COVID-19 disease induced alteration of oxidative stress and clinical laboratory parameters in moderate and severe patients.

OBJECTIVE: The aim of our study was to present the clinical alterations of CRP, LDH, neutrophil to lymphocyte ratio, platelets to lymphocyte ratio, D-dimer, blood gas analyses, vitamin D, VEGF, IL-6, IFN-γ, CD4+, CD8+) and their correlation with oxidative stress index (OSI) in hospitalized COVID-19 patients. PATIENTS AND METHODS: Oxidative stress index and clinical parameters were determined at admission and/or 7 days after hospitalization in 50 patients divided in moderate and severe group. RESULTS: In the moderate group of patients, a good correlation (R2 = 0.7400, p<0.05) was found between OSI and PLR, D-dimers and LDH at admission and after 7 days. The OSI correlated well with vitamin D, INF-γ, IL-6, CD4+, CD8+ and the absolute CD8 cell number on admission (R2=0.7635, p<0.05). Vitamin D deficiency (15.37 ng/mL ± 2.81) was observed at admission in the severe group, accompanied by increased levels of IL-6 (295.3 pg/mL ± 40.06), INF-γ (1.603 pg/mL ± 0.134), VEGF (546.8 pg/mL ± 124.2) compared to non-infected individuals. All patients had low partial pressure of oxygen, although it did not show statistically significant difference between the two groups. CONCLUSIONS: All investigated parameters were altered in both groups of patients and a good correlation between them was demonstrated.

Early prognosis in patients with community-acquired severe sepsis and septic shock: analysis of 184 consecutive cases.

PURPOSE: To determine the risk factors on hospital mortality in patients with community-acquired severe sepsis and septic shock in the first 24 hours after admission to the intensive care unit. MATERIALS AND METHODS: The study was prospective, observational, single-centre and included adult patients with community-acquired severe sepsis and septic shock. Demographics, clinical, laboratory and microbiological data were recorded. The main outcome measure was hospital mortality. RESULTS: During the study period, 184 patients were included. The overall mortality rate was 51.6%, 44.4% with severe sepsis and 71.4% in patients with septic shock. The lung was the most common site of infection (65.8%) and respiratory failure was the most common organ failure (54.9%). Multivariate analysis identified four independent risk factors for mortality in patients with severe sepsis and septic shock: three or more organ dysfunctions (OR, 3.212; 95% CI, 1.585-6.506; p<0.001), acute respiratory failure (OR, 2.649 95% CI, 1.327-5.287; p=0.006), positive blood culture (OR, 2.708; 95% CI, 1.289-5.689; p=0.009) and chronic heart failure (OR, 2.112; 95% CI, 1.036-4.308; p=0.040). CONCLUSION: Our results highlight the importance of three or more organ dys-functions, acute respiratory failure, positive blood culture and chronic heart failure as independent risk factors for mortality in the first 24 hours after admission in patients with severe sepsis and septic shock. This will benefit the early identification of patients at high risk for poor outcomes that contributes to intensive management and appropriate treatment interventions.