Hospitalized COVID-19 Patients Research Articles

Strengths and weaknesses of computerized clinical decision support systems: insights from a digital control center (C3 COVID-19) for early and personalized treatment for COVID-19.

Clinical Decision Support Systems (CDSS) are computer-based tools that leverage the analysis of large volumes of health data to assist healthcare professionals in making clinical decisions, whether preventive, diagnostic, or therapeutic. This review examines the impact of CDSS on clinical practice, highlighting both their potential benefits and their limitations and challenges. We detail the experience of clinical medical professionals in the development of a virtual control center for COVID-19 patients (C3 COVID-19) in Spain during the SARS-CoV-2 pandemic. This tool enabled real-time monitoring of clinical data for hospitalized COVID-19 patients, optimizing personalized and informed medical decision-making. CDSS can offer significant advantages, such as improving the quality of inpatient care, promoting evidence-based clinical and therapeutic decision-making, facilitating treatment personalization, and enhancing healthcare system efficiency and productivity. However, the implementation of CDSS presents challenges, including the need for physicians to become familiar with the systems and software, and the necessity for ongoing updates and technical support of the systems.

Investigating the Relationship Between Demographic and Laboratory Factors with the Incidence of PTE in COVID-19

Background: In 2019, after the first case was discovered in Wuhan, China, the COVID-19 virus began to spread rapidly across the world, leading the WHO to declare the disease a public health emergency. Objectives: Thromboembolism refers to the formation of a clot in a vein, which then travels through the vascular system, potentially blocking blood flow in another location. Methods: This retrospective cohort study aimed to investigate the risk factors for pulmonary embolism in COVID-19 patients hospitalized at Firoozabadi Hospital from May to the end of December 2020. After extracting the required information, the data was entered into SPSS version 26 software for analysis. Results: In total, data from 283 COVID-19 patients admitted to Firouzabadi Hospital in Tehran in 2020 were collected. The average age of the patients was 58.8 ± 15.9 years. Among the 283 patients, 162 (57.6%) were male, 79 patients (27.9%) had pulmonary embolism, 102 patients (36%) were smokers, and 107 patients (37.8%) had a history of hypertension. A significant relationship was observed between the occurrence of pulmonary embolism and elevated levels of, white blood cells (WBC) (P = 0.0001), lactate dehydrogenase (LDH) (P = 0.0001), D-dimer (P = 0.0001), polymorphonuclear neutrophils (PMN) (P = 0.020), lymphocytes (P = 0.013), alkaline phosphatase (Alk.P) (P = 0.025), alanine aminotransferase (ALT) (P = 0.019), and aspartate aminotransferase (AST) (P = 0.017). Conclusions: Based on the results of this study, the incidence of pulmonary embolism in hospitalized COVID-19 patients who underwent CT angiography due to clinical suspicion of thrombosis was 27.9%. Additionally, factors such as smoking, a previous history of pulmonary thromboembolism, high WBC, elevated liver function tests (LFT), and elevated LDH levels were identified as risk factors for the occurrence of pulmonary embolism in these patients.

Using HIS administrative data for initial assessment of comorbid patients’ status (Covid-19 case)

Abstract Background Despite numerous published articles, most of the studies on COVID-19 focused on influence of clinical characteristics and treatments on severity. Yet, the epidemiological viewpoint was rarely discussed. Based on our experience with comorbid hospitalized COVID-19 patients, we aim to show that HIS administrative data can be used to identify individuals that are more prone to worse outcome thus improving patient management not only during pandemics. Methods A retrospective single-center study was conducted using archived anonymized HIS administrative data for all 8319 COVID-19 patients in the university hospital ‘Saint Marina’-Varna, Bulgaria, in the period 14/06/2020-31/12/2021. Up to 7 comorbidities per patient were registered in HIS with ICD-10 codes, used for our analyses. Non-parametric tests and logistic regression were used at α=.05, 95%CI. Results Comorbid patients were 5741(69%), 50.3% ≥69y, 52% male; 1602(27.9%) died, 64% ≥69y, 54.4% male. Deceased were older (p< .01) and had more comorbidities (p< .01). Multimorbid patients (OR = 4.43; 3.80-5.17), male (OR = 4.72; 3.83-5.82) and older ones (OR = 1.91; 1.57-2.34) had higher odds of dying. The odds of dying increased with the number of comorbidities from OR=.635; .559-.721 for 1 to OR = 4.23; 3.28-5.46 for 7. From 4967 comorbid diseases (451 ICD-10 codes), only those from code groups A, J, N, E, I, Z were suitable for analysis. Patients with A41.9 (OR = 213.69; 52.88-863.43), J80 (OR = 52.88; 32.58-85.56), N17 (OR = 18.63; 10.24-33.87), E11.7 (OR = 4.72; 3.09-7.19), I13.2 (OR = 4.67; 3.151-6.93), Z95 (OR = 3.81; 2.74-5.31), I63 (OR = 3.56; 2.25-5.61), E66 (OR = 3.12; 2.10-4.64) died more often. Conclusions Our findings match the results based on EMR data: death with COVID-19 was associated with comorbidities (sepsis, acute RDS and kidney, heart and renal failure, diabetes, cerebral infarction, obesity, implants and grafts), age, gender, i.e. HIS administrative data can be used for quick assessment of comorbid patients’ status. Key messages • HIS administrative data can be used for quick assessment of multimorbidity and following personalized treatment is highly recommended to decrease hospital mortality not only in times of pandemic. • Older Bulgarians have many comorbidities from ICD code groups A, J, N, E, I, Z, and are more prone to death, especially in times of pandemic. Public health measures are needed to prevent comorbidity.

Association Between Serum C-Reactive Protein (CRP) And D-Dimer Levels In Covid-19 Patients In A Tertiary Level Hospital, Khulna

Background: The novel corona virus disease 2019 (COVID-19) is major public health issue. It is the most significant global health challenge in the world. Biomarkers play a significant role to detect the severity of COVID-19 infection in the perspective of management of the patients. Aim and objective: We aimed to assess the association between the levels of C-Reactive Protein and D-dimer in COVID-19 patients. Methods: This cross-sectional study was conducted in the department of Pathology and department of Microbiology GMCH, Khulna. 152 patients with SARS-CoV-2 (COVID -19) positive patients were enrolled in this study. C-reactive protein and D-dimer levels are measured in the laboratory of Pathology department, GMCH, Khulna. All statistical computations were performed by using window-based computer software devised with Statistical Packages for Social Sciences (IBM SPSS Statistics 21 version). Results: In this study CRP level was found of mean value of 62.84± 44.64 mg/L with a range of 1.40-195.20 mg/L. It was normal in 21 (13.8%) patients and increased in in 131 patients (86.2 %). The mean value of D-dimer was 2.48 ± 02.20 mg/L with a range of 0.10-9.35 mg/L. D-dimer was normal in 26 (17.1%) patients, whereas it was increased in 126 patients (82.9 %). We performed Pearson’s correlation-coefficient (r) test to compare the association between the levels of CRP with D-dimer in COVID-19 positive patients. There was moderately positive and significant correlation (r = +0.647, p <0.05) between the levels of CRP and D-dimer. Conclusion: There was statistically significant correlation between the levels of serum CRP with D-dimer in COVID-19 positive patients. These two biomarkers can be used to assess the severity in patients with COVID-19 positive with thrombotic disorder for reduction of morbidity and mortality of COVID positive patients. J Dhaka Med Coll. 2023; 32(1) : 57-62

Serum uromodulin associates with kidney function and outcome in a cohort of hospitalised COVID-19 patients

This study investigates the prevalence and evaluates the prognostic implications of acute kidney injury (AKI) in COVID-19 patients, with a novel emphasis on the evaluation of serum uromodulin (sUmod) as a potential kidney-specific biomarker. A cohort of hospitalised COVID-19 patients (n = 378) was examined for AKI using standard criteria. In addition to traditional urinary biomarkers, sUmod levels were analysed. Univariable and multivariable regression models were employed to evaluate the association of sUmod and AKI and in-hospital mortality. Levels of sUmod were significantly lower in patients with CKD (91.8 ± 60.7 ng/ml) compared to patients with normal kidney function (204.7 ± 91.7 ng/ml; p < 0.001). 151 patients (40.0%) presented with AKI at the time of hospital admission or developed an AKI during hospitalization. 116 patients (76.8%) had an AKI already at the time of hospital admission. COVID-19 patients with AKI had significantly lower levels of sUmod compared to patients without AKI during hospitalisation (124.8 ± 79.5 ng/ml) vs 214.6 ± 92.3 ng/ml; p < 0.001). The in-hospital mortality rate in this cohort of COVID-19 patients was 15.3%. Patients with AKI had a higher probability for in-hospital death (OR 5.6, CI 1.76 to 17.881, p = 0.004). Patients who died during hospital stay, had significantly lower sUmod levels (129.14 ± 89.56 ng/ml) compared to patients surviving hospitalisation (187.71 ± 96,64 ng/ml; p < 0.001). AKI is frequently associated with COVID-19 in hospitalized patients. Serum uromodulin may emerge as a promising biomarker for AKI in COVID-19 patients. Further research is warranted to explore its clinical application and refine risk stratification in this patient population.

Aromatase, testosterone, TMPRSS2: determinants of COVID-19 severity

BackgroundMale sex has been identified as a risk factor for worse COVID-19 outcomes. This sex difference has been mostly attributed to the complex role of sex hormones. Cell surface entry of SARS-CoV-2 is mediated by the transmembrane protease serine 2 (TMPRSS2) which is under transcriptional regulation by androgens. P450 aromatase enzyme converts androgens to estrogens. This study measured concentrations of aromatase enzyme, testosterone, estradiol, and TMPRSS-2 in plasma of hospitalized COVID-19 patients to elucidate the dynamics of sex-linked disparity in COVID-19 and correlate them with disease severity and mortality.MethodsIn this prospective cohort study, a total of 265 patients (41% women), age 18 years and older, who had a positive COVID-19 PCR test and were hospitalized for COVID-19 at Memorial Hermann Hospital in Houston, (between May 2020 and May 2021) were enrolled in the study if met inclusion criteria. Plasma concentrations of Testosterone, aromatase, TMPRSS-2, and estradiol were measured by ELISA. COVID-19 patients were dichotomized based on disease severity into moderate-severe (n = 146) or critical (n = 119). Mann Whitney U and logistic regression were used to correlate the analytes with disease severity and mortality.ResultsTMPRSS2 (2.5 ± 0.31 vs. 1.73 ± 0.21 ng/mL, p < 0.01) and testosterone (1.2 ± 0.1 vs. 0.44 ± 0.12 ng/mL, p < 0.01) were significantly higher in men as compared to women with COVID-19 after adjusting for age in a multivariate model. There was no sex difference seen in the level of estradiol and aromatase in COVID-19 patients. TMPRSS2 and aromatase were higher, while testosterone was lower in patients with increased COVID-19 severity. They were independently associated with COVID-19 severity, after adjusting for several baseline risk factors in a multivariate logistic regression model. In terms of mortality, TMPRRS2 and aromatase levels were significantly higher in non-survivors.ConclusionsOur study demonstrates that testosterone, aromatase, and TMPRSS2 are markers of COVID-19 severity. Estradiol levels do not change with disease severity in COVID-19. In terms of mortality prediction, higher aromatase and TMPRSS-2 levels can be used to predict mortality from COVID-19 in hospitalized patients.Plain English SummaryCOVID-19 has caused over a million deaths in the U.S., with men often getting sicker than women. Testosterone, a male hormone, helps control a protein called TMPRSS-2, which allows the COVID-19 virus to spread more easily in the body. A protein called aromatase converts the male hormone testosterone into the female hormone estrogen. It is thought that female hormone estrogen helps protect women from getting seriously ill from COVID-19. To understand the role of these hormones in COVID-19 and sex differences, we measured levels of testosterone, estrogen, aromatase (which turns testosterone into estrogen), and TMPRSS-2 in hospitalized COVID-19 patients. We also checked how this level might reflect the severity of the disease. We found that critically ill COVID-19 patients (the ones in ICU) had higher levels of TMPRSS-2 and aromatase, and lower testosterone levels. When we used these hormone levels to predict death in hospitalized COVID-19 patients, higher levels of TMPRSS-2 and aromatase were linked to a lower chance of survival.

Respiratory rate-oxygenation index on the 3rd day is the best predictor of treatment failure in COVID-19 patients.

Predictors of outcomes are essential to identifying severe COVID-19 cases and optimizing treatment and care settings. The respiratory rate-oxygenation (ROX) index, originally introduced for predicting the failure of non-invasive support in acute hypoxemic respiratory failure (AHRF), has not been extensively studied over time during hospitalization. This multicenter prospective observational study analyzed COVID-19-related AHRF patients admitted to eight Italian hospitals during the second pandemic wave. The study assessed the ROX index using receiver operator characteristic curves and areas under the curve with 95% confidence intervals to predict treatment failure, defined as endotracheal intubation (ETI) or death. A total of 227 patients (69.2% males) were enrolled, with a median arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at admission of 248 (interquartile range: 170-295). Nearly one-third (29.5%) required ETI or died during hospitalization. Those who experienced treatment failure were older (median age 70 versus 61 years, p<0.001), more likely to be current or former smokers (8.5% versus 6.4% and 42.4% versus 25.5%, p=0.039), had a higher prevalence of cardiovascular diseases (74.6% versus 46.3%, p<0.001), and had a lower PaO2/FiO2 ratio at presentation (median 229 versus 254, p=0.014). Gender, body mass index, and other comorbidities showed no significant differences. In patients who failed treatment, the ROX index was higher at presentation and worsened sharply by days 3 and 4. Conversely, in patients who survived without requiring ETI, the ROX index remained stable and reduced after 5-6 days. The ROX index's predictive ability improved notably by the third day of hospitalization, with the best cut-off value identified at 8.53 (sensitivity 75%, specificity 68%). Kaplan-Meier curves indicated that a ROX index of 8.53 or lower on days 1, 2, or 3 was associated with a higher risk of treatment failure. Thus, a single ROX index assessment on day 3 is more informative than its variability over time, with values of 8.53 or lower predicting non-invasive respiratory support failure in hospitalized COVID-19 patients.

Evaluation of the Effect of Vaccination Status on Lung Involvement and Hospitalization in COVID-19 Patients

Background: The spectrum of COVID-19 in adults ranges from asymptomatic infection to mild respiratory tract symptoms to severe pneumonia with acute respiratory distress syndrome (ARDS) and multiorgan dysfunction. In our study, it was aimed to investigate the effects of COVID- 19 vaccine on lung involvement and hospitalization. Materials and Methods: Cases over the age of 18, who had a history of contact with cases infected with COVID-19 or had clinical findings suggestive of COVID-19, who applied to the emergency department and who were diagnosed with COVID-19 by reverse-transcriptase-polymerase chain reaction (RT-PCR) were included in the study. Age, gender, comorbid diseases, hospitalization status, thorax tomography findings, and vaccination status in the last 3 months of the patients included in the study were obtained by examining the hospital information system and patient files. Results: Our study included 496 patients. One hundred eighty-three of the cases were vaccinated and 42.6% (n = 78) of the vaccinated patients were male. Of the 313 unvaccinated patients, 36% (n = 113) were male. Comorbid disease was observed in 55.2% (n = 101) of the vaccinated patients and 38.7% (n = 121) of the unvaccinated patients. Of the 313 unvaccinated patients, 72.2% (n = 226) were discharged from the emergency department, 19.8% (n = 62) were admitted to the service, and 8% (n = 25) were admitted to the intensive care unit. Of the 183 vaccinated patients, 78.1% (n = 143) were discharged from the emergency department, 16.4% (n = 30) were admitted to the service, and 5.5% (n = 10) were admitted to the intensive care unit. In the vaccinated patient group, both the service admission rate and the intensive care hospitalization rate were found to be significantly lower than the non-vaccinated patient group (p &lt; 0.05). Thoracic tomography findings of 32.9% (n = 103) of 313 unvaccinated patients were reported as CORADS 1-2-3, and thoracic tomography of the remaining 210 patients was reported as CORADS 4-5. The number of patients whose thorax tomography report was CORADS 4-5 was found to be significantly higher in the unvaccinated group than in the vaccinated group (p &lt; 0.05). Conclusion: In our study, it was found that vaccination significantly reduced hospitalization in COVID-19 patients. Although the mean age was higher in the vaccinated patient group, both the service admission rate and the intensive care admission rate were found to be lower.

Neuroinflammation in Severe COVID-19: The Dynamics of Inflammatory and Brain Injury Markers During Hospitalization.

Patients with COVID-19 can develop excessive inflammation in the brain and consequent neurological complications. The aim of this study was to evaluate the inflammatory, endothelial and brain injury markers in hospitalized COVID-19 patients and compare those with or without neurological symptoms. A total of 30 intensive care unit (ICU) COVID-19 patients were allocated into COVID-19 (without neurological symptoms) or neuro-COVID-19 (with neurological symptoms) groups. Patients with respiratory infection symptoms but negative for COVID-19 were included as a control group. Peripheral blood samples were collected at hospital admission (T1) (controls and ICU patients) and during hospitalization (T2: last 72h before hospital discharge or in-hospital death) (ICU COVID-19 patients) to analyze inflammatory markers. Higher ICAM-1, CCL26 and VEGF at T1 were identified in both COVID-19 groups compared with control. Neuro-COVID-19 patients presented lower systemic BDNF levels compared with the control group and increased S100B compared with the control and COVID-19 groups. BDNF levels in survivors were lower in the neuro-COVID-19 group compared to the COVID-19 group, while S100B were higher, regardless of the outcome. In addition, all COVID-19 patients presented increased ICAM-1 and CCL26 levels over the hospitalization period (T2 > T1). Furthermore, S100B, ICAM-1, CCL26 and VEGF levels increased in relation to T1 in neuro-COVID-19 patients, with S100B and CCL26 being significantly higher in relation to the COVID-19 group. In conclusion, high levels of brain injury biomarkers were found in patients with neuro-COVID-19, indicating neuroinflammatory and consequent brain injury in the last 72h of hospitalization.

Immunological, Serological and Hematological Changes in COVID 19 Patients of Dhaka City

The analytical test reports of COVID-19 patients admitted in two major hospitals in Dhaka City were analyzed to observe the immunological, serological and hematological abnormalities that can be significant for managing the patients in emergencies. The observed levels of ferritin, procalcitonin, D–Dimer, C-reactive protein (CRP), creatinine and alkaline phosphatase (Alkp) were taken into consideration for this study. Though these parameters were elevated as mentioned for patients from many other countries, in significant cases, the values were normal or even lower than the normal levels. The ferritin level was normal (For men, 24 to 336 micrograms per liter. For women, 11 to 307 micrograms per liter) in only 30% of the patients, whereas, 50% of the patients had higher values and 20% patients had the lower values. Similarly, the procalcitonin (normal value 0.1 to 0.5 ng/mL) level was found to be normal in only 27% of the patients while remaining 73% patients had the high level of this parameter. The D‑Dimer level (less than 0.50) was also found to be normal in only 27% of the patients, whereas 72% of the patients had the higher levels. The C‑reactive protein was within the normal level in only 22% of the patients, whereas, 76% of the patients had the high level of this marker. The creatinine was found to be increased in 60% of the patients. There were 88% patents having increased levels of Alkp with only 12% patients having normal levels. Thus, the elevations of the immunological, serological and hematological parameters were somehow different from those observed from patients in other countries. This information might be useful in managing the hospitalized COVID-19 patients in our country. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 203−207

Management of vulnerable patients hospitalized for COVID-19 with remdesivir: a retrospective comparative effectiveness study of mortality in US hospitals.

COVID-19 remains a major public health concern, with continued resurgences of cases and substantial risk of mortality for hospitalized patients. Remdesivir has become standard-of-care for hospitalized COVID-19 patients. Given the continued evolution of the disease, clinical management relies on evidence from the current endemic period. Using the PINC AI Healthcare database, effectiveness of remdesivir was evaluated among adults hospitalized with a primary diagnosis of COVID-19 between December 2021 and February 2024. Three cohorts were analysed: adults, elderly (≥65 years), and those with documented COVID-19 pneumonia. Analyses were stratified by oxygen requirements. Patients receiving remdesivir were matched to those not receiving remdesivir using propensity score matching. Cox proportional hazards models were used to examine in-hospital mortality. 169,965 adults hospitalized for COVID-19 were included, of which 94,129 (55.4%) initiated remdesivir in the first two days of hospitalization. Remdesivir was associated with a significantly lower mortality rate as compared to no remdesivir among patients with no supplemental oxygen charges (NSOc) (aHR [95% CI]: 14-day, 0.75 [0.69-0.82]; 28-day, 0.77 [0.72-0.83]) and among those with supplemental oxygen charges (SOc): 14-day, 0.76 [0.72-0.81]; 28-day, 0.79 [0.74-0.83]) (p<0.0001, for all). Similar findings were observed for elderly patients and those hospitalized with COVID-19 pneumonia. This evidence builds on learnings from randomized controlled trials from the pandemic era to inform clinical practices. Remdesivir was associated with significant reduction in mortality for hospitalized patients including the elderly and those with COVID-19 pneumonia.

Blood Eosinophils Matter in Post-COVID-19 Pneumonia.

Even after the development of vaccines, SARS-CoV-2 continues to cause severe pneumonia all over the world. Consequently, in order to improve the management of patients and optimize the use of resources, predictors of disease severity and lung complications after COVID-19 pneumonia are urgently needed. Blood cell count is an easily available and reproducible biomarker. With this study, we aimed to explore the role of eosinophils in predicting disease behavior and pulmonary sequelae at first follow-up with computed tomography (CT). we evaluated blood cell count and other inflammatory markers, both at baseline and during hospitalization, in a large population of hospitalized COVID-19 patients. 327 patients were finally enrolled, 214 were classified as low-intensity medical care (LIMC) and 113 as high-intensity medical care. Eosinophils were higher at discharge in the HIMC group [0.1 (0-0.72) vs. 0.05 (0-0.34) × 109/L; p < 0.0001]. Moreover, in the multivariable analysis, age ≥ 62 years (OR 1.76 (1.05-2.8) p = 0.03) and Δ eosinophils ≥ 0.05 (OR 1.75 (1.05-2.9) p = 0.03) were two independent predictors of residual lung abnormalities in the whole patient population at first follow-up. an eosinophil increase during hospitalization could be a potential predictor of pulmonary sequelae in surviving patients after COVID-19 pneumonia.

Effect of Tenofovir Alafenamide Fumarate on the outcomes of hospitalized COVID-19 patients: a prospective, block-balanced, open-label, randomized controlled trial

BackgroundThe global effort to cure COVID-19 is still ongoing. Thus, a prospective, block-balanced, open-label, randomized controlled trial was conducted to evaluate how Tenofovir Alafenamide Fumarate affects hospitalized COVID-19 patients’ outcomes.MethodsThe intervention and control groups of 60 hospitalized COVID-19 patients were randomly allocated. Along with normal medication, the intervention group received 25 mg of tenofovir orally daily for seven days. The control group got normal therapy, including remdesivir and corticosteroids. ICU hospitalization duration, laboratory data, fever, dyspnea, arterial blood oxygen saturation with and without an oxygen face mask, mechanical ventilation, and mortality were the outcomes.ResultsSixty of 236 eligible patients between September 2020 and February 2021 were enrolled. The intervention group had a mean age (±SD) of 61.33 (±13.09) years and the control group 60.03 (±18.03). Sixteen (53.3%) intervention patients and 15 (50.0%) control patients were males. The intervention group had fewer mechanical ventilation and ICU days. Tenofovir Alafenamide Fumarate did not improve fever, dyspnea, oxygen saturation with or without a face mask or nasal cannula, or laboratory data including WBC, ESR, CRP, AST, ALT, AlkP, total and direct bilirubin, in COVID-19 patients.ConclusionAccording to this pilot trial, Tenofovir Alafenamide Fumarate, along with conventional treatment, significantly reduced mechanical ventilation and ICU stay in COVID-19 patients. Further thorough research is necessary to verify this conclusion.

Prevalent and persistent new-onset autoantibodies in mild to severe COVID-19

Autoantibodies have been shown to be implied in COVID-19 but the emerging autoantibody repertoire remains largely unexplored. We investigated the new-onset autoantibody repertoire in 525 healthcare workers and hospitalized COVID-19 patients at five time points over a 16-month period in 2020 and 2021 using proteome-wide and targeted protein and peptide arrays. Our results show that prevalent new-onset autoantibodies against a wide range of antigens emerged following SARS-CoV-2 infection in relation to pre-infectious baseline samples and remained elevated for at least 12 months. We found an increased prevalence of new-onset autoantibodies after severe COVID-19 and demonstrated associations between distinct new-onset autoantibodies and neuropsychiatric symptoms post-COVID-19. Using epitope mapping, we determined the main epitopes of selected new-onset autoantibodies, validated them in independent cohorts of neuro-COVID and pre-pandemic healthy controls, and identified sequence similarities suggestive of molecular mimicry between main epitopes and the conserved fusion peptide of the SARS-CoV-2 Spike glycoprotein. Our work describes the complexity and dynamics of the autoantibody repertoire emerging with COVID-19 and supports the need for continued analysis of the new-onset autoantibody repertoire to elucidate the mechanisms of the post-COVID-19 condition.

A tri-light warning system for hospitalized COVID-19 patients: Credibility-based risk stratification for future pandemic preparedness

PurposeThe novel coronavirus pneumonia (COVID-19) has continually spread and mutated, requiring a patient risk stratification system to optimize medical resources and improve pandemic response. We aimed to develop a conformal prediction-based tri-light warning system for stratifying COVID-19 patients, applicable to both original and emerging variants. MethodsWe retrospectively collected data from 3646 patients across multiple centers in China. The dataset was divided into a training set (n = 1451), a validation set (n = 662), an external test set from Huoshenshan Field Hospital (n = 1263), and a specific test set for Delta and Omicron variants (n = 544). The tri-light warning system extracts radiomic features from CT (computed tomography) and integrates clinical records to classify patients into high-risk (red), uncertain-risk (yellow), and low-risk (green) categories. Models were built to predict ICU (intensive care unit) admissions (adverse cases in training/validation/Huoshenshan/variant test sets: n = 39/21/262/11) and were evaluated using AUROC ((area under the receiver operating characteristic curve)) and AUPRC ((area under the precision-recall curve)) metrics. ResultsThe dataset included 1830 men (50.2 %) and 1816 women (50.8 %), with a median age of 53.7 years (IQR [interquartile range]: 42–65 years). The system demonstrated strong performance under data distribution shifts, with AUROC of 0.89 and AUPRC of 0.42 for original strains, and AUROC of 0.77–0.85 and AUPRC of 0.51–0.60 for variants. ConclusionThe tri-light warning system can enhance pandemic responses by effectively stratifying COVID-19 patients under varying conditions and data shifts.

Short-term Clinical Outcomes of COVID-19 Patients Hospitalized with Chronic Obstructive Pulmonary Disease and Asthma in Three Tertiary Level Hospitals in Bangladesh

Background: Several comorbidities including chronic obstructive pulmonary disease (COPD) or bronchial asthma have been found associated with COVID-19 cases. But it remains unclear which of the comorbidities are associated with worse outcomes of the patients. Objectives: This study was carried out to determine the clinical outcomes of hospitalized COVID-19 patients with COPD or asthma. Methodology: This prospective study was carried out at Respiratory Medicine unit of Monno Medical College and Hospital, Manikganj, from April 2020 to December 2022. Admitted COVID-19 patients, suffering from COPD or bronchial asthma, were enrolled purposively upon fulfilling the inclusion and exclusion criteria. The patients were divided into two groups with associated comorbidities: Group A suffering from COPD and Group B suffering from Asthma. Data were collected from the patients on variables of interest using a semi-structured questionnaire. Results: Among the 144 enrolled patients, 96(66.67%) in group A were suffering from COPD and the other 48 (33.33%) in group B had bronchial asthma. In this study, 41(42.7%) patients in Group A exhibited &gt;25% lung field involvement in the high-resolution computed tomography (CT) chest imaging, compared to only 10(20.8%) in COVID-19 patients in Group B, and this difference in distribution was statistically significant (p=0.026). The COVID-19 patients in Group A were more severe to critically ill (45, 46.9%), compared to patients in Group B (12, 25.0%) with a p value of 0.011. Group A study subjects required intensive care unit (ICU) admission (49, 51.0%) more than the group B participants (16, 33.3%), which was also found statistically significant (p&lt;0.05). Nearly one-fifth (17, 17.7%) of the patients died among the Group A, compared to only 2(4.2%) mortality observed in Group B (p=0.024). The COVID-19 patients with COPD were found significantly associated with the risk of &gt;25% lung field involvement, severe to critical illness, ICU admission, invasive mechanical ventilation, and death (all p values &lt;0.05). Conclusion: The comorbidity of COPD was found to increase the risk of disease severity and adverse outcomes in COVID-19patients significantly. It also heightened the risk of lung field involvement, exceeding 25% more severe disease and increased mortality rates compared to individuals with bronchial asthma. Journal of Monno Medical College December, 2023; 9 (2):47-52

The Impact of Infliximab on Hyperinflammation State in Hospitalized COVID-19 Patients: A Retrospective Study

Background and Objectives: Elevated levels of pro-inflammatory cytokines have been linked to increased mortality in COVID-19 patients. Infliximab, a tumor necrosis factor inhibitor, has been reported to improve outcomes in COVID-19 patients by targeting the hyperinflammatory response. Our objective was to evaluate the effectiveness of incorporating Infliximab into standard care guidelines for the management of COVID-19. Materials and Methods: A retrospective analysis was conducted on 111 participants who were moderate to severe COVID-19 patients admitted to the hospital. Among them, 74 individuals received solely standard treatment, while 37 received standard therapy plus Infliximab. The primary outcomes of the study centered around the changes in laboratory test parameters. The secondary clinical findings included clinical recovery defined as improvement in patient oxygenation, time till recovery, and assessing necessity for ICU admission, and mortality rates. Results: There was no statistical difference observed in the inflammatory markers including, LDH, Ferritin, CRP, neutrophil to lymphocyte ratio (NLR), and P/F ratio between both groups and in the clinical outcomes including clinical recovery (p = 1.0), time to improvement (p = 0.436), and mortality rate (p = 0.601). However, there was a significant increase in secondary infection (45.9%, 20.3%; p = 0.005), and in liver enzymes, ALT (79.5, 50.0 IU/L; p = 0.02) and AST (57.5, 38.0 IU/L; p = 0.019) in the Infliximab group and the standard care group, respectively. Conclusions: Infliximab therapy did not demonstrate significant benefits compared to standard of care in moderate to severe hospitalized COVID-19 patients.

Association of COVID-19 risk factors with systemic fungal infections in hospitalized patients.

A new category of systemic co-infections that emerged with the COVID-19 pandemic is known as COVID-19-associated (CA) fungal infections, which include pulmonary aspergillosis (CAPA), candidiasis (CAC), and mucormycosis (CAM). We aimed to study the association between patient characteristics of hospitalized COVID-19 patients, COVID-19 comorbidities, and COVID-19 therapies with secondary non-superficial fungal infections. We performed descriptive and regression analyses of data from 4,999 hospitalized COVID-19 patients from the University of Kentucky Healthcare (UKHC) system. The patients with secondary systemic fungal infections had a 6-fold higher risk of death than those without such infections. Generally, the risk factors for severe COVID-19 (age, obesity, cardiovascular disease, diabetes, and lack of COVID-19 vaccination) were strong predictors of a secondary fungal infection. However, several characteristics had much higher risks, suggesting that a causative link may be at play: ICU admission, mechanical ventilation, length of hospital stay, and steroid use. In sum, this study found that the known risk factors for severe COVID-19 disease, age, diabetes, cardiovascular disease, obesity, ventilation, and high steroid doses were all predictors of a secondary fungal infection. Steroid therapy may need to be modified to account for a risk or a presence of a fungal infection in vulnerable patients.

Taiwan Chingguan Yihau may improve post-COVID-19 respiratory complications through PI3K/AKT, HIF-1, and TNF signaling pathways revealed by network pharmacology analysis.

The emergence of new SARS-CoV-2 variants with a higher contagious capability and faster transmissible speed has imposed an incessant menace on global health and the economy. The SARS-CoV-2 infection might reoccur and last much longer than expected. Thence, there is a high possibility that COVID-19 can cause long-term health problems. This condition needs to be investigated thoroughly, especially the post-COVID-19 complications. Respiratory tract disorders are common and typical complications after recovery. Until now, there has been a lack of data on specialized therapeutic medicine for post-COVID-19 complications. The clinical efficacy of NRICM101 has been demonstrated in hospitalized COVID-19 patients. This herbal medicine may also be a promising therapy for post-COVID-19 complications, thanks to its phytochemical constituents. The potential pharmacological mechanisms of NRICM101 in treating post-COVID-19 respiratory complications were investigated using network pharmacology combined with molecular docking, and the results revealed that NRICM101 may exert a beneficial effect through the three primary pathways: PI3K/AKT, HIF-1, and TNF signaling pathways. Flavonoids (especially quercetin) have a predominant role and synergize with other active compounds to produce therapeutic effectiveness. Most of the main active compounds exist in three chief herbal ingredients, including Liquorice root (Glycyrrhiza glabra), Scutellaria root (Scutellaria baicalensis), and Mulberry leaf (Morus alba). To our knowledge, this is the first study of the NRICM101 effect on post-COVID-19 respiratory complications. Our findings may provide a better understanding of the potential mechanisms of NRICM101 in treating SARS-CoV-2 infection and regulating the immunoinflammatory response to improve post-COVID-19 respiratory complications.

Rehabilitation and functional outcomes of COVID-19 patients in a rehabilitation hospital in Qatar.

Patients recovering from severe COVID-19 infections have experienced prolonged cognitive, physical, and psychological sequelae, including cardiorespiratory and motor deconditioning, neurological deterioration, anxiety, and depression. The impact of rehabilitation post-acute COVID-19 infection was recognized in the literature, but studies assessing and quantifying specific functional outcomes were lacking. This study aims to describe the characteristics and quantify the changes in functional outcomes of patients admitted to Qatar Rehabilitation Institute (QRI) for inpatient rehabilitation (IPR) post-COVID-19 infection during a 10-month period in 2021. This is a retrospective observational cohort study, which included individuals over 18 years of age with a documented COVID-19-positive diagnosis who were admitted to QRI for IPR due to COVID-19 complications. Data was collected by the investigators from January 1, 2021, until October 30, 2021. A total of 243 patients were included in this study. The changes in functional rehabilitation outcomes were assessed and quantified at both the patient's baseline (on admission to QRI) and after completion of IPR (on discharge). The duration of the IPR program varied based on each patient's baseline assessment. Patients were given a total of 8-12 weeks to achieve their rehabilitation goals and were discharged once those goals were met. Several validated tools were utilized in this study including Functional Independence Measure (FIM), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Modified Medical Research Council (mMRC) Dyspnea Scale, Mini-Mental State Examination (MMSE), and Right- and left-Hand Grip Strength. In addition, patients' diet, the need for respiratory support, and the presence of a tracheostomy tube before and after IPR were also recorded. In total, 84.4% of the included patients were males (n = 205); with a mean age of 52.44 ± 12.99 years. The most commonly reported comorbidities were type 2 diabetes (62.1%) and hypertension (49.8%) with 83.5% of patients experiencing critical illness neuromyopathy. The average patients' length of stay in QRI was 33.92 ± 27.72 days. A statistically significant improvement in all functional outcome scales was noted following the completion of the IPR program (p = 0.001). The number of patients requiring modification to their diet or feeding via nasogastric tube (NGT) significantly decreased by 35% and 93%, respectively (p = 0.001). Patients requiring respiratory support decreased by 98% (p = 0.001) and the need for a tracheostomy tube among patients was reduced by 95% (p = 0.001). IPR following COVID-19 infection was associated with significant functional, motor, and cardiorespiratory improvement. Dedicating clinics for post-COVID-19 rehabilitation would ensure improved patient outcomes and enhanced recovery.