ABSTRACT
Comparing first and second wave MIS-C cohorts at our quaternary pediatric institution, second wave were older, presented more frequently with shortness of breath, higher maximum troponin and N-terminal BNP, and more frequently required advanced respiratory and inotropic support. Despite increased severity in the second cohort, both cohorts had similar rates of coronary artery abnormalities, systolic dysfunction, and length of stay.
Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/physiopathology , COVID-19/physiopathology , Coronary Artery Disease/pathology , Female , Humans , Infant , Infant, Newborn , Length of Stay/statistics & numerical data , Male , Prospective Studies , SARS-CoV-2/pathogenicity , Severity of Illness IndexABSTRACT
BACKGROUND: Since the outbreak of the COVID-19 pandemic, a number of risk factors for a poor outcome have been identified. Thereby, cardiovascular comorbidity has a major impact on mortality. We investigated whether coronary calcification as a marker for coronary artery disease (CAD) is appropriate for risk prediction in COVID-19. METHODS: Hospitalized patients with COVID-19 (n = 109) were analyzed regarding clinical outcome after native computed tomography (CT) imaging for COVID-19 screening. CAC (coronary calcium score) and clinical outcome (need for intensive care treatment or death) data were calculated following a standardized protocol. We defined three endpoints: critical COVID-19 and transfer to ICU, fatal COVID-19 and death, composite endpoint critical and fatal COVID-19, a composite of ICU treatment and death. We evaluated the association of clinical outcome with the CAC. Patients were dichotomized by the median of CAC. Hazard ratios and odds ratios were calculated for the events death or ICU or a composite of death and ICU. RESULTS: We observed significantly more events for patients with CAC above the group's median of 31 for critical outcome (HR: 1.97[1.09,3.57], p = 0.026), for fatal outcome (HR: 4.95[1.07,22.9], p = 0.041) and the composite endpoint (HR: 2.31[1.28,4.17], p = 0.0056. Also, odds ratio was significantly increased for critical outcome (OR: 3.01 [1.37, 6.61], p = 0.01) and for fatal outcome (OR: 5.3 [1.09, 25.8], p = 0.02). CONCLUSION: The results indicate a significant association between CAC and clinical outcome in COVID-19. Our data therefore suggest that CAC might be useful in risk prediction in patients with COVID-19.
Subject(s)
COVID-19/pathology , Coronary Artery Disease/diagnostic imaging , Vascular Calcification/diagnostic imaging , Vascular Calcification/diagnosis , Aged , COVID-19/diagnostic imaging , COVID-19/therapy , Coronary Angiography/methods , Coronary Artery Disease/pathology , Female , Germany , Humans , Male , Middle Aged , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Calcification/pathologySubject(s)
Asthma/epidemiology , COVID-19/epidemiology , Coronary Artery Disease/epidemiology , Diabetes Mellitus/epidemiology , Heart Failure/epidemiology , Hypertension/epidemiology , Pandemics , Renal Insufficiency, Chronic/epidemiology , Adult , Aged , Asthma/mortality , Asthma/pathology , Asthma/virology , COVID-19/mortality , COVID-19/pathology , COVID-19/virology , Comorbidity , Coronary Artery Disease/mortality , Coronary Artery Disease/pathology , Coronary Artery Disease/virology , Diabetes Mellitus/mortality , Diabetes Mellitus/pathology , Diabetes Mellitus/virology , Electronic Health Records , Heart Failure/mortality , Heart Failure/pathology , Heart Failure/virology , Humans , Hypertension/mortality , Hypertension/pathology , Hypertension/virology , Intensive Care Units , Intubation, Intratracheal/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Prevalence , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/pathology , Renal Insufficiency, Chronic/virology , Retrospective Studies , SARS-CoV-2/pathogenicity , Spain/epidemiology , Survival AnalysisABSTRACT
The autopsy findings for 3 cases of SARS-(CoV-2) pneumonia-related deaths are reported with pulmonary histology and immunohistochemistry findings. In 2 cases (cases 1 and 2), the time interval from presentation to death was approximately 1 week, whereas for case 3, the time interval from presentation to death was hours. Case 1 and case 2 presented with shortness of breath, cough, and flu-like symptoms. The decedent from case 3 died shortly after presenting to a local emergency room with high fever, chest and abdominal pain, and shortness of breath. All 3 cases had 1 or more comorbidities. The postmortem interval for cases 1 and 2 was 2 weeks as they died at sea and were stored on board within the respective cruise ships' refrigeration units, whereas case 3 was examined within 24 hours of death. The autopsies were conducted at the Miami-Dade County Medical Examiners Department under routine infectious precautions. Salient clinical history and autopsy findings are summarized. Microscopic examination revealed pneumonia with associated atypical endovascular cells.