Laboratory Markers Of Inflammation Research Articles

Inflammation and endothelial toxicity: pathogenetic aspects of central nervous system damage due to novel coronavirus disease

Introduction. There are inconsistent data on the incidence of stroke in patients with COVID-19, including acute cerebrovascular accidents in younger people without obligate risk factors, as well as the risk of SARS-CoV-2 infection in patients with acute stroke.
 The aim of the study was to evaluate the features of concomitant stroke and COVID-19, and the role of inflammation and endothelial toxicity in cerebral damage.
 Materials and methods. The study included 1,524 patients admitted to vascular clinics across St. Petersburg in 20202021, including 1,068 people with confirmed COVID-19 infection and 551 death cases. The patients were divided into four groups depending on disease severity, for clinical and laboratory data analysis.
 Results. There were marked changes in the laboratory markers of inflammation, haemostasis, fibrinolysis, cytolysis, iron metabolism, cerebral ischaemia, proteolysis, immunodeficiency (lymphocytopenia, monocytopenia, elevated white blood cell count, elevated levels of C-reactive protein, fibrinogen, D-dimer, creatine kinase, ferritin and neutrophil elastase), with statistically significant differences when compared with patients without COVID-19. Changes in inflammatory markers in the first 2472 hours provided the most information. A multifold increase (escalation) in the marker values was always correlated with an imminent adverse outcome and was usually accompanied by subsequent laboratory confirmation of COVID-19 infection or specific signs of viral pneumonia.
 Conclusion. COVID-19 should be considered an independent risk factor for acute stroke, while the virus-induced thrombosis, manifesting in an escalation in inflammatory factors and products of endothelial damage, should be considered a pathogenetic link leading to cerebral tissue damage.

Comorbidities Effects in COVID-19 Patients on Laboratory Inflammation Markers Test Results

Inflammatory reactions play an important role in the pathophysiology of COVID-19. Levels of D-dimer, procalcitonin (PCT) and C-reactive Protein (CRP) are known to increase in response to an inflammatory reaction. Comorbid COVID-19 patients are often associated with severe conditions and do not survive. In handling COVID-19 patients with comorbidities, it is necessary to recommend specific laboratory examinations to make the actions given more effective and efficient and reduce costs and treatment time. This study aims to determine the effect of comorbid on the results of laboratory examination of inflammatory markers. The study was conducted in June – August 2022 at Siloam Lippo Village Hospital. Subjects and laboratory results were presented descriptively. Test the effect of comorbid and inflammatory marker parameters using a statistical regression test (a=0.5%). Statistical tests showed no significant effect on comorbidity on laboratory results of inflammatory markers D-dimer (P= 0.467) and PCT (P= 0.834). Comorbidities significantly affected CRP examination results (P = 0.002). In this case, it is necessary to prioritize all comorbid COVID-19 patients to have an early CRP examination to treat rapidly decreasing oxygen saturation, deep vein thrombosis and pulmonary embolism and death.

Cardiac megakaryocytes in SARS-CoV-2-positive autopsies.

Thromboembolic phenomena are an important complication of infection by severe acute respiratory coronavirus 2 (SARS‐CoV‐2). Increasing focus on the management of the thrombotic complications of Coronavirus Disease 2019 (COVID‐19) has led to further investigation into the role of platelets, and their precursor cell, the megakaryocyte, during the disease course. Previously published postmortem evaluations of patients who succumbed to COVID‐19 have reported the presence of megakaryocytes in the cardiac microvasculature. Our series evaluated a cohort of autopsies performed on SARS‐CoV‐2‐positive patients in 2020 (n = 36) and prepandemic autopsies performed in early 2020 (n = 12) and selected to represent comorbidities common in cases of severe COVID‐19, in addition to infectious and noninfectious pulmonary disease and thromboembolic phenomena. Cases were assessed for the presence of cardiac megakaryocytes and correlated with the presence of pulmonary emboli and laboratory platelet parameters and inflammatory markers. Cardiac megakaryocytes were detected in 64% (23/36) of COVID‐19 autopsies, and 40% (5/12) prepandemic autopsies, with averages of 1.77 and 0.84 megakaryocytes per cm2, respectively. Within the COVID‐19 cohort, autopsies with detected megakaryocytes had significantly higher platelet counts compared with cases throughout; other platelet parameters were not statistically significant between groups. Although studies have supported a role of platelets and megakaryocytes in the response to viral infections, including SARS‐CoV‐2, our findings suggest cardiac megakaryocytes may be representative of a nonspecific inflammatory response and are frequent in, but not exclusive to, COVID‐19 autopsies.

Investigation of the effects of anti-TNF agents on hemoglobin levels in patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) is characterized by many clinical features. Anemia is 1 of the most frequent complications and/or extraintestinal manifestations of IBD. There are conflicting data regarding the relationship between changes in hemoglobin levels and disease prevalence in IBD patients with and without antitumor necrosis factor (antiTNF) therapy. In our study, we aimed to investigate the long-term effect of antiTNF agents on anemia in IBD.The records of IBD patients followed-up in our hospital between January 2011 and January 2021 were reviewed retrospectively. Demographic, clinical, endoscopic, radiological and medical treatment data of the patients were recorded. Complete blood count and laboratory markers of inflammation and disease activation, were recorded at the beginning and at the first year of treatment in all patients. The data of patients with and without antiTNF therapy were analyzed statistically. A total of 240 IBD patients who met the inclusion criteria were enrolled in the study. The number of patients with and without antiTNF therapy was 102 (42.5%) and 138 (57.5%), respectively. The change in all laboratory parameters between the beginning and the first year of treatment was statistically significant (P < .001) in all IBD patients with and without antiTNF therapy. The change in Hb level after 1 year of treatment was significantly different in patients with antiTNF therapy compared to those without therapy (3.00 ± 1.78 g/dL vs 1.19 ± 1.38 g/dL, P < .001). In the multiple regression analysis, male gender, antiTNF therapy, baseline Hb level and iron therapy were independent significant variables of hematopoietic response. This study showed that with appropriate treatment, hemoglobin levels of IBD patients with and without antiTNF therapy increased within 1 year, and the use of antiTNF agents in the treatment of IBD was an independent variable in correcting anemia.

Sex and Aggression Characteristics in a Cohort of Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome.

Objective:This study describes for the first time the characteristics by sex of patients with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), including clinical phenotype, treatment, and psychosocial aspects of disease.Methods:This cross-sectional study included 205 consecutive community patients evaluated between January 1, 2012 and March 30, 2019 and compared 87 females with 118 males. Our primary hypothesis was that males would display more aggression, as measured by the Modified Overt Aggression Scale (MOAS) and would be treated with immunotherapy earlier than females. The MOAS began to be administered 5 years into the study period, and 57 of the 205 families completed the MOAS for this study.Results:Our analysis revealed that males had a higher median MOAS score in the first year of clinic when compared with females (median 11, interquartile range [IQR] [4–24] vs. median 3, IQR [1–9]; p = 0.03) and a higher median subscore for physical aggression (median 4, IQR [0–12] vs. median 0, IQR [0–8]; p = 0.05). The median time from PANS symptom onset to first administration of immunotherapy, which did not include nonsteroidal anti-inflammatory drugs or short bursts of oral steroids, was 6.9 years for females and 3.7 years for males (p = 0.20). The two groups did not differ significantly in age of PANS onset, time from onset to clinic entry, other psychiatric symptom measures, or laboratory markers of inflammation.Conclusion:Among patients with PANS, males exhibit more aggressive behavior when compared with females, which may advance the decision to treat with immunotherapy. Scores that capture a more global level of functioning show that despite there being a higher level of aggression in males, female patients with PANS have similar levels of overall impairment.

Correlation of Lung Damage on CT Scan with Laboratory Inflammatory Markers in COVID-19 Patients: A Single-Center Study from Romania.

(1) Background: This study aims to evaluate the association of CRP, NLR, IL-6, and Procalcitonin with lung damage observed on CT scans; (2) Methods: A cross-sectional study was performed among 106 COVID-19 patients hospitalized in Timisoara Municipal Emergency Hospital. Chest CT and laboratory analysis were performed in all patients. The rank Spearmen correlation was used to assess the association between inflammatory markers and lung involvement. In addition, ROC curve analysis was used to determine the accuracy of inflammatory markers in the diagnosis of severe lung damage; (3) Results: CRP, NLR, and IL-6 were significantly positively correlated with lung damage. All inflammatory markers had good accuracy for diagnosis of severe lung involvement. Moreover, IL-6 has the highest AUC- ROC curve; (4) Conclusions: The inflammatory markers are associated with lung damage and can be used to evaluate COVID-19 severity.

SCD14-ST and New Generation Inflammatory Biomarkers in the Prediction of COVID-19 Outcome.

Since no definitive cure for COVID-19 is available so far, one of the challenges against the disease is understanding the clinical features and the laboratory inflammatory markers that can differentiate among different severity grades of the disease. The aim of the present study is a comprehensive and longitudinal evaluation of SCD14-ST and other new inflammatory markers, as well as cytokine storm molecules and current inflammatory parameters, in order to define a panel of biomarkers that could be useful for a better prognostic prediction of COVID-19 mortality. SCD14-ST, as well as the inflammatory markers IL-6, IL-10, SuPAR and sRAGE, were measured in plasma-EDTA of ICU COVID-19 positive patients. In this longitudinal study, SCD14-ST resulted significantly higher in patients who eventually died compared to those who were discharged from the ICU. The results suggest that the new infection biomarker SCD14-ST, in addition to new generation inflammatory biomarkers, such as SuPAR, sRAGE and the cytokines IL-6 and IL-10, can be a useful prognostic tool associated with canonical inflammatory parameters, such as CRP, to predict SARS-CoV-2 outcome in ICU patients.

An update on polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease affecting people older than 50 years and is 2-3 times more common in women. The most common symptoms are pain and morning stiffness in the shoulder and pelvic girdle and the onset may be acute or develop over a few days to weeks. General symptoms such as fatigue, fever and weight loss may occur, likely driven by systemic IL-6 signalling. The pathology includes synovial and periarticular inflammation and muscular vasculopathy. A new observation is that PMR may appear as a side effect of cancer treatment with checkpoint inhibitors. The diagnosis of PMR relies mainly on symptoms and signs combined with laboratory markers of inflammation. Imaging modalities including ultrasound, magnetic resonance imaging and positron emission tomography with computed tomography are promising new tools in the investigation of suspected PMR. However, they are still limited by availability, high cost and unclear performance in the diagnostic workup. Glucocorticoid (GC) therapy is effective in PMR, with most patients responding promptly to 15-25mg prednisolone per day. There are challenges in the management of patients with PMR as relapses do occur and patients with PMR may need to stay on GC for extended periods. This is associated with high rates of GC-related comorbidities, such as diabetes and osteoporosis, and there are limited data on the use of disease-modifying antirheumatic drugs and biologics as GC sparing agents. Finally, PMR is associated with giant cell arteritis that may complicate the disease course and require more intense and prolonged treatment.

The importance of the long Covid-19 in the evolution of patients with neoplasms.

e18647 Background: Patients with comorbidities especially those with oncological diseases could have severe COVID-19 outcomes. OBJECTIVE: The aim of this study was to evaluate the role of prolonged positivity of SARS-Cov2 in evolution of patients with various neoplasia. Methods: We analysed clinical and laboratory (hematological parameters and inflammatory markers: interleukin-6 and ferritin) data of COVID-19 patients admitted in intensive care unit (ICU) Department of our hospital, during 2020-2021 and presented in medical history solid tumors or haematological neoplasia . The cohort of patients included 78 patients with severe and critical form of COVID-19, 31 patients with solid tumors and 47 patients with hematologic malignancies. We consider long COVID-19 all cases with SARS Cov2 positivity more than 14 days. Results: The frequency of long COVID-19 was quite equal between patients groups with solid tumors and hematologic malignancies, incidence rate 1:2, the incidence rate differences was 1:18, p = 0.75. Long COVID-19 was observed in 60% cases with favourable evolution, Chi-squared 5.35%, p = 0.02, these patients had moderate form and was admitted in hospital in 1 or more days after the onset, median value 3 (min 1, max 55) compared with patients with normal duration of positivity of SARS-Cov2 test- median value 2 (min 1, max 8), p = 0.01. The Kaplan Meyer survival analyses indicated long COVID-19 as predictive factor for unfavourable evolution, Chi-squared 17.97, p &lt; 0.0001. Although we have not obtain significant differences, we observed more severe lymphopenia in patient without long COVID-19, probably because a part of these patients group died in the first 14 days of COVID-19 (0.765 (min 0.04, max 297.64) vs. 1.01 (min 0.09, max 254.35), p = 0.09). The rest of hematological and biochemistry parameters was not significant different between groups. Infectious and thrombotic complication was most frequent in patients with long COVID-19, Chi squared 8.6, p = 0.003. Conclusions: Long Covid-19 is predictable for unfavourable evolution and is associated with sepsis and thrombotic complication. This diagnosis is frequent in patients who was admitted in hospital after the onset of COVID-19 symptoms, early treatment of COVID-19 in oncological patients being very important for favourable evolution.

Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study.

Our study objective was to construct models using 20 routine laboratory parameters on admission to predict disease severity and mortality risk in a group of 254 hospitalized COVID-19 patients. Considering the influence of confounding factors in this single-center study, we also retrospectively assessed the correlations between the risk of death and the routine laboratory parameters within individual comorbidity subgroups. In multivariate regression models and by ROC curve analysis, a model of three routine laboratory parameters (AUC 0.85; 95% CI: 0.79–0.91) and a model of six laboratory factors (AUC 0.86; 95% CI: 0.81–0.91) were able to predict severity and mortality of COVID-19, respectively, compared with any other individual parameter. Hierarchical cluster analysis showed that inflammatory laboratory markers grouped together in three distinct clusters including positive correlations: WBC with NEU, NEU with neutrophil-to-lymphocyte ratio (NLR), NEU with systemic immune-inflammation index (SII), NLR with SII and platelet-to-lymphocyte ratio (PLR) with SII. When analyzing the routine laboratory parameters in the subgroups of comorbidities, the risk of death was associated with a common set of laboratory markers of systemic inflammation. Our results have shown that a panel of several routine laboratory parameters recorded on admission could be helpful for early evaluation of the risk of disease severity and mortality in COVID-19 patients. Inflammatory markers for mortality risk were similar in the subgroups of comorbidities, suggesting the limited effect of confounding factors in predicting COVID-19 mortality at admission.

Therapeutic effects of complex multimodal rheumatologic treatment in the Rheumatology Center, Rhineland-Palatinate

The concept of complex multimodal rheumatologic treatment (CMRT) has been established for several years in German rheumatologic departments and aims at amultifaceted therapeutic approach to patients with rheumatic diseases. Objective of this study was to examine the therapeutic effect of CMRT in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in an acute rheumatology center. The treatment success of CMRT was evaluated by epidemiologic data, patient questionnaires on visual analog scales (VAS) regarding morning stiffness, pain and disease activity (DA), as well as clinical scores (Disease Activity Score28 [DAS28], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI]), laboratory inflammation markers (CRP, erythrocyte sedimentation rate) and medication in three visits: visit 1 = begin of CMRT; visit 2 = end of CMRT; visit 3 = 3months after CMRT. In this study 162 patients from the Rheumatology Center, Rhineland-Palatinate, Germany (96(59.3%) RA, 30(18.8%) AS, 36(22.2%) PsA) were recruited. Statistical examinations revealed asignificant improvement of VAS(DA) (visit2 versus visit1: RA: p = 0.02, AS: p < 0.001, PsA: p < 0.001), morning stiffness (RA: p < 0.001, AS: p = 0.03, PsA: p < 0.001) and patient reported pain (all; p < 0.001) in the context of CMRT. In the RA and AS subgroups improvements of DAS28 and BASDAI could also be observed (visit2 versus visit1: both; p < 0.001). Moreover, significant improvement of patient reported outcomes could be observed 3months after CMRT regarding VAS(DA) (RA: p = 0.02 und AS: p = 0.03, morning stiffness (PsA: p = 0.02) and patient reported pain (RA: p = 0.01)). Interestingly, subgroup analyses showed that the therapeutic benefit was independent of the concomitant pharmacotherapy. The results of this study suggest atherapeutic benefit for patients being treated by CMRT and highlight the high value of this therapeutic concept in patients with systemic-inflammatory rheumatic diseases.

Presence of diarrhea associated with better outcomes in patients with COVID-19 – A prospective evaluation

PurposeGastrointestinal (GI) manifestations have been well documented in patients with coronavirus disease 2019 (COVID-19), but its clinical impact on the course of the disease is debatable. Majority of the available data is retrospective, and hence this prospective study was planned to study the impact of GI symptoms on COVID-19 outcome. MethodsAll COVID-19 patients admitted in a tertiary care centre from August–October 2020 were screened and patients without pre-existing GI diseases were included. A detailed history of the various symptoms including duration was documented. Various baseline laboratory investigations and inflammatory markers were conducted as per the protocol. Patients with and without diarrhea were compared for the various disease outcome parameters. ResultsOf the 244 patients screened, 203 patients (128 males; 63.1%) were included. Respiratory symptoms alone were present in 49 (24.1%), GI symptoms alone in 20 (9.9%) and 117 (57.6%) had both. Overall GI symptoms was noted in 137 (67.5%) cases with the commonest being diarrhea (61; 30.0%). Patients with both respiratory and any GI symptoms showed a lower trend towards need for mechanical ventilation (12.2% vs 7.7%; p ​= ​0.35) and mortality (10.2% vs 4.3%; p ​= ​0.14) compared to respiratory symptoms alone, although not statistically significant. Patients with diarrhea (n ​= ​61) had no mortality (0% vs 7.7%; p ​= ​0.036) or need for mechanical ventilation and shorter hospital stay compared to those who did not have diarrhea. ConclusionGI symptoms are frequent in patients with SARS-CoV-2 infection and the commonest is diarrhea. Diarrhea is a harbinger of better outcome with lower mortality among COVID-19 positive patients.

Case reports: spondylodiscitis and epiduritis after suffering COVID-19

Background: The study analyzes a possible rare complication of COVID-19 in the form of spondylodiscitis, including that followed by epiduritis, in patients who survived COVID-19 characterized by severe pneumonia, respiratory failure and systemic inflammatory response syndrome (SIRS).&#x0D; Clinical case description: Three clinical cases of patients are presented, each of whom had high fever, SIRS with a significant increase in the laboratory markers of inflammation (C-reactive protein (CRP), leukocytosis, erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, ferritin), bacterial pneumonia, and severe hemostasis disorders. Despite an antibiotic therapy with broad-spectrum drugs, the development of spondylodiscitis was observed, manifested as acute pain syndrome in the lumbar spine. In the first patient, against the background of a massive antibacterial therapy, revisions of purulent foci, therapy with glucocorticosteroids (GCS), and a surgical treatment, there was significant positive dynamics in the form of the pain syndrome relief. The second patient showed positive dynamics against the background of a conservative antibacterial therapy. The third patient, with a paravertebral abscess at the level of developed spondylodiscitis, received a massive antibiotic therapy combined with GCS, and was operated for the spinal cord decompression.&#x0D; Conclusion: Spondylodiscitis and epiduritis may be possible complications of COVID-19, including those resulting from the immunosuppressive therapy, which is actively used to stop the cytokine storm.

Down-regulated Th17 cells in a patient with familial Mediterranean fever associated with amyloid A amyloidosis in the treatment of canakinumab.

Autoinflammatory diseases are innate immune-mediated inflammatory disorders, unlike autoimmune diseases, which are characterised by abnormalities in adoptive immunity, although autoimmune and autoinflammatory diseases have certain similar clinical features. Familial Mediterranean fever (FMF), the most common monogenic autoinflammatory disease, is associated with mutations in the MEFV gene that encodes pyrin, which results in inflammasome activation and uncontrolled production of interleukin (IL)-1β. Regular use of colchicine, the primary drug for FMF treatment, prevents febrile attacks and reduces the long-term risk of subsequent complications of amyloid A (AA) amyloidosis. However, a minority of FMF patients develop colchicine resistance, and anti-IL-1β treatment with canakinumab, which is a genetically modified human IgG subclass type 1 (IgG1) monoclonal antibody specific for human IL-1β, was beneficial in inhibiting inflammation in such patients. Here, we present a patient with FMF associated with AA amyloidosis, who was treated with canakinumab and demonstrated down-regulated Th17 cells and activated Th17 cells (from 21.4% to 12.8%, and from 1.45% to 0.83%, respectively) in peripheral blood, as shown by immunophenotyping via multicolour flow cytometry and by disease activity and improved laboratory inflammatory surrogate markers-C-reactive protein (CRP) and serum AA protein (SAA). CRP had values within normal limits, but SAA did not (Spearman's rank correlation coefficient; ρ = 0.133). We report that SAA and IL-1β may differentiate Th17 cells from CD4+-naïve T cells, and we discuss interactions between autoinflammation and autoimmunity as a model based on this case, through modes of action with IL-1β and SAA. This report is the first demonstrating that an IL-1β antagonist may reduce Th17 cells in FMF as a therapeutic option.

Correlation between chest CT severity scoring system with oxygen saturation and laboratory inflammatory markers in adult patients with COVID-19 infection

BackgroundCOVID-19 pneumonia is responsible for the latest pandemics. Chest computed tomography (CT) scan is known to be an essential tool for diagnosis of COVID-19. In this research, the relationship between on-admission chest CT severity score, capillary blood oxygen saturation level, and laboratory inflammatory markers results in patients with SARS-COV-2 pneumonia was investigated.MethodsThis prospective analytical study was conducted in COVID-19 isolation unit, Zagazig University Hospitals, from 1st to end of April 2021. Adult patients with COVID-19 infection were included. Chest CT scan was performed for all patients, and CT severity score was computed. The initial capillary oxygen saturation was also assessed at the time of admission. The information was gathered and analyzed.ResultsA total number of 305 COVID-19 patients were involved in the study with the following data: age, gender, presence of co morbidities, capillary blood oxygen saturation, laboratory tests including absolute lymphocytic count, CRP, D-dimer and ferritin levels, as well as chest CT severity score. Based on chest CT severity score, we found that 110 cases (36.1%) were mild, 163 cases (53.4%) were moderate, and 32 cases (10.5%) were severe, with significant male predominance among moderate and severe cases. The initial measurements of blood oxygen saturation values revealed that mean blood oxygen saturation was 95.6% among mild to moderate cases and 85.4% among severe cases. Furthermore, there was a high statistically significant negative correlation between chest CT severity score and absolute lymphocytic count of studied cases, while there was a statistically significant positive correlation with D-dimer, CRP and ferritin levels.ConclusionsCT scans can help clinicians in developing a management strategy and serve as a predictor of illness severity and possible outcomes. In individuals with COVID-19 infection, the severity of a chest CT scan is positively correlated to inflammatory markers and oxygen demand.

Thromboembolic complication among COVID-19 patients in the intensive care unit (ICU): a single-centre study from a Malaysian perspective

Funding AcknowledgementsType of funding sources: None.IntroductionThe emerging complications of thromboembolism (TE) in COVID-19 patients have led to severe consequence such as death. Nonetheless, the prevalence of TE complications among COVID-19 patients in the Intensive Care Unit (ICU) in Malaysia is unknown.ObjectiveTo investigate the prevalence of thromboembolic (TE) complications including venous [deep vein thrombosis (DVT), pulmonary embolism (PE), and line related thrombosis] and arterial [stroke, peripheral arterial disease and myocardial infarction (MI)] thrombosis and mortality among COVID-19 patients admitted to an ICU at a single centre hospital. The proportions of patients with TE complication who died, and factors associated with the occurrence of thrombotic complications were explored.MethodsIn this retrospective Malaysian cohort study, patients admitted to a single centre ICU with PCR confirmed of SARS-CoV-2 virus and received adequate thromboprophylaxis within February 2020-2021 were included. Thromboembolic (TE) event is a combination of venous and arterial thrombosis.ResultsMean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. Of 534 patients, 4 (0.7%) developed DVT, 198 (37.1%) PE and 2 (0.4%) line related thrombosis. Meanwhile, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, 240 (44.9%) developed TE event during their ICU admission. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; p = 0.013), PE (47.5% vs 34.0%; p = 0.006), stroke (12.3% vs. 1.5; p < 0.001) and MI (16.4% vs. 4.6%; p < 0.001) died. Age, duration of ICU admission, obesity, white cell count (WCC), troponin, D-Dimer and corticosteroid use were significantly greater among those with TE events. Demographics, co-morbidities, other laboratory parameters and inflammatory markers were similar in COVID-19 patients with and without TE events. Predictors of TE events on multivariate logistic regression analysis were age [OR 1.02 (95% CI 1.00-1.03)], obesity [OR 2.84 (95% CI 1.93-4.18)], WCC [OR 1.04 (95% CI 1.00-1.07)], and duration of ICU admission [OR 1.04 (95% CI 1.02-1.06)].ConclusionIn this cohort of severely ill COVID-19 patients, the overall prevalence of TE complication was high (44.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of TE events included age, obesity, white cell count, and duration of ICU admission. Perhaps a more aggressive treatment (combination of thromboprophylaxis and enhanced anti-inflammatory treatment) may be needed among COVID-19 patients admitted to ICU with high risk factors to prevent further increase in the incidence of thromboembolism and death.

Updates on the Evaluation and Management of Febrile Neonates.

In August 2021, the American Academy of Pediatrics published a guideline, the first of its kind, to synthesize decades of research on the care of febrile neonates. The guideline is not meant to dictate one particular course of treatment for every clinical scenario, but rather to provide evidence-based recommendations to guide care in collaboration with the patient's caretaker(s). The guideline considers evolving bacteriology, costs of care, advances in laboratory testing and inflammatory markers, and known risks related to the hospitalization of young infants. The guideline highlights 21 key action statements to guide practitioners in the care of neonates presenting with fever, with the aim of optimizing outcomes while reducing risk and unnecessary costs. [Pediatr Ann. 2022;51(2):e49-e51.].

P208 Enthesopathies in patients with inflammatory bowel diseases

Abstract Background Background. The aim of study was to evaluate the enthesis in patients with inflammatory bowel diseases (IBD) and to assess the involvement of enthesis in different IBD behavior. Methods Methods. 95 IBD pts were prospectively enrolled into the study: 55 pts with ulcerative colitis (UC) and 40 - with Crohn’s disease (CD). The average duration of the disease was 48 (12; 102) months in UC, and 42 (18; 87) months in CD. The severity of UC exacerbation was assessed by the Mayo index, in CD – by Harvey-Bradshaw index. In UC, moderate and severe exacerbation was revealed in 40 pts (73%), in CD - in 17 (43%). Among 95 pts with IBD, extraintestinal manifestations occurred in 67 pts (71%), of which 34 (62%) pts with UC and 33 (82%) pts with CD. 70 enthesis were evaluated clinically and by US in each pt. The clinical examination included tenderness of enthesis, US examination with power Doppler detected inflammatory (hypoechogenicity of enthesis, thickening of enthesis, presence of vascularization) and structural (erosion, enthesophyte) changes in enthesis. Fisher’s exact test, Spearman’s coefficient and binary logistic regression to determine the odds ratio (OR) were used to calculate differences. Results Results. The duration of IBD course directly correlated with the number of tender entheses (SR = 0.24; p = 0.017), as well as the number of enthesophytes (SR = 0.20; p = 0.044). The severity of IBD exacerbation and enthesis involvement didn’t have statistically significant correlation. However, the inflammatory lesions of entheses (the number of erosions with vascularization) correlated with CRP level (SR = 0.25; p = 0.01). We also identified a relationship between the presence of extraintestinal manifestations and the enthesis involvement: for example, the presence of at least one extraintestinal manifestation increased the likelihood of detecting erosions by 4.77 times (95% CI 1.6–13.9, p = 0.003). The presence of joint pain increased the likelihood of detecting erosions of entheses by 3.37 times (95% CI 1.18–9.65, p = 0.02). Clinical signs of musculoskeletal system involvement (tenderness of enthesises on palpation) significantly increased the frequency of enthesitis, including vascularized enthesitis (p = 0.01). Conclusion Conclusion. In IBD pts with long disease duration and the presence of extraintestinal manifestations, structural (erosion, enthesophytes) changes in enthesis were observed significantly more often. The frequency of entheses erosions was higher in the presence of pain in the joints, and the number of erosions with vascularization with an increase in laboratory markers of inflammation (CRP).

Essential metals, vitamins and antioxidant enzyme activities in COVID-19 patients and their potential associations with the disease severity.

The role of micronutrient deficiency in the pathogenesis of COVID-19 has been reviewed in the literature; however, the data are limited and conflicting. This study investigated the association between the status of essential metals, vitamins, and antioxidant enzyme activities in COVID-19 patients and disease severity. We recruited 155 patients, who were grouped into four classes based on the Adults guideline for the Management of Coronavirus Disease 2019 at King Faisal Specialist & Research Centre (KFSH&RC): asymptomatic (N = 16), mild (N = 49), moderate (N = 68), and severe (N = 22). We measured serum levels of copper (Cu), zinc (Zn), selenium (Se), vitamin D3, vitamin A, vitamin E, total antioxidant capacity, and superoxide dismutase (SOD). Among the patients, 30%, 25%, 37%, and 68% were deficient in Se (< 70.08 µg/L), Zn (< 0.693 µg/mL), vitamin A (< 0.343 µg/mL), and vitamin D3 (< 20.05 µg/L), respectively, and SOD activity was low. Among the patients, 28% had elevated Cu levels (> 1.401 µg/mL, KFSH&RC upper reference limit). Multiple regression analysis revealed an 18% decrease in Se levels in patients with severe symptoms, which increased to 30% after adjusting the model for inflammatory markers. Regardless of inflammation, Se was independently associated with COVID-19 severity. In contrast, a 50% increase in Cu levels was associated with disease severity only after adjusting for C-reactive protein, reflecting its possible inflammatory and pro-oxidant role in COVID-19 pathogenesis. We noted an imbalance in the ratio between Cu and Zn, with ~ 83% of patients having a Cu/Zn ratio > 1, which is an indicator of inflammation. Cu-to-Zn ratio increased to 45% in patients with mild symptoms and 34%–36% in patients with moderate symptoms compared to asymptomatic patients. These relationships were only obtained when one of the laboratory parameters (lymphocyte or monocyte) or inflammatory markers (neutrophil-to-lymphocyte ratio) was included in the regression model. These findings suggest that Cu/Zn might further exacerbate inflammation in COVID-19 patients and might be synergistically associated with disease severity. A 23% decrease in vitamin A was seen in patients with severe symptoms, which disappeared after adjusting for inflammatory markers. This finding may highlight the potential role of inflammation in mediating the relationship between COVID-19 severity and vitamin A levels. Despite our patients’ low status of Zn, vitamin D3, and antioxidant enzyme (SOD), there is no evidence of their role in COVID-19 progression. Our findings reinforce that deficiency or excess of certain micronutrients plays a role in the pathogenesis of COVID-19. More studies are required to support our results.

Factors Associated With Noninfectious Fever After Endovascular Aortic Aneurysm Repair

Purpose: The post–endovascular abdominal aortic aneurysm repair (EVAR) inflammatory response, which is very often associated with fever, has been ascribed to a wide range of proinflammatory mediators and operative events. The aim of this study was to evaluate the impact of such factors in the development of fever of noninfectious origin after elective EVAR. Materials and Methods: A retrospective analysis of prospectively collected data of patients treated with standard elective EVAR between February 2017 and December 2020 was undertaken. The database included patients’ demographics and comorbidities, as well as laboratory inflammatory markers (white blood cell count, neutrophils, and C-reactive protein [CRP]) and anatomical characteristics (sac diameter, inferior mesenteric artery [IMA] patency and diameter, number of patent lumbar arteries, internal iliac artery [IIA] patency or occlusion). Intraoperative details, such as type of stent graft material and IIA overstenting, were also analyzed. Patients with infectious postoperative complications or previously receiving systemic anti-inflammatory medication were excluded. Statistical analysis was performed by SPSS 22.0 for Windows software (IBM Corp, Armonk, New York). Results: From 332 patients treated with elective EVAR between 2017 and 2020, 268 patients (all men) were included in the analysis. The mean age was 72.1±7.5 years and the mean aneurysm diameter was 59.1±12.1 mm. Seventeen patients were excluded due to a known infection site. From the study cohort, 114 (42.5%) patients presented with fever. Multivariate regression analysis confirmed that the occlusion of IMA ≥5 mm (p<0.008) and higher CRP (p<0.001) were independent factors associated with postoperative fever. A subanalysis was performed only on patients with patent IMA before EVAR. In the multivariate regression analysis of this subgroup, IMA ≥5 mm (p=0.008), presence of dyslipidemia (p=0.037), and higher CRP (p<0.001) were related to fever. Conclusion: Occlusion of an existing wide (≥5 mm) and patent IMA prior to EVAR may contribute to the development of post-EVAR pyrexia. The CRP is a reliable marker for post-EVAR fever. Further prospective studies are needed to corroborate these findings.