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1.
NeuroQuantology ; 20(10):7528-7533, 2022.
Article in English | EMBASE | ID: covidwho-2067316

ABSTRACT

Background: The coronavirus disease 19 (COVID-19) is a highly transmittable and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China and spread around the world. Genomic analysis revealed that SARS-CoV-2 is phylogenetically related to severe acute respiratory syndrome-like (SARS-like) bat viruses, therefore bats could be the possible primary reservoir.The intermediate source of origin and transfer to humans is not known, however, the rapid human to human transfer has been confirmed widely. There is no clinically approved antiviral drug or vaccine available to be used against COVID-19. However, few broad-spectrum antiviral drugs have been evaluated against COVID-19 in clinical trials, resulted in clinical recovery.The liver, the largest internal organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. Several studies have shown a significant risk of mortality in patients with cirrhosis and in liver transplantation recipients.2, 3, 4 The severity of presentation and risk of mortality is more in patients with decompensated cirrhosis.5,6 COVID-19 had lead to a significant decrease in number of liver transplant surgeries being performed, which would lead to an increased wait list mortality in these patients.

2.
Chest ; 162(4):A1047, 2022.
Article in English | EMBASE | ID: covidwho-2060760

ABSTRACT

SESSION TITLE: Critical Thinking SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 09:15 am - 10:15 am INTRODUCTION: Cephalosporins have been known to cause hypo-prothrombinemia and prothrombin prolongation (1). The proposed mechanism of this coagulopathy is secondary to a N-methylthiotetrazole side chain interfering with vitamin-k metabolism (1). Current literature supporting the association between cefazolin and hypo-prothombinemia have only been reported through case reports. As cefazolin is a commonly used antibiotic, it is important that healthcare professionals are aware of its potential bleeding risk. We present a case of a 72 year old female with cefazolin-induced hypo-prothrombinemia. CASE PRESENTATION: A malnourished 72-year old female with a past medical history of recent methicillin-susceptible Staphyloccocus aureus (MSSA) bacteremia and COVID-19 pneumonia presented to the emergency department from a skilled nursing facility (SNF) due to shortness of breath. The patient was previously discharged to SNF to complete a 14 day course of IV cefazolin due to her MSSA bacteremia. On admission, vital signs were significant for a respiratory rate of 22 and a pulse oximetry reading of 78% on room air. Laboratory findings were significant for an elevated prothrombin time of >100 seconds, an INR >15, and a D-dimer of 42,344 ng/mlL. A computed tomography angiography (CTA) of the chest revealed a small segmental pulmonary embolus in the right lower lobe of the lung. The patient was started on a heparin drip, placed on a non-rebreather mask, and admitted to the ICU for closer monitoring. Infectious disease was consulted and cefazolin was discontinued. Due to the patient's risk of bleeding her heparin drip was stopped. It was decided not to reverse the patient's coagulopathy with vitamin K as there were no signs of an acute bleed in the setting of an acute pulmonary embolus. The patient was started on nafcillin in place of cefazolin. Four days after discontinuation of cefazolin, the patient's INR had trended down from >15 to 1.6 and she was started on Lovenox 1mg/kg for the treatment of her acute PE. DISCUSSION: Due to the timing of the discontinuation of cefazolin and the correction of the hypo-prothrombinemia, a clear association between the two can be made. It has been proposed that cefazolin's side chain, heterocyclic thiol, 2-methyl-1,3,4-thiadiazole-5-thiol (MTD), causes a similar reaction that other cephalosporins have on the metabolism of Vitamin K (2). This altered Vitamin K metabolism was also likely exacerbated due to the patient's malnourishment and likely depleted vitamin k reserves (2). CONCLUSIONS: Although rare, this case demonstrates the need for clinicians to be aware of the potential bleeding risk associated with cephalosporins and cefazolin in particular. In the future, routine monitoring of PT/INR levels may be recommended when initiating cephalosporins. Reference #1: Park GH, Kim S, Kim MS, Yu YM, Kim GH, Lee JS, Lee E. The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Oct 16;16(20):3937 Reference #2: Shearer, M. J., Bechtold, H., Andrassy, K., Koderisch, J., McCarthy, P. T., Trenk, D., Jähnchen, E., & Ritz, E. (1988). Mechanism of cephalosporin-induced hypoprothrombinemia: relation to cephalosporin side chain, vitamin K metabolism, and vitamin K status. Journal of clinical pharmacology, 28(1), 88–95 DISCLOSURES: no disclosure on file for John Abernathy;No relevant relationships by Ethan Goldberg No relevant relationships by Renee Miu No relevant relationships by Luis Osorio no disclosure on file for Satesh Saroop;no disclosure on file for Oliver Sevilla;no disclosure on file for Kristen Zubel;

3.
Chest ; 162(4):A750, 2022.
Article in English | EMBASE | ID: covidwho-2060681

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: There is a growing volume of evidence of extrapulmonary manifestations of Coronavirus disease 2019 (COVID-19), particularly within the cardiovascular and hematological systems. In this case, we describe a unique manifestation of a COVID-19 presenting with a hemorrhagic pericardial effusion and cardiac tamponade physiology with a supratherapeutic international normalized ratio (INR). CASE PRESENTATION: A 68-year-old male with coronary artery disease and atrial fibrillation on warfarin presented to the emergency department with acutely worsening shortness of breath. Upon arrival, he was hypotensive, tachypneic, and hypoxic. Physical exam findings included jugular venous distention and muffled heart sounds. A transthoracic echocardiogram demonstrated a large concentric pericardial effusion with tamponade physiology (Figure 1). Pertinent initial laboratory values included an elevated INR of 6.1, a prolonged prothrombin time of 61.2 seconds, and an elevated D-dimer level of 5.34 mg/L (Table 1). The prolonged INR was reversed with prothrombin complex concentrate (PCC). Emergent pericardiocentesis yielded 1.7L of dark-bloody appearing fluid. Pericardial fluid analysis (Table 1) demonstrated over 2.4 million red blood cells and 3,650 total nucleated cells with 94% lymphocytes. Cultures and cytology were unrevealing. Given the profound lymphocytic component, a COVID-19 nasal swab was obtained and resulted positive. Prior to contracting COVID-19, the patient's weekly INR levels were consistently at goal. DISCUSSION: The global pandemic of the COVID-19 continues to identify extrapulmonary manifestations of the disease. A rising number of publications have implicated COVID-19 with causing myocarditis, pericardial effusions, and hemorrhagic cardiac tamponade(1). Hemorrhagic cardiac effusions are typically seen with malignancy, tuberculosis, trauma, recent cardiac procedures, post-myocardial infarction, and are also seen in Coxsackie viral infections. Multiple studies implicate COVID-19 interactions with oral-vitamin K antagonists as the cause of unpredictable INR's which can lead to spontaneous bleeding2. There are fewer than 10 reported instances of hemorrhagic pericardial effusions with tamponade physiology in COVID-19 patients;however, none of the other cases presented with a super-therapeutic INR. We are also the first to demonstrate a primary lymphocytic component of the pericardial fluid suggesting viral etiology. Profound coagulopathies in COVID-19 result in an increased mortality(3). CONCLUSIONS: We propose that based on the increase in publications of case-reports describing COVID-19 viral infections and hemorrhagic pericardial effusions, that SARS-CoV-2 should be added to the list of known viral etiologies. Further, COVID-19 patients who are systemic anticoagulation with vitamin K antagonists should be monitored closely for abrupt changes in their INR. Reference #1: 1. Gupta A, Madhavan MV, Sehgal K, et al. Extrapulmonary manifestations of COVID-19. Nature Medicine. 2020;26(7):1017-1032. Reference #2: 2. Camilleri E, Van Rein N, Van Der Meer FJM, Nierman MC, Lijfering WM, Cannegieter SC. Stability of vitamin K antagonist anticoagulation after COVID-19 diagnosis. Research and Practice in Thrombosis and Haemostasis. 2021;5(7) Reference #3: 3. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020;18(4):844-847. DISCLOSURES: No relevant relationships by Gregory Hicks No relevant relationships by Daniel Kissau No relevant relationships by Andrew Labelle No relevant relationships by Scott Mayer No relevant relationships by Dmitriy Scherbak

4.
Sens Actuators B Chem ; 373: 132638, 2022 Dec 15.
Article in English | MEDLINE | ID: covidwho-2031689

ABSTRACT

Stratifying patients according to disease severity has been a major hurdle during the COVID-19 pandemic. This usually requires evaluating the levels of several biomarkers, which may be cumbersome when rapid decisions are required. In this manuscript we show that a single nanoparticle aggregation test can be used to distinguish patients that require intensive care from those that have already been discharged from the intensive care unit (ICU). It consists of diluting a platelet-free plasma sample and then adding gold nanoparticles. The nanoparticles aggregate to a larger extent when the samples are obtained from a patient in the ICU. This changes the color of the colloidal suspension, which can be evaluated by measuring the pixel intensity of a photograph. Although the exact factor or combination of factors behind the different aggregation behavior is unknown, control experiments demonstrate that the presence of proteins in the samples is crucial for the test to work. Principal component analysis demonstrates that the test result is highly correlated to biomarkers of prognosis and inflammation that are commonly used to evaluate the severity of COVID-19 patients. The results shown here pave the way to develop nanoparticle aggregation assays that classify COVID-19 patients according to disease severity, which could be useful to de-escalate care safely and make a better use of hospital resources.

5.
Annals of the Rheumatic Diseases ; 81:1859-1860, 2022.
Article in English | EMBASE | ID: covidwho-2008919

ABSTRACT

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy characterized by microangio-pathic haemolytic anemia, consumption thrombocytopenia and organ injury, particularly kidney failure and neurological manifestation1. Two forms are distinguished: the hereditary one, caused by a deficit of the metallopro-tease ADAMTS13, and the idiopathic one characterized by the presence of antibodies directed against ADAMTS13. The second one is the most common. There are various subgroups of acquired TTP associated with HIV infection, sepsis, pregnancy, autoimmune disease, disseminated malignancies and drugs. Antiphospholipid syndrome (APS) is a clinical immunological condition characterized by thromboembolic events, repe-tead miscarriages or stillbirth and thrombocytopenia;it can be a primary disorder or due to connective tissue disease, in particular systemic lupus erythematosus2. Objectives: We describe a case of TTP associated with a primary APS. The real clinical challenge lies in the differential diagnosis between TTP and anti-phos-pholipid antibody syndrome. Methods: A 37-year-old man presented to the emergency department for short-term episodes of anesthesia of the right upper limb and face with spontaneous resolution. In his past medical history, he suffered of antiphospholipid syndrome treated with warfarin. Upon admission, blood tests revealed severe thrombocytopenia, haemolytic anemia with schistocytes on peripheral blood smear, low thrombin time and prolongation in the prothrombin time. Neurological symptoms were assessed by electroencephalogram and CT brain, resulted negative, while a brain MRI revealed acute-subacute ischemic stroke. Based on these fndings we suspected a diagnosis of TTP, subsequently confrmed by reduced activity of ADAMTS-13 with borderline ADAMTS-13 inhibitory antibodies. Immunological testing confrmed positivity of antiphospholipid antibodies and antinuclear antibodies. Results: According to the last guidelines3 about management of acute episode of TTP, immediate therapy with high-dose corticosteroids (prednisone 1 mg/kg) and plasmapheresis was started and then we added infusion of ritux-imab (375 mg/m2/week for 4 times). Efficacy of treatment was evaluated by weekly dosage of ADAMTS13 activity, with a gradual rise in values (3 → 78%) and improvement in symptoms and laboratory examination. After persistent remission, we gradually reduced steroid therapy. Few months later, in February 2021, patient developed a bilateral comunitary pneumonia, that required hospitalization, oxygen-therapy (also with C-PAP) and endovenous antibiotics. After two weeks patient was discharged from hospital in good clinical health and he was subjected to periodic outpatients visits. Disease activity was in remission, so steroid therapy was reduced and recently we added hydroxychloroquine for APS. Some days ago patient developed covid-19 infection, despite vaccination, and he was treated with monoclonal antibodies, with good clinical response. Conclusion: We have described a rare clinical case of TTP, despite concomitant warfarin treatment for primary anti-phospholipid syndrome. A careful follow-up of these medical conditions is recommended for patient's fragility and for the risk of related serious clinical complications.

6.
International Journal of Pharmaceutical and Clinical Research ; 14(8):316-323, 2022.
Article in English | EMBASE | ID: covidwho-2003201

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the novel coronavirus SARS-CoV2, causing an enormous strain on the already burdened healthcare systems. The clinical course of COVID-19 is variable;those with a poor prognosis tend to develop severe viral pneumonia requiring ventilator support and intensive care unit (ICU) admission. Aim & Objectives: The aim of this study is to correlate the Cycle Threshold (Ct) score of RT-PCR reaction with different biomarkers like White cell count (WCC), Neutrophils%, Lymphocytes%, Monocytes%, Neutrophil-Lymphocyte ratio(NLR), Lymphocyte – Monocyte ratio (LMR), Platelet count, Prothrombin time(PT), Interleukin 6(IL-6), C-Reactive protein (CRP), Blood sugar level(BSL) .Thus enabling if a low Ct score can help early identification of patients at a high risk to progress to a severe disease. Method: A prospective analytical study conducted at a tertiary care hospital, included 114 severe COVID-19 positive patients, admitted in ICU. The medical history, comorbidities, clinical findings, and laboratory data of each patient were obtained with data analyzed to identify and correlate significant laboratory parameters leading to the severe outcome. Results: Total 114 patients were studied. The mean age of the study population was 59 years with a male predominance. Significant positive correlation of Ct values was seen with Total WBC counts (p=0.004), Neutrophil % (p=0.001), NLR (p<0.001), IL-6 (p=0.010), Procalcitonin (p=0.015) and D-dimer (p=0.041). Significant negative correlation of Ct value with Lymphocyte % (p=0.001) and monocyte % (p<0.001). And no significant correlation was seen with Age, Gender, LMR, CRP, Platelet counts, Prothrombin time and Blood Sugar levels. Conclusion: It is known that biomarkers help in identifying the disease severity and mortality and help in proper diagnosis and patient treatment. Ct scores can be used as a surrogate marker of disease severity, although further studies are required to validate the same.

7.
EJVES Vascular Forum ; 54:e11-e12, 2022.
Article in English | EMBASE | ID: covidwho-1982964

ABSTRACT

Introduction: The lack of a history of the course of a new coronavirus infection and the lack of data from randomised trials makes it difficult to choose the right treatment tactics and prescribe adequate prophylaxis in patients who have suffered from COVID-19. Comorbid patients with cardiovascular diseases and endothelial dysfunction have a high risk of a severe course of COVID-19 and subsequent thrombotic complications, which manifest clinically as cardiomyopathy;venous thrombo-embolism (deep vein thrombosis and pulmonary embolism);pulmonary thrombosis in situ;stroke;arterial thrombangiitis;rarely, arterial peripheral thrombosis and microvascular thrombosis, in the lungs, liver, kidneys, brain, etc.;and mild disseminated intravascular coagulation syndrome. The role of endothelial dysfunction in the development of severe complications is underestimated. In the pathogenesis of COVID-19, the defeat of the microcirculatory bed plays a crucial role. The SARS-CoV-2 virus causes associated endotheliitis damage to the endothelium due to virus entry and cytokine storm. Endotheliitis leads to the release of tissue factor, which leads to the formation of an excess of thrombin and fibrin;the body tries to cover the virus with these and prevent its spread, which entails negative side effect such as thrombosis Methods: Sixty-six patients who had COVID-19 were examined (42 women and 24 men;mean age 48 years [range 20 – 80 years]). Patients complained of a feeling of paraesthesia, mainly in the lower extremities, a feeling of heaviness, stiffness in the popliteal region, an increased vascular pattern on the entire surface of the skin, a burning sensation in all vessels, and a feeling of weakness. Ultrasound colour duplex scanning showed no signs of thrombosis in the large vessels. Using a high frequency ultrasound Doppler and a 25 MHz sensor, the nailbed of the first finger of the upper limb was examined. The microcirculatory images were analysed by the shape and spectrum of the curves. Twenty patients received prophylaxis with rivaroxaban 10 mg daily (group 1) and 46 patients did not (group 2). The control examination was carried out four weeks after the start of therapy: sulodexide one capsule twice daily. The coagulogram parameters were also studied. Results: A depletion in spectral characteristics was seen in patients after COVID-19 disease, in comparison to microcirculatory images recorded in healthy individuals. Predominantly, the red part of the spectrum was recorded in patients after COVID-19, the lighter part of the spectrum was not recorded. Group 1 patients had higher amplitude parameters than group 2, but they also registered a depletion in spectral characteristics. Soluble fibrin monomer complexes were increased 4 – 5 times, D-dimer 2 – 2.5 times, and antithrombin III 1.5 times. The international normalised ratio, activated partial thromboplastin time, fibrinogen, prothrombin according to Quick, prothrombin time, clotting time, and bleeding time were within the reference intervals both before and after treatment. Upon repeat examination four weeks after the course of sulodexide therapy, the spectral characteristics were normalised, and the coagulogram parameters were also normalised. Conclusion: The red part of the spectrum, according to the Doppler criteria, corresponds to the fastest particles moving in the middle of the stream. The lighter part of the spectrum corresponds to particles moving more slowly. The reduction in spectral characteristics in patients after COVID-19 disease corresponds to parietal stasis and readiness for thrombosis, which was confirmed by the coagulogram data. Examination of the nailbed using high frequency ultrasound Doppler in patients who have COVID-19 allows the identification of stasis of the parietal blood flow, which corresponds to a prethrombotic state. The prescription of sulodexide allows for an improvement in the condition of patients and normalisation of microcirculation indicators

8.
Journal of the Nepal Medical Association ; 60(252):727-731, 2022.
Article in English | EMBASE | ID: covidwho-1979940

ABSTRACT

The in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms.

9.
Latin American Journal of Pharmacy ; 41(2):357-363, 2022.
Article in English | EMBASE | ID: covidwho-1976051

ABSTRACT

The relevance of coagulation malfunction in COVID-19 (severe coronavirus disease) is ambiguous. Current study aimed to assess the coagulation among SARS-CoV-2 hospitalized patients. A cross sectional study with qualitative approach was conducted among 300 patients who are already diagnosed as COVID 19 compared to 300 apparently healthy control group attended to Red Sea State during study period from April 2020 to April 2021. The Humaclot Due Plus1 coagulation analyser was used to estimate the prothrombin time (PT), activated partial prothrombin time (APTT), and international normalized ratio (INR) (Wiesbaden 1, Germany), adding 25 μL of plasma in cuvette. The study result showed that in COVID-19 patients D.dimer level is high (2000-10000 ng/mL) compared with control group (up to 500 ng/mL). COVID-19 infection cause high D. dimer level which can lead to thrombosis event or bleeding tendency. Abnormal coagulation results were revealed among SARS-CoV-2, with markedly elevated D. dimer.

10.
Open Access Macedonian Journal of Medical Sciences ; 10:1113-1117, 2022.
Article in English | EMBASE | ID: covidwho-1969580

ABSTRACT

BACKGROUND: Coronavirus disease-2019 (COVID-19) has various symptoms ranging from mild to critical. Hypercoagulation state is often observed in severe and critical COVID-19. Both coagulation and inflammation are interrelated and amplifying each other, with protein C and antithrombin (AT) III as two important mediators. AIM: The aim of the study was to determine the association between protein C and AT III levels with the severity of COVID-19 symptoms. METHODS: This analytical study was conducted at Haji Adam Malik Hospital from April to July 2021. Subjects were obtained by consecutive sampling method. Inclusion criteria were patients with confirmed COVID-19 using reverse transcription polymerase chain reaction and willing to participate. Subjects were divided into two groups: Mild-moderate and severe-critical symptom groups. Demographic and blood sample was obtained from each subject. Blood samples underwent examination for leukocyte, thrombocyte, PT, aPTT, protein C, and AT III. RESULTS: A total of 50 patients were obtained with female domination (58%) and mean age of 41.44 (standard deviation 20.90) years. Most subjects (86%) were in mild-to-moderate symptom group. There were significant differences in the level of protein C and AT III in both group (p = 0.029 and 0.034, respectively). Using the cutoff value for AT III of 45.6%, subjects who had mediator level below the value tend to develop severe and critical symptoms compared to their counterparts (odds ratio = 6.458). CONCLUSION: AT III is associated with severity of COVID-19 symptoms. Lower AT III level increases the risk for developing severe and critical symptoms.

11.
Open Access Macedonian Journal of Medical Sciences ; 10(B):1097-1101, 2022.
Article in English | EMBASE | ID: covidwho-1969578

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a viral pneumonia that spreads rapidly globally and was designated a pandemic by the World Health Organization (WHO). The number of cases has exceeded 15,000,000 worldwide, and the disease carries a mortality rate of ± 4%. One of the complications of COVID-19 is the incidence of coagulopathy and thromboembolism. The coronavirus (SARS-CoV-2) activates inflammatory and thrombotic processes, and the presence of coagulopathy and abnormal coagulation parameters is among the most significant biomarkers for poor prognosis in COVID-19 patients. COVID-19-associated coagulopathy is characterized by a decreased platelet count and the presence of a cytokine storm, indicating an extreme hypercoagulable state. AIM: This study aims to determine the coagulation profile and outcomes of patients with moderate-severe COVID-19. METHODS: This study was conducted in Wahidin Sudirohusodo Hospital. Medical record data were included for all inpatients diagnosed with COVID-19 using the RT-PCR test, from January 2021 to August 2021. The Kolmogorov– Smirnov normality test, Chi-squared test, odds ratio (OR), Mann–Whitney U-test, and independent t-test were used for statistical analysis. Multivariate analysis was carried out using the multiple logistic regression – backward Wald method. p < 0.05 was taken as statistically significant. RESULTS: A total of 231 patients with confirmed COVID-19 were included in this study. The mean prothrombin time (PT), D-dimer, and fibrinogen were higher in severe COVID-19 patients than in moderate patients and had significant results. Platelet (PLT) levels were not found to be significant in moderate-severe COVID-19. The relationship between groups of coagulation marker variables was found to be significantly associated with moderate-severe COVID-19. All coagulation markers were significantly related to patient outcome (p < 0.05). The mean value of each variable was found to be higher in patients who died than in those with better outcomes. CONCLUSION: An increase in PT, activated partial thromboplastin time (APTT), and fibrinogen is associated with mortality in patients with moderate COVID-19. In patients with severe COVID-19, mortality is associated with increased PT. PT is, therefore, a coagulation marker that is significantly related to COVID-19 outcome.

12.
Klimik Dergisi ; 35(2):68-73, 2022.
Article in Turkish | EMBASE | ID: covidwho-1929120

ABSTRACT

Objective: COVID-19 infection causes severe pneumonia and multi-organ failure in adults, increases morbidity and mortality. Our study aimed to determine the factors affecting intensive care unit admission and mortality in hospitalized COVID-19 patients. Methods: The demographic, clinical, and laboratory data of hospitalized patients due to COVID-19 between May 1, 2020 and August 1, 2020 were evaluated retrospectively. Patients who were admitted to the intensive care unit or died during follow-up were included in the study group, and patients who were followed in the inpatient settings and sur-vived consisted the control group. The data obtained at the time of hospitalization were evaluated statistically. Results: A total of 473 patients were included in the study. The median age of the patients was 53 years (40-68 years), and 269 (56.9%) were male. During the follow-up, 93(19.7%) patients were admitted to the intensive care unit (ICU). Of the 468 patients for whom follow-up data were available, 62(13.2%) patients died. Patients with older age and comorbid diseases had higher ICU admission and mortality rates (p<0.001 and p<0.001). ICU admission rate was higher in patients with cough (p=0.002), myalgia (p=0.016), and dyspnea (p<0.001) during hospital admission. At the same time, dyspnea was more common in patients who died (p<0.001), and myalgia was more common in surviving patients (p=0.020). Laboratory values associated with both ICU admission and mortality were glucose (p<0.001, p<0.001), AST (p<0.001, p<0.001), serum creatinine (p<0.001, p<0.001), direct bilirubin (p<0.001, p=0.009), albumin (p<0.001, p<0.001), CRP (C-reactive protein) (p<0.001, p<0.001), procalcitonin (p<0.001, p<0.001), leukocyte count (p<0.001, p<0.001), lymphocyte count (p<0.001, p<0.001), neutrophil count (p=0.007, p<0.001), hemoglobin (p<0.001, p<0.001), troponin (p<0.001, p<0.001), D-dimer (p<0.001, p<0.001), ferritin (p<0.001, p<0.001), prothrombin time (p<0.001, p<0.001) and INR (international normalized ratio) (p<0.001, p<0.001) levels. Conclusions: Determining the parameters that define high-risk COVID-19 infected patients in the early period can contribute to reduce ICU admissions and mortality by improving patient management and resource utilization in hospitals.

13.
Journal of Clinical and Diagnostic Research ; 16(6):BC12-BC16, 2022.
Article in English | EMBASE | ID: covidwho-1918104

ABSTRACT

group and non diabetic control group. Data was presented as Introduction: Since the end of 2019, a novel Coronavirus percentages for categorical variables and median (interquartile Disease 2019 (COVID-19), declared a pandemic by World Health range) for continuous variables. Chi-square test was used to see Organization (WHO) has ravaged the world. Diabetic patients the association of different qualitative information and Mann-have been reported to be more susceptible to intensive care Whitney U test was used to see the association of quantitative admissions, and deaths due to COVID-19. Diabetes Mellitus data and all p-values were given for justification. A p-value <0.05 (DM) and COVID-19, both associated with chronic and acute was considered statistically significant. inflammation respectively can impact each other in terms of Results: The sample included 300 diabetic and 200 non diabetic clinical progression and outcome. Given the novelty of Severe COVID-19 patients. The mean age non diabetic patients (47.5 Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) years) was significantly less as compared to the diabetic group pathogen, there is need to update and increase the limited (54.5 years), p-value <0.001. The serum level of inflammatory evidence on the probability of DM acting as a risk factor and biomarkers, C-Reactive Protein (CRP), ferritin, and markers of influencing disease severity and progression. hypercoagulable state, D-dimer, was found to be significantly high Aim: To compare the markers of inflammation and coagulation (p-value <0.001) in diabetic patients as compared to non diabetic dysfunction between COVID-19 patients with and without DM patients. Diabetics had a poor prognosis with 231 (77%) receiving as co-morbidity and thereby to study the effect DM has on the oxygen as compared to 51 (25.5%) of non diabetic patients. Total prognosis of COVID-19. 173 (57.7%) of diabetic COVID-19 patients had to be shifted to Materials and Methods: This was a retrospective, observational, ICU, 201 (67%) suffered from post COVID-19 complications and single-centre study, conducted Department of Biochemistry at the mortality rate was higher at 18% in diabetics as compared to Gauhati Medical College and Hospital, Guwahati, Assam, India, 1.5% in non diabetic subjects. from January 2021 to June 2021. Clinical and laboratory data Conclusion: Diabetic patients are at higher risk of uncontrolled of 500 laboratory confirmed COVID-19 patients were reviewed inflammation and hypercoagulable state which eventually leads in this study. The patients were grouped as diabetic case to deterioration of COVID-19 infection status.

14.
Nephrology Dialysis Transplantation ; 37(SUPPL 3):i61-i62, 2022.
Article in English | EMBASE | ID: covidwho-1915660

ABSTRACT

BACKGROUND AND AIMS: Renal manifestations are common in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report here the case of a patient with confirmed SARS-CoV-2 infection with the clinical picture of atypical haemolytic uremic syndrome (aHUS). METHOD: Case report RESULTS: Our case is a 31-year-old man with a nasopharyngeal swab with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 positive, who was hospitalized in the Clinic of Infectious Diseases. His medical history had a respiratory illness of 7-day evolution characterized by cough, fever, dyspnoea, muscle pain, nausea, vomiting and non-bloody diarrhoea, and decreased urine output with dark colour urine. The chest computed tomography (CT) scan showed few rounded ground-glass opacities. Laboratory tests at admission revealed the following: (i) acute kidney injury stage 3 with a serum creatinine of 3.85 mg/dL (basal value 0.9 mg/dL);serum urea 221 mg/dL. His urinary volume in the first 24 h of hospitalization was 800 mL. (ii) Severe haemolytic anaemia with haemoglobin (Hgb) level of 3.7 g/dL, and peripheral smear showing large number of schistocytes, haptoglobin <10 mg/dL and indirect bilirubin 9.7 mg/dL, direct coombs testing was negative;reticulocyte count 8.9%. (iii) Severe thrombocytopaenia with platelet count of 25 000/μL, prothrombin time 45%, international normalized ratio 1.7, D-dimer 1082 ng/dL and fibrinogen 880 mg/dL. Increased blood levels of enzymes and inflammatory markers were present: lactate dehydrogenase 1867 U/L and protein C reactive 9.1 mg/dL. Electrolyte disturbances characterized by hyperkalaemia, hyperphosphatemia, hypocalcaemia and severe metabolic acidosis. Dynamic changes of laboratory data are presented in Table 1. The usual liver panel tests, alkaline phosphatase, γ -glutamyl transferase and albuminemia were normal. Toxic hepatitis was excluded. Hepatobiliary and spleen imaging (ultrasonography) was normal. ELISA serologic tests for HIV, hepatitis B, hepatitis C virus and cytomegalovirus were negative. Serological and virological tests for hepatitis A, B, C, HIV and CMV were negative. Stool was negative for Shiga toxin-producing Escherichia coli (STEC). The results of antinuclear antibodies and anti-smooth-muscle antibodies were negative, C3 serum level was mildly depressed (82 mg/dL;normal range 88- 201 mg/dL) and C4 serum level was normal (20 mg/dL;normal range 10-44 mg/dL). ADAMTS13 activity was 90% on day 10. He was treated with broad spectrum antibiotics, intravenous dexamethasone and supportive therapy. One week from admission, renal function recovered, and 1 week after intravascular haemolysis and thrombocytopaenia recovered. The patient was hospitalized for 21 days. CONCLUSION: Close monitoring and early intervention can help for a better outcome of SARS-CoV-2 patients complicated with aHUS.

15.
Italian Journal of Medicine ; 16(SUPPL 1):49-50, 2022.
Article in English | EMBASE | ID: covidwho-1913264

ABSTRACT

Background: Infections, drugs, surgical procedures, blood transfusions, solid and hematological cancers, and autoimmune disorders are associated with the risk of developing acquired FV inhibitors. Case report presentation: A 66-year-old Caucasian woman presented to the Emergency Department because of recurrent episodes of bowel bleeding from 2 week, and bleeding from the sites of venous sampling. Coagulation tests showed that the platelet count was normal: prolonged prothrombin time (PT): 45.5 seconds, international normalized ratio: 4.03, and activated partial thromboplastin time (aPTT): 165 seconds, aPTT ratio: 5.4. Coagulation factor II (FII), factor X (FX), factor VIII (FVIII), and fibrinogen were normal. The FV activity was 0.2% (range of normality 60-120%). The PT, aPTT, and one-stage coagulation factors assays were performed using an ACL TOP 550 coagulometer, and factor V was determined using a onestage PT-based assay, and factor V-deficient substrate plasma. Anticardiolipin antibodies were negative. Mixing test of patient's plasma with normal pooled plasma revealed the existence of an FV inhibitor, with an activity level of 4.0 Bethesda unit/mL. Three weeks before, the patient had been treated for coronavirus disease 2019 (COVID- 19) at home, with steroids (dexamethasone 6 mg daily for 5 days), enoxaparin 4,000 IU daily, and oxygen. Conclusions: The Authors presented a case report with acquired factor V inhibitor after SARS-CoV2 disease.

16.
ASAIO Journal ; 68(SUPPL 1):6, 2022.
Article in English | EMBASE | ID: covidwho-1912996

ABSTRACT

Introduction: Management of coagulation remains the foremost challenge during extracorporeal life support (ECLS). Thromboelastography (TEG) and other viscoelastic clotting tests have shown utility for assessing coagulation status in trauma and ECLS patients and have also been utilized in COVID 19 patients. However, with few exceptions, these methods are performed in a laboratory setting, not at the bedside, and rely on cumbersome, non-portable equipment. The Viscoelastic Coagulation Monitor (VCM;Entegrion;Durham, NC) is a portable device/test developed for use at the bedside and outside hospitals to assess clot formation and lysis using a small sample of whole blood. Blood coagulation is activated by contact with the glass surface on the cartridge, and measurements are derived pertaining to clot formation, stability, and lysis - similar to metrics obtained by the TEG 5000 (Haemonetics;Boston, MA). In a recent study, the relationship of VCM results and heparin dose administered in 36 COVID-19 patients was investigated;however, use of VCM for ECLS with application of heparinase has not been reported. We investigated efficacy of the VCM for coagulation monitoring during 72 hours of continuous ECLS in swine and hypothesized that the VCM with heparinase correlates with TEG heparinase. Methods: Female Yorkshire swine (n=3, 53.4±1.6kg) were anesthetized, mechanically ventilated, and systemically heparinized. Blood samples were collected at baseline, post ECLS, 6, 24, 48, and 72-hours post ECLS initiation. For the VCM, 350μL of whole blood was added to a 0.05 IU heparinase vial, mixed, and then added to a VCM cartridge. For TEG, 340μL of citrated whole blood was added to 20μL 0.2 M CaCl2, and samples were activated with a kaolin reagent. Heparinase cups (Haemonetics;Boston, MA) were used for testing. Spearman correlation was performed to compare standard VCM metrics (clotting time [CT], clot formation time [CFT], alpha, maximum clot firmness [MCF], clot retraction/fibrinolysis [LI30]) to the respective TEG metrics (reaction time [R], clot formation time [K], alpha, maximum amplitude [MA], clot retraction/fibrinolysis [LY30]), and also to other conventional coagulation measurements such as prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FIB), and platelet count (PLT) for each timepoint. A p-value of 0.05 was used for significance. Results: All VCM metrics significantly correlated with the respective TEG measurements (see Table 1). Both VCM and TEG show the same positive and negative correlation relationships for clot formation time, clot kinetics, and clot retraction with conventional coagulation tests (see Table 2). Additionally, clotting time and maximum clot firmness did not show moderate or significant correlation with conventional tests. Prothrombin time did not correlate with any values. Conclusion: The VCM is comparable to TEG in assessing coagulation status in heparinized swine and can be used during austere care with ECLS application. In the next round of experiments, we will validate the VCM in clinically-relevant trauma with and without ECLS.

17.
Journal of Experimental and Clinical Medicine (Turkey) ; 39(1):232-236, 2022.
Article in English | EMBASE | ID: covidwho-1897395

ABSTRACT

Covid-19 is a viral infection have a high pathogencitity and contagiousness that primarily targets the human respiratory system and leading to a global pandemic. Abnormal coagulation parameters are quite common in Covid-19 patients. In our study, we aimed to evaluate the relationship between coagulation function with disease severity and survival status in Covid-19 patients and the prognostic, predictive value of these parameters. Results of prothrombin time (PT), activated partial thromboplastin time (aPTT), Fibrinogen, and D-Dimer parameters at admission time of 76 Covid-19 negative healthy control with 188 confirmed Covid-19 patients, as well as death events were retrospectively analyzed. Compared with the healthy control group, higher levels of D-Dimer, PT, aPTT, fibrinogen, and CRP (p <0.001 for each) were present during admission in Covid- 19 patients. The non-survivor group had higher levels of PT, D-Dimer, and CRP (p <0.001 for each) and aPTT (p =0.004), fibrinogen (p =0.019) compared to the survivor group. 28 (14.89%) of 188 Covid-19 patients lost their lives. Analysis of the ROC curve revealed that D-Dimer, Fibrinogen, PT, aPTT, and CRP had high diagnostic value in distinguishing Covid-19 patients from healthy control group, the critical group from the severe group, and non-survivors from survivors. This study shows that coagulation function is significantly impaired in patients with Covid-19 infection compared to normal patients, and as particularly marked high levels of D-Dimer, PT, aPTT, fibrinogen, and CRP are common. This condition is associated with disease severity and increased mortality. Coagulation parameters are an effective and useful marker for assessing prognosis and for the management of Covid-19 patients.

18.
Clinica Chimica Acta ; 530:S183-S184, 2022.
Article in English | EMBASE | ID: covidwho-1885655

ABSTRACT

Background-aim: Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is not well known. Methods: Retrospective cohort study including 84 patients, during 16 months, divided into two groups: patients with severe SARS-Cov-2 pneumonia (group 1, N=42) and patients with severe non-COVID-19 pneumonia (group 2, N=42). We evaluated coagulation standard parameters (hemoglobin, platelet count and conventional laboratory coagulation tests) in group 1 vs group 2 and coagulation standard parameters on day of admission (T0) and 10 (T10) days after admission to ICU and coagulation function using rotational thromboelastometry (ROTEM) in patients with severe SARS-Cov-2 pneumonia. Results: 84 patients were enrolled into the study. Similar results in conventional laboratory coagulation tests were detected in group 1 and group 2: prothrombin time (15.14s vs 14.76s, p=0.212), international normalized ratio (1.21 vs 1.19, p=0.112), activated partial thromboplastin time (32.17s vs 25.52s, p=0.06), fibrinogen level (6.15 mg/dl vs 3.39 mg/dl, p=0.208), hemoglobin (11.81 g/dl vs 11.20 g/dl, p=0.139) and platelet count (208.98x103/ul vs 288.74 x103/ul, p=0.123). However, a statistically significant difference was observed in the D-dimer count (2442.11 ng/ml vs 370 ng/ml, p=0.03). In addition, statistically significant increase in D-dimer count during Intensive Care Unit (ICU) stay (T0=2442.11 ng/ml vs T10=8564.39 ng/ml, p=0.000) in group 1 were detected. Finally, blood thromboelastometry profiles were consistent with hypercoagulability characterized by higher clot strength (MCF or maximum clot firmness close to upper limit in FIBTEM test, MCF median value= 25.9 mm). Clotting time presented normal results in INTEM (163.41 s) and EXTEM (68.74 s). No sign of secondary hyperfibrinolysis were found during the study period. In six patients a deep vein thrombosis and in six patients a thromboembolic event. Eighteen patients (43%) died during hospitalization due to coagulopathy produced by SARS-Cov-2 pneumonia. Conclusions: The results observed in our study support hypercoagulability in a severe inflammatory state, rather than a Consumption Coagulopathy (DIC) state. More studies are needed to better understanding of coagulopathy produced in patients with severe COVID-19 pneumonia.

19.
US Oncology and Hematology Review ; 18(1):78-87, 2022.
Article in English | EMBASE | ID: covidwho-1879950

ABSTRACT

Introduction: Since the onset of the SARS-CoV-2 pandemic, haematological laboratory abnormalities and thrombotic complications have been observed among infected patients. We aimed to highlight key pathophysiological mechanisms of COVID-19-associated coagulopathy and to summarize incidence rates of venous and arterial thrombotic events, comorbidities conferring risk, and current treatment guidelines including data from ongoing clinical trials. Methods: A systematic review was performed according to PRISMA recommendations of case–control studies, cohort studies, observational studies and randomized clinical trials (RCTs) published between 1 December 2019 and 30 September 2021 within PubMed and Web of Science. Inclusion criteria were English language, adult patients and at least one coagulation parameter described. Results: 2,554 records were screened, from which 59 studies were included. Abnormalities in several laboratory parameters were associated with worse clinical outcomes including elevations in prothrombin time, activated partial thromboplastin time, D-dimer, fibrinogen, von Willebrand factor antigen/activity and lupus anticoagulant antibodies. Rates of venous and arterial thromboembolism varied significantly among studies performed early in the pandemic and across different nations. Pathophysiological mechanisms included vascular endotheliopathy, increased inflammation and macrophage activation, neutrophil extracellular traps, antiphospholipid antibody production and obesity/adipose tissue signalling. Current recommendations for management of COVID coagulopathy from various societies include the use and dosing of systemic anticoagulation to prevent thrombotic sequelae in the outpatient, inpatient and critical care settings. The optimal anticoagulant dose for thromboprophylaxis in the inpatient and critical care settings is currently not well established. Conclusions: SARS-CoV-2 infection can cause a distinct form of coagulopathy, with thromboembolic complications leading to significant morbidity and mortality. The optimal treatment requires further refinement pending the results from key ongoing RCTs.

20.
European Journal of Inflammation ; 17, 2022.
Article in English | EMBASE | ID: covidwho-1868842

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) became pandemic in 2020 and recently, mutated coronaviruses have emerged in many countries. The aim of this study was to identify the clinical characteristics and risk factors for critical illness in hospitalized COVID-19 patients in Zhengzhou for clinical prevention and management. Materials and methods: A total of 70 patients hospitalized with COVID-19 were enrolled between 21 January and 29 February 2020, in Zhengzhou, China. Clinical characteristics, hematological findings, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and inflammatory index on admission were obtained from medical records, COVID-19 patients with different outcomes were compared. Results: The median age was 55 years. Forty-three (61.0%) patients were classified as having severe or critical cases. Eighteen (25.7%) patients died in hospital and the remaining 52 were discharged. Patients who died tend to be old with expectoration and chronic obstructive pulmonary disease. Compared to survivor, non-survivor had significantly higher numbers of leucocytes and neutrophils, NLR, aspartate aminotransferase (AST), γ-glutamyl transpeptidase, total bilirubin, direct bilirubin, lactate dehydrogenase (LDH), prothrombin time, D-dimer, C-reactive protein, and decreased platelets, lymphocytes, uric acid, and albumin (ALB). Logistic regression analysis identified leucocytes, platelets, PLR, NLR, AST, and ALB as independent predictive factors for poor outcomes. The area under curve of the combination of leucocytes, PLR, NLR, and AST was 0.87, with a sensitivity of 0.83 and specificity of 0.81. Conclusion: Our results identified risk factors among COVID-19 patients for in-hospital mortality. Leucocytes, PLR, NLR, and AST could have important reference value for predicting prognosis, especially in low-resource countries.

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