ABSTRACT
BackgroundBased on the detailed review of available research and case studies reported in reputed international journals, it can be concluded that endothelial damage (En-dotheliitis) both in small and large arteries may be an important factor of morbidity and mortality in COVID-19 patients. Arterial stiffness due to Endothelial Dysfunction has been established as an independent and specific marker of various chronic cardiovascular diseases. ObjectiveOur objective was to examine functional impairment of the arteries in COVID-19 disease and establish the non-invasive measurement of Arterial Stiffness as an independent marker of disease severity. MethodsWe recorded the Arterial Stiffness of 23 Mild, 21 Moderate and 20 Severe COVID-19 patients grouped on latest NIH severity criteria. We observed Arterial Stiffness of COVID-19 patients with standard parameters like non-invasive Carotid-Femoral Pulse Wave velocity (cfPWV), Age-Normalized increase in cfPWV (ANI_cfPWV). ResultsModerate and Severe COVID-19 patients have extremely elevated arterial stiffness than Mild patients. In Mild patients, cfPWV (829.1 {+/-} 139.2 cm/s) was extremely significantly lower than both Moderate (1067 {+/-} 152.5 cm/s, P< 0.0001) and Severe (1416 {+/-} 253.9 cm/s, P < 0.0001) patients. ANI_cfPWV in Moderate and Severe patients was significantly higher than Mild patients. (Mild: 101.2 {+/-} 126.1 cm/s; Moderate: 279 {+/-} 114.4 cm/s; Severe: 580.1 {+/-} 216.4 cm/s; intergroup P <0.0001). Conclusion: Our findings strongly suggest that arterial stiffness can be an independent and accurate marker for objective risk stratification and therapeutic alleviation of the acute cardiovascular complications like MODS in COVID-19.
ABSTRACT
ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19. DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial. SettingThirty-nine public and private hospitals across India. ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 [≤] 93% on room air). InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm. Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment. ResultsBetween 22nd April to 14th July 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: -0.61 to 1.83]. InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19. Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.
