Clinical Course Of COVID-19 Patients Research Articles

The role of platelet large cell ratio in determining mortality in COVID-19 patients.

Inflammatory mechanisms have been implicated and have been subject to research in the clinical course of COVID-19 patients. In this study, platelet large cell ratio (P-LCR) has been examined as a novel prognostic and inflammatory parameter. A total of 1992 COVID-19-positive patients admitted to COVID-19 unit of Infectious Diseases were included. In order to identify a potential relationship between P-LCR and mortality, surviving patients were compared with subjects who died as a result of the disease. Although P-LCR levels showed a steady increase in all COVID-19 patients after admission, they were significantly higher in those who eventually died (P < .001), indicating a positive correlation between mortality and P-LCR. The P-LCR levels of patients followed up in the intensive care unit were statistically significantly higher than those followed up in the ward (P < .001). P-LCR levels of patients intubated in intensive care unit were statistically significantly higher than those who were not intubated (P < .001). Also, P-LCR levels were subdivided into 3 categories as normal, low, and elevated. Elevated P-LCR was found to be positively correlated with leukocyte count, neutrophil count, D-dimer, troponin, ferritin, and C-Reactive Protein (CRP) and showed negative correlation with fibrinogen, lymphocyte count, and platelet count. As P-LCR was correlated with the severity of inflammation in all COVID-19 patients, it was significantly higher in those patients who died. Elevated P-LCR was considered to be associated with the risk of severe disease and death. This inexpensive, readily available test may be incorporated into our clinical practice as a novel marker of poor prognosis in addition to other valuable laboratory parameters.

Retrospective analysis of epidemiologic features and clinical course of COVID-19 patients and comparison between vaccinated and unvaccinated patients.

At our Pneumology Department, we dealt with three waves of COVID-19 pandemics. The purpose of this study is to compare patients' epidemiological and clinical characteristics across waves and to assess the effect of vaccination on clinical presentation, course, and prognosis. From March 2020 to March 2022, a retrospective cohort study was conducted to compare patient characteristics. Based on the time of hospital admission, data from 456 patients were collected and divided into three groups (IW, IIW, and IIIW). In addition, we looked at the link between vaccination and clinical presentation and hospitalization outcome. The average age and comorbidities of patients increased, as did the worsening of respiratory conditions at admission (PaO2/FiO2 median 207 in IW, 95.5 in IIW, and 99 in IIIW). Continuous positive airway pressure (CPAP) was the primary respiratory support during the first wave, but an increase in the use of high flow nasal cannula and noninvasive ventilation was later observed, resulting in a higher hospital discharge rate and a lower intubation rate. Vaccinated patients had less severe COVID-19-related respiratory failure, a better clinical course, and a higher hospital discharge rate (71.4% in V-group vs 44.7% in NV-group, p<0.001). Patients' characteristics changed over the three waves, possibly due to virus mutations. The advancement of clinical and therapeutic management knowledge has contributed to a reduction in the severity of respiratory failure. The vaccination campaign improved the clinical course and reduced mortality.

Discovery and systematic assessment of early biomarkers that predict progression to severe COVID-19 disease

BackgroundThe clinical course of COVID-19 patients ranges from asymptomatic infection, via mild and moderate illness, to severe disease and even fatal outcome. Biomarkers which enable an early prediction of the severity of COVID-19 progression, would be enormously beneficial to guide patient care and early intervention prior to hospitalization.MethodsHere we describe the identification of plasma protein biomarkers using an antibody microarray-based approach in order to predict a severe cause of a COVID-19 disease already in an early phase of SARS-CoV-2 infection. To this end, plasma samples from two independent cohorts were analyzed by antibody microarrays targeting up to 998 different proteins.ResultsIn total, we identified 11 promising protein biomarker candidates to predict disease severity during an early phase of COVID-19 infection coherently in both analyzed cohorts. A set of four (S100A8/A9, TSP1, FINC, IFNL1), and two sets of three proteins (S100A8/A9, TSP1, ERBB2 and S100A8/A9, TSP1, IFNL1) were selected using machine learning as multimarker panels with sufficient accuracy for the implementation in a prognostic test.ConclusionsUsing these biomarkers, patients at high risk of developing a severe or critical disease may be selected for treatment with specialized therapeutic options such as neutralizing antibodies or antivirals. Early therapy through early stratification may not only have a positive impact on the outcome of individual COVID-19 patients but could additionally prevent hospitals from being overwhelmed in potential future pandemic situations.

774 THE PROGNOSTIC ROLE OF GENOTYPIC VARIANTS OF ACE2 AND TMPRSS2 POLYMORPHISMS IN SARS-COV2 / COVID-19 INFECTION

Abstract Background to date, more than 243 million COVID-19 cases have been diagnosed globally, with 4.94 million deaths, 489.000 new cases and 8.474 deaths per day. In Italy there are currently 4.73 million cases and 132.000 deaths. It is well known that the entry of the SARS- CoV-2 virus into cells is mediated by the binding between the virus Spike-glycoprotein (S) and the membrane ACE2-receptor (ACE2-R). When SARS-CoV-2 binds to ACE2-R, with subsequent membrane fusion and virus entry into the cell, a down-regulation of these receptors occurs. ACE2 –R downregulation plays a crucial role in the pulmonary and systemic inflammatory response. A serious clinical course appears to be associated with some factors such as age, previous pathologies and comorbidities. However, also a dysregulation of the RAA system linked to a different expression of ACE-2 R and TMPRSS2 gene polymorphisms and different serum levels of soluble ACE2 (sACE2), could be associated with abnormal inflammatory and immune response to SARS-CoV-2 infection. Aim of the Study we aimed to verify whether there is an association between the clinical course of COVID-19 patients (pts) and the presence of more frequent ACE2 and TMPRSS2 single-nucleotide polymorphisms (SNPs) and if sACE2 levels are related to specific ACE2 and TMPRSS2 polymorphic variants. Methods we consecutively enrolled subjects with previous documented SARS-CoV-2 infection and divided our sample into three groups: pts with asymptomatic course; pts with symptomatic course but without the need for hospitalization for COVID-19; pts with severe symptomatic course requiring hospitalization in intensive care unit. Data about age, clinical course, comorbidities, and therapies were collected. Blood samples were taken for the genetic analysis of the most frequent SNPs of the ACE2-R and TMPRSS2 detected in Italian population, in particular genotypic variants TT and CC of ACE2 SNPs 1 and 5 (rate of 5% and 14% respectively) and genotypic variants TT and CC of TMPRSS2 SNPs 2 and 3 (rate of 50% and 30% respective). Results among 178 pts enrolled up to March 2022, we have so far analyzed the genetic polymorphisms of 74 pts.; 21 (28%) were hospitalized for COVID-19, 38 (51%) had symptomatic course without hospitalization and 15 (21%) were completely pauci-asymptomatics. Serum concentrations of sACE2 and distribution of polymorphic variants in the three groups are summarized in Table 1. We found that sACE2 levels were higher in genotypic variant CC of SNP 1 of TMPRSS2 gene (Table 2). Considering that a high concentration of sACE2 outlines a proinflammatory condition, it could be hypothesized that the CC genotype may be a predisposing condition to the cytokine storm of COVID-19. Perspectives: Genetic analysis of ACE2 and TMPRSS2 SNPs will help to clarify the relationship between these polymorphic variant, sACE2 levels, risk of SARS-CoV2 infection and severity of clinical presentation of COVID-19 in patients with or without CV diseases.

Clinical Course and Risk Factors for Liver Injury of Severe and Critical Patients with COVID-19.

Information regarding the clinical course of COVID-19 patients with liver injury is very limited, especially in severe and critical patients. The objective of this study was to describe the characteristics and clinical course of liver function in patients admitted with severe and/or critical SARS-CoV-2 infection, as well as explore the risk factors that affect liver function in the enrolled COVID-19 patients. Information on clinical characteristics of 63 severe and critical patients with confirmed COVID-19 was collected. Data on patients' demographics, laboratory characteristics, laboratory examination, SARS-CoV-2 RNA results and liver test parameters were acquired and analyzed. The incidence of abnormal aspartate aminotransferase, alanine aminotransferase, and total bilirubin in the critical group was significantly higher than in the severe group (respectively 81.48%, 81.49%, 62.67%, and 45.71%, 63.88%, 22.86%, p < 0.05). The time for liver function parameters to reach their extremes was approximately 2-3 weeks after admission. The independent factors associated with liver injury were patients with invasive ventilators, decreased percentages of neutrophils, lymphocytes and monocytes, and sequential organ failure assessment (SOFA) score ≥2 (p < 0.05). Abnormal liver tests are commonly observed in severe and critical patients with COVID-19. Severe patients infected by SARS-CoV-2 should be closely observed and monitored the liver function parameters, particularly when they present with independent risk factors for liver injury.

Investigation of the clinical course of Covid-19 patients according to blood groups

The aim of this study is to evaluate the effect of blood groups (BGs) on Covid-19 contraction and prognosis and to reveal the coefficients. Patients who referred to Covid-19 outpatient clinics and had an established diagnosis of Covid-19 were included in the study. Their BGs, previous diagnoses and blood examination findings were retrospectively analyzed. Duration of hospitalization, clinical course and survival were recorded. The mean age of 365 subjects, 210 female and 155 male, was 45,5 years. Subjects with BG A developed Covid-19 at significantly higher rates (p = 0.001), while BG O was found associated with lower rates (p = 0.005). Lymphocyte count was found lower (p = 0.035) and rate of lung parenchymal involvement was higher (p = 0.003) in patients with Rh antigen. It was found that a higher percentage of patients with B BG required treatment in the intensive care unit (ICU) compared to other ABO BGs (p = 0.015). These results suggest a higher risk of Covid-19 contraction in the population with BG A and lower risk for BG O population while indicating poorer prognosis for patients with BG B.

Relation of high resolution pulmonary CT findings and clinical condition of COVID-19 patients.

At present, chest computed tomography (CT) is accepted as a tool for assessment COVID-19 patients. However, there are few data about the relationship between initial imaging results at presentation and the presence of systemic inflamma-tory mediators and outcome in patients with COVID-19. The aim of study is to evaluate the relation of initial high resolution com-puted tomography (HRCT) chest findings to inflammatory indices and clinical course of COVID-19 patients during hospitalization. This is a retrospective cohort study carried out on 108 confirmed COVID-19 patients. Demographic, lab-oratory and radiological data were recorded from patients medical records. Based on predominant HRCT density, patients were classified into either normal, ground glass opacity (GGO) and consolidation groups. By HRCT score, patients were classified into either no infilteration, ≤ 50% infilteration and > 50% infilteration groups. Comparison between clinical and laboratory parameters were observed among the groups. More hypoxemia, higher inflammatory indices (CRP, d-dimer, ferritin), more requirement of ventilatory support and more mortality rate were observed in consolidation group compared to GGO (p < 0.05) and in patients with HRCT score > 50% compared to ≤ 50% infilteration group (p < 0.05). Consolidation pattern and high CT chest quantitative score are associated with elevated inflammatory indices and poor outcome in COVID-19 patients. HRCT chest can be used for risk stratification of COVID-19 patients.

The Role of Disease Severity and Demographics in the Clinical Course of COVID-19 Patients Treated With Convalescent Plasma.

Treatment of patients with COVID-19 using convalescent plasma from recently recovered patients has been shown to be safe, but the time course of change in clinical status following plasma transfusion in relation to baseline disease severity has not yet been described. We analyzed short, descriptive daily reports of patient status in 7,180 hospitalized recipients of COVID-19 convalescent plasma in the Mayo Clinic Expanded Access Program. We assessed, from the day following transfusion, whether the patient was categorized by his or her physician as better, worse or unchanged compared to the day before, and whether, on the reporting day, the patient received mechanical ventilation, was in the ICU, had died or had been discharged. Most patients improved following transfusion, but clinical improvement was most notable in mild to moderately ill patients. Patients classified as severely ill upon enrollment improved, but not as rapidly, while patients classified as critically ill/end-stage and patients on ventilators showed worsening of disease status even after treatment with convalescent plasma. Patients age 80 and over showed little or no clinical improvement following transfusion. Clinical status at the time of convalescent plasma treatment and age appear to be the primary factors in determining the therapeutic effectiveness of COVID-19 convalescent plasma among hospitalized patients.

The clinical course of hospitalized moderately ill COVID-19 patients is mirrored by routine hematologic tests and influenced by renal transplantation.

Several studies of patients with COVID-19 have evaluated biological markers for predicting outcomes, most of them retrospectively and with a wide scope of clinical severity. We followed a prospective cohort of patients admitted in hospital wards with moderate COVID-19 disease, including those with a history of kidney transplantation, and examined the ability of changes in routine hematologic laboratory parameters to predict and mirror the patients' clinical course regarding the severity of their condition (classified as critical vs. non-critical) and in-hospital mortality or hospital discharge. Among the 68 patients, 20 (29%) were kidney transplanted patients (KT), and they had much higher mortality than non-kidney transplanted patients in this cohort (40% X 8.3%). Lymphocytes, neutrophils and neutrophils/lymphocytes ratio (NLR) at admission and platelets as well as the red blood cells parameters hemoglobin, hematocrit, and RDW by the time of hospital discharge or death clearly differentiated patients progressing to critical disease and those with clinical recovery. Patients with deteriorating clinical courses presented elevated and similar NLRs during the first week of hospitalization. However, they were dramatically different at hospital discharge, with a decrease in the survivors (NLR around 5.5) and sustained elevation in non-survivors (NLR around 21). Platelets also could distinguish survivors from non-survivors among the critical patients. In conclusion, routine hematologic tests are useful to monitor the clinical course of COVID-19 patients admitted with moderate disease. Unexpectedly, changes in hematologic tests, including lymphopenia, were not predictive of complicated outcomes among KT recipients.

Perioperative Anesthetic Management of Molar Pregnancy Patients with Hyperthyroidism and COVID-19 Underwent Suction Curettage

Background: The incidence of molar pregnancies has increased during the COVID-19 pandemic. Molar pregnancy can cause hyperthyroidism and if not treated immediately can worsen the patient’s condition. A molar pregnancy with hyperthyroidism infected with SARS-CoV-2 poses a challenge for anesthesiologists in perioperative management to prevent complications of thyroid crisis and worsening of COVID-19. &#x0D; Case presentation: A 38-year-old woman was referred to our hospital with a gestational age of 11-12 weeks with vaginal bleeding. Since 2 weeks before being admitted to the hospital the patient complained of fever and the last 3 days had a cough and runny nose. She had no history of contact with COVID-19 patient. On physical examination, her blood pressure was 160/90 mmHg, heart rate was 114 beats per minute, respiratory rate was 18 times per minute, SpO2 was 97% on room air, and body temperature was 37.4oC. Laboratory tests revealed hemoglobin level of 9.2 g/dl, hCG levels &gt; 1,000,000 mIU/ml, and thyroid function tests showed hyperthyroidism. Obstetric ultrasound examination revealed a molar pregnancy. A Burch-Wartofsky score was 20. The real-time transcription-polymerase chain reaction (RT-PCR) test were positive for SARS-CoV-2. In the pre-operative period, the patient was treated with 100 mg of propylthiouracil (PTU) orally every 8 hours and 20 mg of propranolol orally once a day. We performed the curettage suction on the next day under spinal anesthesia using 10 mg of 0.5% hyperbaric bupivacaine. Surgery lasted 75 minutes and performed uneventfully. Evaluation up to 30 days after curettage we found no complications of thyroid crisis and worsening of COVID-19.&#x0D; Conclusion: Innate immune dysregulation due to hyperthyroidism may worsen the clinical course of COVID-19 patients, and conversely, SARS-CoV-2 infection can cause thyroid hormone disorders. Spinal anesthesia can be safely performed in patients with molar pregnancy accompanied by hyperthyroidism and COVID-19

Clinical course of COVID-19 patients needing supplemental oxygen outside the intensive care unit

Patients suffering from CVOID-19 mostly experience a benign course of the disease. Approximately 14% of SARS-CoV2 infected patients are admitted to a hospital. Cohorts exhibiting severe lung failure in the form of acute respiratory distress syndrome (ARDS) have been well characterized. Patients without ARDS but in need of supplementary oxygen have received much less attention. This study describes the diagnosis, symptoms, treatment and outcomes of hospitalized patients with COVID-19 needing oxygen support during their stay on regular ward. All 133 patients admitted to the RWTH Aachen university hospital with the diagnosis of COVID-19 were included in an observational registry. Clinical data sets were extracted from the hospital information system. This analysis includes all 57 patients requiring supplemental oxygen not admitted to the ICU. 57 patients needing supplemental oxygen and being treated outside the ICU were analyzed. Patients exhibited the typical set of symptoms for COVID-19. Of note, hypoxic patients mostly did not suffer from clinically relevant dyspnea despite oxygen saturations below 92%. Patients had fever for 7 [2–11] days and needed supplemental oxygen for 8 [5–13] days resulting in an overall hospitalization time of 12 [7–20] days. In addition, patients had persisting systemic inflammation with CRP levels remaining elevated until discharge or death. This description of COVID-19 patients requiring oxygen therapy should be taken into account when planning treatment capacity. Patients on oxygen need long-term inpatient care.

The Impact of Peripheral Eosinophil Counts and Eosinophil to Lymphocyte Ratio (ELR) in the Clinical Course of COVID-19 Patients: A Retrospective Study.

Eosinophils are blood cells responsible for response against parasites and allergens. Eosinophil to lymphocyte ratio (ELR) is a biomarker for inflammatory conditions. Our aim was to evaluate the role of eosinophils and ELR in COVID-19 patients. The study included 96 patients hospitalized with COVID-19. They were classified into moderate to severe cases and critical cases. Eosinophils and ELR were determined in both groups, in patients that died or survived and were correlated to duration of hospitalization. There was a statistically significant decrease in eosinophils and ELR between patients that died and patients that survived (p<0.05), and in mean values of the two biomarkers (p<0.05 for eosinophils and p<0.05 for ELR) between patients hospitalized for more or less than 15 days among those with moderate to severe disease. Lower eosinophil counts and ERL could probably predict worse outcome in COVID-19 patients.

Lymphocytes, Interleukin 6 and D-dimer Cannot Predict Clinical Outcome in Coronavirus Cancer Patients: LyNC1.20 Study.

Knowledge of Coronavirus 19 (COVID19) pathogenetic mechanisms is necessary to provide new treatment strategies. This study aims to assess how oncological disease impacts on the clinical course of COVID-19 patients. From 1st March to 30th April 2020, 96 COVID-19 patients were classified according to clinical outcome as severe (n=67) and moderate (n=29). Demographic data, medical history, admission lymphocytes, procalcitonin (PCT), c-reactive-protein (CRP), D-dimer, and Interleukin-6 (IL-6) were collected. A statistically significant association was found between hypertension (p=0.007) and three or more comorbidities with severe outcomes (p=0.034). No statistical differences were found between the severe and moderate groups with regards to the rate of patients with past oncological history. However, no patient allocated in the moderate group had received oncological treatment within 12 months. Higher values of CRP, IL-6, D-Dimer and lower values of lymphocytes were reported in the severe group (p=0.0007, p=0.00386, p=0.041, and p=0.007, respectively). Using binary logistic regression, higher values of CRP (OR=8.861; p=0.012) and PCT were associated with a higher risk of severe outcome (OR=21.075; p=0.008). Within the oncological population, D-Dimer and IL-6 did not confirm their prognostic significance as in the general population (p>0.05). Specific prognostic factors for oncological patients should be designed for COVID-19 clinical practice.

Clinical course of COVID-19 patients treated with ECMO: A multicenter study in Daegu, South Korea

BackgroundThe COVID-19 pandemic has caused an epidemic of critical patients, some of whom have been treated with extracorporeal membrane oxygenation (ECMO). This purpose of study is to describe the clinical course of COVID-19 patients treated with ECMO. MethodsA multicentered study of critical patients with COVID-19 treated at six hospitals in Daegu was conducted between January and April 2020. ResultsAmong the 80 patients receiving mechanical ventilation support, 19 (24%) were treated with ECMO included (median age 63.0 years). Eight of the 19 patients (42%) were weaned off ECMO (9.8 days, IQR 7.0-13.7). Among them, four patients were also weaned off mechanical ventilation (33.4 days, IQR 29.3 - 35.7), three were still receiving mechanical ventilation (50.9 days), and one expired after ECMO weaning. According to the univariate analysis, the factor that was associated with successful ECMO weaning was vitamin B12 treatment (p = 0.028). ConclusionsDuring the COVID-19 epidemic, ECMO weaning and mortality rates were 42% and 58%, respectively.

Clinical characteristics and survival analysis in critical and non-critical patients with COVID-19 in Wuhan, China: a single-center retrospective case control study

Since the outbreak of COVID-19 in China at the end of 2019, the world has experienced a large-scale epidemic caused by the SARS-CoV-2. The epidemiological and clinical course of COVID-19 patients has been reported, but there have been few analyses about the characteristics, predictive risk factors, and outcomes of critical patients. In this single-center retrospective case–control study, 90 adult inpatients hospitalized at Tongji Hospital (Wuhan, China) were included. Demographic, clinical, laboratory tests, and treatment data were obtained and compared between critical and non-critical patients. We found that compared with non-critical patients, the critical patients had higher SOFA score and qSOFA scores. Critical patients had lower lymphocyte and platelet count, elevated D-dimer, decreased fibrinogen, and elevated high-sensitivity C-reactive protein (hsCRP), and interleukin-6(IL-6). More critical patients received treatment including antibiotics, anticoagulation, corticosteroid, and oxygen therapy than non-critical ones. Multivariable regression showed higher qSOFA score and elevation of IL-6 were related to critical patients. Antibiotic usage and anticoagulation were associated with decreased in-hospital mortality. And critical grouping contributed greatly to in-hospital death. Critical COVID-19 patients have a more severe clinical course. qSOFA score and elevation of IL-6 are risk factors for critical condition. Non-critical grouping, positive antibiotic application, and anticoagulation may be beneficial for patient survival.

Clinical significance of SARS-CoV-2-specific IgG detection with a rapid antibody kit for COVID-19 patients.

BackgroundThe longitudinal observation of the detection of antibody responses to SARS‐CoV‐2 using antibody kits during the clinical course of COVID‐19 is not yet fully investigated.ObjectivesTo understand the significance of the detection of anti‐SARS‐CoV‐2 antibodies, particularly IgG, using a rapid antibody kit, during the clinical course of COVID‐19 patients with different severities.MethodsSixty‐three serum samples from 18 patients (5 asymptomatic and 13 symptomatic patients) were retrospectively examined using a commercial SARS‐CoV‐2 IgM/IgG antibody kit. PCR positivity of patient samples was also examined as a marker of current SARS‐CoV‐2 infection.ResultsIgG antibodies were detected in all cases in this study. The IgG detection rates reached 100.0% in samples collected on day 13 or later. IgG seropositivity after an initial negative status was observed in 13 patients (3/5 asymptomatic and 10/13 symptomatic cases). Interestingly, the persistence of both PCR and IgG positivity was detected in seven cases, of which three were asymptomatic. The longest overlap duration of the PCR and IgG positivity was 17 days in asymptomatic status.ConclusionsSARS‐CoV‐2‐specific IgG production can be detected in all infected individuals, using a rapid antibody kit, irrespective of clinical status. However, these findings suggest that, in some infected individuals, particularly those with asymptomatic status, the presence of virus‐specific IgG antibodies does not imply prompt viral clearance.

Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy.

The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to 28 April 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48–69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.