PCR Confirmed COVID-19 Patients Research Articles

Monocyte-to-Hdl-Cholesterol Ratio as a Prognostic Marker in Covid-19

Background: There is an urgent need for mortality predictors for COVID-19 so that clinicians can diagnose severe cases and triage them as soon as possible. Many studies have suggested using hematologic markers to predict mortality and severity of COVID-19 disease. This study investigates the use of monocyte-to-high density lipoprotein cholesterol ratio (MHR) as a predictive marker for COVID-19 severity and mortality. Methods: This retrospective cross-sectional study was performed on 81 PCR-confirmed COVID-19 patients between 25 March 2020 to 26 June 2020. Patients were classified into two presentation categories: the non-severe group (n=37) and the severe group (n=44). Patients in the severe group were also divided into two subgroups: severe survivors (n=14) and severe non-survivors (n=30). In the receiver operating characteristic (ROC) analysis, optimal cut-off values of the monocyte count, high-density lipoprotein cholesterol (HDL-C), and MHR were calculated for the differentiation of severe and non-severe COVID-19 patients, as well as survivors and non-survivors. Results: A total of 81 patients, 29 (35.8%) males and 52 (64.2) females, with a median age of 71 (IQR 63-81) years. Both HDL-C and MHR showed a reasonable ability to distinguish severe disease from non-severe disease, while MHR had a higher area under curve (AUC) than HDL-C (0.799, 95%CI 0.704-0.894, p 0.001 vs 0.734, 95% Cl 0.626-0.843, p 0.001). Only MHR could distinguish survivors from non-survivors with an ROC AUC of 0.735 (95%Cl 0.619-0.850). The optimal cut-off values of MHR for predicting severe disease were 0.0061 (sensitivity: 66% and specificity: 66%) and 0.0066 (sensitivity: 70% and specificity: 62%) for predicting mortality. The optimal cut-off value of MHR for predicting severe disease was 0.0061 (sensitivity: 66% and specificity: 66%), and it was 0.0066 for predicting mortality among patients with severe disease (sensitivity: 70% and specificity: 62%). Conclusion: Our results showed that MHR was observed to be able to distinguish severe COVID-19 patients from non-severe patients as well as survivors from non-survivors.

Abdominal Imaging Findings in Laboratory-Confirmed COVID-19 Patients: A Retrospective Observational Study.

Coronavirus disease 2019 (CO-VID-19) is known to predominantly present with respiratory symptoms; however, a significant proportion of patients present with digestive symptoms. These symptoms are often non-specific and as such prompt the treating physician to request further imaging evaluation. Understanding the abdominal imaging findings in COVID-19 and their possible associations is thus crucial to direct patient care and prevent misdiagnosis.The aim of this study was to describe abdominal imaging findings on both computed tomography (CT) and ultrasound scans in cases with positive COVID-19 polymerase chain reaction (PCR) tests performed at our institution, and also, to evaluate the reason for requesting these imaging studies, and to correlate these findings with patients' demographics. A retrospective observational study was conducted at Salmaniya Medical Complex, Bahrain, between February 2021 and March 2022. We examinedthe abdominal CT and ultrasound data for PCR-confirmed COVID-19 patients. The demographic data, reason for requesting imaging and imaging findings were gathered by reviewing the hospital's electronic health records and picture archiving and communicating system (PACS). The study included 97 patients, with the majority being male (57.7%). The most common reason for imaging was abdominal pain, as seen in over half of the patients (60.8%), followed by deranged liver enzymes (18.6%). More than 75% of imaging studies showed positive abdominal findings with the majority (19.6%) showing non-specific inflammatory findings, followed by gallbladder disease (13.4%). The CT studies were more likely to yield positive findings as compared to ultrasound, with only 7 (11.3%) CT scans yielding normal findings (χ2 = 14.65; P < 0.01). To our knowledge, the research conducted on the abdominal manifestations of COVID-19 is still limited, especially in our region. Our study showed that there are variable presentations of abdominal organ involvement in COVID-19 cases, and as such more data is required to direct choice of imaging study, protocol, and interpretation of findings to better guide patient management.

The impact of blood group phenotypes on COVID-19 severity and mortality in Duhok province: a prospective cross-sectional study

Objectives: This study aimed to determine the frequency of blood group types among COVID-19 patients and to investigate its potential association with disease severity and patient outcomes.&#x0D; Methods: this prospective cross-sectional study was conducted from February to July 2022 in three different healthcare facilities in the Duhok region. All confirmed PCR confirmed COVID-19 patients were classified into: mild, moderate, severe, and critical cases. Information on demographic, clinical, and laboratory characteristics were collected using a standardized questionnaire. All patients were subjected to ABO blood grouping. The statistical calculations were performed by JMP Pro 14.3.0. A p value of &lt; 0.05 was considered significant.&#x0D; Results: the study comprised of 404 patients. The age range of the patients varied from 16 to 100 years with a male predominance (204, 50.5%). Out of the total patients, 250 (61.88%) had mild-moderate course, while 154 (38.12%) had severe-critical course. The most frequent blood group was O (164, 41.58%), followed by blood group A (121, 29.95%). There was no significant difference in the distribution of the Rh factor among the studied subjects (p=0.426). There was a significant increase in disease severity and worse outcome with increasing age (p=&lt;0.0001). Considering blood group types, there were no significant differences between blood group types with COVID-19 severity and patients’ outcome. &#x0D; Conclusions: individuals with blood group O may have a higher risk of contracting COVID-19. Advanced age is a crucial predictor of disease severity and poor outcomes. There were no significant association between blood group types with COVID-19 severity and patients’ outcome. However, further research is needed to confirm these findings and determine the underlying mechanisms behind any potential association between blood groups and COVID-19 susceptibility, severity, and outcome.

Memory SARS-CoV-2 T-cell response in convalescent COVID-19 patients with undetectable specific IgG antibodies: a comparative study.

During the COVID-19 pandemic, a variable percentage of patients with SARS-CoV-2 infection failed to elicit humoral response. This study investigates whether patients with undetectable SARS-CoV-2 IgG are able to generate SARS-CoV-2 memory T cells with proliferative capacity upon stimulation. This cross-sectional study was conducted with convalescent COVID-19 patients, diagnosed with a positive real-time PCR (RT-PCR) from nasal and pharyngeal swab specimens. COVID-19 patients were enrolled ≥3 months after the last PCR positive. Proliferative T-cell response after whole blood stimulation was assessed using the FASCIA assay. A total of 119 participants (86 PCR-confirmed COVID-19 patients and 33 healthy controls) were randomly filtered from an initial cohort. Of these 86 patients, 59 had detectable (seropositive) and 27 had undetectable (seronegative) SARS-CoV-2 IgG. Seropositive patients were subclassified as asymptomatic/mild or severe according to the oxygen supplementation requirement. SARS-CoV-2 CD3+ and CD4+ T cells showed significantly lower proliferative response in seronegative than in seropositive patients. The ROC curve analysis indicated that ≥ 5 CD4+ blasts/μL of blood defined a "positive SARS-CoV-2 T cell response". According to this cut-off, 93.2% of seropositive patients had a positive T-cell response compared to 50% of seronegative patients and 20% of negative controls (chi-square; p < 0.001). This proliferative assay is useful not only to discriminate convalescent patients from negative controls, but also to distinguish seropositive patients from those with undetectable SARS-CoV-2 IgG antibodies. Memory T cells in seronegative patients are able to respond to SARSCoV-2 peptides, although at a lower magnitude than seropositive patients.

Factors Associated with Depression in Post-Covid-19 Patients: A Tool for Prediction of Depression in Neurotropic Viral Infections

Background: Post-COVID-19 patients might be at higher risk of developing long-term depression. Objectives: to determine risk factors associated with depression among COVID-19 long-haulers. Methodology: This is a retrospective cohort study of 510 PCR-confirmed COVID-19 subjects. Integrative Classification for Defining Post-COVID-19 Symptoms was used in this study to define post COVID-19 syndrome. Depression severity was assessed for all patients during the long-term period of symptoms using PHQ-9 scale. Factors associated with depression were analyzed for all patients using SPSS V22. Results: This retrospective cohort study involved 510 PCR-confirmed COVID-19 patients. They were 73 % females. Average age of participants was 27.2±11.38 years old. Almost 92.5 % of subjects suffered from long-term COVID-19 symptoms. A hundred- fifteen patients (22.5 %) suffered from depression. There was a significant relationship between number of symptoms, gender, and depression at p value &lt; 0.001 for each factor. There was a significant relationship between first symptom(s) patient suffered from, type of respiratory symptoms, both ageusia and anosmia, and depression, at p value &lt; 0.001, for each factor. The odds of depression in females were 3 times more than males, p=0.012 and 1.15 in patients with increased number of symptoms, p=0.036. The odds of depression for patients with ageusia and anosmia, or who had a cluster of symptoms were 25 and 32, p=0.041, and 0.025, respectively. In contrast, headache and dizziness, anosmia alone, or GIT symptoms as first symptom (s), decreases risk of developing depression markedly, p=0.027, 0.033, and 0.014, respectively. Conclusions: Depression among post-COVID-19 patients was associated with female gender, number of symptoms suffered during the acute phase, ageusia and anosmia, and cluster of symptoms.

Association of Inflammatory Markers with Disease Severity and Outcome in Covid-19 Patients.

Objectives: The coronavirus pandemic was associated with a high mortality rate in the Republic of North Macedonia. Finding early markers of the disease's severity may predict outcomes and guide the treatment of the disease. The aim of our study was to evaluate the role of inflammatory markers in predicting the outcome of COVID-19 in hospitalized patients. Methods: The study included 104 PCR-confirmed COVID-19 patients who underwent hospital treatment at the Institute of Lung Diseases and Tuberculosis in Skopje, North Macedonia, between November 2020 and May 2021. Inflammatory markers were assessed in all patients and correlated with the disease severity and outcome in terms of survival or death. Results: IL-6 and LDH at admission were significantly elevated in patients with a severe or critical form of the disease and among non-survivors. In addition, IL-6 showed 87.9% of sensitivity and 61.8% of specificity for distinguishing non-survivors from survivors with a cut-off value of 21.7 pg/ml in the receiver operator curve (ROC). Procalcitonin was significantly increased in non-survivors. Parallel to the increase of disease severity, the values of CRP and LDH increased significantly during hospitalization. Conclusion: The results of the study indicate that a significant association exists between the highly increased levels of CRP, LDH, IL-6 and procalcitonin and the severity of the disease and mortality in COVID-19 patients. Their measurements and follow-up during the course of the disease could be used as predictors for prognosis and outcome but also as a subject for targeted therapy.

Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients:Apropensity score adjusted retrospective cohort study.

Early treatment of high-risk COVID-19 patients may prevent disease progression. However, there are limited data to support treatment of hospitalized or fully vaccinated patients with mild-to-moderate disease. In this retrospective cohort study, we studied the effect of early use of sotrovimab and remdesivir in high-risk hospitalized COVID-19 patients. We included PCR-confirmed COVID-19 patients admitted to the National Centre for Infectious Diseases who presented within the first 5 days of illness, and who were not requiring oxygen or ICU care at presentation. Sotrovimab- and remdesivir-treated groups were compared with control (no early treatment). A multiple propensity-score adjusted multivariable regression analysis was conducted with a composite primary endpoint of in-hospital deterioration (oxygen requirement, ICU admission, or mortality). Of 1118 patients, 841 were in the control group, 106 in the sotrovimab group and 169 in the remdesivir group. The median age was 63 years (IQR 46-74 years) and 505 (45.2%) were female. In unvaccinated patients, both remdesivir and sotrovimab treatment were protective (adjusted odds ratio [aOR] 0.19, 95% CI 0.064-0.60 and 0.18 [95% CI 0.066-0.47]), respectively. Contrarily, among the vaccinated patients there was no significant treatment effect with early remdesivir treatment (aOR 2.51, 95% CI 0.83-7.57, p = 0.10). Remdesivir and sotrovimab treatment, given early in the disease course to unvaccinated high-risk patients, was effective in reducing the risk of in-hospital deterioration and severe disease. This effect was not seen in fully vaccinated patients, which may be due to a small sample size or residual confounding.

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

IntroductionCritical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. MethodsMulticenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. ResultsThe median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. ConclusionAge and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

Prognostic value of intensive care scores concerning the prediction of 30-day mortality in COVID-19

Objective: The goal of our study was to determine the prognostic value of CURB-65, Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA, and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission in patients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off value for death regarding these parameters. Methods: This observational retrospective study was performed in COVID-19 triage in Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI, MuLBSTA, and CURB-65, data were collected from patients who were selected by available sampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality was assessed as the primary outcome. ROC analysis was conducted using the STATA software to evaluate the prognostic value of the scoring systems. DeLong test was utilized to compare AUC of scores using a web based tool. Results:Ninety-two patients were included in this study with the mean age of 51.02±17.81 years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P=0.130), but other indices had statistically significant values of AUC. Based on the comparison of the AUCs, SOFA was the worst scoring system in COVID-19 as it had significantly lower AUC than PSI and APACHE II (P&lt;0.05); while its comparison with MULBSTA and CURB65 was not statistically significant (P&gt;0.05). Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our study with no statistical difference compared together (P&gt;0.05). The sensitivity of APACHE II and PSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off point was 13 and 50 for APACHE II and PSI, respectively.

The Use of Mebendazole in COVID-19 Patients: An Observational Retrospective Single Center Study.

An in-silico screen identified mebendazole with potential antiviral activity that could be a repurposed drug against SARS-CoV-2. Mebendazole is a well-tolerated and cheap antihelminthic agent that is readily available worldwide and thus could be a therapeutic tool in the fight against COVID-19. This is an observational retrospective study of PCR-confirmed COVID-19 patients who received mebendazole with the intention-to-treat. The study included an inpatient cohort (157 inpatients) and an outpatient cohort (185 outpatients). Of the 157 inpatients and 185 outpatients, 68 (43.3%) and 94 (50.8%) received mebendazole, respectively. Patients who presented within the same timeframe but did not receive mebendazole were used as controls. Patients received standard-of-care treatment including remdesivir, dexamethasone, and anticoagulants as deemed necessary by the treating physician. The following clinical outcomes were evaluated: for the inpatient cohort, length of stay (LOS) at the hospital, need for ventilation (combined invasive and noninvasive), and mortality; for the outpatient cohort, time to symptom resolution, need for hospitalization, and mortality. For the inpatient cohort, the median age did not differ between the treatment and control groups; 62 (56, 67) vs. 62 (56, 68), P, and there was a comparable proportion of males in both groups; 43 (63%) vs. 55 (62%), P=0.85. The hospital LOS was 3.5 days shorter in the treatment group compared to the control group (P < 0.001). There were fewer patients who required invasive or noninvasive ventilation in the treatment group, 2 (2.9%) vs. 7 (7.9%), and the mortality rate is lower in the treatment group, 3 (4.4%) vs. 8 (9.0%), though the differences did not reach statistical significance. For the outpatient cohort, the median age was lower in the treatment group compared with the control group; 40 (34, 48) vs. 48 (41, 54), P < 0.001. There was a comparable proportion of males between both groups; 50 (53%) vs. 52 (57%), P=0.59. Patients in the treatment group were 3.3 days closer to symptom resolution (P < 0.001). There were numerically fewer patients requiring hospitalization in the treatment group compared with the control group, 3 (3.2%) vs. 6 (6.6%), though this did not reach statistical significance (P=0.33). In this retrospective observational study, the use of mebendazole in COVID-19 patients was associated with shorter hospitalizations in the inpatient cohort and shorter durations of symptom resolution in the outpatient cohort. The findings from this small observational study are hypothesis-generating and preclude drawing conclusions about clinical efficacy. Further studies are needed to examine the role of mebendazole in the treatment of COVID-19 patients.

Pan-neutralizing, germline-encoded antibodies against SARS-CoV-2: Addressing the long-term problem of escape variants.

Despite the initially reported high efficacy of vaccines directed against ancestral SARS-CoV-2, repeated infections in both unvaccinated and vaccinated populations remain a major global health challenge. Because of mutation-mediated immune escape by variants-of-concern (VOC), approved neutralizing antibodies (neutAbs) effective against the original strains have been rendered non-protective. Identification and characterization of mutation-independent pan-neutralizing antibody responses are therefore essential for controlling the pandemic. Here, we characterize and discuss the origins of SARS-CoV-2 neutAbs, arising from either natural infection or following vaccination. In our study, neutAbs in COVID-19 patients were detected using the combination of two lateral flow immunoassay (LFIA) tests, corroborated by plaque reduction neutralization testing (PRNT). A point-of-care neutAb LFIA, NeutraXpress™, was validated using serum samples from historical pre-COVID-19 negative controls, patients infected with other respiratory pathogens, and PCR-confirmed COVID-19 patients. Surprisingly, potent neutAb activity was mainly noted in patients generating both IgM and IgG against the Spike receptor-binding domain (RBD), in contrast to samples possessing anti-RBD IgG alone. We propose that low-affinity, high-avidity, germline-encoded natural IgM and subsequent generation of class-switched IgG may have an underappreciated role in cross-protection, potentially offsetting immune escape by SARS-CoV-2 variants. We suggest Reverse Vaccinology 3.0 to further exploit this innate-like defense mechanism. Our proposition has potential implications for immunogen design, and provides strategies to elicit pan-neutAbs from natural B1-like cells. Refinements in future immunization protocols might further boost long-term cross-protection, even at the mucosal level, against clinical manifestations of COVID-19.

Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients

BackgroundThe impact of the right ventricular (RV) structure and function on the in-hospital outcomes in patients with COVID-19 infection has not been rigorously investigated. ObjectivesThe main aim of our study was to investigate in-hospital outcomes including mortality, ICU admission, mechanical ventilation, pressor support, associated with RV dilatation, and RV systolic dysfunction in COVID-19 patients without a history of pulmonary hypertension. MethodsIt was a single academic tertiary center, retrospective cohort study of 997 PCR-confirmed COVID-19 patients. One hundred ninty-four of those patients did not have a history of pulmonary hypertension and underwent transthoracic echocardiography at the request of the treating physicians for clinical indications. Clinical endpoints which included mortality, ICU admission, need for mechanical ventilation or pressor support were abstracted from the electronic charts. ResultsPatients’ mean age was 68+/-16 years old and 42% of the study population were females. COPD was reported in 13% of the study population, whereas asthma was 10%, and CAD was 25%. The mean BMI was 29.8+/-9.5 kg/m2. Overall mortality was 27%, 46% in ICU patients, and 9% in the rest of the cohort. There were no significant differences in co-morbidities between expired patients and the survivors. A total of 19% of patients had evidence of RV dilatation and 17% manifested decreased RV systolic function. RV dilatation or decreased RV systolic function were noted in 24% of the total study population. RV dilatation was significantly more common in expired patients (15% vs 29%, p = 0.026) and was associated with increased mortality in patients treated in the ICU (HR 2.966, 95%CI 1.067–8.243, p = 0.037), who did not need require positive pressure ventilation, IV pressor support or acute hemodialysis. ConclusionsIn hospitalized COVID-19 patients without a history of pulmonary hypertension, RV dilatation is associated with a 2-fold increase in inpatient mortality and a 3-fold increase in ICU mortality.

The relationship between BCG scar size and socioeconomic status on the severity and mortality of COVID-19 patients, “as indicators of the immunity”

Background: The severity and mortality by COVID-19 vary among countries. This may be related to the underlying immunity. Response to the vaccine effect is immunologically related to several factors like vaccination, infestation with parasites and nutrition. Socioeconomic status is an important factor in health problems.Objectives: The purpose of the study is to understand the effect of the BCG scar size and the socioeconomic status as indicators of underlying immunity on the severity and mortality of COVID-19 patients.Method: A comparative study of PCR-confirmed COVID-19 patients were done in Basrah, Teaching Hospital. The patients were divided into two groups: Severe and mild to moderate cases. All confirmed cases during April and May 2020 in Basrah Teaching Hospital were included. The BCG scar size and socioeconomic status were studied and related to the severity and mortality of COVID-19 cases.Results: Patients who had small BCG scar size and high socioeconomic status were significantly associated with higher severity and mortality due to COVID-19 infection.Conclusion: BCG scar size and socioeconomic class can be used as good indicators for immune response against infection and the extent of their severity and mortality.

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study.

SummaryBackgroundThe clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae.MethodsMulticenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months.FindingsLatent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01).InterpretationComorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae.FundingISCIII, UNESPA, CIBERES, FEDER, ESF.

Clinical features and risk predictor markers in COVID-19 patients in correlation with disease severity and comorbidities- A data-based retrospective study

Background: COVID-19 infection displays a highly heterogeneous spectrum of severities. Laboratory findings are pivotal cues to assess disease severity and aid in retarding/ reversing disease progression. This study aims to identify the haematological, biochemical, and immunological specifics of COVID-19 patients with varying severity and associated comorbidities. Methods: This retrospective study recruited a total of 192 RT PCR confirmed COVID-19 patients. Data on laboratory findings, clinical characteristics, treatment, and hospital stay were obtained and analysed. Results: The patients were grouped into mild, moderate, and severe categories based on disease severity. 96 patients had mild disease, 31 were classified as having moderate COVID-19, and 67 patients had severe COVID-19. 39.58% of the patients were females. The overall death rate among admitted COVID-19 patients is observed to be 19.02%, sepsis and multi-organ failure as the most common cause. The variation in laboratory variables and comorbidities as CAD, CKD, HTN, DM strongly correlate with the severity and increases with the age factor. Pre-existing chronic liver disease emerged to be a comorbidity of significance for acquiring severe COVID-19. Conclusion: Presence of comorbidities, advanced age and male sex emerged as important risk factors while derangements in thrombo-inflammatory markers and haematological indices might be crucial predictors of disease progression. Thromboembolism or superinfection induced sepsis, and multi-organ failure emerged as leading contributors to mortality. High-risk patterns in thrombo inflammatory and immunohematological markers allow for early detection of the disease progression and aid in the institution of personalized intensive therapeutic interventions and monitoring to avoid further deaths.

Correlation of inflammatory biomarkers with disease severity in hospitalised patients of COVID-19 at presentation

Background: The course of COVID-19 ranges from asymptomatic infection to life threatening critical illness. Inflammatory biomarkers have vital role in predicting outcome, disease severity and disease prognosis in COVID-19 cases. This study aims to observe the correlation of these biomarkers with disease severity in COVID-19.Patients and methods: This cross-sectional study was conducted in Chughtai Institute of Pathology from February 2021 to May 2021. Blood was collected from 1300 hospitalized adult PCR confirmed COVID-19 patients categorized in mild to critical disease classes. Asymptomatic cases, patients having coagulopathies and those who received plasma infusion were excluded from the study. Blood was analyzed for serum Interleukin-6 (IL-6), Ferritin, C-reactive protein (CRP), procalcitonin and D Dimers. Data was analyzed using SPSS 23.0.Results: From the study patients, 65.3% (n=849) were male and 34.7% (n=451) were female. Majority of the cases (43.5%, N=565) belonged to moderate group whereas only 0.6% (N=8) were in critical group. Study population had a mean age of 56 (+13.98) years. Serum IL-6 was taken as marker of disease severity, showed significant positive correlation with CRP (r =0.52), ferritin (r =0.33), D-dimers (r =0.32) but no correlation with procalcitonin (r =0.17) using spearmen correlation coefficient. All patients with critical disease had IL-6 levels above 1000pg/ml.Conclusion: The inclusion of inflammatory biomarkers in routine panel of COVID-19 patients can allow risk stratification of COVID-19 patients in different disease severity groups as cases with critical disease had higher levels.

Longitudinal profile of antibody response to SARS-CoV-2 in patients with COVID-19 in a setting from Sub-Saharan Africa: A prospective longitudinal study.

BackgroundSerological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia.MethodsIn this prospective study, a total of 102 PCR-confirmed COVID-19 patients were enrolled. We obtained 802 plasma samples collected serially. SARS-CoV-2 antibodies were determined using four lateral flow immune-assays (LFIAs), and an electrochemiluminescent immunoassay. We determined longitudinal antibody response to SARS-CoV-2 as well as seroconversion dynamics.ResultsSerological positivity rate ranged between 12%-91%, depending on timing after symptom onset. There was no difference in positivity rate between severe and non-severe COVID-19 cases. The specificity ranged between 90%-97%. Agreement between different assays ranged between 84%-92%. The estimated positive predictive value (PPV) for IgM or IgG in a scenario with seroprevalence at 5% varies from 33% to 58%. Nonetheless, when the population seroprevalence increases to 25% and 50%, there is a corresponding increases in the estimated PPVs. The estimated negative-predictive value (NPV) in a low seroprevalence scenario (5%) is high (>99%). However, the estimated NPV in a high seroprevalence scenario (50%) for IgM or IgG is reduced significantly to 80% to 85%. Overall, 28/102 (27.5%) seroconverted by one or more assays tested, within a median time of 11 (IQR: 9–15) days post symptom onset. The median seroconversion time among symptomatic cases tended to be shorter when compared to asymptomatic patients [9 (IQR: 6–11) vs. 15 (IQR: 13–21) days; p = 0.002]. Overall, seroconversion reached 100% 5.5 weeks after the onset of symptoms. Notably, of the remaining 74 COVID-19 patients included in the cohort, 64 (62.8%) were positive for antibody at the time of enrollment, and 10 (9.8%) patients failed to mount a detectable antibody response by any of the assays tested during follow-up.ConclusionsLongitudinal assessment of antibody response in African COVID-19 patients revealed heterogeneous responses. This underscores the need for a comprehensive evaluation of seroassays before implementation. Factors associated with failure to seroconvert needs further research.

Evaluation of Neuropatic Pain Features in COVID-19 Patients.

Pain is a common complaint in COVID-19 disease. Neurotrophic features of the COVID virus are reported. Neuropathic pain is seen during many viral infections and observed during the COVID-19 pandemic part of the clinical presentations. The aim of this is to evaluate neuroptic pain as presenting symptom in COVID-19 patients. In this cross-sectional descriptive study, adult patients (18 years and older) who applied to the COVID Outpatient Clinic completed the demographic data form and the neuropathic pain questionnaire. The patients were divided into positive and negative according to the PCR test results and the presence of neuropathic pain was compared. In total, 440 participants included in the study. Among 301 who stated to had any complaints, 197 (65.4%) had pain. The intensity of their pain was 5.8 ± 2.4 (0 - no pain and 10 - the most severe pain of life). Neuropathic pain component was present in 29.2% of the patients. Among the first admissions, neuropathic pain component was observed significantly higher in those with positive PCR test (55.0%) than negative ones (23.8%), and the Odd's ratio was calculated as 3.911. COVID-19 virus is thought to have neuroinvasion and neurotropic effects. In this study, neuropathic pain specifically was evaluated in COVID-19 patients, and the frequency of neuropathic pain was significantly higher in PCR confirmed COVID-19 patients at the onset of the disease.

Studying the clinical, radiological, histological, microbiological, and immunological evolution during the different COVID-19 disease stages using minimal invasive autopsy

The WHO defines different COVID-19 disease stages in which the pathophysiological mechanisms differ. We evaluated the characteristics of these COVID-19 disease stages. Forty-four PCR-confirmed COVID-19 patients were included in a prospective minimal invasive autopsy cohort. Patients were classified into mild-moderate (n = 4), severe-critical (n = 32) and post-acute disease (n = 8) and clinical, radiological, histological, microbiological and immunological data were compared. Classified according to Thoracic Society of America, patients with mild-moderate disease had no typical COVID-19 images on CT-Thorax versus 71.9% with typical images in severe-critical disease and 87.5% in post-acute disease (P < 0.001). Diffuse alveolar damage was absent in mild-moderate disease but present in 93.8% and 87.5% of patients with severe-critical and post-acute COVID-19 respectively (P = 0.002). Other organs with COVID-19 related histopathological changes were liver and heart. Interferon-γ levels were significantly higher in patients with severe-critical COVID-19 (P = 0.046). Anti-SARS CoV-2 IgG was positive in 66%, 40.6% and 87.5% of patients with mild-moderate, severe-critical and post-acute COVID-19 respectively (n.s.). Significant differences in histopathological and immunological characteristics between patients with mild-moderate disease compared to patients with severe-critical disease were found, whereas differences between patients with severe-critical disease and post-acute disease were limited. This emphasizes the need for tailored treatment of COVID-19 patients.

COVID-19 post-vaccination in healthcare workers and vaccine effectiveness, Brazil, 2021

ObjectsThis study aimed to describe COVID-19 cases in healthcare workers at a large tertiary hospital, after a vaccination campaign, to understand the individual characteristics, timeliness, symptomatology, and severity of the conditions. MethodsThe COVID-19 reporting files from the hospital's healthcare workers and their records in the vaccine registry were analyzed, regarding vaccination status, symptoms, sociodemographic characteristics, comorbidities, and outcomes. Vaccination descriptive analysis was carried out and the impact and effectiveness of vaccination in relation to symptomatic infection and hospitalization were estimated. ResultsIn a total of 696 PCR-confirmed COVID-19 patients, vaccination coverage for the 1st and 2nd dose was 92.8% and 85.5%. Patients with complete doses had a mean interval of 96.8 days between vaccination and the onset of symptoms. Of the 664 participants with available clinical data, 165 had at least 1 comorbidity. During the study, 12 patients were hospitalized, 58.3% with a complete vaccination schedule. Three of this group died. The effectiveness of vaccination for symptomatic cases and hospitalization was 22.1% and 69.0%, respectively. The impact of vaccination on symptomatic cases and hospitalization was 81.4% and 89.7%, respectively. DiscussionThe majority of COVID-19 cases in the study were classified as mild. The impact of vaccination for confirmed cases was significant, both in reducing the incidence of symptomatic cases and hospitalizations. The presence of comorbidities in approximately ¼ of the patients increased the risk of these individuals. The mean time interval between diagnosis and the 2nd dose of vaccine was longer in the hospitalized group, reinforcing the protective decline over longer periods.