RESUMEN
Background: To investigate the prevalence and clinical and laboratory characteristics of the cases with pulmonary embolism (PE) in the pace of coronavirus disease-2019 (COVID-19). Materials and methods: COVID-19 patients' records were retrospectively scanned from the hospital's automation system and recorded on patients' files. Results: Of 1452 COVID-19 patients, 17 (1.2%) were diagnosed with PE. Compared cases with PE with controls, it was seen that mean age was higher (p=0.036), male gender was prominent (p=0.016), patients presented with dyspnea symptoms further (p<0.001), while O2 saturation measured at room air on admission was lower (p=0.002). In PE patients, glucose (p=0.007), D-dimer (p<0.001), C-reactive protein (p<0.001) and ferritin levels (p=0.002) were higher than controls. In Receiver-Operator Characteristics analysis, the cut-off value of D-dimer in predicting PE was found to be 4211 ng/mL (p<0.001). COVID-19 patients were diagnosed with PE median five (min:max=0:36) days after hospitalization. Additionally, PE patients were found to have longer hospitalization time (p<0.001), the requirement for caring in the intensive care unit (p<0.001), and intubation (p=0.001), and non-invasive mechanical ventilation (p<0.001) in more patients, compared to controls. Mortality rates were similar in both groups, with three and 106 deaths in PE and control groups, respectively. Lower-extremity Doppler ultrasonography was performed in 196 patients, and thrombi were detected in the femoral vein in four patients, also presenting with PE. Conclusions: Even if there is no embolism without any obvious clinic of PE in all cases with COVID-19, such cases should be screened for PE in the presence of significant D-dimer elevation. © 2021 A. CARBONE Editore. All rights reserved.
RESUMEN
Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is observed by hyperinflammation and cytokine storm. The spectrum of severity ranged from standard hospitalization to pediatric intensive care unit management. There is no specific activity score that predicts whether this hyperinflammatory state will be severe or result in mortality in pediatric patients. There are activity scores used in KD and other vasculitis such as Kobayashi score (KS) and Pediatric Vasculitis Activity Score (PVAS) that determine the severity of the disease in children. Objectives: Based on the clinical similarity of MIS-C to these disease groups, we wanted to evaluate the performance of these disease activity scores. Also, we aimed to identify the factors associated with the disease severity of patients with MISC Methods: We retrospectively enrolled a single-center cohort of 45 consecutive pediatric patients with MISC admitted to Umraniye Training and Resrach Hospital, Pediatric Rheumatology Clinic, Istanbul, Turkey, from April 20 to December 31, 2020. Medical information of each patient including demographic data, clinical characteristics, laboratory results, and outcomes was extracted retrospectively through review of electronic medical records. We analyzed all score systems including KS, PVAS, NLR, cHIS, and C-reactive protein/albumin ratio (CAR) as assessment factors for diagnosis for severe disease and evaluation of disease activity in MISC. All scores were compared between two groups and receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic utility. Results: We reported 45 patients (10 female, 35male) with MISC. Their mean age was 9.65±4.93 years (7 months-18 years). All patients had fever (median 4 days), 71 % patients had acute gastrointestinal symptoms, 37.8 % of patient's conjunctivitis and only 5 patients had respiratory findings at admission. Twenty-four (46.7%) patients met criteria for classic KD. Macrophage activation syndrome and myocardial dysfunction with or without cardiogenic shock were seen 14 and 10 patients respectively. All the patients had positive serology for SARSCoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. We divided the disease severity into a moderate or severe group based on admission on intensive care unit (ICU). There were 15 patients with severe illness (33%). The median age of these patients was significantly older (11.3 years vs 9.16 years, p=0.05). The median hospital stay period was 10 days. The median need for intensive care was on the first day (1-14th days), and the median lasted 5 (1-9) days. The majority of MISC patients were on Intravenous immunoglobulin (IVIG) (89%), and corticosteroid (73.3%). A total of 12 patients received anakinra. In the severe group, all patients had higher values of KD, PVAS, NLR, cHIS, and CAR than the patients in moderate group. For severe MISC, the area under receiver operating characteristic curve (AUC) was 0.864 (95% confidence interval [CI], 0.729-1) for the PVAS, 0.911 (95% CI, 0.827-0.995) for the NLR, and 0.853 (95% CI, 0.744-0.963) for the CAR, with optimal cut-off values of 3.5, 9.05, and 4.86, respectively. Thirty-eight (84.4%) of the 45 patients met two or more cHIS criteria at the time of their hospitalization;39% of these patients were identified as severe group (OR 1.62, 95% CI 1.27-2.13, p=0.04). At the time of diagnosis, 29 patients with a Kobayashi score greater than 4 were detected, of which 15 required intensive care (OR 2.07, 95% CI 1.42-3.0, p=0.00). Conclusion: This study demonstrated that both inflammatory scores (CAR and NLR) and disease activity scores (KS, PVAS and cHIS) can be used to aid the assessment for severity of MISC.
RESUMEN
Background: Patients with rheumatic diseases are considered at risk for serious infections due to their immune-compromised-status set in their primary systemic disease and the usage of immune-modulating therapies. Although various results have been reported on the subject, it is still unknown whether patients with rheumatic disease, many of whom are on immune-suppression, are at higher risk of severe COVID-19. Objectives: We aim to share our clinical SARS-CoV-2 experience in patient with the childhood rheumatic disease during pandemic. Methods: We evaluated 4470 patients at our pediatric-rheumatology clinic during the pandemic, from 11-March to 15-October-2020. Demographic and clinical features, treatments, laboratory results, imaging findings, and clinical outcomes of patients diagnosed with COVID-19 and/or multisystem inflammatory syndrome (MIS-C) were review from the medical records. The data of all these patients were compared between groups and presented. A p-value <0.05 was considered statistically significant. Results: Among 4470 patients, 87 COVID-19 suspected patients were included in the study. Fifty six (64.4%) patients were hospitalized and 31 were followed without hospitalization. The most common rheumatic diseases among them were juvenile idiopathic arthritis and familial Mediterranean fever (35.6% and 34.5%). The primary disease status of these patients were;78 (89.6%) were in remission, while 9 (10.3%) had active disease at the time of COVID-19 diagnosis. Twenty six of these patients were treated with biologic DMARDs. SARS-CoV-2 infection (RT-PCR and/or antibody test) was found positive in 84 patients (96.5%). Also, fifty one (58.6%) patients had an epidemiologic contact to a person with COVID-19. Fifty six of 87 (64.3%) had a fever and 20 (23%) had a fever for five or more days. Gastrointestinal system involvement was in 11 (12.6%), the respiratory system was in 40 (46%) and fatigue was in 57 (65.5%) patients. Cutaneous involvement was seen in 5 patients including maculopapular rash in two, vasculitic rash in two, and chilblain in one patient. 63.2% of patients had increased C-reactive protein (CRP), 40.2% had lymphocytopenia (<1500/mm3) and 26.4 % had elevated D-dimer level. SARS-CoV-2 infection was confirmed in 84 patients (96.5%). The diagnosis was confirmed by RT-PCR in 74 patients and by antibody test in 10. 18 patients met the clinical criteria and diagnosed with MIS-C. Nine of them had also hypotension and seven patients admitted the intensive care unit because of shock and severe end-organ illness. COVID-19 outbreak also caused exacerbation of systemic disease in 56 children due to a discontinue of medication, postponed drug switch, or viral infection triggered. Conclusion: In conclusion, children with rheumatic disease do not appear to present a higher risk of severe COVID-19. Whether these patients receive biological treatment does not affect the severity of the disease, but it is still not true to say that these drugs are protective. The immunosuppressive treatments can be adjusted in case of infection, otherwise it is not recommended interrupt the treatments. Physicians should be cautious about the hyperinflammatory syndrome associated with COVID-19 in rheumatic children, which may be severe in this group of patients and may be confused with primary diseases.
RESUMEN
BACKGROUND AND STUDY AIMS: To investigate the clinical and laboratory characteristics of the cases with high lipase levels in the course of COVID-19. PATIENTS AND METHODS: Hospital records of all cases, where lipase levels were measured, and the reverse transcriptase-polymerase chain reaction test due to SARS-CoV-2 was found positive, were retrospectively investigated. Of 127 COVID-19 patients tested for lipase, 20 (15.7%) had serum lipase levels above the upper laboratory limit. The patient group with the "high lipase level" was created from these subjects, and the rest constituted the "control" group. RESULTS: While body mass index (BMI) levels were higher in the high lipase group, (p=0.014), the number of those with pre-existing diabetes mellitus (DM) was also found higher in the high lipase group than the controls (p=0.002). The history of DM was detected to increase the risk of developing high lipase level 4.63 times higher. Only two patients were diagnosed with acute pancreatitis (AP). While oxygen saturations on admission (p=0.019) and discharge (p=0.011) were lower in the high lipase group than the controls, amylase (p<0.001), C-reactive protein (CRP) (p=0.002) and D-dimer (p=0.004) levels were found higher. In addition, more patients required the treatment in intensive care unit in the high lipase group, compared to the controls (p=0.027). Accordingly, time of hospital stay became also prolonged (p=0.003). CONCLUSIONS: Pancreatic injuries or even AP may develop during SARS-CoV-2 infection, especially in those with pre-existing DM. Monitoring of pancreatic enzymes is important in COVID-19 patients, especially with pre-existing DM.