Independent Predictors Of Severe Disease Research Articles

Optic nerve sheath diameters predict mortality and severity in hepatic encephalopathy.

The aim of this study was to compare the predictive power of optic nerve sheath diameter (ONSD) measured by brain computed tomography (CT) in patients diagnosed with hepatic encephalopathy (HE) in the emergency department, with other factors for mortality and disease severity. A total of 217 patients aged 18 years and older with acute decompensation of cirrhosis diagnosed with HE in the emergency department were included in the study. To compare with patients diagnosed with HE, a total of 217 individuals were included in the study as the healthy control group. ONSD measurements were performed on both the HE patients and the healthy control group in the brain CT. The mortality rate of HE patients was 32.7%. Regarding the severity of the disease, 53% of the patients had late-stage HE. The presence of acute-on-chronic liver failure was detected in 51.4% of patients. The mortality rate among acute-on-chronic liver failure patients was 56.6%. According to the study data, ONSD, creatinine, lactate, and procalcitonin were independent predictors of mortality. Meanwhile, Child-Pugh score, direct bilirubin, ONSD, ammonia, and total bilirubin were independent predictors of disease severity. In the receiver operating characteristic curve analysis, the ONSD had the highest predictive power for mortality and disease severity among the determined predictive values. The data from the study suggests that assessing the ONSD through brain CT scans in individuals diagnosed with HE in the emergency department may provide valuable insights for clinicians, aiding in the prediction of both mortality rates and the severity of the disease.

A single-center experience in home management of mild and moderate COVID-19 cases.

The use of telemedicine for treatment of coronavirus disease 2019 (COVID-19) infection has been effective in lowering the risk of infection and relieving strain on the healthcare system. This study aimed to describe the clinical characteristics of COVID-19 cases, their follow-up, risk factors of disease severity, and predictors of hospital admission while using telemedicine. The study included 611 Egyptian patients with mild and moderate COVID-19 disease. The patients were isolated at home and monitored daily. Based on the World Health Organization classification, 79% of studied patients had mild illness while 20.5% had moderate illness. The initial symptoms included cough (51.7%), fever (50.8%), fatigue (45.9%), sore throat (41.1%), dyspnea (35.2%), and headache (34%); 25.2% patients had prolonged symptoms (≥ 21 days). Dyspnea was the most frequent (15.5%) long-term symptom. Age, co-existing diabetes, and COVID-19 infection with moderate severity, were associated with the need for hospitalization. We compared patients with COVID-19 infection who required hospital admission (n = 37) versus patients who continued in home isolation (n = 574). High neutrophil/lymphocyte ratio, transaminases, and ferritin significantly correlated with the need for hospitalization. 18.9% of the patients who required hospital admission had diabetes. Multivariate analysis described age and diabetes as independent predictors of disease severity. Age and high neutrophil/lymphocyte ratio were independent predictors of hospital admission. Telemedicine is effective in-home management of mild/moderate COVID-19 patients, which may ease the pressure on the healthcare system, even beyond the pandemic.

La Crosse virus encephalitis in children.

La Crosse virus encephalitis (LACV-E) is among the most common neuroinvasive arthropod-borne viral infections of childhood in North America. Children are uniquely predisposed to symptomatic disease, whereas symptomatic adult infections remain uncommon. Infection results frequently in neurologic symptomatology including headaches, seizures, and altered mentation, often necessitating hospitalization and significant diagnostic evaluation. The purpose of this review is to provide a contemporary assessment of clinical, laboratory, and neurobehavioral outcomes of children with LACV-E. Common clinical manifestations at presentation, specifically seizure activity and altered mental status, are independent predictors of disease severity. Epileptiform discharges on electroencephalogram (EEG) during hospitalization may predict long-term epilepsy diagnosis. Lastly, long-term neurologic sequelae from acute infection is persistent and likely under-recognized among children with LACV-E. As climate change alters the geographic distribution of mosquito borne illnesses, a possibility of regional expansion of La Crosse virus (LACV) endemicity exists. The above data highlight readily identifiable features and testing modalities for clinicians who may encounter this viral infection. Importantly, an emphasis on long term neurobehavioral follow up is necessary to better identify and provide support of affected individuals. Future research in identifying host immune responses to LACV infection, as well as therapeutic options, are needed.

Evaluation of Oxidative Stress and Endothelial Dysfunction in COVID-19 Patients.

Background and Objectives: Heat shock proteins (HSPs) are stress proteins. The endogenous nitric oxide (NO) synthase inhibitor asymmetric dimethyl arginine (ADMA) is a mediator of endothelial dysfunction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes endothelial dysfunction and coagulopathy through severe inflammation and oxidative stress. Using these markers, we analyzed the prognostic value of serum ADMA and HSP-90 levels for early prediction of severe coronavirus disease (COVID-19) patients. Materials and Methods: A total of 76 COVID-19 patients and 35 healthy control subjects were included in this case-control study. COVID-19 patients were divided into two groups: mild and severe. Results: Serum ADMA and HSP-90 levels were significantly higher in the COVID-19 patients compared to the control subjects (p < 0.001). Additionally, serum ADMA and HSP-90 levels were determined to be higher in a statistically significant way in severe COVID-19 compared to mild COVID-19 (p < 0.001). Univariable logistic regression analysis revealed that ADMA and HSP-90, respectively, were independent predictors of severe disease in COVID-19 patients (ADMA (OR = 1.099, 95% CI = 1.048-1.152, p < 0.001) and HSP-90 (OR = 5.296, 95% CI = 1.719-16.316, p = 0.004)). When the cut-off value for ADMA was determined as 208.94 for the prediction of the severity of COVID-19 patients, the sensitivity was 72.9% and the specificity was 100% (AUC = 0.938, 95%CI = 0.858-0.981, p < 0.001). When the cut-off value for HSP-90 was determined as 12.68 for the prediction of the severity of COVID-19 patients, the sensitivity was 88.1% and the specificity was 100% (AUC = 0.975, 95% CI= 0.910-0.997, p < 0.001). Conclusions: Increased levels of Heat shock proteins-90 (HSP-90) and ADMA were positively correlated with increased endothelial damage in COVID-19 patients, suggesting that treatments focused on preventing and improving endothelial dysfunction could significantly improve the outcomes and reduce the mortality rate of COVID-19. ADMA and HSP-90 might be simple, useful, and prognostic biomarkers that can be utilized to predict patients who are at high risk of severe disease due to COVID-19.

Comparative analysis of prognostic scoring systems in predicting severity and outcomes of Omicron variant COVID-19 pneumonia.

The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality. In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk. The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively. The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.

Bio-electrical impedance phase angle and impedance ratio as predictors of disease severity among critically ill children

ObjectiveTo find out the predictive ability of bio-electrical impedance analysis (BIA) phase angle and impedance ratio for disease severity/mortality among critically ill children. MethodsA prospective observational study, among eighty-one children admitted to pediatric intensive care unit (PICU) was undertaken. Using bioelectrical impedance analyzer, phase angle (PA) and impedance ratio (IR) were recorded. Pediatric index mortality score (PIM3) was used to assess disease severity and mortality. Length of hospital stay (LOS), 30-day mortality, demographic and anthropometric measurements were recorded. ResultsMean age of the patients was 4.11 ± 4.60 years, majority were males (54.32 %). Mortality was 6.2 %. IR was significantly lower among survivor group than non-survivor group, while rest of the variables were comparable. The mean PIM3 score was lower (12.71 ± 7.39) among survivors than non-survivors (14.56 ± 5.56). Receiver operator characteristic (ROC) curve analysis showed a cutoff of 3.9° PA predicted the mortality with sensitivity of 93 % and specificity of 86.8 %. At a cutoff of 0.879, IR predicted the mortality with sensitivity and specificity of 93 %. The LOS increased with disease severity, and this difference was statistically significant. Although the mean LOS among survivors was less in comparison to the non-survivors; this difference was not statistically significant. ConclusionsBio-electric impedance PA and IR at the time of PICU admission can be used as an independent predictor of disease severity and 30-day mortality and can be a prognostic marker. Further multicentric studies with large sample size can strengthen our study findings.

IP-10, MIP1α, IL-6, and IL-1β as Biomarkers Associated with Disease Severity of COVID-19

Background: The factors responsible for the progression of COVID-19 from a mild illness to a severe and often lethal condition, characterized by respiratory failure and multiple organ involvement, remain unclear. The identification of biomarkers capable of predicting disease progression is of the highest importance. Objectives: This study sought to assess laboratory measurements of interferon-gamma inducible protein-10 (IP-10), macrophage inflammatory protein 1-alpha (MIP1α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) to achieve this objective. Methods: We measured IP-10 and MIP1α by qRT-PCR and IL-6 and IL-1β using an enzyme-linked immunosorbent assay in 120 serum samples. We analyzed differences between patients with moderate, severe, and recovered COVID-19. Results: The number of positive cases for biomarkers IP-10, MIP1α, IL-6, and IL-1β were significantly different between groups. The expression levels of IP-10 and MIP1α were significantly higher in patients with severe COVID-19 compared to those who had recovered. A strong positive association was observed between IP-10 and MIP1α in severe infection cases. Additionally, these biomarkers were relatively independent predictors of disease severity. Conclusions: The results suggest that IP-10, MIP1α, IL-6, and IL-1β are promising research candidates for understanding the severity of COVID-19 and for investigating possible pathophysiological mechanisms of the disease.

Fibrinogen-to-albumin ratio percentage: An independent predictor of disease severity and prognosis in anti-N-methyl-D-aspartate receptor encephalitis.

This retrospective study aimed to investigate the relationship between fibrinogen-to-albumin ratio percentage (FARP) and disease severity and prognosis in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Medical records and clinical characteristics from 181 patients with anti-NMDAR encephalitis were included. The modified Rankin Scale (mRS) was used to analyze disease severity and prognosis at admission and discharge, and correlations between FARP, disease severity, and prognosis were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the efficiency of FARP in assessing disease severity and prognosis. Compared to the control group, patients with anti-NMDAR encephalitis had higher fibrinogen (Fib) levels (P < 0.001), neutrophil counts (P < 0.001), and FARP levels (P < 0.001) but had lower albumin levels (P = 0.003). The enrolled patients were divided into mild-to-moderate and severe groups according to their mRS scores both at admission and discharge. FARP levels were significantly elevated in the severe group compared to the mild-to-moderate group among patients with anti-NMDAR encephalitis both at admission and discharge (admission 6.0 vs. 7.40, P < 0.001; discharge 6.43 vs. 8.18, P<0.001). Indeed, the mRS scores at admission (56 vs. 26%, P < 0.001) and discharge (26 vs. 11%, P = 0.006) in the high FARP group were significantly higher than those in the low FARP group. Furthermore, FARP was positively correlated with the mRS scores at admission (r = 0.383, P < 0.001) and discharge (r =0.312, P < 0.001). In the multivariate analysis, FARP was significantly associated with disease severity (odds ratio [OR] = 1.416, 95% confidence interval [CI] = 1.117-1.795, P = 0.004) and prognosis (OR = 1.252, 95% CI = 1.010-1.552, P = 0.040). FARP-based ROC curves predicted disease severity, with a sensitivity of 0.756, a specificity of 0.626, and an area under the ROC curve of 0.722 (95% CI = 0.648-0.796, P < 0.001*). The ROC curve predicted the disease prognosis with a sensitivity of 0.703, a specificity of 0.667, and an area under the ROC curve of 0.723 (95% CI = 0.629-0.817, P < 0.001*). Our results indicate that FARP is a novel predictive marker for disease severity and prognosis of anti-NMDAR encephalitis.

C-reactive protein isoforms as prognostic markers of COVID-19 severity.

C-reactive protein (CRP), an active regulator of the innate immune system, has been related to COVID-19 severity. CRP is a dynamic protein undergoing conformational changes upon activation in inflammatory microenvironments between pentameric and monomeric isoforms. Although pentameric CRP is the circulating isoform routinely tested for clinical purposes, monomeric CRP shows more proinflammatory properties. Therefore, we aimed to determine the potential of monomeric CRP in serum as a biomarker of disease severity in COVID-19 patients (admission to intensive care unit [ICU] and/or in-hospital mortality). We retrospectively determined clinical and biological features as well as pentameric and monomeric CRP levels in a cohort of 97 COVID-19 patients within 72h of hospital admission. Patients with severe disease had higher levels of both pentameric and monomeric CRP. However, multivariate analysis showed increased mCRP but not pCRP to be independently associated to disease severity. Notably, mCRP levels higher than 4000 ng/mL (OR: 4.551, 95% CI: 1.329-15.58), together with number of co-morbidities, low lymphocyte count, and procalcitonin levels were independent predictors of disease severity in the multivariate model. Our results show the potential of mCRP levels as a marker of clinical severity in COVID-19 disease.

Elevated plasma D-dimer levels in patients with anti-N-methyl-D-aspartate receptor encephalitis.

We aimed to explore the difference in coagulation function between healthy individuals and patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis and its relationship with disease severity. We retrospectively compared coagulation function in 161 patients with first-attack anti-NMDAR encephalitis and 178 healthy individuals. The association between D-dimer levels and disease severity was analyzed using binary logistic regression. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of D-dimer levels for the severity of anti-NMDAR encephalitis. Compared to control individuals, patients with anti-NMDAR encephalitis had higher D-dimer levels (median 0.14 vs. 0.05 mg/L, p < 0.001), blood white blood cell (WBC) count (median 8.54 vs. 5.95 × 109/L, p < 0.001), and neutrophil count (median 6.14 vs. 3.1 × 109/L, p < 0.001). D-dimers (median 0.22 vs. 0.10 mg/L, p < 0.001), blood WBC count (median 9.70 vs. 7.70 × 109/L, p < 0.001), neutrophil count (median 7.50 vs. 4.80 × 109/L, p < 0.001), and C-reactive protein (median 2.61 vs. 1.50 mg/l, p = 0.017) were higher; however, eosinophils (median 0.02 vs. 0.06 × 109/L, p < 0.001), and blood calcium (median 2.26 vs. 2.31 mmol/L, p = 0.003) were lower in patients with severe forms of anti-NMDAR encephalitis than in those with mild to moderate forms, and were associated with initial modified Rankin Scale scores. Multivariate analysis showed that D-dimer levels were significantly associated with severity [odds ratio =2.631, 95% confidence interval (CI) = 1.018-6.802, p = 0.046]. The ROC curve was used to analyze the predictive value of D-dimer levels for disease severity. The area under the curve was 0.716 (95% CI = 0.64-0.80, p < 0.001), and the best cut-off value was D-dimer = 0.147 mg/L (sensitivity 0.651; specificity, 0.705). Serum D-dimer and neutrophil levels were independent predictors of disease severity in patients with first-attack anti-NMDAR encephalitis.

Abstract 13723: Uric Acid and Treatment With Empagliflozin in Heart Failure With Preserved Ejection Fraction: The EMPEROR-Preserved Trial

Background: The sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin reduces CV death and hospitalization for HF (HHF) in patients with HF with preserved ejection fraction (HFpEF). Empagliflozin reduces serum uric acid (SUA), but the relevance of this effect in HFpEF is unclear. Methods: This post-hoc analysis of the EMPEROR-Preserved trial assessed the association between SUA and the composite primary outcome of CV death or hospitalization for worsening HF, its components and all-cause mortality (ACM) in 5,924 patients with HFpEF (98.9% of study cohort). We investigated effects of empagliflozin on SUA levels and hyperuricemic events (acute gout, gouty arthritis or initiation of anti-gout therapy), and on outcomes in relation to baseline SUA and the change in SUA levels Results: Hyperuricemia was prevalent in 49% of patients (male: 42%, female: 57%). Elevated SUA (highest tertile, mean SUA 8.8±1.4mg/dL) was associated with severity of HF and higher risk of HHF (first HHF: HR 1.42 [95%CI 1.08-1.86], recurrent HHF: HR 1.69 [95%CI 1.23-2.32], in comparison with the lowest tertile within the placebo group, both p&lt;0.01). Elevated SUA was not associated with increased CV death and ACM. Empagliflozin reduced SUA at 4 weeks (vs. placebo: -1.0±0.03mg/dL, p&lt;0.0001) and SUA remained lower throughout follow up. Empagliflozin reduced events of clinically relevant hyperuricemia by 38% (HR 0.62 [95%CI 0.51-0.76], p&lt;0.0001). The benefit of empagliflozin on the primary endpoint was independent of baseline SUA (HR 0.79 [95%CI 0.69-0.90], p=0.0007) and absolute change in SUA at 4 weeks (HR 0.87 [95%CI 0.75-1.01, p=0.07] landmark analysis). The benefit of empagliflozin versus placebo on the rate of decline of eGFR and time to first renal composite outcome was consistent across SUA tertiles (p for interaction 0.92 and 0.89, respectively) Conclusion: Hyperuricemia is common in HFpEF and is an independent predictor of disease severity and increased risk of hospitalization. Empagliflozin induced a rapid, sustained reduction of SUA levels and clinical events related to hyperuricemia. The benefit of empagliflozin on the primary outcome in HFpEF was observed independently of SUA.

Age and respiratory syncytial virus etiology in bronchiolitis clinical outcomes.

Respiratory syncytial virus (RSV) is the most frequent cause of bronchiolitis. Precise and updated information about demographic characteristics, clinical manifestations, and risk factors for severe disease are needed for optimal implementation of upcoming new therapeutic and preventive interventions. The main goals of this study were to define the epidemiology of acute bronchiolitis in hospitalized young children during 5 calendar years in Spain; evaluate the differences in clinical manifestations between children hospitalized with RSV infection and those hospitalized with non-RSV infection; and identify demographic characteristics, clinical parameters, and risk factors associated with disease severity. We performed a retrospective review of the medical records of children younger than 2 years who were hospitalized with bronchiolitis between January 2015 and December 2019. We constructed multivariable models to identify independent predictors of disease severity defined as length of hospital stay (LOS), pediatric intensive care unit (PICU) admission, and need for a high-flow-nasal canula (HFNC). From January 2015 to December 2019, 1437 children were hospitalized with bronchiolitis and met the inclusion criteria. The proportion of children hospitalized with bronchiolitis caused by RSV increased significantly during the study period, from 60% to 65% (P= .03). The children with RSV bronchiolitis were younger than those with non-RSV bronchiolitis (median age= 3 months [interquartile range= 1.5-6.5 months] vs 4 months [interquartile range= 2-7.5 months], respectively (P< .01). The children younger than 6 months with RSV bronchiolitis had enhanced disease severity compared with those with non-RSV bronchiolitis, as defined by an LOS of more than 4 days, severity scores, need for an HFNC, intravenous fluids, enteral feeding, and PICU admissions (P< .01). Age younger than 6 months and RSV-positive etiology were independently associated with greater odds of PICU admission, need for an HFNC, and longer LOS. This study identified differences in disease severity between young children with RSV bronchiolitis and those with non-RSV bronchiolitis. These differences are particularly significant in children younger than 6 months, who comprise a group of infants with suboptimal innate immunity to RSV and may benefit from new preventive strategies.

Clinical Characteristics and Prognostic Factors of Severity in Covid-19 Patients in Lahore, Pakistan

Background: The coronavirus disease outbreak of 2019 (COVID-19) has developed into a global emergency. COVID-19's severity is strongly correlated with its mortality rate. We aimed to examine the demographic, medical, laboratory, and imaging characteristics of 120 patients affected by COVID-19. Methods: 120 COVID-19 infected- patients who tested positive from the throat swab specimen on quantitative reverse transcriptase-polymerase chain reaction (q RT-PCR) were included. Demographic, clinical, radiographic, and laboratory data were obtained and analyzed. Results: Male gender, urban residence, current smoker, exposure history, sore-throat, dyspnoea, cough, headache, diarrhea, coronary heart disease, chronic obstructive lung disease, and cancer, decreased level of hemoglobin and albumin and increased level of lymphocyte count, leukocyte count, LDH level, D-dimer, serum ferritin, total bilirubin, urea level (p-value &lt; 0.05) were contributing factors towards disease severity. In the binary logistic regression model LDH (OR 1.002, [CI, 1.001-1.003]; p = 0.001), and D-dimer (OR 1.377, [CI, 1.161-1.633]; p=0.001) were independent predictors of disease severity. Conclusion: Appropriate evaluation of prognostic factors and provision of the appropriate interventions in high-risk patients can decrease the mortality associated with COVID-19

La Crosse Virus Neuroinvasive Disease in Children: A Contemporary Analysis of Clinical/Neurobehavioral Outcomes and Predictors of Disease Severity.

La Crosse virus (LACV) is the most common neuroinvasive arboviral infection in children in the United States. However, data regarding predictors of disease severity and neurologic outcome are limited. Additionally, long-term neurologic and neurobehavioral outcomes remain relatively sparse. This was a single-center, retrospective cohort study, followed by recruitment for a cross-sectional analysis of long-term neurobehavioral outcomes, among children aged 0-18 years with proven or probable LACV neuroinvasive disease (LACV-ND) between January 2009 and December 2018. Case ascertainment was assured by International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes cross-referenced with laboratory results detecting LACV. Demographics, diagnostics, radiographs, and outcomes were evaluated. Recruitment of patients with prior diagnosis of LACV-ND occurred from January 2020 to March 2020, with assessment performed by validated pediatric questionnaires. One-hundred fifty-two children (83 males; median age, 8 years [interquartile range, 5-11.5 years]) were diagnosed with proven (n = 61 [47%]) and probable (n = 91 [60%]) LACV-ND. Sixty-five patients (43%) had severe disease. Altered mental status (AMS) (odds ratio [OR], 6.36 [95% confidence interval {CI}, 2.03-19.95]; P = .0002) and seizures at presentation (OR, 10.31 [95% CI, 3.45-30.86]; P = .0001) were independent predictors of severe disease. Epileptiform discharges on electroencephalogram (EEG) were independently associated with epilepsy diagnosis at follow-up (OR, 13.45 [95% CI, 1.4-128.77]; P = .024). Fifty-four patients were recruited for long-term neurobehavioral follow-up, with frequent abnormal assessments identified (19%-54%) irrespective of disease severity. Severe disease was observed frequently among children with LACV-ND. Seizures and AMS at presentation were independent predictors of severe disease. EEG may help determine long-term epilepsy risk. Long-term neurobehavioral issues are frequent and likely underrecognized among children with LACV-ND.

Association Between Known Close Contact History and Severity of COVID-19 Pneumonia: A Preliminary Evidence Supporting Importance of Filiation.

OBJECTIVE:The role of a known contact history in coronavirus disease 2019 severity in secondary cases is unknown. The study was aimed to investigate the relationship between the close contact history and the severity of the disease in coronavirus disease 2019 pneumonia.MATERIAL AND METHODS: Hospitalized patients diagnosed with coronavirus disease 2019 pneumonia were included. The demographic, clinical, and laboratory data of the patients were collected retrospectively and patients with or without close contact history were analyzed with respect to the severity of pneumonia.Results: In a total of 100 patients with coronavirus disease 2019 pneumonia, 54 (54%) were male and mean age was 42.28 ± 17.13 years. Respiratory rate/min (P = .033) was higher, duration of hospitalization (P = .043) was longer, need for oxygen therapy (P < .001), intensive care unit admission (P = .001), and severe pneumonia (P < .001) were higher in the group without a close contact history (n = 50). Male gender (OR, 4.77; 95% CI, 1.06-21.32; P = .041), not having a close contact history (OR, 4.03; 95% CI, 1.00-16.13; P = .049), non-hospital-associated patients (OR, 9.59; 95% CI, 1.47-62.41; P = .018), and dyspnea (OR, 7.58; 95% CI, 1.64-34.93; P = .009) were found to be risk factors for severe pneumonia.Conclusion:Known close contact history was associated with non-severe pneumonia and was found to be an independent predictor of disease severity in coronavirus disease 2019 pneumonia. The study provides evidence that filiation may prevent severe disease.

Coagulation Profile in COVID-19 Patients and its Relation to Disease Severity and Overall Survival: A Single-Center Study.

Objectives: This study aims to investigate hemostatic changes in patients with coronavirus disease (COVID-19) and their relationship to disease severity and survival. Methods: This study included 284 patients with COVID-19 who attended the Security Forces Hospital, Makkah, Saudi Arabia between October 2020 and March 2021, and retrospectively reviewed their demographic, radiological, and laboratory findings. The coagulation profile was assayed at the time of diagnosis for platelet counts using an automated hematology analyzer; Sysmex XN2000 while international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, factor VIII, ristocetin cofactor (RiCoF), and von Willebrand factor antigen (VWF-Ag) were measured by Stago kits on a Stago automated coagulation analyzer (STA Compact Max®). Results: In this study, 32.3% of the cases had severe disease, while 8.8% of the cases died. D-dimer, factor VIII, and RiCoF were the only independent predictors of disease severity, with factor VIII and RiCoF having significantly higher areas under the curve (AUCs) than D-dimer (all p < 0.001). Furthermore, age, aPTT, and factor VIII were associated with an increased risk of mortality in multivariate Cox regression analysis, with factor VIII having a higher AUC of 0.98 than aPTT with an optimal cut-off value of >314 IU/dl in predicting mortality. Cases with factor VIII levels >314 IU/dl, compared to those with factor VIII levels <314 IU/dl, were associated with a significantly shorter mean overall survival time (20.08 vs. 31.35 days, p < 0.001), a lower survival rate (30.3% vs. 99.2%, p < 0.001), and a 16.62-fold increased mortality risk. Conclusion: RiCoF is a novel predictor of disease severity in COVID-19, while factor VIII is confirmed as a predictor of severity and mortality in COVID-19 patients and is associated with lower overall survival and increased mortality risk.

Serum IL-28A/IFN-\u03bb2 is linked to disease severity of COVID-19

Type III interferons (IFNs) play an important role in respiratory viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to determine whether the expression of serum type III IFNs predicted disease severity among patients with the coronavirus disease (COVID-19). A retrospective cohort study was conducted of patients admitted to a single hospital between March 21, 2020, and March 31, 2021. Patients were divided into mild to moderate I (MM) and moderate II to severe (MS) groups based on the COVID-19 severity classification developed by the Japanese Ministry of Health, Labor and Welfare. A total of 257 patients were included in the analysis. Human interleukin-28A (IL-28A/IFN-λ2) expression was significantly lower, and interleukin (IL)-6 expression was significantly higher in the MS group than in the MM group (both p < 0.001). In addition, IL-28A/IFN-λ2 was statistically significantly inversely correlated with the time from disease onset to negative SARS-CoV-2 PCR results (p = 0.049). Multivariable logistic regression analysis showed that IL-28A/IFN-λ2 was an independent predictor of disease severity (p = 0.021). The low expression of IL-28A/IFN-λ2 may serve as a serum biomarker that predicts the severity of COVID-19, possibly through the mechanism of delayed viral elimination.

Systematic Review Children's Immunity Response to Covid-19 Infection

Immunity is resistance from infection and the immune response is the coordination of cells in the body and other molecules against infection. Corona Virus is a positive chain Ribonucleic acid (RNA) virus whose transmission occurs more often from infected closest relatives with the main route through inhalation. direct respiratory droplets from coughing and sneezing. This systematic review aims to identify the immune response of children infected with Covid-19. Search articles using 4 databases, namely Scopus, ProQuest, Pubmed, and Science Direct using keywords and Boolean operators. Strategy to find articles using PICO. The results obtained 14 articles, assessment using PRISMA checklist.The results of the review show that SARS-CoV-2 infection in children triggers non-specific and specific immune responses. The non-specific immune response begins with an increase in white blood cells and triggers a specific immune response, namely T and B cells that will produce antibodies. There are increased levels of CRP, IL-6, IL-10, IFN-g,TNF-a and IP-10 which can be an independent predictor of disease severity. Excessive levels of mediators can causes a cytokine storm that damage the human body and increased D-dimer in severe cases. The specific immune response will mediate the formation of antibodies. B cells are assisted by T cells to differentiate into plasma cells, which then produce specific antibodies for viral antigens, in the form of IgM which is detected early and is then replaced by IgG. To improve the performance of the immune system, there needs to be an increase in nutrition, adequate rest, support and family motivation.

Predictors of severity and mortality in COVID-19 patients

BackgroundDue to limited capacity, health care systems worldwide have been put in challenging situations since the emergence of COVID-19. To prioritize patients who need hospital admission, a better understanding of the clinical predictors of disease severity is required. In the current study, we investigated the predictors of mortality and severity of illness in COVID-19 from a single center in Cairo, Egypt.MethodsThis retrospective cohort study included 175 patients hospitalized with COVID-19 pneumonia and had positive real-time polymerase chain reaction (RT-PCR) results for SARS-CoV-2 from 1 May 2020 to 1 December 2020. Severe COVID-19 was defined as requiring high-flow oxygen (flow rate of more than 8 L/min or use of high flow oxygen cannula), noninvasive ventilation, or invasive mechanical ventilation at any time point during the hospitalization. We used univariate and multivariate regression analyses to examine the differences in patient demographics and clinical and laboratory data collected during the first 24 h of hospitalization related to severe disease or death in all 175 patients.ResultsSixty-seven (38.3%) of the study subjects had a severe or critical disease. Elevated d-dimer, leukocytosis, and elevated CRP were found to be independent predictors of severe disease. In-hospital mortality occurred in 34 (19.4%) of the cases. Elevated TLC, urea, the use of invasive mechanical ventilation, and the presence of respiratory bacterial co-infection were found to be independently associated with mortality.ConclusionClinical and laboratory data of COVID-19 patients at their hospital admission may aid clinicians in the early identification and triage of high-risk patients.

Elevated levels of serum CDCP1 in individuals recovering from severe COVID-19 disease.

Background: COVID-19 survivors report residual lung abnormalities after discharge from the hospital. The aim of this study was to identify biomarkers in serum and induced sputum samples from patients after hospitalization for COVID-19.Methods: Patients admitted to hospitals in Spain with laboratory-confirmed COVID-19 were recruited for this study. SARS-CoV-2-infected patients were divided into groups with mild/moderate and severe disease according to the severity of their symptoms during hospitalization. Levels of 92 biomarkers were measured in serum and induced sputum samples.Results: A total of 108 patients (46.2% severe cases) were included in this study. The median number of days after the onset of symptoms was 104. A significant difference was observed in diffusing capacity for carbon monoxide (DLCO), an indicator of lung function, whereby DLCO <80% was significantly lower in severe cases (p <0.001). Differences in inflammatory biomarkers were observed between patients with mild/moderate and severe disease. For some biomarkers, correlations in serum and induced sputum levels were detected. Independent predictors of severe disease were DLCO <80% and the serum CDCP1 value.Conclusions: Higher levels of CDCP1 remain after hospital discharge and are associated with the severity of COVID-19. The possible prognostic implications warrant further investigation.