs, CRP and hsTn at the time of admission were associated with the greatest risk of death, independent of other biomarkers and clinical variables, whereas D-dimer and ferritin did not offer independent prognostic information for mortality.