Dynamic inflammatory response among routine laboratory biomarkers and their predictive ability for mortality in patients with severe COVID-19.

Background: The severity of coronavirus disease 2019 (COVID-19) is related to several factors, including age, sex, and comorbidities (obesity, type 2 diabetes, and hypertension). However, systemic inflammation plays a fundamental role in COVID-19 pathophysiology. Several studies have described this association employing specific biomarkers that are not routinely used in clinical practice. On the other hand, very few reports in the literature focused on the analysis of the routine laboratory biomarkers to predict the outcome of severe COVID-19 patients. Objective: We aimed to analyze the dynamic inflammatory response using routine laboratory biomarkers to predict in-hospital mortality in Mexican patients with severe COVID-19. Methods: This is a cohort study including patients with severe COVID-19. Demographic characteristics were retrieved from medical charts and biochemical parameters were measured at hospital admission and subsequently on days 3, 5, 7, 10, 14, and 21 during the hospital stay; measurements were stopped when patients were discharged from the hospital (alive or death). Results: A total of 250 patients were included in the study, 40.8% of patients died. The analyzed routine laboratory parameters, such as serum levels of neutrophil-to-lymphocyte ratio, C-reactive protein, and D-dimer remained elevated in hospitalized patients who did not survive, whereas eosinophil and platelets were maintained at lower levels. In the multivariate analysis, leukocytes, and neutrophils were the best biomarkers for predicting mortality risk and were independent of age, gender, or comorbidities. Conclusion: Our results support the use of routine laboratory biomarkers as predictors of mortality in Mexican hospitalized patients with severe COVID-19.

Effect of Altitude on Respiratory Functional Status in COVID-19 Survivors: Results from a Latin American Cohort-FIRCOV.

Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.

Dynamic inflammatory response among routine laboratory biomarkers and their predictive ability for mortality in patients with severe COVID-19

Background The severity of coronavirus disease 2019 (COVID-19) is related to several factors, including age, sex, and comorbidities (obesity, type 2 diabetes, and hypertension). However, systemic inflammation plays a fundamental role in COVID-19 pathophysiology. Several studies have described this association employing specific biomarkers that are not routinely used in clinical practice. On the other hand, very few reports in the literature focused on the analysis of the routine laboratory biomarkers to predict the outcome of severe COVID-19 patients. Objective We aimed to analyze the dynamic inflammatory response using routine laboratory biomarkers to predict in-hospital mortality in Mexican patients with severe COVID-19. Methods This is a cohort study including patients with severe COVID-19. Demographic characteristics were retrieved from medical charts and biochemical parameters were measured at hospital admission and subsequently on days 3, 5, 7, 10, 14, and 21 during the hospital stay;measurements were stopped when patients were discharged from the hospital (alive or death). Results A total of 250 patients were included in the study, 40.8% of patients died. The analyzed routine laboratory parameters, such as serum levels of neutrophil-to-lymphocyte ratio, C-reactive protein, and D-dimer remained elevated in hospitalized patients who did not survive, whereas eosinophil and platelets were maintained at lower levels. In the multivariate analysis, leukocytes, and neutrophils were the best biomarkers for predicting mortality risk and were independent of age, gender, or comorbidities. Conclusion Our results support the use of routine laboratory biomarkers as predictors of mortality in Mexican hospitalized patients with severe COVID-19.

Challenges in the Management of Post-COVID-19 Pulmonary Fibrosis for the Latin American Population.

This commentary aims to highlight some of the major issues (with possible solutions) that the Latin American region is currently dealing with in managing post-COVID-19 pulmonary fibrosis. Overall, there is little evidence for successful long-term COVID-19 follow-up treatment. The lack of knowledge regarding proper treatment is exacerbated in Latin America by a general lack of resources devoted to healthcare, and a lack of availability and access to multidisciplinary teams. The discussion suggests that better infrastructure (primarily multicenter cohorts of COVID-19 survivors) and well-designed studies are required to develop scientific knowledge to improve treatment for the increasing prevalence of pulmonary fibrosis in Latin America.

Clinical predictors of lung function in patients recovering from mild COVID-19.

BACKGROUND: Few studies have assessed lung function in Hispanic subjects recovering from mild COVID-19. Therefore, we examined the prevalence of impaired pulmonary diffusing capacity for carbon monoxide (DLCO) as defined by values below the lower limit of normal (< LLN, < 5th percentile) or less than 80% of predicted in Hispanics recovering from mild COVID-19. We also examined the prevalence of a restrictive spirometric pattern as defined by the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) being ≥ LLN with the FVC being < LLN. Finally, we evaluated previous studies to find factors correlated to impaired DLCO post-COVID-19. METHODS: In this observational study, adult patients (n = 146) with mild COVID-19 were recruited from a long-term follow-up COVID-19 clinic in Yucatan, Mexico, between March and August 2021. Spirometry, DLCO, and self-reported signs/symptoms were recorded 34 ± 4 days after diagnosis. RESULTS: At post-evaluation, 20% and 30% of patients recovering from COVID-19 were classified as having a restrictive spirometric pattern and impaired DLCO, respectively; 13% had both. The most prevalent reported symptoms were fatigue (73%), a persistent cough (43%), shortness of breath (42%) and a blocked/runny nose (36%). Increased age and a restrictive spirometric pattern increased the probability of having an impaired DLCO while having a blocked nose and excessive sweating decreased the likelihood. The proportion of patients with previous mild COVID-19 and impaired DLCO increased by 13% when the definition of impaired DLCO was < 80% predicted instead of below the LLN. When comparing previous studies, having severe COVID-19 increased the proportion of those with impaired DLCO by 21% compared to those with mild COVID-19. CONCLUSIONS: One-third of patients with mild COVID-19 have impaired DLCO thirty-four days post-diagnosis. The criteria that define impaired DLCO and the severity of COVID-19 disease affects the proportion of those with impaired DLCO at follow-up. One-fifth of patients have a restrictive spirometric pattern.

Cystatin C is a marker for acute kidney injury, but not for mortality among COVID-19 patients in Mexico.

BACKGROUND: Patients infected with SARS-CoV-2 can develop acute kidney injury (AKI), associated with adverse clinical outcomes. In Mexico, an AKI incidence of 60.7% was reported in patients with COVID-19. Serum cystatin C is a well-known marker for AKI. It has been postulated as a marker for mortality in Chinese patients with COVID-19. Information regarding levels of cystatin C in COVID-19-infected patients is nonexistent among Mexican or Latin American populations. AIM: This work aimed to assess the level of cystatin C as an indicator of AKI and mortality among COVID-19 patients from Mexico. METHODS: A cross-sectional study among 38 adults was performed in the Regional High Specialty Hospital of the Yucatan Peninsula in Merida, Yucatan, Mexico. Baseline characteristics and clinical and biomechanical parameters were collected, and serum levels of cystatin C were measured by ELISA. RESULTS: A total of 71% (27 patients) with COVID-19 developed AKI; 78% were men, and 22% were women. In addition, 60% of individuals (16 men; 7 women) died due to COVID-19 complications. Serum levels of cystatin C were higher in those individuals who developed AKI (p = 0.001). A logistic regression model indicated that individuals with serum levels of cystatin C above 0.84 ng/mL had a 23-fold increased risk of developing AKI (OR, 23.7, 95% CI, 2.59-217.00, p = 0.005). However, increased cystatin C was not independently associated with mortality in the Mexican population (HR, 1.01, 95% CI, 0.66-1.56, p = 0.959). CONCLUSION: The results suggest that serum levels of cystatin C indicate AKI in COVID-19 patients. Although we recommend caution when using serum cystatin C levels as an indicator of mortality among the Mexican population, it is essential to note that cystatin C elevates earlier than creatinine, which is an advantage for timely clinical interventions.

Humoral immune response in healthcare workers after two doses of a BNT162b2 mRNA vaccine in Yucatan, Mexico.

The antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as the host immune response after vaccination and viral infection have shown to be highly heterogeneous. This is a case series study analysing humoral immune response and vaccination side effects after two doses of a BNT162b2 mRNA among healthcare workers (HCWs) in Mexico. All participants were scheduled for their two doses of mRNA BNT162b2 vaccine and provided information through a questionnaire: demographic characteristics, antibody serum titres and vaccination-related side effects. Blood samples were obtained for serology testing after the first and second doses of vaccine. No serious adverse effects due to vaccination were reported; nonetheless, non-medical HCWs reported more side effects after the second dose. The previous infection with SARS-CoV-2 boosted immune response after receiving the first vaccination (roughly 30 times higher than those without previous infection); nonetheless, after the second dose, the immune response did not show a higher titre as might be expected.

Secondary spontaneous pneumothorax: a time to re-evaluate management.

Spontaneous pneumothorax (SP) is defined as the presence of air in the pleural cavity and remains a significant health problem. Secondary SP (SSP) is associated with underlying lung diseases, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD), and is associated with poor outcomes. The current guidelines in the management of SSP have not been updated since the last decade; therefore, new protocols focused on the management of SSP should be evaluated. We present two cases of patients admitted with SSP who were treated conservatively due to haemodynamic stability. In both cases, the pneumothoraces resolved without further complications.

Serum IL-6: A potential biomarker of mortality among SARS-CoV-2 infected patients in Mexico.

BACKGROUND: The first case of SARS-CoV-2 in Mexico was reported in February 2020, since then, high rates of mortality due to COVID-19 have been found. Cytokine storm is linked to the severity and decreasing the survival among infected patients by COVID-19. The serum levels of Interleukin 6 (IL-6) have been correlated to mortality in COVID-19 cases and could be used as indicator of mortality in COVID-19 cases. The aim of this study was to determine levels of IL-6 and assess its usefulness as indicator of mortality among COVID-19 patients from Mexico. METHODS: A cohort study among 38 adults (28 men, 10 women) was carried out in the Regional High Specialty Hospital of the Yucatan Peninsula in Merida, Yucatan, Mexico. Demographic and clinical biochemistry data were collected. The serum levels of IL-6 were measured in each patient by specific immunoassays. RESULTS: High frequency of mortality (36.84%) was found in the sample. The average age of individuals that non-survive was significantly higher (59.71 ± 13.83 years) than the survival group (43.29 ± 11.80 years). Serum levels of IL-6 were significantly higher in patients that did not survive. A correlation between IL-6 levels with lymphocyte count, LDH, CRP and procaciltonin was found. The optimal cutoff value of IL-6 was 30.95 pg/mL with high sensitivity and specificity. CONCLUSION: Our findings demonstrate that level of IL-6 is an indicator of mortality among hospitalized COVID-19 patients in Mexico.

Pulmonary function and functional capacity in COVID-19 survivors with persistent dyspnoea.

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.

Risk Factors for Mortality in Hospitalized Patients with COVID-19: An Overview in a Mexican Population.

BACKGROUND: Currently, Mexico ranks third worldwide in mortality due to coronavirus disease pandemic 2019 (COVID-19) and reliable information is scarce, with the available data focused on epidemiological characteristics. This study aimed to identify the risk factors associated with mortality and outcomes in hospitalized Mexican patients with COVID-19. METHODS: We prospectively assessed patients admitted to a COVID-19 reference center in southeast Mexico between March 28 and June 30, 2020. Mortality was defined as survivors or non-survivors and univariate and multivariate logistic regression analyses were performed to explore the association of the clinical characteristics and laboratory parameters with mortality. RESULTS: We included 200 patients with a mean age of 55 years, 69% were men and 72% had at least one chronic comorbidity. Eighty-six patients required invasive mechanical ventilation (IMV) with an overall mortality rate of 82.5%. Only 51% of the patients with IMV were admitted to the intensive care unit (ICU), with a survival rate of 27.3%, but only 7.2% for patients without ICU admissions (p=0.014). The multivariate analysis found that a neutrophil-to-lymphocyte ratio ≥9 (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.05-10.53) albumin <3.5 g/dL (OR, 3.76; 95% CI, 1.56-9.07), lactate dehydrogenase (LDH) level ≥725 U/L (OR, 5.45; 95% CI, 2.36-12.57), and IMV (OR, 64.7; 95% CI, 15.20-275.39) were independent risk factors associated with mortality. CONCLUSION: Neutrophil-to-lymphocyte ratio, LDH, albumin, and IMV were independent risk factors for mortality in Mexican patients with COVID-19. Also, the availability of ICU resources is invaluable for better outcomes in critically ill patients. Our results could provide clinical information for timely decision-making in low-and-middle income countries to overcome the pandemic.