Non-severe Patients Research Articles

Assessment of Long-Term Effects on Pulmonary Functions Between Severe and Non-Severe Convalescent COVID-19 Patients: A Single-Center Study in China.

ObjectiveTo explore the long-term effects of SARS-Cov-2 infection on the pulmonary function in the severe convalescent COVID-19 patients for 6 to 9 months follow-up in Beijing, China.MethodsA total of 64 cases of COVID-19 patients were recruited for the study and discharged from the Beijing Ditan Hospital, Capital Medical University, for 6 to 9 months. COVID-19 patients were divided into non-severe (mild and moderate) and severe groups. The follow-up investigated the lung function tests, the novel coronavirus antibody (IgM and IgG), chest CT and blood tests.ResultsAbout 25.00% (16/64) patients had pulmonary ventilation dysfunction and 35.9% (23/64) had diffusion dysfunction. In the severe group, 56.50% (13/23) individuals showed decreased diffusion function. The diffusion dysfunction of the severe group was significantly decreased than the non-severe group (P = 0.01). Among 56 cases, the positive rate of IgG titers was 73.2% (41/56). The result of chest CT showed 55.36% (31/56) cases in nodules, 44.64% (25/56) in strip-like changes, 37.5% (21/56) in-ground glass shadow, and 5.36% (3/56) in grid shadow, which was significantly different between the severe group and the non-severe group. Patients tended to have ground glass changes in the severe group while nodules in the non-severe group.ConclusionFor the 6 to 9 months in convalescent COVID-19 patients, 56.50% (13/23) of severe patients had pulmonary diffusion dysfunction. Convalescent COVID-19 patients should have their pulmonary function regularly tested, especially those with severe illness.

Hepatobiliary System Effects And Clinical Features of Sars-Cov-2 Infection; Case-Control Study

Introduction: Pandemic caused by SARS-CoV-2 infection has been an important health problem worldwide for the last 3 years. The pathogenesis and consequences of liver injury developed in COVID-19 disease are still unclear. We investigated the prevalence of liver function tests (LFTs) abnormalities in COVID-19 patients, their relationship with drugs, the difference between severe and non-severe COVID-19 patients, and the results of the course of LFTs among patients hospitalized in intensive care units and clinics. Methods: 389 patients who applied to Eskişehir City Hospital between March 2020 and October 2020 were included in the study. Demographic data of RT-PCR (+) patients and RT-PCR (-) control groups (age, gender, comorbidities, symptoms), laboratory parameters, radiological examinations, follow-ups in the clinics and intensive care units, drugs used for the infection were collected retrospectively. All patients with COVID-19 were classified as severe cases or mild to moderate cases groups. Results: Abnormal LFTs were found in 115 (35.2%) of 321 patients with RT-PCR(+), and in 10 (14.7%) of 68 patients in the PCR(-) control group. LFTs at the time of hospitalization were 10.3%, 22.7%, 4.9%, 11.4% and 1.2% in the patient group, respectively; in the control group, it was 1.9%, 2.9%, 2%, 3.3%, 0.8% (p=0.610, p=0.00, p=0.269, p=0.198, p=0.158). There was a significant increase in LFTs in patients who received antibiotics (Levofloxacin, Ceftriaxone, Clarithromycin, Tazobactam, Carbapenem), low molecular weight heparins and antiviral (favipravir) treatments (p=0.001, p=0.001, p=0.001). While the increase in LFTs were significant in the mild (40.2%; 8.2%) and severe groups (41.2%; 5.2%), the number of patients with elevated LFTs in the control group was low (0.5%). Conclusion: Liver damage is common in SARS-CoV-2 infection, but it is quite mild. Patients with severe COVID-19 have a higher frequency of abnormal LFTs than those with mild disease. Disease severity, pre-existing liver disease, and advanced age are risk factors for liver damage. Drug-induced liver injury, systemic inflammatory response syndrome, and hypoxia-induced liver injury may be the main etiological factors for liver injury in COVID-19.

The Relation between Immunological Features and the Positive SARS-CoV-2 Nucleic Acid in Patients with Nonsevere COVID⁃19.

Objective The novel coronavirus nucleic acid results are the core indicators of illness monitoring. This study aimed to evaluate the relationship between immunological features and positive SARS-CoV-2 nucleic acid by analyzing the clinical and immunological features in nonsevere COVID-19 cases. Methods Data from nonsevere COVID-19 patients admitted to Haihe Hospital from May 2020 to June 2021 were retrospectively reviewed and analyzed. Results (1) A total of 122 cases were reviewed in the present study, including 38 mild and 84 moderate cases. The average age of mild cases was significantly different from moderate cases (P < 0.001). Eight patients complained of hyposmia and it was more frequent in mild cases (P < 0.001). The nucleic acid positive duration (NPD) of nonsevere novel coronavirus was 20.49 (confidence interval (CI) 17.50–3.49) days. (2) The levels of specific IgM and IgG for COVID-19 were higher in mild cases than in moderate cases (P=0.023 and P=0.047, respectively). (3) The correlation analysis with antibodies and T-cell subtypes showed that the lymphocyte (LYM) count, T cells, CD4+T cells, and CD8+T cells had a linear correlation with NPD. (4) Among the 93 patients monitored, 62 COVID-19 cases presented a progressive rise of specific IgM and IgG. The daily increase rates of IgM and IgG were 38.42% (CI 28.22–48.61%) and 24.90% (CI 0.23–29.58%), respectively. Conclusion The levels and daily increase rates of specific IgM and IgG against the virus can vary between cases. The NPD presented a linear correlation with the LYM, T cells, CD4+T cells, and CD8+T cells. Hence, more attention should be paid to these indicators in clinical practice.

Serum SARS-CoV-2 Antigens for the Determination of COVID-19 Severity.

The diagnostic of SARS-CoV-2 infection relies on reverse transcriptase polymerase chain reactions (RT-PCRs) performed on nasopharyngeal (NP) swabs. Nevertheless, false-negative results can be obtained with inadequate sampling procedures, making the use of other biological matrices worthy of investigation. This study aims to evaluate the kinetics of serum N antigens in severe and non-severe patients and compare the clinical performance of serum antigenic assays with NP RT-PCR. Ninety patients were included in the study and monitored for several days. Disease severity was determined according to the WHO clinical progression scale. Serum N antigen levels were measured with a chemiluminescent assay (CLIA) and the Single Molecular Array (Simoa) assay. Viremia thresholds for severity were determined and proposed. In severe patients, the peak antigen response was observed 7 days after the onset of symptoms, followed by a decline. No real peak response was observed in non-severe patients. Severity thresholds for the Simoa and the CLIA provided positive likelihood ratios of 30.0 and 10.9 for the timeframe between day 2 and day 14, respectively. Sensitive detection of N antigens in serum may thus provide a valuable new marker for COVID-19 diagnosis and evaluation of disease severity. When assessed during the first 2 weeks since the onset of symptoms, it may help in identifying patients at risk of developing severe COVID-19 to optimize better intensive care utilization.

The Value of Cardiopulmonary Exercise Testing in Predicting the Severity of Coronary Artery Disease.

Background: There have been a limited number of quantitative studies on the relationship between coronary artery disease (CAD) and cardiorespiratory fitness (CRF), as measured by cardiopulmonary exercise testing (CPET). Thus, we aimed to investigate the association between CRF and the severity of coronary artery disease from the most comprehensive perspective possible, and to affirm the predictive value of CPET in the severity assessment of CAD. Methods: Our study included 280 patients with coronary angiography, who had undergone CPET in Tongji Hospital. The patients’ CRF was measured through their peak oxygen uptake (VO2@peak), their oxygen uptake at the anaerobic threshold (VO2@AT) and through other parameters of CPET on a bicycle ergometer. The severity of the coronary artery disease was assessed in the following three layers: functionally significant lesions (quantitative flow ratio [QFR] ≤ 0.8), the number of stenotic coronary arteries (SCA, stenosis ≥ 50%) and the Gensini score. The correlation analyses were carried out between the CRF and the severity of the coronary artery disease. A ROC curve was plotted, and the AUC was calculated to distinguish the severe CAD and the non-severe CAD patients, as measured by the QFR, the number of SCA, and the Gensini score. Results: The VO2@AT and VO2@peak were inversely associated with the QFR. The VO2@AT, VO2@peak and VO2/kg@peak were associated with the number of SCA. Meanwhile, the VO2@AT, VO2/kg@AT, VO2@peak and VO2/kg@peak were associated with the Gensini score. An ROC analysis proved that a combination of traditional clinical risk factors and the VO2@peak/VO2prediction is valuable in predicting CAD severity. Conclusions: Our study demonstrated a strong and inverse association between CRF and the severity of CAD. A combination of traditional clinical risk factors and CRF is valuable in predicting CAD severity.

Duration of infectious shedding of SARS-CoV-2 Omicron variant and its relation with symptoms

ObjectivesSARS-CoV-2 infections with Omicron variants have a high capability of human-to-human transmission. Nevertheless, the duration of isolation for mild cases was shortened to 5 to 7 days. We aimed to detect the duration of viral shedding among healthcare workers (HCWs) with Omicron by using viral culture. MethodsWe prospectively included newly diagnosed nonsevere, symptomatic SARS-CoV-2 positive HCWs. Nasopharyngeal swab samples were obtained consecutively on days 5, 7,10, and 14 of onset of symptoms. The samples were examined by nucleic acid amplification test and viral culture. ResultsIn total, 55 non-severe patients with SARS-CoV-2 Omicron variant were included. The mean age of the population was 34 years (range, 23 to 54) and 78% (43/55) were female. The PCR positivity rate on days 5, 7, 10, and 14 was 96.4% (53/55), 87.3% (48/55), 74.545% (41/55), and 41.8% (23/55) consecutively, whereas the viral culture positivity rates were 83% (44/53), 52% (26/50), 13.5% (7/52), and 8% (4/50). Among the patients who became symptom-free, the viral culture positivity rates were 100% (4/4), 58% (7/12), 11% (3/27), and 5% (2/41). DiscussionWe showed that among the SARS-CoV-2 Omicron variant infected patients, viral shedding continues for ≥10 days in 13.5% of all cases and 11% in symptom-free cases. The decision for cessation of isolation according to the presence of symptoms could be reconsidered until further studies disapprove of our results. Meanwhile, the infected HCWs who give care to high-risk patients for severe COVID-19 might extend their isolations ≤10 days after the onset of symptoms, regardless of their symptoms.

Epidemiology, Clinical Characteristics and Short-term Follow-up of Asymptomatic and Non-severe COVID-19 Patients

COVID-19 broke out in Wuhan in 2019, and spread rapidly around the world. More than 80% of COVID-19 patients are asymptomatic and non-severe, which may be an important source of infection. Therefore, the infectivity, clinical characteristics and outcome of such patients should be studied. The epidemiological data of 108 COVID-19 patients, as well as the clinical characteristics and treatment conditions of 100 asymptomatic and non-severe patients in Bozhou City, Anhui Province were collected. A retrospective analysis of the infectivity of asymptomatic patients was carried out, and a comparative study on clinical characteristics between asymptomatic patients and non-severe patients was also conducted. Eighty-six non-severe patients mainly had a cough (81.4%) and fever (70.9%), and only a few had the symptoms of upper respiratory tract infection such as sore throat (9.3%) and running nose (4.7%). Lymphopenia (20.9%) and elevated C-reaction protein (57.0%) were more frequent in non-severe patients compared with asymptomatic patients which were 0% and 14.3%, respectively. Among 100 asymptomatic and non-severe patients, 84 patients showed abnormal findings on the first chest CT, but meanwhile, 19 patients showed negative results on the viral RNA test. In 14 asymptomatic patients, five had lung abnormalities, which were all pure ground glass opacity. Eleven patients were infected by two asymptomatic patients; in the whole course of the disease, the two patients remained asymptomatic, but chest CT showed multifocal GGO. The time for clearance of SARS-CoV-2 in 12 patients taking methylprednisolone was longer than in other patients (21.2 d vs. 16.4 d). During follow-up, lung lesions found by chest CT in 58.3% of patients completely disappeared. Asymptomatic patients with abnormal chest CT were highly infectious, so SARS-CoV-2 RNA test, combined with a chest CT scan, could discover asymptomatic patients with strong infectivity. The application of glucocorticoids might lengthen the clearance time for SARS-CoV-2 RNA. Both asymptomatic and non-severe COVID-19 patients showed a better prognosis.

Treatment Effect of Qingfei Paidu Decoction Combined With Conventional Treatment on COVID-19 Patients and Other Respiratory Diseases: A Multi-Center Retrospective Case Series.

Background: Qingfei Paidu decoction (QFPDD) has been widely used in treating coronavirus disease 2019 (COVID-19) in China. However, studies on the treatment effect of COVID-19 patients and other respiratory diseases have not been well demonstrated. Our study aims to determine the treatment effect of QFPDD in combination with conventional treatment on COVID-19 patients and other respiratory diseases. Methods: This retrospective study recruited COVID-19 patients who were treated with QFPDD for at least two courses (6 days) from seven hospitals in five provinces from January 21 to March 18 2020. Demographic, epidemiological, clinical, laboratory, computed tomography characteristics, treatment, and outcome data were collected and analyzed. The improvements in clinical symptoms before and after QFPDD treatment were compared. Results: Eight COVID-19 patients were included in this study. Of them, six were males (75.0%). The median age of the patients was 66 (60–82) years. Four patients were classified as mild and moderate cases (50.0%); there were two severe cases (25.0%) and critical cases (25.0%). The most common symptom was cough (7 [87.5%]), followed by fever (6 [75.0%]), fatigue (4 [50.0%]), asthma (4 [50.0%]), and anorexia (3 [37.5%]). Abnormal findings included decrease in neutrophils (3 [37.5%]), lymphocytes (2 [25.0%]), alkaline phosphatase (3 [37.5%]), lactic dehydrogenase (4 [50.0%]), erythrocyte sedimentation rate (2 [25.0%]), and C-reactive protein (5 [83.3%]) at admission. After one course (3 days) of QFPDD, nasal obstruction and sore throat completely disappeared, and fever (5 [83.3%]), fatigue (2 [50.0%]), and cough (2 [28.6%]) were improved. After two courses (6 days), the fever disappeared completely in all patients, and the other symptoms showed a tendency to improve. In non-severe patients, 87.5% baseline symptoms completely disappeared. In severe patients, 61.1% of the baseline symptoms completely disappeared after patients were administered QFPDD for two courses. Of the abnormal indicators, 55.6% returned to normal levels. The median duration to complete fever recovery was 1.0 day. The median durations of viral shedding and hospitalization were 10.5 and 21.5 days, respectively. None of the patients worsened and died, and no serious adverse events occurred related to QFPDD during hospitalization. Conclusion: QFPDD combined with conventional treatment improved clinical symptoms in COVID-19 patients with other respiratory diseases, and no serious adverse reactions associated with QFPDD were observed. Larger sample studies confirm our findings in the future.

Development of a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients.

PurposeThyroid dysfunction in COVID-19 carries clinical and prognostic implications. In this study, we developed a prediction score (ThyroCOVID) for abnormal thyroid function (TFT) on admission amongst COVID-19 patients.MethodsConsecutive COVID-19 patients admitted to Queen Mary Hospital were prospectively recruited during July 2020–May 2021. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were measured on admission. Multivariable logistic regression analysis was performed to identify independent determinants of abnormal TFTs. ThyroCOVID was developed based on a clinical model with the lowest Akaike information criteria.ResultsFive hundred and forty six COVID-19 patients were recruited (median age 50 years, 45.4% men, 72.9% mild disease on admission). 84 patients (15.4%) had abnormal TFTs on admission. Patients with abnormal TFTs were more likely to be older, have more comorbidities, symptomatic, have worse COVID-19 severity, higher SARS-CoV-2 viral loads and more adverse profile of acute-phase reactants, haematological and biochemical parameters. ThyroCOVID consisted of five parameters: symptoms (malaise), comorbidities (ischaemic heart disease/congestive heart failure) and laboratory parameters (lymphocyte count, C-reactive protein, and SARS-CoV-2 cycle threshold values). It was able to identify abnormal TFT on admission with an AUROC of 0.73 (95% CI 0.67–0.79). The optimal cut-off of 0.15 had a sensitivity of 75.0%, specificity of 65.2%, negative predictive value of 93.5% and positive predictive value of 28.1% in identifying abnormal TFTs on admission amongst COVID-19 patients.ConclusionThyroCOVID, a prediction score to identify COVID-19 patients at risk of having abnormal TFT on admission, was developed based on a cohort of predominantly non-severe COVID-19 patients.

Impact of Various Hematological and Biochemical Parameters in Severe and Nonsevere COVID-19 Patients

Background: COVID-19 infection has been declared a pandemic in 2020 and since then it has been affecting the vast population of the world till today. Alteration of various hematological and biochemical parameters has been documented in various literatures. Aim: The aim of our study is to find out the prognostic role of hematological and biochemical parameters in severe and nonsevere COVID-19 patients. Materials and Methods: It was a retrospective record-based study conducted in a district-level COVID hospital of West Bengal, India. The COVID-confirmed patients admitted to the hospital during the second wave of COVID were included and data from records, including laboratory investigations were collected from the hospital registry. The severity of COVID was categorized based on the national guidelines. Independent samples t-test was applied to find out any relation of hematological and biochemical parameters abnormality in relation to disease severity. P &lt; 0.05 was considered statistically significant. Results: A total of 94 COVID-confirmed cases were included in our study. Males constitute the majority of cases (51 males vs. 43 females). Seventeen cases were categorized as severe COVID (18.09%), whereas others were nonsevere COVID. Among hematological parameters, total leukocyte count (TLC), neutrophil and lymphocyte percentage, and neutrophil-to-lymphocyte ratio (NLR) were significantly altered among the severe compared to the nonsevere group (P &lt; 0.05). While C-reactive protein (CRP), D-dimer, and serum ferritin levels also showed significant alteration among severe COVID patients (P &lt; 0.05). Conclusion: Our study showed that severe COVID patients were significantly associated with neutrophilia, raised NLR, CRP, D-dimer, and serum ferritin levels.

Target Therapeutic Ranges of Anti-MRSA Drugs, Linezolid, Tedizolid and Daptomycin, and the Necessity of TDM

The target therapeutic ranges of vancomycin, teicoplanin, and arbekacin have been determined, and therapeutic drug monitoring (TDM) is performed in clinical practice. However, TDM is not obligatory for daptomycin, linezolid, or tedizolid. In this study, we examined whether TDM will be necessary for these 3 drugs in the future. There was no significant difference in therapeutic effects on acute bacterial skin and skin structure infection between linezolid and tedizolid by meta-analysis. Concerning the therapeutic effects on pneumonia, the rate of effectiveness after treatment with tedizolid was significantly lower than with linezolid. With respect to safety, the incidences of gastrointestinal adverse events and blood/lymphatic system disorders related to tedizolid were significantly lower than those related to linezolid. Linezolid exhibits potent therapeutic effects on pneumonia, but the appearance of adverse reactions is indicated as a problem. There was a dose-dependent decrease in the platelet count, and the target trough concentration (Ctrough) was estimated to be 4-6 or 2-7 µg/mL in accordance with the patient's condition. The efficacy of linezolid may be obtained while minimizing the appearance of adverse reactions by performing TDM. The target therapeutic range of tedizolid cannot be achieved in immunocompromised or severe patients. Therefore, we concluded that TDM was unnecessary, considering step-down therapy with oral drugs, use in non-severe patients, and high-level safety. Concerning daptomycin, high-dose administration is necessary to achieve an area under the curve (AUC) of ≥666 as an index of efficacy. To secure its safety, Ctrough (<20 µg/mL) monitoring is important. Therefore, TDM is necessary.

Severe COVID-19 correlates with lower mitochondrial cristae density in PBMCs and greater sitting time in humans.

An interaction between mitochondrial dynamics, physical activity levels, and COVID‐19 severity has been previously hypothesized. However, this has not been tested. We aimed to compare mitochondrial morphology and cristae density of PBMCs between subjects with non‐severe COVID‐19, subjects with severe COVID‐19, and healthy controls. Additionally, we compared the level of moderate‐vigorous physical activity (MVPA) and sitting time between groups. Blood samples were taken to obtain PBMCs. Mitochondrial dynamics were assessed by electron microscopy images and western blot of protein that regulate mitochondrial dynamics. The International Physical Activity Questionnaire (IPAQ; short version) was used to estimate the level of MVPA and the sitting time The patients who develop severe COVID‐19 (COVID‐19++) not present alterations of mitochondrial size neither mitochondrial density in comparison to non‐severe patients COVID‐19 (COVID‐19) and control subjects (CTRL). However, compared to CTRL, COVID‐19 and COVID‐19++ groups have lower mitochondrial cristae length, a higher proportion of abnormal mitochondrial cristae. The COVID‐19++ group has lower number (trend) and length of mitochondrial cristae in comparison to COVID‐19 group. COVID‐19, but not COVID‐19++ group had lower Opa 1, Mfn 2 and SDHB (Complex II) proteins than CTRL group. Besides, COVID‐19++ group has a higher time sitting. Our results show that low mitochondrial cristae density, potentially due to physical inactivity, is associated with COVID‐19 severity.

A systematic review and meta‐analysis of abnormalities in hematological and biochemical markers among Bangladeshi COVID‐19 cases

Background and AimsAbnormalities in hematological and biochemical markers are assumed to be associated with the progression of COVID‐19 disease. This meta‐analysis was performed to assess the consequences of abnormalities of biomarkers (D‐dimers, C‐reactive protein [CRP], serum ferritin, lactate dehydrogenase [LDH], random blood sugar [RBS], absolute neutrophil count [ANC], neutrophil to lymphocyte ratio (NLR), serum creatinine, and hemoglobin) in the Bangladeshi COVID‐19 patients.MethodsThe data of biomarker levels in Bangladeshi COVID‐19 patients were gathered from five databases: PubMed, ScienceDirect, Web of Science, Google Scholar and Bangladesh Journals Online between January 2020 to March 2022. Review Manager 5.4 was used for the meta‐analysis, and Egger's test and Begg‐Mazumdar's rank correlation were used to investigate publication bias.ResultsThis study included 1542 patients with 567 severe and 975 nonsevere statuses. Based on the accumulated data synthesis, there is a strong correlation between disease severity and different biomarkers, including D‐dimer, CRP, ferritin, LDH, RBS, NLR, and serum creatinine (MD = 1.16, p = 0.0004; MD = 22.97, p = 0.003; MD = 419.26, p < 0.00001; MD = 118.37, p = 0.004; MD = 1.96, p = 0.02; MD = 1.26, p = 0.02; and MD = 0.31, p = 0.008, respectively). A significantly decreased correlation was observed for hemoglobin levels in severe COVID‐19 patients (MD = −0.73, p = 0.10).ConclusionThe elevated biomarkers level was noticed in severe cases compared to nonsevere patients, revealing that D‐dimer, CRP, ferritin, LDH, RBS, NLR, and serum creatinine are significantly correlated to COVID‐19 severity. Only lower hemoglobin level was found to be associated with COVID‐19 severity.

Chest-X-ray-based scoring, total leukocyte count, and neutrophil-to-lymphocyte ratio to predict in-hospital mortality in COVID-19 patients: a retrospective study

Background: The objective of this study was to assess the demographical characteristic, laboratory and radiological findings associated with COVID-19 mortality in hospitalized patients and also to co-relate neutrophil-to-lymphocyte ratio (NLR) and chest x-ray (CXR) score with severity of the disease.Methods: This is a retrospective study done in Bowring and Lady Curzon hospital between the period of May 2021 to July 2021. 100 patients who were tested positive for SARS-CoV2 with RT-PCR were taken for the study after fulfilling the inclusion criteria. On day 1 of admission, routine blood investigations including CBC with differential count and chest X ray is taken. From the above said data, NLR and CXR score is calculated and a comparison is made to determine severity and in-hospital mortality between mild, moderate and severe COVID pneumonia patients. This study is being carried out after obtaining institutional ethical committee approval clearance. All analysis were performed using SPSS software version 10.Results: The sample size studied was 100. The mean age of patients was 28.3 in mild, 49.9 in moderate and 62.6 in severe COVID patients. Among these 67% were males and 33% were females. It was noted that, leukocytosis (mean-13245), neutrophilia (mean-83.05%), lymphocytopenia (mean-10.45%) and chest X-ray score (mean-4.98) was seen among severe group with p value being significant.Conclusions: TLC, NLR and CXR score were significantly different between severe and non-severe patients, so assessment of these simple parameters may help identify high risk COVID-19 patients at an early stage in a resource limited setting from the data retrieved from our hospital, NLR and CXR Score showed an acceptable efficiency to separate COVID-19 patients among severe and non-severe patients with a significant p value thereby helping in triaging the patients and need for early ICU needs.

EPH63 Identification of a Warm Autoimmune Hemolytic Anemia (wAIHA) Population Using Predictive Analytics of a Known Clinically Profiled Cohort

The disease burden of wAIHA is not well known due to the difficulty of identifying patients in the absence of a diagnostic code for wAIHA. Our goals were to 1) identify a wAIHA cohort, 2) bisect severe versus non-severe patients, 3) compare comorbidities, anemia symptoms, treatments, diagnostic tests, and healthcare provider visits in these two groups, and 4) use a predictive model to validate clinical variables and prevalence estimates.

Efficacy of hematopoietic stem cell transplantation in the treatment of children with non-severe aplastic anemia.

Non-severe aplastic anemia is more likely to develop into severe aplastic anemia, and there is no widely accepted treatment plan at present. Hematopoietic stem cell transplantation might be a new therapeutic strategy. Retrospectively analyzed 32 patients with non-severe aplastic anemia who underwent hematopoietic stem cell transplantation from September 2007 to September 2020, and the 5-year estimated overall survival rate and the incidence of graft-versus-host disease were analyzed to evaluate the efficacy and safety of hematopoietic stem cell transplantation in the treatment of pediatric non-severe aplastic anemia. Thirty-two patients who underwent transplantation, 29 patients (90.6%) survived, 3 patients (9.4%) died. The incidence of acute graft-versus-host disease was 51.6% (16/31), including 15 cases (48.4%) of grade I-II and 1 case (3.2%) of grade III-IV. The incidence of chronic graft-versus-host disease was 38.7% (12/31). The 5-year overall survival rate was 91.8%. Hematopoietic stem cell transplantation is a practicable, safe, and effective treatment option for non-severe aplastic anemia pediatric patients who are suitable for transplant.

Homocysteine in coronavirus disease (COVID-19): a systematic literature review.

Coronavirus disease 2019 (COVID-19) is a life-threatening infectious disorder characterized by a sustained prothrombotic state. Since homocysteine is a potential biomarker of thrombotic diseases, the aim of this article is to provide an updated overview on the possible role played by hyperhomocysteinemia in influencing an unfavorable COVID-19 progression. We carried out an electronic search in Medline (PubMed interface) using the keywords ("COVID-19" OR "SARS-CoV-2") AND "homocysteine", between 2019 and the present time, with no language restrictions, to identify all articles which explored the concentration of homocysteine in COVID-19 patients with or without unfavorable disease progression. Three studies, totaling 694 hospitalized COVID-19 patients, were included in our systematic review. Overall, the differences between the mean homocysteine values in non-severe vs. severe COVID-19 patients were always positive (i.e.,15.1%, 24.1% and 22.8%, generating a positive weight mean difference of 1.75μmol/L (95%CI, 1.26-2.25μmol/L; p=0.011), which translates into a cumulative difference of approximately ∼1.2μmol/L. Despite the limited evidence that has been garnered so far, increased homocysteine ​​levels may be a potentially useful marker for predicting the risk of unfavorable progression in patients with COVID-19.

Alveolar-Arterial Gradient Is an Early Marker to Predict Severe Pneumonia in COVID-19 Patients.

Background: One of the main challenges in the management of COVID-19 patients is to early assess and stratify them according to their risk of developing severe pneumonia. The alveolar–arterial oxygen gradient (D(A-a)O2) is defined as the difference between the alveolar and arteriolar concentration of oxygen, an accurate index of the ventilatory function. The aim of this study is to evaluate D(A-a)O2 as a marker for predicting severe pneumonia in COVID-19 patients, in comparison to the PaO2/FiO2. Methods: This retrospective, multicentric cohort study included COVID-19 patients admitted to two Italian hospitals between April and July 2020. Clinical and laboratory data were retrospectively collected at the time of hospital admission and during hospitalization. The presence of severe COVID-19 pneumonia was evaluated, as defined by the Infectious Diseases Society of America (IDSA) criteria for community-acquired pneumonia (CAP). Patients were divided in severe and non-severe groups. Results: Overall, 53 COVID-19 patients were included in the study: male were 30/53 (57%), and 10/53 (19%) had severe pneumonia. Patients with severe pneumonia reported dyspnea more often than non-severe patients (90% vs. 39.5%; p = 0.031). A history of chronic obstructive pulmonary disease (COPD) was recalled by 5/10 (50%) patients with severe pneumonia, and only in 6/43 (1.4%) of non-severe cases (p = 0.023). A ROC curve, for D(A-a)O2 >60 mmHg in detecting severe pneumonia, showed an area under the curve (AUC) of 0.877 (95% CI: 0.675–1), while the AUC of PaO2/FiO2 < 263 mmHg resulted 0.802 (95% CI: 0.544–1). D(A-a)O2 in comparison to PaO2/FiO2 had a higher sensibility (77.8% vs. 66.7%), positive predictive value (75% vs. 71.4%), negative predictive value (94% vs. 91%), and similar specificity (94.4% vs. 95.5%). Conclusions: Our study suggests that the D(A-a)O2 is more appropriate than PaO2/FiO2 to identify COVID-19 patients at risk of developing severe pneumonia early.

Effective Natural Killer Cell Degranulation Is an Essential Key in COVID-19 Evolution.

NK degranulation plays an important role in the cytotoxic activity of innate immunity in the clearance of intracellular infections and is an important factor in the outcome of the disease. This work has studied NK degranulation and innate immunological profiles and functionalities in COVID-19 patients and its association with the severity of the disease. A prospective observational study with 99 COVID-19 patients was conducted. Patients were grouped according to hospital requirements and severity. Innate immune cell subpopulations and functionalities were analyzed. The profile and functionality of innate immune cells differ between healthy controls and severe patients; CD56dim NK cells increased and MAIT cells and NK degranulation rates decreased in the COVID-19 subjects. Higher degranulation rates were observed in the non-severe patients and in the healthy controls compared to the severe patients. Benign forms of the disease had a higher granzymeA/granzymeB ratio than complex forms. In a multivariate analysis, the degranulation capacity resulted in a protective factor against severe forms of the disease (OR: 0.86), whereas the permanent expression of NKG2D in NKT cells was an independent risk factor (OR: 3.81; AUC: 0.84). In conclusion, a prompt and efficient degranulation functionality in the early stages of infection could be used as a tool to identify patients who will have a better evolution.

Clinical characteristics and outcomes of COVID-19 patients in Bali, Indonesia.

IntroductionThe spectrum of illness and outcomes of coronavirus disease 2019 (COVID-19) patients may vary. This study reports the characteristics of COVID-19 patients in Bali, Indonesia, and evaluates the diagnostic value of their clinical symptoms.MethodThis observational study was conducted in eight hospitals. The patients were classified as non-severe COVID-19, severe COVID-19, and non-COVID-19. Demographics, clinical, laboratory, and radiologic characteristics, and outcomes of COVID-19 patients were collected. Factors associated with the severity and outcomes were assessed using the chi-squared test or ANOVA when appropriate. We also compared the clinical features of non-severe COVID-19 and non-COVID-19 patients to evaluate the diagnostic accuracy.ResultsThis study included 92 patients: 41 non-COVID-19 and 51 COVID-19 patients, comprising 45 non-severe and six severe cases. The most common symptoms of COVID-19 were cough (47.1%), fever (31.0%), and dyspnea (25.3%). Cough, fatigue, and anosmia have high accuracy, and combining these complaints in clinical diagnostics offered a higher accuracy in predicting COVID-19 patients (60.1%). We found lower lymphocyte counts and interleukin-1R levels and higher levels of C-reactive protein, interleukin-6, and interleukin-8 in severe compared than in non-severe COVID-19 patients. Lactate dehydrogenase was associated with intensive care unit admission and ventilator use, while other markers such as neutrophil-lymphocyte ratio, C-reactive protein, and interleukin-6 were not.ConclusionA battery of symptoms, including cough, fatigue, and anosmia, is likely associated with COVID-19 in Bali. Clinicians should be aware of these symptoms to ensure a prompt diagnostic test for COVID-19, beyond other causes of acute febrile illnesses.