Coronavirus Disease 2019 Pneumonia Patients Research Articles

Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study.

BackgroundIt is unclear whether the changes in critical care throughout the pandemic have improved the outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care units (ICUs).MethodsWe conducted a retrospective cohort study in adults with COVID-19 pneumonia admitted to 73 ICUs from Spain, Andorra and Ireland between February 2020 and March 2021. The first wave corresponded with the period from February 2020 to June 2020, whereas the second/third waves occurred from July 2020 to March 2021. The primary outcome was ICU mortality between study periods. Mortality predictors and differences in mortality between COVID-19 waves were identified using logistic regression.FindingsAs of March 2021, the participating ICUs had included 3795 COVID-19 pneumonia patients, 2479 (65·3%) and 1316 (34·7%) belonging to the first and second/third waves, respectively. Illness severity scores predicting mortality were lower in the second/third waves compared with the first wave according with the Acute Physiology and Chronic Health Evaluation system (median APACHE II score 12 [IQR 9–16] vs 14 [IQR 10–19]) and the organ failure assessment score (median SOFA 4 [3–6] vs 5 [3–7], p<0·001). The need of invasive mechanical ventilation was high (76·1%) during the whole study period. However, a significant increase in the use of high flow nasal cannula (48·7% vs 18·2%, p<0·001) was found in the second/third waves compared with the first surge. Significant changes on treatments prescribed were also observed, highlighting the remarkable increase on the use of corticosteroids to up to 95.9% in the second/third waves. A significant reduction on the use of tocilizumab was found during the study (first wave 28·9% vs second/third waves 6·2%, p<0·001), and a negligible administration of lopinavir/ritonavir, hydroxychloroquine, and interferon during the second/third waves compared with the first wave. Overall ICU mortality was 30·7% (n = 1166), without significant differences between study periods (first wave 31·7% vs second/third waves 28·8%, p = 0·06). No significant differences were found in ICU mortality between waves according to age subsets except for the subgroup of 61–75 years of age, in whom a reduced unadjusted ICU mortality was observed in the second/third waves (first 38·7% vs second/third 34·0%, p = 0·048). Non-survivors were older, with higher severity of the disease, had more comorbidities, and developed more complications. After adjusting for confounding factors through a multivariable analysis, no significant association was found between the COVID-19 waves and mortality (OR 0·81, 95% CI 0·64–1·03; p = 0·09). Ventilator-associated pneumonia rate increased significantly during the second/third waves and it was independently associated with ICU mortality (OR 1·48, 95% CI 1·19–1·85, p<0·001). Nevertheless, a significant reduction both in the ICU and hospital length of stay in survivors was observed during the second/third waves.InterpretationDespite substantial changes on supportive care and management, we did not find significant improvement on case-fatality rates among critical COVID-19 pneumonia patients.FundingRicardo Barri Casanovas Foundation (RBCF2020) and SEMICYUC.

Clinical and Laboratory Profile of COVID-19 Pneumonia Patients With a Complicated Post-Intensive Care Unit Hospital Course

Background: Characteristics of intensive care unit (ICU) downgrades who experience a complicated post-ICU ward course (ICU return or floor death) and the incidence of this phenomenon have not been examined in ICU survivors of coronavirus disease 2019 (COVID-19) pneumonia. The aim of the present study was to establish the rate of a complicated post-ICU ward course among survivors of COVID-19 pneumonia and describe the associated patient, ICU management, and serum biomarker characteristics. An additional aim was to compare these parameters between those who experienced a complicated post-ICU course and those who did not. Methods: This was a retrospective study of patients who were admitted to the ICU with COVID-19 pneumonia and were downgraded to a hospital floor at the end of their initial ICU stay. Patients were divided based on a complicated or uncomplicated post-ICU course. Groups were compared with respect to relevant clinical variables. Serum biomarker levels were compared on day of ICU exit and were trended in the days preceding the downgrade. Ward stay of patients who had a complicated course was examined for notable floor events surrounding their decompensation. Results: Eighteen out of 99 downgraded patients (18%) experienced a complicated post-ICU course, among them there were 14 returns (14%) and four deaths (4%). They had higher Charlson Comorbidity Index, higher Acute Physiology and Chronic Health Evaluation (APACHE) IV score, as well as higher D-dimer and C-reactive protein (CRP) at ICU departure. They were less likely to have received therapeutic anticoagulation and convalescent plasma during their ICU stay. On multivariable analysis, these parameters except D-dimer remained independently associated with a complicated course. Review of biomarker trends preceding ICU exit demonstrated an upward trajectory of D-dimer, CRP, and lactate dehydrogenase (LDH) in the complicated course group not mirrored by the uncomplicated course group. Examination of notable floor events leading up to decompensation revealed that in 50% the ward course was characterized by new cardiac disturbances. Conclusions: Our rate of ward death among ICU downgrades was similar to pre-COVID data, but the rate of ICU return was higher. Complicated post-ICU course patients were exhibiting upward biomarker trends at ICU exit, and their ward stay was punctuated by acute cardiac abnormalities. J Clin Med Res. 2021;13(10-11):487-496 doi: https://doi.org/10.14740/jocmr4555

Clinical and Laboratory Profile of COVID-19 Pneumonia Patients With a Complicated Post-Intensive Care Unit Hospital Course.

BackgroundCharacteristics of intensive care unit (ICU) downgrades who experience a complicated post-ICU ward course (ICU return or floor death) and the incidence of this phenomenon have not been examined in ICU survivors of coronavirus disease 2019 (COVID-19) pneumonia. The aim of the present study was to establish the rate of a complicated post-ICU ward course among survivors of COVID-19 pneumonia and describe the associated patient, ICU management, and serum biomarker characteristics. An additional aim was to compare these parameters between those who experienced a complicated post-ICU course and those who did not.MethodsThis was a retrospective study of patients who were admitted to the ICU with COVID-19 pneumonia and were downgraded to a hospital floor at the end of their initial ICU stay. Patients were divided based on a complicated or uncomplicated post-ICU course. Groups were compared with respect to relevant clinical variables. Serum biomarker levels were compared on day of ICU exit and were trended in the days preceding the downgrade. Ward stay of patients who had a complicated course was examined for notable floor events surrounding their decompensation.ResultsEighteen out of 99 downgraded patients (18%) experienced a complicated post-ICU course, among them there were 14 returns (14%) and four deaths (4%). They had higher Charlson Comorbidity Index, higher Acute Physiology and Chronic Health Evaluation (APACHE) IV score, as well as higher D-dimer and C-reactive protein (CRP) at ICU departure. They were less likely to have received therapeutic anticoagulation and convalescent plasma during their ICU stay. On multivariable analysis, these parameters except D-dimer remained independently associated with a complicated course. Review of biomarker trends preceding ICU exit demonstrated an upward trajectory of D-dimer, CRP, and lactate dehydrogenase (LDH) in the complicated course group not mirrored by the uncomplicated course group. Examination of notable floor events leading up to decompensation revealed that in 50% the ward course was characterized by new cardiac disturbances.ConclusionsOur rate of ward death among ICU downgrades was similar to pre-COVID data, but the rate of ICU return was higher. Complicated post-ICU course patients were exhibiting upward biomarker trends at ICU exit, and their ward stay was punctuated by acute cardiac abnormalities.

Single-center register of myocardial revascularization in patients with coronary artery disease and acute coronary syndrome in the context of COVID-19 pandemic

Aim. To assess the short- and long-term outcomes of myocardial re- vascularization (MR) in patients with coronary artery disease (CAD) and acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In the period from April to August 2020, 550 patients with CAD and ACS were included in the register. Emergency percutaneous transluminal coronary angioplasty (n=499) and on-pump coronary artery bypass grafting (CABG) (n=51) were performed. The follow-up period lasted 6 months. The pattern of complications after MR and effects of COVID-19 were analyzed.Results. The studied cohort is represented by patients with CAD &gt;65 years old. ST segment elevation ACS was detected in 23%, acute myocardial infarction — in 59,1%, in other cases — unstable angina. During hospitalization after MR, atrial fibrillation prevailed among cardiovascular complications (4,7%). During this period, 29 (5,3%) patients was diagnosed with COVID-19. In the short-term period after MR, 3 (0,5%) people died due to COVID-19 complications-. In the long-term period after MR, 4 (0,7%) cases of non-fatal stroke were registered, while repeated MR — in 7,1%. The all-cause mortality rate was 1,3% (n=7), of which 57,1% of patients died due to COVID-19 complications. In the subgroup of patients who underwent CABG, the greatest number of in-hospital complications was noted, where exudative pleurisy, atrial fibrillation and anemia prevailed. Of the patients with COVID-19, pneumonia in the short-and long-term posto perative periods was recorded in 48,3 and 61,3%, respectively. Pneumonia is associated with respiratory failure, cardiac dysfunction, and anemia. The risk of COVID-19 pneumonia during the entire follow-up period was higher in patients with ACS who underwent CABG (odds ratio, 19,4; confidence interval: 13,3-26,1; p&lt;0,001). The overall survival rate was 98,7%.Conclusion. COVID-19 infection in patients with ACS after MR effects pattern of postoperative complications. The proportion of COVID-19 pneumonia in patients with ACS in hospital, short- and long-term postoperative periods after MR significantly exceeds that in the general population. The leading factor associated with COVID-19 pneumonia in patients with ACS is on-pump CABG.

One-year follow-up\u2014case report of secondary tension pneumothorax in a COVID-19 pneumonia patient

PurposeThe Coronavirus Disease 2019 (COVID-19) may result not only in acute symptoms such as severe pneumonia, but also in persisting symptoms after months. Here we present a 1 year follow-up of a patient with a secondary tension pneumothorax due to COVID-19 pneumonia.Case presentationIn May 2020, a 47-year-old male was admitted to the emergency department with fever, dry cough, and sore throat as well as acute chest pain and shortness of breath. Sputum testing (polymerase chain reaction, PCR) and computed tomography (CT) confirmed infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Eleven days after discharge, the patient returned to the emergency department with pronounced dyspnoea after coughing. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. For a period of 3 months following resolution of the pneumothorax the patient complained of fatigue with mild joint pain and dyspnoea. After 1 year, the patient did not suffer from any persisting symptoms. The pulmonary function and blood parameters were normal, with the exception of slightly increased levels of D-Dimer. The CT scan revealed only discrete ground glass opacities (GGO) and subpleural linear opacities.ConclusionTension pneumothorax is a rare, severe complication of a SARS-CoV-2 infection but may resolve after treatment without negative long-term sequelae.Level of evidenceV.

Longitudinal changes of laboratory measurements after discharged from hospital in 268 COVID-19 pneumonia patients.

Monitoring recovery process of coronavirus disease 2019 (COVID-19) patients released from hospital is crucial for exploring residual effects of COVID-19 and beneficial for clinical care. In this study, a comprehensive analysis was carried out to clarify residual effects of COVID-19 on hospital discharged patients. Two hundred sixty-eight cases with laboratory measured data at hospital discharge record and five follow-up visits were retrospectively collected to carry out statistical data analysis comprehensively, which includes multiple statistical methods (e.g., chi-square, T-test and regression) used in this study. Study found that 13 of 21 hematologic parameters in laboratory measured dataset and volume ratio of right lung lesions on CT images highly associated with COVID-19. Moderate patients had statistically significant lower neutrophils than mild and severe patients after hospital discharge, which is probably caused by more efforts on severe patients and slightly neglection of moderate patients. COVID-19 has residual effects on neutrophil-to-lymphocyte ratio (NLR) of patients who have hypertension or chronic obstructive pulmonary disease (COPD). After released from hospital, female showed better performance in T lymphocytes subset cells, especially T helper lymphocyte% (16% higher than male). According to this sex-based differentiation of COVID-19, male should be recommended to take clinical test more frequently to monitor recovery of immune system. Patients over 60 years old showed unstable recovery process of immune cells (e.g., CD45 + lymphocyte) within 75 days after discharge requiring longer clinical care. Additionally, right lung was vulnerable to COVID-19 and required more time to recover than left lung. Criterion of hospital discharge and strategy of clinical care should be flexible in different cases due to residual effects of COVID-19, which depend on several impact factors. Revealing remaining effects of COVID-19 is an effective way to eliminate disorder of mental health caused by COVID-19 infection.

Role of total lung stress on the progression of early COVID-19 pneumonia

PurposeWe investigated if the stress applied to the lung during non-invasive respiratory support may contribute to the coronavirus disease 2019 (COVID-19) progression.MethodsSingle-center, prospective, cohort study of 140 consecutive COVID-19 pneumonia patients treated in high-dependency unit with continuous positive airway pressure (n = 131) or non-invasive ventilation (n = 9). We measured quantitative lung computed tomography, esophageal pressure swings and total lung stress.ResultsPatients were divided in five subgroups based on their baseline PaO2/FiO2 (day 1): non-CARDS (median PaO2/FiO2 361 mmHg, IQR [323–379]), mild (224 mmHg [211–249]), mild-moderate (173 mmHg [164–185]), moderate-severe (126 mmHg [114–138]) and severe (88 mmHg [86–99], p < 0.001). Each subgroup had similar median lung weight: 1215 g [1083–1294], 1153 [888–1321], 968 [858–1253], 1060 [869–1269], and 1127 [937–1193] (p = 0.37). They also had similar non-aerated tissue fraction: 10.4% [5.9–13.7], 9.6 [7.1–15.8], 9.4 [5.8–16.7], 8.4 [6.7–12.3] and 9.4 [5.9–13.8], respectively (p = 0.85).Treatment failure of CPAP/NIV occurred in 34 patients (24.3%). Only three variables, at day one, distinguished patients with negative outcome: PaO2/FiO2 ratio (OR 0.99 [0.98–0.99], p = 0.02), esophageal pressure swing (OR 1.13 [1.01–1.27], p = 0.032) and total stress (OR 1.17 [1.06–1.31], p = 0.004). When these three variables were evaluated together in a multivariate logistic regression analysis, only the total stress was independently associated with negative outcome (OR 1.16 [1.01–1.33], p = 0.032).ConclusionsIn early COVID-19 pneumonia, hypoxemia is not linked to computed tomography (CT) pathoanatomy, differently from typical ARDS. High lung stress was independently associated with the failure of non-invasive respiratory support.

Evaluation of textural-based radiomics features for differentiation of COVID-19 pneumonia from non-COVID pneumonia

BackgroundThe false-positive rate of computed tomography (CT) images in the diagnosis of coronavirus disease 2019 (COVID-19) is a challenge for the management in the pandemic. The main purpose of this study is to investigate the textural radiomics features on chest CT images of COVID-19 pneumonia patients and compare them with those of non-COVID pneumonia. This is a retrospective study. Some textural radiomics features were extracted from the CT images of 66 patients with COVID-19 pneumonia and 40 with non-COVID pneumonia. For radiomics analysis, the regions of interest (ROIs) were manually identified inside the pulmonary ground-glass opacities. For each ROI, 12 textural features were obtained and, then, statistical analysis was performed to assess the differences in these features between the two study groups.Results8 of the 12 texture features demonstrated a significant difference (P < 0.05) in two groups, with COVID-19 pneumonia lesions tending to be more heterogeneous in comparison with the non-COVID cases. Among the 8 significant features, only two (homogeneity and energy) were found to be higher in non-COVID cases.ConclusionsTextural radiomics features can be used for differentiating COVID-19 pneumonia from non-COVID pneumonia, as a non-invasive method, and help with better prognosis and diagnosis of COVID-19 patients.

Pulmonary function and six-minute-walk test in patients after recovery from COVID-19: A prospective cohort study.

To study abnormality of spirometry, six-minute walk distance, and chest radiograph among patients recovered from Coronavirus Disease 2019 (COVID-19). A prospective cohort study was conducted in 87 COVID-19 confirmed cases who recovered and discharged from a medical school hospital in Thailand. At the follow-up visit on day 60 after onset of symptoms, patients underwent an evaluation by spirometry (FVC, FEV1, FEV1/FVC, FEF25-75, and PEF), a six-minute-walk test (6MWT), and a chest radiograph. There were 35 men and 52 women, with a mean age of 39.6±11.8 years and the mean body mass index (BMI) was 23.8±4.3 kg/m2. Of all, 45 cases had mild symptoms; 35 had non-severe pneumonia, and 7 had severe pneumonia. Abnormality in spirometry was observed in 15 cases (17.2%), with 8% of restrictive defect and 9.2% of obstructive defect. Among the patients with an abnormal spirometry, the majority of the cases were in the severe pneumonia group (71.4%), compared with 15.6% in the non-severe pneumonia group, and 10.2% in the mild symptom group (p = 0.001). The mean six-minute-walk distance (6MWD) in the mild symptom and non-severe pneumonia groups was 538±56.8 and 527.5±53.5 meters, respectively. Although the severe pneumonia group tended to have a shorter mean 6-min walking distance, but this was not statistically significant (p = 0.118). Twelve patients (13.8%) had abnormal chest radiographs that showed residual fibrosis. This abnormality was more common in the severe pneumonia group (85.7%) and in others (7.5%) (p<0.001). Abnormal spirometry was noted in 17.2% of COVID-19 survivors with both restrictive and obstructive defects. Severe COVID-19 pneumonia patients had higher prevalence rates of abnormal spirometry and residual fibrosis on the chest radiographs when compared to patients in the mild symptom and non-severe pneumonia groups.

Efficacy and Safety of Favipiravir in Moderate COVID-19 Pneumonia Patients without Oxygen Therapy: A Randomized, Phase III Clinical Trial.

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), is an enveloped, single-stranded RNA virus. Favipiravir is an orally administrable antiviral drug whose mechanism of action is to selectively inhibit RNA-dependent RNA polymerase. A preliminary trial in COVID-19 patients reported significant improvements across a multitude of clinical parameters, but these findings have not been confirmed in an adequate well-controlled trial. We conducted a randomized, single-blind, placebo-controlled Phase III trial assessing the efficacy and safety of favipiravir in patients with moderate pneumonia not requiring oxygen therapy.MethodsCOVID-19 patients with moderate pneumonia (SpO2 ≥ 94%) within 10 days of onset of fever (temperature ≥ 37.5 °C) were assigned to receive either placebo or favipiravir (1800 mg twice a day on Day 1, followed by 800 mg twice a day for up to 13 days) in a ratio of 1:2. An adaptive design was used to re-estimate the sample size. The primary endpoint was a composite outcome defined as the time to improvement in temperature, oxygen saturation levels (SpO2), and findings on chest imaging, and recovery to SARS-CoV-2-negative. This endpoint was re-examined by the Central Committee under blinded conditions.ResultsA total of 156 patients were randomized. The median time of the primary endpoint was 11.9 days in the favipiravir group and 14.7 days in the placebo group, with a significant difference (p = 0.0136). Favipiravir-treated patients with known risk factors such as obesity or coexisting conditions provided better effects. Furthermore, patients with early-onset in the favipiravir group showed higher odds ratio. No deaths were documented. Although adverse events in the favipiravir group were predominantly transient, the incidence was significantly higher.ConclusionsThe results suggested favipiravir may be one of options for moderate COVID-19 pneumonia treatment. However, the risk of adverse events, including hyperuricemia, should be carefully considered.Trial registrationClinicaltrials.jp number: JapicCTI-205238.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00517-4.

Late Impact of COVID-19 Pneumonia on Testosterone Levels in Recovered, Post-Hospitalized Male Patients

Background: Recent studies reported lower androgen levels in coronavirus disease 2019 (COVID-19) hospitalized patients which linked to a worse prognosis. However, these studies were conducted in patients with active disease and long-term consequences are still not yet known. Therefore, we aimed to evaluate the late impact of COVID-19 pneumonia on testosterone levels in late recovered, post-hospitalized males. Methods: We enrolled 55 COVID-19 pneumonia-recovered, post-hospitalized male patients after an average of 60 days of discharge from the hospital and 40 age, body mass index (BMI), and waist-matched participants enrolled in this case-control study. The total testosterone cut-off point was set as 300 ng/dL and the cut-off point for luteinizing hormone (LH) was set as 9.4 IU/L. Results: Testosterone deficiency prevalence was 50.9%, and testosterone deficiency was mainly hypogonadotropic (60.7%). Late recovered COVID-19 pneumonia patients had significantly lower total testosterone and calculated free testosterone and higher testosterone to LH ratio and prevalence of testosterone deficiency in comparison with the control group. Testosterone-deficient COVID-19 pneumonia patients had significantly higher anthropometric parameters such as waist circumference and BMI, higher Charlson Comorbidity Index, and longer hospitalization time in comparison with testosterone-sufficient patients. Visceral obesity estimated with waist circumference was a significant predictor for total testosterone levels in COVID patients in regression analysis. Conclusion: Late recovered post-hospitalized COVID-19 pneumonia patients still have lower androgen levels and a higher prevalence of testosterone deficiency in comparison with matched control participants. Moreover, visceral obesity was the most significant predictor of low testosterone levels in recovered COVID-19 patients. J Endocrinol Metab. 2021;11(3-4):76-82 doi: https://doi.org/10.14740/jem749

The Crazy-Paving Pattern in Chest CT Imaging of COVID-19 Patients: An Alarming Sign for Hospitalization

Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a major threat to all humans. Objectives: To assess the association between the patients’ clinical and laboratory records, computed tomography (CT) findings, and epidemiological features of COVID-19 with the severity of the disease. Patients and Methods: In this retrospective case-control study conducted on the medical records of confirmed COVID-19 pneumonia patients on admission, we investigated the CT manifestations and clinical and laboratory risk factors for progression to severe COVID-19 pneumonia. The medical records and radiological CT features of confirmed COVID-19 patients were reviewed in one public hospital and one respiratory clinic in Qom, Iran, from August 1 to September 30, 2020. Results: Of 236 confirmed COVID-19 cases, 62 were infected with moderate to severe COVID-19 and required hospital admission, and 174 were followed-up on an outpatient basis. A significant difference was found in the mean age of the outpatient and hospitalized groups. The incidence of bilateral lung involvement, consolidations, linear opacities, crazy-paving pattern, air bronchogram, and number of lobes involved were significantly higher in the hospitalized group compared to the outpatient group. However, the crazy-paving pattern was only significantly associated with an oxygen saturation (SpO2) level &lt; 90% and, coughing. Our findings indicated that the crazy-paving pattern was significantly associated with the inflammatory phase. The presence of this pattern on admission, SpO2 &lt; 90%, older age, and diabetes were independent risk factors for progression to severe COVID-19. Conclusion: The crazy-paving pattern can predict the severity of COVID-19, which is of great importance in the management and follow-up of COVID-19 pneumonia patients. Clinical factors, such as aging, male gender, and diabetes, may be risk factors for the crazy-paving pattern. Severe cough is the most important clinical sign related to this pattern, along with an SpO2 &lt; 90%, which is an important sign of COVID-19 severity.

Evaluation of the Prognostic Utility of Computed Tomography New Severity Score in COVID-19 Pneumonia Patients

Aim: To investigate the relationship between infection markers (lymphocyte, C-reactive protein, and D-dimer) at the time of diagnosis, and the new scoring system created according to the amount and pattern of pneumonic involvement in recent computed tomography (CT) of patients with Coronavirus disease-2019 (COVID-19) pneumonia Methods: We investigated retrospectively patients diagnosed with COVID-19 with positive reverse transcriptase-polymerase chain reaction on throat swabs between March 17 and May 1, 2020. Eighty-nine cases with COVID-19 pneumonia were divided into two groups according to the level of poor prognostic criteria (blood lymphocyte count 10x upper limit of normal value or D-dimer >1000 ng/mL). The severity of pulmonary parenchymal findings was scored using two separate scoring systems previously as well as a third separate scoring system, namely the “modified CT severity scoring”. The cut-off point for severe infection was investigated by comparing the scores of the groups with and without severe infection. Results: All three scoring systems were significantly higher in the group with severe infection compared to those without severe infections. A modified CT score above 3.4 accompanies at least one of the poor prognosis findings (sensitivity 77.6%, specificity 61%). Conclusion: In patients with COVID-19 pneumonia, the presence of at least one of the infection markers that are poor prognosis markers at the time of diagnosis indicate that the modified CT severity score of pneumonia will be above 3.4.

Comparison of Clinical Characteristics Among COVID-19 and Non-COVID-19 Pediatric Pneumonias: A Multicenter Cross-Sectional Study.

BackgroundThe pandemic of Coronavirus Disease 2019 (COVID-19) brings new challenges for pediatricians, especially in the differentiation with non-COVID-19 pneumonia in the peak season of pneumonia. We aimed to compare the clinical characteristics of pediatric patients with COVID-19 and other respiratory pathogens infected pneumonias.MethodsWe conducted a multi-center, cross-sectional study of pediatric inpatients in China. Based on pathogenic test results, pediatric patients were divided into three groups, including COVID-19 pneumonia group, Non-COVID-19 viral (NCV) pneumonia group and Non-viral (NV) pneumonia group. Their clinical characteristics were compared by Kruskal-Wallis H test or chi-square test.ResultsA total of 636 pediatric pneumonia inpatients, among which 87 in COVID-19 group, 194 in NCV group, and 355 in NV group, were included in analysis. Compared with NCV and NV patients, COVID-19 patients were older (median age 6.33, IQR 2.00-12.00 years), and relatively fewer COVID-19 patients presented fever (63.2%), cough (60.9%), shortness of breath (1.1%), and abnormal pulmonary auscultation (18.4%). The results were verified by the comparison of COVID-19, respiratory syncytial virus (RSV) and influenza A (IFA) pneumonia patients. Approximately 42.5%, 44.8%, and 12.6% of the COVID-19 patients presented simply ground-glass opacity (GGO), simply consolidation, and the both changes on computed tomography (CT) scans, respectively; the proportions were similar as those in NCV and NV group (p>0.05). Only 47.1% of COVID-19 patients had both lungs pneumonia, which was significantly lower than that proportion of nearly 80% in the other two groups. COVID-19 patients presented lower proportions of increased white blood cell count (16.5%) and abnormal procalcitonin (PCT) (10.7%), and a higher proportion of decreased lymphocyte count (44.0%) compared with the other two groups.ConclusionMajority clinical characteristics of pediatric COVID-19 pneumonia patients were milder than non-COVID-19 patients. However, lymphocytopenia remained a prominent feature of COVID-19 pediatric pneumonia.

Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study

ObjectivesSuperimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment.MethodsAll eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated.ResultsOf 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (5 isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (4 isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% vs 15%; P = .001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; P = .004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; P = .048) were associated with MDRO isolation.ConclusionsMDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors.

Clinical Characteristics and Early Interventional Responses in Patients with Severe COVID-19 Pneumonia.

Progressive acute respiratory distress syndrome (ARDS) is the most lethal cause in patients with severe COVID-19 pneumonia due to uncontrolled inflammatory reaction, for which we found that early intervention of combined treatment with methylprednisolone and human immunoglobulin is a highly effective therapy to improve the prognosis of COVID-19-induced pneumonia patients. Objective. Herein, we have demonstrated the clinical manifestations, laboratory, and radiological characteristics of patients with severe Coronavirus Disease-2019 (COVID-19) pneumonia, as well as measures to ensure early diagnosis and intervention for improving clinical outcomes of COVID-19 patients. Summary Background Data. The COVID-19 is a new infection caused by a severe acute respiratory syndrome- (SARS-) like coronavirus that emerged in China in December 2019 and has claimed millions of lives. Methods. We included 37 severe COVID-19 pneumonia patients who were hospitalized at Taizhou Public Health Medical Center in Zhejiang province from January 17, 2020, to February 18, 2020. Demographic, clinical, and laboratory features; imaging characteristics; treatment history; and clinical outcomes of all patients were collected from electronic medical records. Results. The patients' mean age was 54 years (interquartile range, 43−64), with a slightly higher male preponderance (57%). The most common clinical features of COVID-19 pneumonia were fever (29 (78%)), dry cough (28 (76%)), dyspnea (9 (24%)), and fatigue (9 (24%)). Serum interleukin (IL)-6 and IL-10 were elevated in 35 (95%) and 19 (51%) patients, respectively. Chest computerized tomography scan revealed bilateral pneumonia in 35 (95%) patients. Early intervention with a combination of methylprednisolone and human immunoglobulin was highly effective in improving the prognosis of these patients. Conclusions. Progressive acute respiratory distress syndrome is the most common cause of death in patients with severe COVID-19 pneumonia owing to an uncontrolled inflammatory response. Early intervention with methylprednisolone and human immunoglobulin was highly effective in improving their prognosis.

Functional and Radiological Improvement in a COVID-19 Pneumonia Patient Treated With Steroids

Like its predecessors, coronavirus disease 2019 (COVID-19) can lead to long-term health-related consequences in a significant segment of the afflicted population. Although the medical community has developed multiple vaccines by now, COVID-19 has affected over 100 million individuals worldwide and will infect millions more before vaccines can be effectively distributed on a global scale. Additionally, it seems probable that another outbreak caused by a coronavirus may occur in the future, given that this is the third outbreak caused by a coronavirus in recent history. In light of this, the medical community must develop reliable methods of curtailing long-term sequelae of coronaviruses, and the use of corticosteroids in affected patients may be vital for this purpose. In this report, we present a case of progressive dyspnea caused by COVID-19 pneumonia; the patient was treated with a short course of oral corticosteroids, and subsequently showed marked improvement of the dyspnea with corresponding improvements on chest CT.

Off-label tocilizumab and adjuvant iron chelator effectiveness in a group of severe COVID-19 pneumonia patients: A single center experience.

Tocilizumab (TCZ), a monoclonal recombinant antibody against IL-6 receptor, is currently used in managing the cytokine release syndrome (CRS) that occurred in coronavirus disease 2019 (COVID-19) selected cases. The primary objective of our study was to establish the effectiveness of TCZ in patients with severe or critical severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia.We retrospectively analyzed 25 consecutive patients, admitted in the Academic Emergency Hospital Sibiu, Romania from April 1, 2020 until May 25, 2020, all with confirmed SARS-CoV-2 infection and severe pneumonia. All patients were treated off-label with TCZ, beside their standard care. Adjuvant iron chelator was associated in 11 patients.Six female and 19 male patients admitted in our hospital all with confirmed SARS-CoV-2 infection and severe pneumonia as defined by Chinese Centers for Disease Control and Prevention were enrolled in this study. Seventeen of the 25 enrolled patients (68%) were seriously ill requiring noninvasive ventilation or oxygen mask, and 8 cases (32%) were critically ill requiring invasive mechanical ventilation. All patients received TCZ, and also received hydroxychloroquine, and lopinavir/ritonavir 200/50 mg for 10 days. Adjuvant iron chelator (deferasirox – marketed as Exjade) was associated in 11 patients who had ferritin serum levels above 1000 ng/mL. No side effects were encountered during infusions or after TCZ. We observed a rapid increase in arterial oxygen saturation for 20 of the 25 cases (80%) with a favorable evolution toward healing. Survivors were younger than 60 years old (80%), had less comorbidities (10% no comorbidities, 70% with 1 or 2 comorbidities), lower serum ferritin levels (30% under 1000 ng/mL), and 50% had no serum glucose elevation. Our patients with CRS had no response to corticosteroid therapy. Five out of the 25 patients had an unfavorable evolution to death. The off-label use of TCZ in patients with severe or critically ill form of SARS-CoV-2 infection had good results in our study.Off-label use of TCZ in severe and critical cases of COVID-19 pneumonia is effective in managing the “cytokine storm.” Better outcomes were noted in younger patients. Associated adjuvant iron chelators may contribute to a good outcome and needs to be confirmed in larger studies.

The prognostic value of IL-8 for the death of severe or critical patients with COVID-19.

Inflammation has been believed to contribute to coronavirus disease 2019 (COVID-19). Risk factors for death of COVID-19 pneumonia have not yet been well established.In this retrospective cohort study, we included the deceased patients in COVID-19 specialized ICU with laboratory-confirmed COVID-19 from Guanggu hospital area of Tongji Hospital from February 8th to March 30th. Demographic, clinical, laboratory, and outcome data were extracted from electronic medical records using a standard data collection form. We used Spearman rank correlation and Cox regression analysis to explore the risk factors associated with in-hospital death, especially the association between inflammatory cytokines and death.A total of 205 severe/critical COVID-19 pneumonia patients were admitted in the COVID-19 specialized ICU and 75 deceased patients were included in the final analysis. The median age of the deceasing patients was 70 years (IQR 65–79). The common symptoms were fever (78.9%), cough (70.4%), and expectoration (39.4%). The BNP and CRP levels were far beyond the normal reference range. In the Spearman rank correlation analysis, IL-8 was found to be significantly associated with the time from onset to death (rs= −0.30, P = .034) and that from admission to death (rs= −0.32, P = .019). Cox regression showed after adjusting age and sex, IL-8 levels were still significantly associated with the time from onset to death (P = .003) and that from admission to death (P = .01).IL-8 levels were associated with in-hospital death in severe/critical COVID-19 patients, which could help clinicians to identify patients with high risk of death at an early stage.

Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia.

Background and Objectives: The potential role of lung ultrasound (LUS) in characterizing lung involvement in Coronavirus disease 2019 (COVID-19) is still debated. The aim of the study was to estimate sensitivity of admission LUS for the detection of SARS-CoV-2 lung involvement using Chest-CT (Computed Tomography) as reference standard in order to assess LUS usefulness in ruling out COVID-19 pneumonia in the Emergency Department (ED). Methods: Eighty-two patients with confirmed COVID-19 and signs of lung involvement on Chest-CT were consecutively admitted to our hospital and recruited in the study. Chest-CT and LUS examination were concurrently performed within the first 6–12h from admission. Sensitivity of LUS was calculated using CT findings as a reference standard. Results: Global LUS sensitivity in detecting COVID-19 pulmonary lesions was 52%. LUS sensitivity ranged from 8% in case of focal and sporadic ground-glass opacities (mild disease), to 52% for a crazy-paving pattern (moderate disease) and up to 100% in case of extensive subpleural consolidations (severe disease), although LUS was not always able to detect all the consolidations assessed at Chest-CT. LUS sensitivity was higher in detecting a typical Chest-CT pattern (60%) and abnormalities showing a middle-lower zone predominance (79%). Conclusions: As admission LUS may result falsely negative in most cases, it should not be considered as a reliable imaging tool in ruling out COVID-19 pneumonia in patients presenting in ED. It may at least represent an expanded clinical evaluation that needs integration with other diagnostic tests (e.g., nasopharyngeal swab, Chest-CT).