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1.
Biomark Med ; 15(11): 807-820, 2021 08.
Article in English | MEDLINE | ID: covidwho-1319562

ABSTRACT

Aim: We aimed to determine the prognostic values of the National Early Warning Score 2 (NEWS2) and laboratory parameters during the first week of COVID-19. Materials & methods: All adult patients who were hospitalized for confirmed COVID-19 between 11 March and 11 May 2020 were retrospectively included. Results: Overall, 611 patients were included. Our results showed that NEWS2, procalcitonin, neutrophil/lymphocyte ratio and albumin at D0, D3, D5 and D7 were the best predictors for clinical deterioration defined as a composite of ICU admission during hospitalization or in-hospital death. Procalcitonin had the highest odds ratio for clinical deterioration on all days. Conclusion: This study provides a list of several laboratory parameters correlated with NEWS2 and potential predictors for clinical deterioration in patients with COVID-19.


Subject(s)
COVID-19/metabolism , Procalcitonin/metabolism , Albumins/metabolism , Hospital Mortality , Humans , Lymphocytes/metabolism , Neutrophils/metabolism , Odds Ratio
2.
Turk J Med Sci ; 51(2): 421-427, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-1211944

ABSTRACT

Background/aim: The COVID-19 infection, which started in Wuhan City, China, in December 2019, turned into a pandemic in a very short time, affecting mainly the elderly and those with serious chronic illnesses. COVID-19 infections have been observed to have a high mortality rate, especially in patients undergoing maintenance hemodialysis. Materials and methods: Forty-two patients over 18 years of age who underwent a maintenance hemodialysis program at our unit, who tested positive for COVID-19 by PCR from nasopharyngeal swabs, and/or who were observed to have disease-related signs in their CTs were included in the study. Results: In this study, 23 of 42 patients receiving hemodialysis support in our clinic were included. The median age was 67 years old (min: 35; max: 91 years), and all of our patients had primary hypertension and other comorbidities. Their clinical evaluation showed that dry cough (47.8%) and shortness of breath (47.8%) were the most common symptoms. Fever was less pronounced (30.4%). The median time from the onset of symptoms to hospitalization was 1 day (min: 0; max:), and the time from hospitalization to death was 18 days (min: 1; max: 22). Transfer from the inpatient ward to the ICU took a median of 7 days (min: 1; max: 13). Among the 23 patients, 3 died during follow-up, and 20 were discharged with full recovery. Baseline ferritin, procalcitonin levels, and CRP/albumin rates were higher, and neutrophil/lymphocyte levels were lower in patients who eventually died. In these patients, despite being nonsignificant, there were more diabetic patients, and the D-dimer levels were higher than 1000 ugFEU/L. Conclusion: The COVID-19 infection is associated with increased mortality in chronic kidney diseases patients. Despite being nonsignificant, there was a trend towards increased mortality in patient with diabetes, D-dimer levels >1000 ugFEU/L, higher ferritin and prokalsitonin levels, an increased CRP/albumin ratio, and a lower neutrophil/lymphocyte ratio.


Subject(s)
COVID-19/physiopathology , Kidney Failure, Chronic/therapy , Adult , Aged , Aged, 80 and over , C-Reactive Protein/metabolism , COVID-19/complications , COVID-19/metabolism , COVID-19/mortality , Cough/physiopathology , Cross-Sectional Studies , Dyspnea/physiopathology , Female , Ferritins/metabolism , Fever/physiopathology , Hospital Mortality , Humans , Kidney Failure, Chronic/complications , Length of Stay , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Neutrophils , Procalcitonin/metabolism , Prognosis , Renal Dialysis , SARS-CoV-2 , Serum Albumin/metabolism , Time Factors
3.
Turk J Med Sci ; 51(2): 440-447, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-1211943

ABSTRACT

Background/aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Turkey on March 10, 2020 and the number of the patients are increasing day by day. Coronavirus disease 2019 (Covid-19) has high mortality rates in intensive care units (ICUs). We aimed to describe the demographic characteristics, comorbidities, treatment protocols, and clinical outcomes among the critically ill patients admitted to the ICU of our hospital. Materials and methods: This cohort study included 103 consecutive patients who had laboratory confirmed Covid-19 and admitted to ICU of Sakarya University Training and Research Hospital between March 19 and April 13, 2020. The final date of the follow-up was April 18. Results: The mean age of the patients was 69.6 ± 14.1 years. Most of the patients had increased CRP (99%), serum ferritin (73.8%), d-dimer (82.5%), and hs-troponin levels (38.8%). 34 patients (33%) had lymphocytopenia, 24 patients (23.3%) had thrombocytopenia. 63 patients (61.2%) developed acute respiratory distress syndrome (ARDS), 31 patients (30.1%) had acute kidney injury, and 52 patients (50.5%) had multiple organ dysfunction syndrome (MODS) during follow-up. Sixty-two patients (60.2%) received mechanical ventilation. As of April 18, of the 103 patients, 52 (50.5%) had died, 30 (29.1%) had been discharged from the ICU, 21 (20.4%) were still in the ICU. Conclusions: Covid-19 has high mortality rates in ICU. Patients with elevated procalcitonin, hs-troponin, d-dimer, and CRP levels and lower platelet count at admission have higher mortality.


Subject(s)
Acute Kidney Injury/physiopathology , COVID-19/physiopathology , Multiple Organ Failure/physiopathology , Respiratory Distress Syndrome/physiopathology , Respiratory Insufficiency/physiopathology , Age Factors , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , C-Reactive Protein/metabolism , COVID-19/metabolism , COVID-19/mortality , COVID-19/therapy , Cohort Studies , Continuous Renal Replacement Therapy , Critical Illness , Female , Ferritins/metabolism , Fibrin Fibrinogen Degradation Products/metabolism , Glucocorticoids/therapeutic use , Hospital Mortality , Humans , Intensive Care Units , Length of Stay , Lymphopenia/blood , Male , Middle Aged , Oxygen Inhalation Therapy , Platelet Count , Procalcitonin/metabolism , Prognosis , Respiration, Artificial , Respiratory Insufficiency/therapy , SARS-CoV-2 , Severity of Illness Index , Thrombocytopenia/blood , Troponin/metabolism , Turkey
4.
J Med Virol ; 93(3): 1832-1836, 2021 03.
Article in English | MEDLINE | ID: covidwho-1196521

ABSTRACT

Coronavirus disease 2019 (COVID-19) has caused a significant impact on all aspects of life, with the number of death cases still increasing. Therefore, identification of potential treatment for reducing the severity of the disease is important. Currently, the data regarding the effectiveness of tocilizumab as treatment agents for COVID-19 infection is still conflicting. This study aims to give clear evidence regarding the potential benefit of tocilizumab in reducing the biomarkers of COVID-19 infection. We systematically searched the PubMed Central database using specific keywords related to our aims until July 24th, 2020. All articles published on COVID-19 and tocilizumab were retrieved. A total of 9 studies with a total of 577 patients were included in our analysis. Our meta-analysis showed that tocilizumab treatment is associated with reduction of C-reactive protein (mean difference [MD]: -106.69 mg/L [95% confidence interval [CI]: -146.90, -66.49 mg/L], p < .00001; I2 = 98%, random-effect modeling), d-dimer (MD: -3.06 mg/L [95% CI: -5.81, -0.31 mg/L], p = .03; I2 = 98%, random-effect modeling), Ferritin (MD: -532.80 ng/ml [95% CI: -810.93, -254.67 ng/ml], p = .0002; I2 = 25%, random-effect modeling), procalcitonin (MD: -0.67 ng/ml [95% CI: -1.13, -0.22 ng/ml], p = .004; I2 = 92%, random-effect modeling], and increment in the levels of lymphocyte count (MD: 0.36 × 103 /µl [95% CI: 0.18, 0.54 × 103 /µl], p < .0001; I2 = 88%, random-effect modeling). Administration of tocilizumab is effective in reducing the biomarkers of the COVID-19 infection.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Biomarkers/metabolism , COVID-19/drug therapy , COVID-19/metabolism , Aged , C-Reactive Protein/metabolism , Ferritins/metabolism , Humans , Middle Aged , Procalcitonin/metabolism , SARS-CoV-2/drug effects , Severity of Illness Index
5.
Curr Res Transl Med ; 69(2): 103289, 2021 05.
Article in English | MEDLINE | ID: covidwho-1179993

ABSTRACT

Elevated PCT level in COVID-19 was associated with higher risk of severe disease and higher risk of overall mortality. An increased PCT level of PCT in COVID-19 patients especially in severe cases would be assumed as bacterial coinfection. Could PCT level increase in SARS-CoV-2 infection without bacterial coinfection? Several SARS-CoV-2 proteins activate STAT3-dependent transcriptional pathways particularly in monocytes, that could lead to increased PCT production. STAT3α isoform could cause increased ACE2 expression, resulting more SARS-CoV-2 infected cells and further production of PCT.


Subject(s)
Bacterial Infections/diagnosis , COVID-19/diagnosis , Coinfection/diagnosis , Procalcitonin/blood , SARS-CoV-2/immunology , Bacterial Infections/blood , Bacterial Infections/complications , Biomarkers/blood , COVID-19/blood , COVID-19/complications , COVID-19/immunology , Coinfection/blood , Coinfection/complications , Humans , Immunity/physiology , Monocytes/metabolism , Monocytes/virology , Predictive Value of Tests , Procalcitonin/metabolism , STAT3 Transcription Factor/metabolism , Severity of Illness Index , Signal Transduction/immunology
6.
Int Immunopharmacol ; 90: 107157, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1065211

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic has brought challenges to health and social care systems. However, the empirical use of antibiotics is still confusing. Presently, a total of 1123 patients with COVID-19 admitted to Renmin Hospital of Wuhan University was included in this retrospective cohort study. The clinical features, complications and outcomes were compared between the suspected bacterial infection and the no evidence of bacterial infection. The risk factors of mortality and the incidence of acute organ injury were analyzed. As a result, 473 patients were selected to suspected bacterial infection (SI) group based on higher white blood cell count and procalcitonin or bacterial pneumonia on chest radiography. 650 patients were selected to the no evidence of bacterial infection (NI) group. The SI group had more severely ill patients (70.2% vs. 39.8%), more death (20.5% vs. 2.2%), and more acute organ injury (40.2% vs. 11.2%). Antibiotics were found associated with improved mortality and an increased risk for acute organ injury in hospitalized patients with COVID-19. Intravenous moxifloxacin and meropenem increased the death rate in patients with suspected bacterial infection, while oral antibiotics reduced mortality in this group. Moreover, penicillin and meropenem treatments were associated with increased mortality of the patients with no evidence of bacterial infection. In conclusion, patients with suspected bacterial infection were more likely to have negative clinical outcomes than those without bacterial infection. Empirical use of antibiotics may not have the expected benefits.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , COVID-19/drug therapy , Leukocytes/pathology , Lung/diagnostic imaging , SARS-CoV-2/physiology , Aged , Bacterial Infections/complications , Bacterial Infections/mortality , COVID-19/complications , COVID-19/mortality , China , Cohort Studies , Female , Humans , Lung/pathology , Male , Middle Aged , Pneumonia, Bacterial , Procalcitonin/metabolism , Retrospective Studies , Risk Factors , Survival Analysis
8.
Turk J Med Sci ; 51(2): 448-453, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-976380

ABSTRACT

Background/aim: The purpose of this study is to evaluate serum pentraxin-3 (PTX-3) levels in Sars-CoV-2 virus infection (COVID-19) patients and to investigate whether PTX-3 predicts the disease prognosis. Materials and methods: This study was conducted on 88 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia between April 15 and August 15, 2020. The patients were divided into two groups as survived patients and non-survived patients. Both groups were compared according to demographic features, comorbid conditions and measurement of the PTX-3 and other laboratory parameters of the patients. Results: Of 88 patients with COVID-19, 59 (67%) were discharged with complete cure and 29 (33%) resulted in death. 46 (52.3%) of the patients were men. PTX-3 median value (IQR) was 3.66 ng/mL (0.9­27.9) in all patients, 3.3 ng/mL (0.9­27.9) in survivors and 3.91 ng/mL (1.9­23.2) in nonsurvivors which was significantly higher (P = 0.045). As a receiver operating characteristic curve analysis the cut-off value of PTX-3 for predicting mortality in patients was 3.73 with 65% sensitivity and 65% specificity (AUC: 0.646, 95% CI: 0.525­ 0.767, P = 0.045). Also, we found significant cut-off values with respect to D-dimer, D-dimer/PTX-3, high-sensitivity troponin, high- sensitivity troponin/PTX-3, lymphocyte, PTX-3/lymphocyte, procalcitonin, procalcitonin/PTX-3, CRP, and CRP/PTX-3 (P < 0.05). Conclusion: In this study, as far as we know, for the first time, we have shown PTX-3 as the new mortality biomarker for COVID-19 disease.


Subject(s)
C-Reactive Protein/metabolism , COVID-19/metabolism , Serum Amyloid P-Component/metabolism , Adult , Aged , Aged, 80 and over , Area Under Curve , Biomarkers/metabolism , COVID-19/mortality , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Lymphocyte Count , Male , Middle Aged , Mortality , Procalcitonin/metabolism , Prognosis , ROC Curve , SARS-CoV-2 , Troponin/metabolism , Young Adult
9.
Cardiol Rev ; 29(1): 39-42, 2021.
Article in English | MEDLINE | ID: covidwho-900593

ABSTRACT

Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/therapy , Hospital Mortality , Renal Replacement Therapy/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Vasoconstrictor Agents/therapeutic use , Academic Medical Centers , Accidental Falls , Acute Kidney Injury/etiology , Aged, 80 and over , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Aspartate Aminotransferases/metabolism , C-Reactive Protein/metabolism , COVID-19/complications , COVID-19/metabolism , COVID-19/physiopathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/physiopathology , Cause of Death , Consciousness Disorders/physiopathology , Dyspnea/physiopathology , Female , Ferritins/metabolism , Fever/physiopathology , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Hypoxia/physiopathology , Hypoxia/therapy , Independent Living , Intensive Care Units/statistics & numerical data , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/physiopathology , Leukocyte Count , Liver Diseases/etiology , Liver Diseases/metabolism , Lymphocyte Count , Male , Muscle Weakness/physiopathology , Natriuretic Peptide, Brain/metabolism , Nursing Homes , Oxygen Inhalation Therapy , Procalcitonin/metabolism , Stroke/etiology , Stroke/physiopathology , Troponin I/metabolism
10.
Eur J Clin Invest ; 50(10): e13378, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-695540

ABSTRACT

BACKGROUND: To systematically review clinical and biochemical characteristics associated with the severity of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19). MATERIALS AND METHODS: Systematic review of observational studies from PubMed, ISI Web of Science, SCOPUS and Cochrane databases including people affected by COVID-19 and reporting data according to the severity of the disease. Data were combined with odds ratio (OR) and metanalysed. Severe COVID-19 was defined by acute respiratory distress syndrome, intensive care unit admission and death. RESULTS: We included 12 studies with 2794 patients, of whom 596 (21.33%) had severe disease. A slightly higher age was found in severe vs non-severe disease. We found that prevalent cerebrovascular disease (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.73-7.72), chronic obstructive pulmonary disease (OR: 2.39, 95% CI 1.10-5.19), prevalent cardiovascular disease (OR: 2.84, 95% CI 1.59-5.10), diabetes (OR: 2.78, 95% CI 2.09-3.72), hypertension (OR: 2.24, 95% CI 1.63-3.08), smoking (OR: 1.54, 95% CI 1.07-2.22) and male sex (OR: 1.22, 95% CI 1.01-1.49) were associated with severe disease. Furthermore, increased procalcitonin (OR: 8.21, 95% CI 4.48-15.07), increased D-Dimer (OR: 5.67, 95% CI 1.45-22.16) and thrombocytopenia (OR: 3.61, 95% CI 2.62-4.97) predicted severe infection. CONCLUSION: Characteristics associated with the severity of SARS-CoV-2 infection may allow an early identification and management of patients with poor outcomes.


Subject(s)
Cardiovascular Diseases/epidemiology , Coronavirus Infections/metabolism , Diabetes Mellitus/epidemiology , Fibrin Fibrinogen Degradation Products/metabolism , Pneumonia, Viral/metabolism , Procalcitonin/metabolism , Pulmonary Disease, Chronic Obstructive/epidemiology , Smoking/epidemiology , Thrombocytopenia/epidemiology , Betacoronavirus , COVID-19 , Cerebrovascular Disorders/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Humans , Hypertension/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Prevalence , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sex Factors
11.
Eur J Clin Invest ; 50(10): e13362, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-684327

ABSTRACT

BACKGROUND: Identification of reliable outcome predictors in coronavirus disease 2019 (COVID-19) is of paramount importance for improving patient's management. METHODS: A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in-hospital mortality. We extracted numeric data on patients' characteristics and cases with adverse outcomes and employed inverse variance random-effects models to derive pooled estimates. RESULTS: We identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26-4.41), acute cardiac (OR = 10.58, 5.00-22.40) or kidney (OR = 5.13, 1.78-14.83) injury, increased procalcitonin (OR = 4.8, 2.034-11.31) or D-dimer (OR = 3.7, 1.74-7.89), and thrombocytopenia (OR = 6.23, 1.031-37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D-dimer conferred an increased risk of in-hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934-6.73), but not with mortality. CONCLUSIONS: Advanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in-hospital mortality.


Subject(s)
Acute Kidney Injury/epidemiology , Cardiovascular Diseases/epidemiology , Coronavirus Infections/therapy , Fibrin Fibrinogen Degradation Products/metabolism , Pneumonia, Viral/therapy , Procalcitonin/metabolism , Smoking/epidemiology , Thrombocytopenia/epidemiology , Acute Disease , Adrenal Cortex Hormones/therapeutic use , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Cerebrovascular Disorders/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/mortality , Diabetes Mellitus/epidemiology , Female , Ferritins/metabolism , Heart Diseases , Hospital Mortality , Hospitalization , Humans , Hypertension/epidemiology , Intensive Care Units , Interleukin-6/metabolism , Liver Diseases/epidemiology , Lymphopenia/epidemiology , Male , Middle Aged , Neoplasms/epidemiology , Obesity/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/mortality , Prognosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiration, Artificial , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Young Adult
12.
Respir Res ; 21(1): 180, 2020 Jul 14.
Article in English | MEDLINE | ID: covidwho-647137

ABSTRACT

BACKGROUND: In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. OBJECTIVE: Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. METHODS: This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. RESULTS: All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. CONCLUSIONS: COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/epidemiology , Tomography, X-Ray Computed/methods , Academic Medical Centers , Aged , Aged, 80 and over , Blood Chemical Analysis , Blood Sedimentation , C-Reactive Protein/analysis , COVID-19 , China/epidemiology , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Hospital Mortality/trends , Hospitalization/statistics & numerical data , Humans , Incidence , Leukocyte Count , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Procalcitonin/metabolism , Radiography, Thoracic/methods , Respiratory Distress Syndrome/physiopathology , Retrospective Studies , Risk Assessment , Survival Analysis
13.
Hosp Pediatr ; 10(10): 902-905, 2020 10.
Article in English | MEDLINE | ID: covidwho-637116

ABSTRACT

Coronavirus disease (COVID-19) has affected children differently from adults worldwide. Data on the clinical presentation of the infection in children are limited. We present a detailed account of pediatric inpatients infected with severe acute respiratory syndrome coronavirus 2 virus at our institution during widespread local transmission, aiming to understand disease presentation and outcomes. A retrospective chart review was performed of children, ages 0 to 18 years, with a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal specimens admitted to our hospital over a 4-week period. We present clinical data from 22 patients and highlight the variability of the presentation. In our study, most children presented without respiratory illness or symptoms suggestive of COVID-19; many were identified only because of universal testing. Because children may have variable signs and symptoms of COVID-19 infection, targeted testing may miss some cases.


Subject(s)
Coronavirus Infections/physiopathology , Cough/physiopathology , Dyspnea/physiopathology , Fatigue/physiopathology , Fever/physiopathology , Pneumonia, Viral/physiopathology , Seizures/physiopathology , Adolescent , Age Distribution , Alanine Transaminase/metabolism , Aspartate Aminotransferases/metabolism , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , COVID-19 Testing , Child , Child, Preschool , Chronic Disease , Clinical Laboratory Techniques , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/therapy , Female , Heart Diseases/epidemiology , Hospitalization , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Lung Diseases/epidemiology , Lymphopenia/epidemiology , Male , Mass Screening , Neoplasms/epidemiology , New York City/epidemiology , Noninvasive Ventilation , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/therapy , Procalcitonin/metabolism , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Sex Distribution , United States
14.
Travel Med Infect Dis ; 36: 101782, 2020.
Article in English | MEDLINE | ID: covidwho-595825

ABSTRACT

INTRODUCTION: There are currently no satisfactory methods for predicting the outcome of Coronavirus Disease-2019 (COVID-19). The aim of this study is to establish a model for predicting the prognosis of the disease. METHODS: The laboratory results were collected from 54 deceased COVID-19 patients on admission and before death. Another 54 recovered COVID-19 patients were enrolled as control cases. RESULTS: Many laboratory indicators, such as neutrophils, AST, γ-GT, ALP, LDH, NT-proBNP, Hs-cTnT, PT, APTT, D-dimer, IL-2R, IL-6, IL-8, IL-10, TNF-α, CRP, ferritin and procalcitonin, were all significantly increased in deceased patients compared with recovered patients on admission. In contrast, other indicators such as lymphocytes, platelets, total protein and albumin were significantly decreased in deceased patients on admission. Some indicators such as neutrophils and procalcitonin, others such as lymphocytes and platelets, continuously increased or decreased from admission to death in deceased patients respectively. Using these indicators alone had moderate performance in differentiating between recovered and deceased COVID-19 patients. A model based on combination of four indicators (P = 1/[1 + e-(-2.658+0.587×neutrophils - 2.087×lymphocytes - 0.01×platelets+0.004×IL-2R)]) showed good performance in predicting the death of COVID-19 patients. When cutoff value of 0.572 was used, the sensitivity and specificity of the prediction model were 90.74% and 94.44%, respectively. CONCLUSIONS: Using the current indicators alone is of modest value in differentiating between recovered and deceased COVID-19 patients. A prediction model based on combination of neutrophils, lymphocytes, platelets and IL-2R shows good performance in predicting the outcome of COVID-19.


Subject(s)
Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Aged , Aged, 80 and over , Alkaline Phosphatase/metabolism , Aspartate Aminotransferases/metabolism , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Case-Control Studies , Coronavirus Infections/blood , Coronavirus Infections/metabolism , Female , Ferritins/metabolism , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Interleukin-10/metabolism , Interleukin-6/metabolism , Interleukin-8/metabolism , L-Lactate Dehydrogenase/metabolism , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Models, Theoretical , Natriuretic Peptide, Brain/metabolism , Neutrophils , Pandemics , Partial Thromboplastin Time , Peptide Fragments/metabolism , Pneumonia, Viral/blood , Pneumonia, Viral/metabolism , Procalcitonin/metabolism , Prognosis , Prothrombin Time , ROC Curve , Receptors, Interleukin-2/metabolism , SARS-CoV-2 , Troponin T/metabolism , Tumor Necrosis Factor-alpha/metabolism , gamma-Glutamyltransferase/metabolism
15.
Int J Antimicrob Agents ; 56(2): 106051, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-592124

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a pandemic. This study analysed 95 SARS-CoV-2-infected patients, including 62 moderate COVID-19 patients, 21 severe COVID-19 patients and 12 critical COVID-19 patients (6 patients died, all critical). The results showed that the mean serum procalcitonin (PCT) levels were over four times higher in severe patients than in moderate patients and were over eight times higher in critical patients than in moderate patients. For discharged patients, both high-normal PCT levels and abnormal PCT levels decreased during recovery. However, in death cases, serum levels of PCT increased as the disease worsened. We demonstrate that PCT may be an indicator of disease severity in COVID-19 and may contribute to determining the severity of patients infected with SARS-CoV-2. Moreover, serial PCT measurements may be useful in predicting the prognosis.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/metabolism , Pneumonia, Viral/metabolism , Procalcitonin/metabolism , COVID-19 , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
16.
Eur Respir J ; 55(5)2020 05.
Article in English | MEDLINE | ID: covidwho-143997

ABSTRACT

Patients with COVID-19 present a broad spectrum of clinical presentation. Whereas hypoxaemia is the marker of severity, different strategies of management should be customised to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with "normal" (>40 mL·cmH2O-1) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. Identifying these clinical phenotypes and applying a personalised approach would benefit the optimisation of therapies and improve outcomes.


Subject(s)
Acute Lung Injury/physiopathology , Betacoronavirus/genetics , Coronavirus Infections/genetics , Phenotype , Pneumonia, Viral/genetics , SARS Virus/genetics , Acute Lung Injury/therapy , Acute Lung Injury/virology , Biomarkers/blood , Biomedical Research , COVID-19 , Coronavirus Infections/therapy , Disease Management , Female , Humans , Hypoxia/diagnosis , Hypoxia/etiology , Lung Compliance/genetics , Male , Pandemics , Pneumonia, Viral/therapy , Procalcitonin/metabolism , SARS Virus/pathogenicity , SARS-CoV-2
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