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1.
BMC Infect Dis ; 20(1): 640, 2020 Aug 31.
Article in English | MEDLINE | ID: covidwho-736377

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected the world deeply, with more than 14,000,000 people infected and nearly 600,000 deaths. This review aimed to summarize the epidemiologic traits, clinical spectrum, CT results and laboratory findings of the COVID-19 pandemic. METHODS: We scoped for relevant literatures published during 1st December 2019 to 16th July 2020 based on three databases using English and Chinese languages. We reviewed and analyzed the relevant outcomes. RESULTS: The COVID-19 pandemic was found to have a higher transmission rate compared to SARS and MERS and involved 4 stages of evolution. The basic reproduction number (R0) is 3.32 (95% CI:3.24-3.39), the incubation period was 5.24 days (95% CI:3.97-6.50, 5 studies) on average, and the average time for symptoms onset varied by countries. Common clinical spectrums identified included fever (38.1-39.0 °C), cough and fatigue, with Acute Respiratory Distress Syndrome (ARDS) being the most common complication reported. Body temperatures above 39.0 °C, dyspnea, and anorexia were more common symptoms in severe patients. Aged over 65 years old, having co-morbidities, and developing complications were the commonest high-risk factors associated with severe conditions. Leucopenia and lymphopenia were the most common signs of infection while liver and kidney damage were rare but may cause bad outcomes for patients. The bilateral, multifocal Ground-Glass Opacification (GGO) on peripheral, and the consolidative pulmonary opacity were the most frequent CT results and the tendency of mortality rates differed by region. CONCLUSIONS: We provided a bird's-eye view of the COVID-19 during the current pandemic, which will help better understanding the key traits of the disease. The findings could be used for disease's future research, control and prevention.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/epidemiology , Lymphopenia/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Age Factors , Aged , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Coronavirus Infections/transmission , Cough/epidemiology , Demography , Disease Progression , Dyspnea/epidemiology , Fatigue/epidemiology , Female , Fever/epidemiology , Humans , Laboratories , Male , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , Pneumonia, Viral/transmission , Risk Factors , Sex Factors , Tomography, X-Ray Computed
3.
Med Sci Monit ; 26: e925047, 2020 Jul 28.
Article in English | MEDLINE | ID: covidwho-689085

ABSTRACT

BACKGROUND The aim of this study was to describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and compare these parameters in an elderly group with those in a younger group. MATERIAL AND METHODS This retrospective, single-center observational study included 69 hospitalized patients with laboratory-confirmed COVID-19 from a tertiary hospital in Wuhan, China, between January 14, 2020, and February 26, 2020. Epidemiological, demographic, clinical, and laboratory data, as well as treatments, complications, and outcomes were extracted from electronic medical records and compared between elderly patients (aged ≥60 years) and younger patients (aged <60 years). Patients were followed until March 19, 2020. RESULTS Elderly patients had more complications than younger patients, including acute respiratory distress syndrome (ARDS; 9/25, 36% vs. 5/44, 11.4%) and cardiac injury (7/25, 28% vs. 1/44, 2.3%), and they were more likely to be admitted to the intensive care unit (6/25, 24% vs. 2/44, 4.5%). As of March 19, 2020, 60/69 (87%) of the patients had been discharged, 6/69 (8.7%) had died, and 3/69 (4.3%) remained in the hospital. Of those who were discharged or died, the median duration of hospitalization was 13.5 days (interquartile range, 10-18 days). CONCLUSIONS Elderly patients with confirmed COVID-19 were more likely to develop ARDS and cardiac injury than younger patients and were more likely to be admitted to the intensive care unit. In addition to routine monitoring and respiratory support, cardiac monitoring and supportive care should be a focus in elderly patients with COVID-19.


Subject(s)
Age Factors , Coronavirus Infections/epidemiology , Heart Diseases/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adult , Aged , Aged, 80 and over , Betacoronavirus , China/epidemiology , Combined Modality Therapy , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Heart Diseases/etiology , Humans , Inpatients , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Multiple Organ Failure/epidemiology , Multiple Organ Failure/etiology , Palliative Care/statistics & numerical data , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/etiology , Retrospective Studies , Tertiary Care Centers , Treatment Outcome , Young Adult
4.
Adv Respir Med ; 88(3): 245-266, 2020.
Article in English | MEDLINE | ID: covidwho-676031

ABSTRACT

In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a result of COVID-19 can develop very quickly and a small percent of those infected will die because of it. There is currently no treatment for COVID-19, therefore the key therapeutic intervention centers around the symptomatic treatment of respiratory failure. The main therapeutic goal is to main-tain gas exchange, mainly oxygenation, at an appropriate level and prevent the intensification of changes in the lung parenchyma. Depending on the severity of hypoxemia different techniques can be used to improve oxygenation. Medical staff dealing with COVID-19 patients should be familiar with both, methods used to treat respiratory failure and the epidemiological risks arising from their use. In some patients, conventional (passive) oxygen therapy alone is sufficient. In patients with worsening respiratory failure high flow nasal oxygen therapy (HFNOT) may be effective. The continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) methods can be used to a limited extent. With further disease progression, invasive ventilation must be used and in special situations, extracorporeal membrane oxygenation (ECMO) can also be administered. The authors of this article set themselves the goal of presenting the most current knowledge about the epidemiology and patho-physiology of respiratory failure in COVID-19, as well as the methods of its treatment. Given the dynamics of the developing pandemic, this is not an easy task as new scientific data is presented almost every day. However, we believe the knowledge contained in this study will help doctors care for patients with COVID-19. The main target audience of this study is not so much pneumonologists or intensivists who have extensive experience in the application of the techniques discussed here, but rather doctors of other specializations who must master new skills in order to help patients during the time of a pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Pneumonia, Viral/rehabilitation , Practice Guidelines as Topic , Respiratory Distress Syndrome, Adult/rehabilitation , Coronavirus Infections/epidemiology , Critical Care/organization & administration , Humans , Pandemics , Pneumonia, Viral/epidemiology , Poland , Respiratory Distress Syndrome, Adult/epidemiology , Societies, Medical
5.
Lancet ; 395(10223): 497-506, 2020 02 15.
Article in English | MEDLINE | ID: covidwho-665705

ABSTRACT

BACKGROUND: A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. METHODS: All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. FINDINGS: By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. INTERPRETATION: The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. FUNDING: Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adult , Age Distribution , Aged , China/epidemiology , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/transmission , Cough/epidemiology , Cough/virology , Female , Fever/epidemiology , Fever/virology , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Myalgia/epidemiology , Myalgia/virology , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Prognosis , Radiography, Thoracic , Respiratory Distress Syndrome, Adult/epidemiology , Respiratory Distress Syndrome, Adult/virology , Time Factors , Tomography, X-Ray Computed , Young Adult
6.
PLoS One ; 15(1): e0227346, 2020.
Article in English | MEDLINE | ID: covidwho-660587

ABSTRACT

BACKGROUND: Acute respiratory distress syndrome (ARDS) is heterogeneous. As an indication of the heterogeneity of ARDS, there are patients whose syndrome improves rapidly (i.e., within 24 hours), others whose hypoxemia improves gradually and still others whose severe hypoxemia persists for several days. The latter group of patients with persistent severe ARDS poses challenges to clinicians. We attempted to assess the baseline characteristics and outcomes of persistent severe ARDS and to identify which variables are useful to predict it. METHODS: A secondary analysis of patient-level data from the ALTA, EDEN and SAILS ARDSNet clinical trials was conducted. We defined persistent severe ARDS as a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) of equal to or less than 100 mmHg on the second study day following enrollment. Regularized logistic regression with an L1 penalty [Least Absolute Shrinkage and Selection Operator (LASSO)] techniques were used to identify predictive variables of persistent severe ARDS. RESULTS: Of the 1531 individuals with ARDS alive on the second study day after enrollment, 232 (15%) had persistent severe ARDS. Of the latter, 100 (43%) individuals had mild or moderate hypoxemia at baseline. Usage of vasopressors was greater [144/232 (62%) versus 623/1299 (48%); p<0.001] and baseline severity of illness was higher in patients with versus without persistent severe ARDS. Mortality at 60 days [95/232 (41%) versus 233/1299 (18%); p<0.001] was higher, and ventilator-free (p<0.001), intensive care unit-free [0 (0-14) versus 19 (7-23); p<0.001] and non-pulmonary organ failure-free [3 (0-21) versus 20 (1-26); p<0.001] days were fewer in patients with versus without persistent severe ARDS. PaO2:FiO2, FiO2, hepatic failure and positive end-expiratory pressure at enrollment were useful predictive variables. CONCLUSIONS: Patients with persistent severe ARDS have distinct baseline characteristics and poor prognosis. Identifying such patients at enrollment may be useful for the prognostic enrichment of trials.


Subject(s)
Hypoxia/epidemiology , Prognosis , Respiratory Distress Syndrome, Adult/epidemiology , Adult , Arterial Pressure/physiology , Female , Humans , Hypoxia/complications , Hypoxia/diagnosis , Hypoxia/physiopathology , Male , Middle Aged , Oxygen/metabolism , Partial Pressure , Randomized Controlled Trials as Topic , Respiratory Distress Syndrome, Adult/complications , Respiratory Distress Syndrome, Adult/diagnosis , Respiratory Distress Syndrome, Adult/physiopathology
7.
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, Adult/diagnostic imaging , Respiratory Distress Syndrome, Adult/epidemiology , Tomography, X-Ray Computed/methods , Academic Medical Centers , Aged , Aged, 80 and over , Blood Chemical Analysis , Blood Sedimentation , C-Reactive Protein/analysis , 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, Adult/physiopathology , Retrospective Studies , Risk Assessment , Survival Analysis
8.
Respir Res ; 21(1): 182, 2020 Jul 14.
Article in English | MEDLINE | ID: covidwho-647112

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome (SARS)-CoV-2-induced coronavirus disease-2019 (COVID-19) is a pandemic disease that affects > 2.8 million people worldwide, with numbers increasing dramatically daily. However, there is no specific treatment for COVID-19 and much remains unknown about this disease. Angiotensin-converting enzyme (ACE)2 is a cellular receptor of SARS-CoV-2. It is cleaved by type II transmembrane serine protease (TMPRSS)2 and disintegrin and metallopeptidase domain (ADAM)17 to assist viral entry into host cells. Clinically, SARS-CoV-2 infection may result in acute lung injury and lung fibrosis, but the underlying mechanisms of COVID-19 induced lung fibrosis are not fully understood. METHODS: The networks of ACE2 and its interacting molecules were identified using bioinformatic methods. Their gene and protein expressions were measured in human epithelial cells after 24 h SARS-CoV-2 infection, or in existing datasets of lung fibrosis patients. RESULTS: We confirmed the binding of SARS-CoV-2 and ACE2 by bioinformatic analysis. TMPRSS2, ADAM17, tissue inhibitor of metalloproteinase (TIMP)3, angiotensinogen (AGT), transformation growth factor beta (TGFB1), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF) A and fibronectin (FN) were interacted with ACE2, and the mRNA and protein of these molecules were expressed in lung epithelial cells. SARS-CoV-2 infection increased ACE2, TGFB1, CTGF and FN1 mRNA that were drivers of lung fibrosis. These changes were also found in lung tissues from lung fibrosis patients. CONCLUSIONS: Therefore, SARS-CoV-2 binds with ACE2 and activates fibrosis-related genes and processes to induce lung fibrosis.


Subject(s)
Coronavirus Infections/genetics , Gene Expression Regulation , Peptidyl-Dipeptidase A/genetics , Pneumonia, Viral/genetics , Pulmonary Fibrosis/genetics , Respiratory Distress Syndrome, Adult/genetics , SARS Virus/genetics , China , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Disease Progression , Epithelial Cells/cytology , Epithelial Cells/metabolism , Female , Humans , Male , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Prevalence , Pulmonary Fibrosis/epidemiology , Pulmonary Fibrosis/etiology , Receptors, Virus/metabolism , Respiratory Distress Syndrome, Adult/diagnosis , Respiratory Distress Syndrome, Adult/epidemiology , Risk Assessment , Survival Analysis , Transcription, Genetic , Transcriptional Activation/genetics
11.
Respir Investig ; 58(5): 409-418, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-628661

ABSTRACT

BACKGROUND: Since novel coronavirus disease (COVID-19) emerged, various clinical features of COVID-19 have been reported. METHODS: We conducted a systematic review of published studies reporting the clinical features of COVID-19. Two investigators independently searched PubMed (December 2019-February 2020) for eligible articles. A meta-analysis was performed to measure the frequencies of clinical outcomes and symptoms of COVID-19. A stratified analysis was conducted according to the timeline of outbreak and exposure histories: Group I, most patients were exposed to the Hunan seafood wholesale market and lived in Wuhan, Hubei province; Group II, patients lived in Hubei province but were not directly exposed to the market; and Group III, patients lived outside Hubei. RESULTS: Thirteen studies, all from China, were eligible. The estimated mortality rate among all studies was 2.12%, but that in Group I was 8.66%. The incidence of acute respiratory distress syndrome in Group I was 20.00%. Both fever and cough were major symptoms, and their frequencies were higher in Group I than in Groups II and III, while the frequency of diarrhea in Group I was lower than that in Group III. The estimated frequency of dyspnea in Group I was 37.18%, while those in Groups II and III were 16.95% and 7.03%, respectively. CONCLUSIONS: The trends in the clinical features of COVID-19 changed from December 2019 to February 2020. During this observation period, as the infection continued to spread, the clinical conditions for majority of patients became less severe with the changes in the route of transmission.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Coronavirus Infections/transmission , Cough/epidemiology , Diarrhea/epidemiology , Dyspnea/epidemiology , Humans , Incidence , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Pneumonia, Viral/transmission , Respiratory Distress Syndrome, Adult/epidemiology , Time Factors
12.
Am J Perinatol ; 37(10): 1044-1051, 2020 08.
Article in English | MEDLINE | ID: covidwho-612524

ABSTRACT

Pregnant patients with severe acute respiratory syndrome coronavirus 2, the virus responsible for the clinical condition newly described in 2019 as coronavirus disease 2019 (COVID-19) and illness severity to warrant intensive care have a complex disease process that must involve multiple disciplines. Guidelines from various clinical societies, along with direction from local health authorities, must be considered when approaching the care of an obstetric patient with known or suspected COVID-19. With a rapidly changing landscape, a simplified and cohesive perspective using guidance from different clinical society recommendations regarding the critically-ill obstetric patient with COVID-19 is needed. In this article, we synthesize various high-level guidelines of clinical relevance in the management of pregnant patients with severe disease or critical illness due to COVID-19. KEY POINTS: · When caring for severely ill obstetric patients with COVID-19, one must be well versed in the complications that may need to be managed including, but not limited to adult respiratory distress syndrome with need for mechanical ventilation, approach to refractory hypoxemia, hemodynamic shock, and multiorgan system failure.. · Prone positioning can be done safely in gravid patients but requires key areas of support to avoid abdominal compression.. · For the critically ill obstetric patient with COVID-19, the focus should be on supportive care as a bridge to recovery rather than delivery as a solution to recovery..


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/methods , Delivery, Obstetric/methods , Infectious Disease Transmission, Vertical/prevention & control , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Comorbidity , Coronavirus Infections/prevention & control , Delivery, Obstetric/adverse effects , Female , Humans , Intensive Care Units , Pandemics/prevention & control , Patient Positioning/methods , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome , Pregnancy, High-Risk , Risk Assessment , Thromboembolism/prevention & control , Young Adult
13.
A A Pract ; 14(7): e01236, 2020 May.
Article in English | MEDLINE | ID: covidwho-601387

ABSTRACT

Critically ill patients with coronavirus disease 2019 (COVID-19) have been observed to be hypercoagulable, but the mechanisms for this remain poorly described. Factor VIII is a procoagulant factor that increases during inflammation and is cleaved by activated protein C. To our knowledge, there is only 1 prior study of factor VIII and functional protein C activity in critically ill patients with COVID-19. Here, we present a case series of 10 critically ill patients with COVID-19 who had severe elevations in factor VIII activity and low normal functional protein C activity, which may have contributed to hypercoagulability.


Subject(s)
Coronavirus Infections/blood , Factor VIII/metabolism , Pneumonia, Viral/blood , Protein C/metabolism , Respiratory Distress Syndrome, Adult/blood , Thrombophilia/blood , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adult , Aged , Aged, 80 and over , Antithrombins/metabolism , Betacoronavirus , C-Reactive Protein/metabolism , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Illness , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Extracorporeal Membrane Oxygenation , Female , Ferritins/metabolism , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Humans , Hypertension/epidemiology , International Normalized Ratio , Male , Middle Aged , Obesity/epidemiology , Pandemics , Partial Thromboplastin Time , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Prothrombin Time , Renal Dialysis , Renal Insufficiency, Chronic/epidemiology , Respiration, Artificial , Respiratory Distress Syndrome, Adult/epidemiology , Respiratory Distress Syndrome, Adult/therapy
14.
Dtsch Arztebl Int ; 117(16): 271-278, 2020 04 17.
Article in English | MEDLINE | ID: covidwho-596720

ABSTRACT

BACKGROUND: The type of pneumonia (coronavirus disease 2019, COVID-19) that is caused by the new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) is now spreading across the world in a pandemic. Many patients with COVID-19 were admitted to the University Hospital Aachen during an outbreak that first struck the Heinsberg district in February 2020. METHODS: A comparative presentation of the clinical features of the first 50 COVID-19 patients with and without acute respiratory distress syndrome (ARDS) who were hospitalized in the University Hospital Aachen. RESULTS: 24 intubated patients were treated in the intensive care unit for ARDS of varying degrees of severity, while 26 patients who were breathing spontaneously without ARDS, but nevertheless needed supplemental oxygen, were treated in a separate isolation ward. The median age of the patients was 65 (IQR 58-76). The median latency from symptom onset to hospitalization was four days (IQR 1-8). Patients with ARDS had preexisting respiratory diseases more commonly than patients without ARDS (58% [95% confidence interval: 39; 76] versus 42% [26; 61]) and were more commonly overweight or obese (83% [64; 93] versus 42% [26; 61]). The two groups did not differ in viral burden but displayed significant differences in laboratory findings: ARDS patients had persistently elevated values for leukocytes, interleukin-6, lactate dehydrogenase, creatine kinase, and D-dimers over the period of observation. Patients without ARDS had persistently elevated inflammatory parameters and fever for at least one week, with an accompanying need for supplemental oxygen. Three of the patients with ARDS died of multiorgan failure, while four in the non-ARDS group died of respiratory insufficiency. CONCLUSION: This initial description of a cohort of COVID-19 patients with and without ARDS in Germany reveals that those with ARDS more commonly have preexisting respiratory diseases and obesity, as well as persistently elevated inflammatory markers. COVID-19 patients without ARDS may likewise require prolonged hospitalization because of persistently elevated inflammatory values with a simultaneous need for supplemental oxygen.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/epidemiology , Aged , Aged, 80 and over , Cohort Studies , Female , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics
15.
Eur J Clin Invest ; 50(9): e13276, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-260421

ABSTRACT

The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared in the last weeks as global pandemic. Currently affecting more than 5 000 000 individuals worldwide, COVID-19 is most commonly associated with symptoms caused by the acute respiratory distress syndrome (ARDS). As the number of infected individuals increases, we are learning that not only lungs, but also other organs can be affected by the virus. The gastrointestinal symptoms, for example diarrhoea, vomiting, nausea or abdominal pain, are frequent in patients with COVID-19. Moreover, alimentary tract symptoms may precede the respiratory presentation of SARS-CoV-2 infection. This can lead to delayed diagnosis and inappropriate management of infected patients. In addition, SARS-CoV-2 nucleic acid can be detected in faeces of infected patients and rectal swabs are even reported to remain positive for a longer period of time than nasopharyngeal swabs. Here, we aim to provide an update on the gastrointestinal involvement of COVID-19 presenting the symptoms that can be encountered in infected patients. We address the role of angiotensin-converting enzyme 2 (ACE2), as a functional receptor for SARS-CoV-2, which also was found in the gastrointestinal tract. Finally, we briefly discuss faecal shedding of SARS-CoV-2 and its potential role in the pathogenesis of the disease.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/statistics & numerical data , Gastrointestinal Diseases/epidemiology , Pandemics/statistics & numerical data , Peptidyl-Dipeptidase A/blood , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Biomarkers/blood , Comorbidity , Coronavirus Infections/physiopathology , Disease Transmission, Infectious/prevention & control , Female , Gastrointestinal Diseases/physiopathology , Humans , Male , Pneumonia, Viral/physiopathology , Prognosis , Respiratory Distress Syndrome, Adult/diagnostic imaging , Risk Assessment
16.
Anaesth Crit Care Pain Med ; 39(3): 345-349, 2020 06.
Article in English | MEDLINE | ID: covidwho-245466
18.
Kidney Int ; 98(1): 20-26, 2020 07.
Article in English | MEDLINE | ID: covidwho-209991

ABSTRACT

The SARS-CoV-2 epidemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients are still scarce, and data are needed. Therefore, we describe here the experience of four dialysis centers of the Brescia Renal COVID Task Force. During March 2020, within an overall population of 643 hemodialysis patients, SARS-CoV-2 RNA positivity was detected in 94 (15%). At disease diagnosis, 37 of the 94 (39%) patients (group 1) were managed on an outpatient basis, whereas the remaining 57 (61%) (group 2) required hospitalization. Choices regarding management strategy were made based on disease severity. In group 1, 41% received antivirals and 76% hydroxychloroquine. Eight percent died and 5% developed acute respiratory distress syndrome (ARDS). In group 2, 79% received antivirals and 77% hydroxychloroquine. Forty two percent died and 79% developed ARDS. Overall mortality rate for the entire cohort was 29%. History of ischemic cardiac disease, fever, older age (over age 70), and dyspnea at presentation were associated with the risk of developing ARDS, whereas fever, cough and a C-reactive protein higher than 50 mg/l at disease presentation were associated with the risk of death. Thus, in our population of hemodialysis patients with SARS-CoV-2 infection, we documented a wide range of disease severity. The risk of ARDS and death is significant for patients requiring hospital admission at disease diagnosis.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/mortality , Kidney Failure, Chronic/complications , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Respiratory Distress Syndrome, Adult/virology , Aged , Aged, 80 and over , Antimalarials/therapeutic use , Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Female , Hospitalization/statistics & numerical data , Humans , Hydroxychloroquine/therapeutic use , Italy/epidemiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Renal Dialysis , Respiratory Distress Syndrome, Adult/epidemiology , Retrospective Studies
19.
Crit Care ; 24(1): 198, 2020 05 06.
Article in English | MEDLINE | ID: covidwho-186729

ABSTRACT

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China. The World Health Organization (WHO) declared this outbreak a significant threat to international health. COVID-19 is highly infectious and can lead to fatal comorbidities especially acute respiratory distress syndrome (ARDS). Thus, fully understanding the characteristics of COVID-19-related ARDS is conducive to early identification and precise treatment. We aimed to describe the characteristics of COVID-19-related ARDS and to elucidate the differences from ARDS caused by other factors. COVID-19 mainly affected the respiratory system with minor damage to other organs. Injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS, and endothelial cells were less damaged with therefore less exudation. The clinical manifestations were relatively mild in some COVID-19 patients, which was inconsistent with the severity of laboratory and imaging findings. The onset time of COVID-19-related ARDS was 8-12 days, which was inconsistent with ARDS Berlin criteria, which defined a 1-week onset limit. Some of these patients might have a relatively normal lung compliance. The severity was redefined into three stages according to its specificity: mild, mild-moderate, and moderate-severe. HFNO can be safe in COVID-19-related ARDS patients, even in some moderate-severe patients. The more likely cause of death is severe respiratory failure. Thus, the timing of invasive mechanical ventilation is very important. The effects of corticosteroids in COVID-19-related ARDS patients were uncertain. We hope to help improve the prognosis of severe cases and reduce the mortality.


Subject(s)
Acute Lung Injury/diagnostic imaging , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/diagnostic imaging , Respiratory Distress Syndrome, Adult/therapy , Acute Lung Injury/epidemiology , Acute Lung Injury/therapy , Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Creatine Kinase/blood , Female , Humans , L-Lactate Dehydrogenase/blood , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Radiography , Respiration, Artificial , Respiratory Distress Syndrome, Adult/classification , Respiratory Distress Syndrome, Adult/epidemiology , Severity of Illness Index , Time Factors
20.
Am J Respir Crit Care Med ; 201(12): 1560-1564, 2020 06 15.
Article in English | MEDLINE | ID: covidwho-155108
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