Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 197
Filter
Add filters

Year range
2.
Bioanalysis ; 12(13): 919-935, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-656243

ABSTRACT

Aim: Evaluation of a novel microsampling device for its use in clinical sample collection and biomarker analysis. Methodology: Matching samples were collected from 16 healthy donors (ten females, six males; age 42 ± 20) via K2EDTA touch activated phlebotomy (TAP) device and phlebotomy. The protein profile differences between sampling groups was evaluated using aptamer-based proteomic assay SomaScan and selected ELISA. Conclusion: Somascan signal concordance between phlebotomy- and TAP-generated samples was studied and comparability of protein abundances between these blood sample collection methods was demonstrated. Statistically significant correlation in selected ELISA assays also confirmed the TAP device applicability to the quantitative analysis of protein biomarkers in clinical trials.


Subject(s)
Blood Proteins/analysis , Phlebotomy/instrumentation , Adult , Biomarkers/blood , Clinical Trials as Topic , Coronavirus Infections/blood , Enzyme-Linked Immunosorbent Assay , Female , Hemolysis , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Proteomics/instrumentation , Young Adult
3.
Mol Diagn Ther ; 24(3): 251-262, 2020 06.
Article in English | MEDLINE | ID: covidwho-634822

ABSTRACT

This opinion article discusses the increasing attention paid to the role of activating damage-associated molecular patterns (DAMPs) in initiation of inflammatory diseases and suppressing/inhibiting DAMPs (SAMPs) in resolution of inflammatory diseases and, consequently, to the future roles of these novel biomarkers as therapeutic targets and therapeutics. Since controlled production of DAMPs and SAMPs is needed to achieve full homeostatic restoration and repair from tissue injury, only their pathological, not their homeostatic, concentrations should be therapeutically tackled. Therefore, distinct caveats are proposed regarding choosing DAMPs and SAMPs for therapeutic purposes. For example, we discuss the need to a priori identify and define a context-dependent "homeostatic DAMP:SAMP ratio" in each case and a "homeostatic window" of DAMP and SAMP concentrations to guarantee a safe treatment modality to patients. Finally, a few clinical examples of how DAMPs and SAMPs might be used as therapeutic targets or therapeutics in the future are discussed, including inhibition of DAMPs in hyperinflammatory processes (e.g., systemic inflammatory response syndrome, as currently observed in Covid-19), administration of SAMPs in chronic inflammatory diseases, inhibition of SAMPs in hyperresolving processes (e.g., compensatory anti-inflammatory response syndrome), and administration/induction of DAMPs in vaccination procedures and anti-cancer therapy.


Subject(s)
Inflammation/drug therapy , Inflammation/metabolism , Molecular Targeted Therapy/methods , Biomarkers/blood , Cell-Free Nucleic Acids/blood , Chronic Disease , Coronavirus Infections/drug therapy , HMGB1 Protein/blood , Homeostasis , Humans , Immunity, Innate/drug effects , Immunity, Innate/physiology , Pathogen-Associated Molecular Pattern Molecules/metabolism , S100 Proteins/blood , Vaccination
4.
Clin Lab ; 66(9)2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-750435

ABSTRACT

BACKGROUND: Real-time reverse transcription polymerase chain reaction assay (RT-PCR) is the gold standard for diagnosis of coronavirus disease 2019 (COVID-19); however, it is not universally available and may have limitations in response times. The aim was to evaluate the routine blood tests for diagnosis of COVID-19, determining the diagnostic accuracy of blood biomarkers to differentiate between patients with and without COVID-19. METHODS: Clinical charts, nursing records, laboratory findings, and chest x-rays from adult patients with clinical suspicion of COVID-19 (fever, cough and/or dyspnea) at hospital admission were reviewed. Patients were classified into two groups according to RT-PCR COVID-19: positive (COVID-19) or negative (NON-COVID-19). Diagnostic accuracy was determined by analyzing receiver operating characteristic (ROC) curve, calculating the area under the ROC curve (AUC) and the cutoff value. In order to reduce the number of false positives, the cutoff value with a specificity of 80% was considered. RESULTS: Two hundred three patients (101 females, 102 males) with ages between 18 and 96 years (mean = 61.3) were studied. Ninety-four were COVID-19 and 109 were NON-COVID-19. Plasma ferritin level was the most accurate biomarker (AUC = 0.847 and 0.804 in women and men, respectively). The following diagnostic criteria for suspected COVID-19 were established with biomarker cutoff values to differentiate between COVID-19 and NON-COVID-19 patients: lymphocytes ≤ 1.0 x 109/L; eosinophils ≤ 0.02 x 109/L; ferritin > 125% of upper reference limit (URL); LDH > 125% of URL; hsCRP > 80 mg/L; and D-dimer > 1.2 mg/L. Sensitivity was 66%, 64% 62%, 46%, 43%, and 33% for ferritin, eosinophils, LDH, hsCRP, lymphocytes, and D-dimer, respectively. Of those determined to be COVID-19 patients, 91% met one or more of the diagnostic criteria with these blood biomarkers, and of the NON-COVID-19 patients, 47% did not met any diagnostic criteria. CONCLUSIONS: Blood counts of lymphocytes and eosinophils, and plasma levels of D-dimer, LDH, hsCRP, and ferritin can be used to differentiate patients with and without COVID-19 and as a tool for diagnosis of suspected COVID-19 in adult patients at hospital admission.


Subject(s)
Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Biomarkers/blood , C-Reactive Protein/analysis , Cross-Sectional Studies , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/analysis , Humans , L-Lactate Dehydrogenase/blood , Leukocyte Count , Male , Middle Aged , Pandemics , Spain , Young Adult
5.
ESMO Open ; 5(5)2020 09.
Article in English | MEDLINE | ID: covidwho-744875

ABSTRACT

BACKGROUND: During the COVID-19 outbreak, healthcare professionals (HCP) are at the frontline of clinical management and at increased risk for infection. The SARS-CoV-2 seroprevalence of oncological HCP and their patients has significant implications for oncological care. METHODS: HCP and patients with cancer at the Division of Oncology, Medical University of Vienna were included between 21 March and 4 June and tested for total antibodies against SARS-CoV-2 employing the Roche Elecsys Anti-SARS-CoV-2 immunoassay. Reactive samples were confirmed or disproved by the Abbott SARS-CoV-2 IgG test. Additionally, a structured questionnaire regarding basic demographic parameters, travel history and COVID-19-associated symptoms had to be completed by HCP. RESULTS: 146 subjects (62 HCP and 84 patients with cancer) were enrolled. In the oncological HCP cohort, 20 (32.3%) subjects were medical oncologists, 28 (45.2%) nurses at our ward and 14 (22.6%) fulfil other functions such as study coordinators. In the patient cohort, most individuals are on active anticancer treatment (96.4%). 26% of the HCP and 6% of the patients had symptoms potentially associated with COVID-19 since the end of February 2020. However, only in 2 (3.2%) HCP and in 3 (3.6%) patients, anti-SARS-Cov-2 total antibodies were detected. The second assay for anti-SARS-Cov-2 IgG antibodies confirmed the positive result in all HCP and in 2 (2.4%) patients, suggesting an initial assay's unspecific reaction in one case. In individuals with a confirmed test result, an active COVID-19 infection was documented by a positive SARS-CoV-2 RNA PCR test. CONCLUSION: Specific anti-SARS-CoV-2 antibodies were found solely in persons after a documented SARS-CoV-2 viral infection, thus supporting the test methods' high sensitivity and specificity. The low prevalence of anti-SARS-CoV-2 antibodies in our cohorts indicates a lack of immunity against SARS-CoV-2. It highlights the need for continued strict safety measures to prevent uncontrolled viral spread among oncological HCPs and patients with cancer.


Subject(s)
Antibodies, Viral/blood , Betacoronavirus/immunology , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Medical Staff, Hospital , Oncology Service, Hospital , Patients , Pneumonia, Viral/diagnosis , Serologic Tests , Tertiary Care Centers , Adolescent , Adult , Aged , Aged, 80 and over , Austria/epidemiology , Betacoronavirus/pathogenicity , Biomarkers/blood , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Host-Pathogen Interactions , Humans , Male , Middle Aged , Nursing Staff, Hospital , Oncologists , Oncology Nursing , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Retrospective Studies , Seroepidemiologic Studies , Young Adult
6.
Arq Bras Cardiol ; 115(2): 273-277, 2020 Aug 28.
Article in Portuguese, English | MEDLINE | ID: covidwho-740655

ABSTRACT

BACKGROUND: SARS-CoV-2 is an emerging RNA virus associated with a severe acute respiratory disease known as COVID-19. Although COVID-19 is predominantly a pulmonary disease, some patients have severe cardiovascular damage. We performed a quantitative evidence synthesis of clinical data, myocardial injury biomarkers, and cardiac complications associated with in-hospital death in patients with COVID-19. METHODS: We searched the databases PubMed, Embase, and Google Scholar to identify studies comparing clinical data, myocardial injury biomarkers, and cardiac complications between non-survivors and survivors of COVID-19. Effect sizes were reported as mean difference or standardized mean difference for continuous variables and risk ratio for dichotomous variables with 95% confidence intervals. A random effects model was used to pool the results. RESULTS: Six retrospective studies reporting data from 1,141 patients (832 survivors and 309 non-survivors) were included. We found that underlying cardiovascular conditions; elevation of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and creatine kinase-MB; and cardiac complications were associated with increased risk of death for patients with SARS-CoV-2 infection. CONCLUSIONS: The confirmation that underlying cardiovascular conditions, elevation of myocardial injury biomarkers during COVID-19 infection, and acute cardiovascular decompensation are predictors for mortality in SARS-CoV-2 infection must encourage new research to clarify potential mechanisms and test appropriate treatments. (Arq Bras Cardiol. 2020; 115(2):273-277).


Subject(s)
Cardiovascular Diseases/mortality , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Coronavirus Infections/mortality , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Betacoronavirus , Biomarkers/blood , Humans , Myocardium/pathology , Pandemics , Retrospective Studies
7.
Nephrol Dial Transplant ; 35(8): 1338-1411, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-740180

ABSTRACT

BACKGROUND: There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. METHODS: All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. RESULTS: Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66-83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0-5), 7 (4-11) and 32 (26.5-35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25-106) and 690 Ly/µL (IQR 450-960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11-3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005-1.017); P < 0.0001]. CONCLUSIONS: HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.


Subject(s)
Betacoronavirus/genetics , C-Reactive Protein/metabolism , Coronavirus Infections/epidemiology , DNA, Viral/analysis , Kidney Failure, Chronic/epidemiology , Pneumonia, Viral/epidemiology , Renal Dialysis/methods , Aged , Aged, 80 and over , Biomarkers/blood , Comorbidity , Coronavirus Infections/blood , Female , France/epidemiology , Humans , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapy , Male , Pandemics , Pneumonia, Viral/blood , Prospective Studies , Survival Rate/trends
9.
PLoS One ; 15(8): e0238160, 2020.
Article in English | MEDLINE | ID: covidwho-727331

ABSTRACT

OBJECTIVE: Evidence-based characterization of the diagnostic and prognostic value of the hematological and immunological markers related to the epidemic of Coronavirus Disease 2019 (COVID-19) is critical to understand the clinical course of the infection and to assess in development and validation of biomarkers. METHODS: Based on systematic search in Web of Science, PubMed, Scopus, and Science Direct up to April 22, 2020, a total of 52 eligible articles with 6,320 laboratory-confirmed COVID-19 cohorts were included. Pairwise comparison between severe versus mild disease, Intensive Care Unit (ICU) versus general ward admission and expired versus survivors were performed for 36 laboratory parameters. The pooled standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated using the DerSimonian Laird method/random effects model and converted to the Odds ratio (OR). The decision tree algorithm was employed to identify the key risk factor(s) attributed to severe COVID-19 disease. RESULTS: Cohorts with elevated levels of white blood cells (WBCs) (OR = 1.75), neutrophil count (OR = 2.62), D-dimer (OR = 3.97), prolonged prothrombin time (PT) (OR = 1.82), fibrinogen (OR = 3.14), erythrocyte sedimentation rate (OR = 1.60), procalcitonin (OR = 4.76), IL-6 (OR = 2.10), and IL-10 (OR = 4.93) had higher odds of progression to severe phenotype. Decision tree model (sensitivity = 100%, specificity = 81%) showed the high performance of neutrophil count at a cut-off value of more than 3.74x109/L for identifying patients at high risk of severe COVID-19. Likewise, ICU admission was associated with higher levels of WBCs (OR = 5.21), neutrophils (OR = 6.25), D-dimer (OR = 4.19), and prolonged PT (OR = 2.18). Patients with high IL-6 (OR = 13.87), CRP (OR = 7.09), D-dimer (OR = 6.36), and neutrophils (OR = 6.25) had the highest likelihood of mortality. CONCLUSIONS: Several hematological and immunological markers, in particular neutrophilic count, could be helpful to be included within the routine panel for COVID-19 infection evaluation to ensure risk stratification and effective management.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Blood Sedimentation , C-Reactive Protein/analysis , Child , Coronavirus Infections/immunology , Coronavirus Infections/virology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Interleukin-10/blood , Interleukin-6/blood , Leukocyte Count , Male , Middle Aged , Neutrophils , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Procalcitonin/blood , Prognosis , Prothrombin Time , Young Adult
10.
Eur J Epidemiol ; 35(8): 763-773, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-725658

ABSTRACT

Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and erythrocyte indices) in patients diagnosed with COVID-19, and explored their prognostic value. Six bibliographic databases were searched up to August 3rd 2020. We included 189 unique studies, with data from 57,563 COVID-19 patients. Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 129.7 g/L (95% Confidence Interval (CI), 128.51; 130.88) and 777.33 ng/mL (95% CI, 701.33; 852.77), respectively. Hemoglobin levels were lower with older age, higher percentage of subjects with diabetes, hypertension and overall comorbidities, and admitted to intensive care. Ferritin level increased with older age, increasing proportion of hypertensive study participants, and increasing proportion of mortality. Compared to moderate cases, severe COVID-19 cases had lower hemoglobin [weighted mean difference (WMD), - 4.08 g/L (95% CI - 5.12; - 3.05)] and red blood cell count [WMD, - 0.16 × 1012 /L (95% CI - 0.31; - 0.014)], and higher ferritin [WMD, - 473.25 ng/mL (95% CI 382.52; 563.98)] and red cell distribution width [WMD, 1.82% (95% CI 0.10; 3.55)]. A significant difference in mean ferritin levels of 606.37 ng/mL (95% CI 461.86; 750.88) was found between survivors and non-survivors, but not in hemoglobin levels. Future studies should explore the impact of iron metabolism and anemia in the pathophysiology, prognosis, and treatment of COVID-19.


Subject(s)
Anemia/diagnosis , Coronavirus Infections , Coronavirus/metabolism , Iron/metabolism , Pandemics , Pneumonia, Viral , Betacoronavirus , Biomarkers/analysis , Biomarkers/blood , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Erythropoietin , Ferritins/blood , Hemoglobins/analysis , Hemoglobins/metabolism , Hepcidins/blood , Hepcidins/metabolism , Humans , Iron/blood , Pneumonia, Viral/epidemiology , Receptors, Transferrin/blood , Transferrin/analysis , Transferrin/metabolism
12.
BMJ Case Rep ; 13(8)2020 Aug 19.
Article in English | MEDLINE | ID: covidwho-724263

ABSTRACT

The COVID-19 pandemic with its severe respiratory disease has caused overflow to hospitals and intensive care units. Elevated troponins and natriuretic peptides are related to cardiac injury and poor prognosis. We present a young woman with COVID-19 infection with haemodynamic instability caused by acute perimyocarditis and cardiac tamponade. Troponin T was modestly elevated. Focused cardiac ultrasound made the diagnosis. Echocardiography revealed transient thickening of the myocardial walls. After pericardial drainage and supportive care, she improved significantly within 1 week without targeted therapy. The case illustrates the importance of cardiac diagnostic imaging in patients with COVID-19 and elevated cardiac biomarkers.


Subject(s)
Betacoronavirus , Cardiac Tamponade/virology , Coronavirus Infections/complications , Myocarditis/virology , Pneumonia, Viral/complications , Acute Disease , Biomarkers/blood , Cardiac Tamponade/blood , Coronavirus Infections/blood , Coronavirus Infections/virology , Female , Humans , Middle Aged , Myocarditis/blood , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/virology , Troponin T/blood
13.
Elife ; 92020 08 17.
Article in English | MEDLINE | ID: covidwho-721626

ABSTRACT

Temporal inference from laboratory testing results and triangulation with clinical outcomes extracted from unstructured electronic health record (EHR) provider notes is integral to advancing precision medicine. Here, we studied 246 SARS-CoV-2 PCR-positive (COVIDpos) patients and propensity-matched 2460 SARS-CoV-2 PCR-negative (COVIDneg) patients subjected to around 700,000 lab tests cumulatively across 194 assays. Compared to COVIDneg patients at the time of diagnostic testing, COVIDpos patients tended to have higher plasma fibrinogen levels and lower platelet counts. However, as the infection evolves, COVIDpos patients distinctively show declining fibrinogen, increasing platelet counts, and lower white blood cell counts. Augmented curation of EHRs suggests that only a minority of COVIDpos patients develop thromboembolism, and rarely, disseminated intravascular coagulopathy (DIC), with patients generally not displaying platelet reductions typical of consumptive coagulopathies. These temporal trends provide fine-grained resolution into COVID-19 associated coagulopathy (CAC) and set the stage for personalizing thromboprophylaxis.


Subject(s)
Betacoronavirus/isolation & purification , Blood Coagulation Disorders/diagnosis , Blood Coagulation Tests , Blood Coagulation , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Aged , Betacoronavirus/pathogenicity , Biomarkers/blood , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/virology , Coronavirus Infections/blood , Coronavirus Infections/virology , Disease Progression , Female , Fibrinogen/metabolism , Host Microbial Interactions , Humans , Leukocyte Count , Longitudinal Studies , Male , Middle Aged , Pandemics , Platelet Count , Pneumonia, Viral/blood , Pneumonia, Viral/virology , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Time Factors
14.
BMC Med ; 18(1): 260, 2020 08 19.
Article in English | MEDLINE | ID: covidwho-721302

ABSTRACT

BACKGROUND: The current target oxygen saturation range for patients with COVID-19 recommended by the National Institutes of Health is 92-96%. MAIN BODY: This article critically examines the evidence guiding current target oxygen saturation recommendation for COVID-19 patients, and raises important concerns in the extrapolation of data from the two studies stated to be guiding the recommendation. Next, it examines the influence of hypoxia on upregulation of ACE2 (target receptor for SARS-CoV-2 entry) expression, with supporting transcriptomic analysis of a publicly available gene expression profile dataset of human renal proximal tubular epithelial cells cultured in normoxic or hypoxic conditions. Finally, it discusses potential implications of specific clinical observations and considerations in COVID-19 patients on target oxygen saturation, such as diffuse systemic endothelitis and microthrombi playing an important pathogenic role in the wide range of systemic manifestations, exacerbation of hypoxic pulmonary vasoconstriction in the setting of pulmonary vascular endothelitis/microthrombi, the phenomenon of "silent hypoxemia" with some patients presenting to the hospital with severe hypoxemia disproportional to symptoms, and overburdened health systems and public health resources in many parts of the world with adverse implications on outpatient monitoring and early institution of oxygen supplementation. CONCLUSIONS: The above factors and analyses, put together, call for an urgent exploration and re-evaluation of target oxygen saturation in COVID-19 patients, both in the inpatient and outpatient settings. Until data from such trials become available, where possible, it may be prudent to target an oxygen saturation at least at the upper end of the recommended 92-96% range in COVID-19 patients both in the inpatient and outpatient settings (in patients that are normoxemic at pre-COVID baseline). Home pulse oximetry, tele-monitoring, and earlier institution of oxygen supplementation for hypoxemic COVID-19 outpatients could be beneficial, where public health resources allow for their implementation.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Hypoxia/prevention & control , Oxygen/blood , Pneumonia, Viral/blood , Biomarkers/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Hypoxia/blood , Hypoxia/diagnosis , Hypoxia/etiology , Oximetry , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Telemedicine
15.
BMC Cardiovasc Disord ; 20(1): 373, 2020 08 14.
Article in English | MEDLINE | ID: covidwho-714180

ABSTRACT

BACKGROUND: Hypertension is the most frequent co-morbidity in patients with covid-19 infection, and we might speculate that a specific blood group could play a key role in the clinical outcome of hypertensive patients with covid-19. METHODS: In this prospective study, we compared 0 vs. non-0 blood group in hypertensive patients with covid-19 infection. In these patients, we evaluated inflammatory and thrombotic status, cardiac injury, and death events. RESULTS: Patients in non-0 (n = 92) vs. 0 blood group (n = 72) had significantly different values of activated pro-thrombin time, D-dimer, and thrombotic indexes as Von Willebrand factor and Factor VIII (p < 0.05). Furthermore, patients in non-0 vs. 0 blood group had higher rate of cardiac injury (10 (13.9%) vs. 27 (29.3%)) and death, (6 (8.3%) vs. 18 (19.6%)), (p < 0.05). At the multivariate analysis, Interleukin-6 (1.118, CI 95% 1.067-1.171) and non-0 blood group (2.574, CI 95% 1.207-5.490) were independent predictors of cardiac injury in hypertensive patients with covid-19. D-dimer (1.082, CI 95% 1.027-1.140), Interleukin-6 (1.216, CI 95% 1.082-1.367) and non-0 blood group (3.706, CI 95% 1.223-11.235) were independent predictors of deaths events in hypertensive patients with covid-19. CONCLUSIONS: Taken together, our data indicate that non-0 covid-19 hypertensive patients have significantly higher values of pro-thrombotic indexes, as well as higher rate of cardiac injury and deaths compared to 0 patients. Moreover, AB0 blood type influences worse prognosis in hypertensive patients with covid-19 infection.


Subject(s)
ABO Blood-Group System , Betacoronavirus/pathogenicity , Blood Pressure , Coronavirus Infections/blood , Hypertension/blood , Pneumonia, Viral/blood , Adult , Aged , Biomarkers/blood , Blood Coagulation , Blood Coagulation Factors/analysis , Case-Control Studies , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Female , Host-Pathogen Interactions , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Inflammation Mediators/blood , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Prospective Studies , Risk Factors
16.
ACS Chem Neurosci ; 11(17): 2774-2781, 2020 09 02.
Article in English | MEDLINE | ID: covidwho-713083

ABSTRACT

The rapid recovery of smell and taste functions in COVID-19 patients could be attributed to a decrease in interleukin-6 levels rather than central nervous system ischemic injury or viral damage to neuronal cells. To correlate interleukin-6 levels in COVID-19 patients with olfactory or gustatory dysfunctions and to investigate the role of IL-6 in the onset of these disorders, this observational study investigated 67 COVID-19 patients with taste or smell disorders or both, who did not require intensive care admission, admitted at COVID Hospital of Policlinico of Bari from March to May 2020. Interleukin-6 was assayed in COVID-19 patients with taste or smell disturbances at the time of admission and at the time of swab negativization. At the same time, patients have been given a specific survey to evaluate the severity of taste and smell disturbances. Of 125 patients with smell or taste dysfunctions at onset of disease, 67 fulfilled the inclusion criteria, while 58 were excluded because 35 of them required intensive care admission, 5 were unable to answer, 5 died, 7 had finished chemotherapy recently, and 5 refused to participate. The evaluation of taste and smell disorders was carried out using a survey performed at the time of admission and at the time of swab negativization. Sinonasal outcome test 22 (SNOT-22) was used as a reference for olfactory function assessment, and Taste and Smell Questionnaire Section of the US NHANES 2011-2014 protocol (CDC 2013b) was used as reference for gustatory function assessment. A venous blood sample was taken for each patient to measure IL-6 levels upon entry and at swab negativization. Interleukin-6 levels in COVID-19 patients in relation to olfactory or gustatory disorders were correlated from the time of their admission to the time of swab negativization. Statistically significant correlations were obtained between the decrease of interleukin-6 levels and the improvement of smell (p value < 0.05) and taste (p = 0.047) functions at swab negativization. The acquired results demonstrate the key role of interleukin-6 in the pathogenesis of chemosensitive disorders in COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Interleukin-6/blood , Olfaction Disorders/blood , Pneumonia, Viral/blood , Taste Disorders/blood , Aged , Aged, 80 and over , Biomarkers/blood , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Health Surveys/methods , Humans , Interleukin-6/physiology , Male , Middle Aged , Olfaction Disorders/diagnosis , Olfaction Disorders/etiology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Taste/physiology , Taste Disorders/diagnosis , Taste Disorders/etiology
18.
Blood ; 136(4): 489-500, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-704282

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) have elevated D-dimer levels. Early reports describe high venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) rates, but data are limited. This multicenter retrospective study describes the rate and severity of hemostatic and thrombotic complications of 400 hospital-admitted COVID-19 patients (144 critically ill) primarily receiving standard-dose prophylactic anticoagulation. Coagulation and inflammatory parameters were compared between patients with and without coagulation-associated complications. Multivariable logistic models examined the utility of these markers in predicting coagulation-associated complications, critical illness, and death. The radiographically confirmed VTE rate was 4.8% (95% confidence interval [CI], 2.9-7.3), and the overall thrombotic complication rate was 9.5% (95% CI, 6.8-12.8). The overall and major bleeding rates were 4.8% (95% CI, 2.9-7.3) and 2.3% (95% CI, 1.0-4.2), respectively. In the critically ill, radiographically confirmed VTE and major bleeding rates were 7.6% (95% CI, 3.9-13.3) and 5.6% (95% CI, 2.4-10.7), respectively. Elevated D-dimer at initial presentation was predictive of coagulation-associated complications during hospitalization (D-dimer >2500 ng/mL, adjusted odds ratio [OR] for thrombosis, 6.79 [95% CI, 2.39-19.30]; adjusted OR for bleeding, 3.56 [95% CI, 1.01-12.66]), critical illness, and death. Additional markers at initial presentation predictive of thrombosis during hospitalization included platelet count >450 × 109/L (adjusted OR, 3.56 [95% CI, 1.27-9.97]), C-reactive protein (CRP) >100 mg/L (adjusted OR, 2.71 [95% CI, 1.26-5.86]), and erythrocyte sedimentation rate (ESR) >40 mm/h (adjusted OR, 2.64 [95% CI, 1.07-6.51]). ESR, CRP, fibrinogen, ferritin, and procalcitonin were higher in patients with thrombotic complications than in those without. DIC, clinically relevant thrombocytopenia, and reduced fibrinogen were rare and were associated with significant bleeding manifestations. Given the observed bleeding rates, randomized trials are needed to determine any potential benefit of intensified anticoagulant prophylaxis in COVID-19 patients.


Subject(s)
Betacoronavirus/metabolism , Blood Coagulation , Coronavirus Infections/blood , Hemorrhage/blood , Pneumonia, Viral/blood , Thrombosis/blood , Adult , Aged , Aged, 80 and over , Biomarkers/blood , C-Reactive Protein/metabolism , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Fibrin Fibrinogen Degradation Products/metabolism , Hemorrhage/epidemiology , Hemorrhage/therapy , Hospitalization , Humans , Male , Middle Aged , Pandemics , Platelet Count , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Thrombosis/epidemiology , Thrombosis/therapy
SELECTION OF CITATIONS
SEARCH DETAIL