Severe Course Of COVID-19 Research Articles

Wpływ polimorfizmu genetycznego na przebieg oraz ciężkość zakażenia wirusem SARS-CoV-2 oraz choroby COVID-19

COVID-19 is severe respiratory and systemic disease with complex pathogenesis and many clinical symptoms, including symptoms from respiratory system, immunology system, cardio-vascular system, haematopoietic system and neurological system. Severe character of the disease is associated with occurrence of respiratory failure, septic shock, multiple organ dysfunctions syndrome, which can lead to patients death due to cardiac arrest. Knowledge about interactions between the virus and human proteins as well as knowledge of immunological mechanisms against infection is a key to identifying the area of virus activity and severity factors of COVID-19. Multiple variants of genes encoding proteins involved in host cell invasion by SARS-CoV-2 virus have been identified: ACE2 i TMPRSS2, TMPRSS11A (HGNC:27954), ELANE (HGNC:3309) oraz CTSL (HGNC:2537), IL-6 rs1800795 variant associated with an increased risk of COVID-19, variant rs35705950:G>T located in the promoter of the MUC5B gene (11p15.5), encoding a protein that plays a key role in maintaining the proper function of the bronchoalveolar epithelium, having a protective effect against the form of the disease requiring hospitalization of the patient, as well as GC rs2282679 gene variant in the vitamin D binding protein associated with a more severe course of COVID-19. 48 of these variants were proved to be directly specific for some populations. Novel techniques of genome analysis enabled the research of the impact of specific polymorphism variants on the severity of various diseases including, COVID-19. Genetic factors analysis can permit understanding of disease pathogenesis, which is a chance to find effective treatment and prevention methods. Collected data from literature indicate that, in the case of COVID-19 disease, there are genes polymorphisms which affect the severity course.

Risk factors for a severe course of COVID-19 in a hotspot clinic during the first and second wave of the SARS-CoV-2 pandemic in Germany

During the first wave of the SARS-CoV-2 pandemic, Weiden Hospital was a hotspot and was thus in an exceptional medical situation. This study deals with the question of whether the recognized risk factors for a severe course of COVID-19 also apply to the patients treated in Weiden Hospital during this time or whether other factors could have influenced patient outcomes. In a retrospective analysis, data on 669 patients of Weiden Hospital with proven SARS-CoV-2 infections in the first year of the pandemic were evaluated. Risk factors for a severe case of COVID-19 were determined from medical and demographic information in a univariate analysis and subjected to logistic regression. The logistic regression analysis was performed for the overall collective as well as separately for patients from Wave 1 (3-6/2020) and 2 (7-12/2020). Looking at all of 2020, significant risk factors for severe COVID-19 included being male, being a smoker, being 71 years or older, and a history of depression. All other commonly recognized risk factors were not applicable for the Weiden collective. When looking at both waves separately, in Wave 1 age was not a significant risk factor, whereas in Wave 2 an age of 61 years or older was associated with an increased risk of severe progression. For patients who were admitted to hospital in Wave 2, the risk of severe progression was reduced almost by half. It can be assumed that patient outcomes in Weiden's hotspot collective were predominantly determined by non-individual factors, like the difficult care situation in a hotspot clinic at the beginning of the pandemic. In preparation for future pandemics, provision of sufficient resources might significantly contribute to better patient outcomes.

Resilience as a protective factor in the development of post-traumatic stress disorder in patients hospitalised for COVID-19

Introduction and objective: Both the illness itself and hospitalisation due to COVID-19 are potentially traumatic experiences, especially when the course of the disease is severe. Resilience has been identified as a crucial factor in the process of successfully coping with traumatic events and may protect against the development of symptoms of post-traumatic stress disorder. The aim of this study was to determine the role of resilience in the prevention of post-traumatic stress disorder symptoms in patients requiring hospitalisation due to COVID-19. Materials and methods: A total of 138 patients (59 women, 79 men; mean age: 52.34 years; standard deviation, SD = 12.46) hospitalised at the University Hospital in Krakow were included in the study, which was conducted 7–8 months after their COVID-19 diagnosis. The PTSD Checklist for DSM-5 (PCL-5) and the Resilience Measurement Scale (SPP-25) were administered, and stepwise multiple regression analysis was used in the predictive models. Results: A total of 31 participants (22.5%) met the criteria for probable post-traumatic stress disorder symptoms. The study participants were characterised by a moderate level of resilience (5th sten), with women exhibiting lower levels than men. Higher levels of resilience were associated with lower severity of PTSD symptoms. A significant predictor of post-traumatic stress disorder symptoms was “Tolerance for failure and treating life as a challenge”. Conclusions: Resilience has an impact on the severity of symptoms of post-traumatic stress disorder. Specifically, the dimension of “Tolerance” within resilience appears to be an important protective factor against post-traumatic stress disorder symptoms after hospitalisation for COVID-19. Patients hospitalised with severe course of COVID-19 exhibit a moderate level of resilience, with men demonstrating higher resilience levels than women.

GWAS and polygenic risk score of severe COVID-19 in Eastern Europe.

COVID-19 disease has infected more than 772 million people, leading to 7 million deaths. Although the severe course of COVID-19 can be prevented using appropriate treatments, effective interventions require a thorough research of the genetic factors involved in its pathogenesis. We conducted a genome-wide association study (GWAS) on 7,124 individuals (comprising 6,400 controls who had mild to moderate COVID-19 and 724 cases with severe COVID-19). The inclusion criteria were acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF) requiring respiratory support, or CT scans indicative of severe COVID-19 infection without any competing diseases. We also developed a polygenic risk score (PRS) model to identify individuals at high risk. We identified two genome-wide significant loci (P-value <5 × 10-8) and one locus with approximately genome-wide significance (P-value = 5.92 × 10-8-6.15 × 10-8). The most genome-wide significant variants were located in the leucine zipper transcription factor like 1 (LZTFL1) gene, which has been highlighted in several previous GWAS studies. Our PRS model results indicated that individuals in the top 10% group of the PRS had twice the risk of severe course of the disease compared to those at median risk [odds ratio = 2.18 (1.66, 2.86), P-value = 8.9 × 10-9]. We conducted one of the largest studies to date on the genetics of severe COVID-19 in an Eastern European cohort. Our results are consistent with previous research and will guide further epidemiologic studies on host genetics, as well as for the development of targeted treatments.

Post-vaccination, post-infection and hybrid immunity against severe cases of COVID-19 and long COVID after infection with SARS-CoV-2 Omicron subvariants, Czechia, December 2021 to August 2023.

BackgroundCOVID-19 remains a major infectious disease with substantial implications for individual and public health including the risk of a post-infection syndrome, long COVID. The continuous changes in dominant variants of SARS-CoV-2 necessitate a careful study of the effect of preventative strategies.AimWe aimed to estimate the effectiveness of post-vaccination, post-infection and hybrid immunity against severe cases requiring oxygen support caused by infections with SARS-CoV-2 variants BA1/2 and BA4/5+, and against long COVID in the infected population and their changes over time.MethodsWe used a Cox regression analysis with time-varying covariates and calendar time and logistic regression applied to national-level data from Czechia from December 2021 until August 2023.ResultsRecently boosted vaccination, post-infection and hybrid immunity provide significant protection against a severe course of COVID-19, while unboosted vaccination more than 10 months ago has a negligible protective effect. The post-vaccination immunity against the BA1/2 or BA4/5+ variants, especially based on the original vaccine types, appears to wane rapidly compared with post-infection and hybrid immunity. Once infected, however, previous immunity plays only a small protective role against long COVID.ConclusionVaccination remains an effective preventative measure against a severe course of COVID-19 but its effectiveness wanes over time thus highlighting the importance of booster doses. Once infected, vaccines may have a small protective effect against the development of long COVID.

Immunological insights: assessing immune parameters in medical professionals exposed to SARS-CoV-2

BackgroundThe immunological background responsible for the severe course of COVID-19 and the immune factors that protect against SARS-CoV-2 infection are still unclear. The aim of this study was to investigate immune system status in persons with high exposure to SARS-CoV-2 infection.MethodsSeventy-one persons employed in the observation and infectious diseases unit were qualified for the study between November 2020 and October 2021. Symptomatic COVID-19 was diagnosed in 35 persons. Anti-SARS-CoV-2 antibodies were also found in 8 persons. Peripheral blood mononuclear cells subpopulations were analyzed by flow cytometry, and the concentrations of cytokines and anti-SARS-CoV-2 antibodies were determined by ELISA.ResultsThe percentages of cytotoxic T lymphocytes (CTLs), CD28+ and T helper (Th) cells with invariant T-cell receptors were significantly higher in persons with symptomatic COVID-19 than in those who did not develop COVID-19’ symptoms. Conversely, symptomatic COVID-19 persons had significantly lower percentages of: a) CTLs in the late stage of activation (CD8+/CD95+), b) NK cells, c) regulatory-like Th cells (CD4+/CTLA-4+), and d) Th17-like cells (CD4+/CD161+) compared to asymptomatic COVID-19’ persons. Additionally, persons with anti-SARS-CoV-2 antibodies had a significantly higher lymphocyte count and IL-6 concentration than persons without these antibodies.ConclusionNumerous lymphocyte populations are permanently altered by SARS-CoV-2 infection. High percentages of both populations: NK cells—as a part of the non-specific response, and T helper cells’ as those regulating the immune response, could protect against the acute COVID-19 symptoms development. Understanding the immune background of COVID-19 may improve the prevention of this disease by identifying people at risk of a severe course of infection.Trial registrationThis is a retrospective observational study without a trial registration number.

Alterations in plasma proteome during acute COVID-19 and recovery

BackgroundThe severe course of COVID-19 causes cardiovascular injuries, although the mechanisms involved are still not fully recognized, linked, and understood. Their characterization is of great importance with the establishment of the conception of post-acute sequelae of COVID-19, referred to as long COVID, where blood clotting and endothelial abnormalities are believed to be the key pathomechanisms driving circulatory system impairment.MethodsThe presented study investigates temporal changes in plasma proteins in COVID-19 patients during hospitalization due to SARS-CoV-2 infection and six months after recovery by targeted SureQuant acquisition using PQ500 panel.ResultsIn total, we identified 167 proteins that were differentially regulated between follow-up and hospitalization, which functionally aggregated into immune system activation, complement and coagulation cascades, interleukins signalling, platelet activation, and extracellular matrix organization. Furthermore, we found that temporal quantitative changes in acute phase proteins correlate with selected clinical characteristics of COVID-19 patients.ConclusionsIn-depth targeted proteome investigation evidenced substantial changes in plasma protein composition of patients during and recovering from COVID-19, evidencing a wide range of functional pathways induced by SARS-CoV-2 infection. In addition, we show that a subset of acute phase proteins, clotting cascade regulators and lipoproteins could have clinical value as potential predictors of long-term cardiovascular events in COVID-19 convalescents.

Immune signature of patients with cardiovascular disease predicts increased risk for a severe course of COVID-19.

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection can lead to life-threatening clinical manifestations. Patients with cardiovascular disease (CVD) are at higher risk for severe courses of COVID-19. So far, however, there are hardly any strategies for predicting the course of SARS-CoV-2 infection in CVD patients at hospital admission. Thus, we investigated whether this prediction is achievable by prospectively analysing the blood immunophenotype of 94 nonvaccinated participants, including uninfected and acutely SARS-CoV-2-infected CVD patients and healthy donors, using a 36-colour spectral flow cytometry panel. Unsupervised data analysis revealed little differences between healthy donors and CVD patients, whereas the distribution of the cell populations changed dramatically in SARS-CoV-2-infected CVD patients. The latter had more mature NK cells, activated monocyte subsets, central memory CD4+ T cells, and plasmablasts but fewer dendritic cells, CD16+ monocytes, innate lymphoid cells, and CD8+ T-cell subsets. Moreover, we identified an immune signature characterised by CD161+ T cells, intermediate effector CD8+ T cells, and natural killer T (NKT) cells that is predictive for CVD patients with a severe course of COVID-19. Thus, intensified immunophenotype analyses can help identify patients at risk of severe COVID-19 at hospital admission, improving clinical outcomes through specific treatment.

The Predictive Performance of Risk Scores for the Outcome of COVID-19 in a 2-Year Swiss Cohort.

Various scoring systems are available for COVID-19 risk stratification. This study aimed to validate their performance in predicting severe COVID-19 course in a large, heterogeneous Swiss cohort. Scores like the National Early Warning Score (NEWS), CURB-65, 4C mortality score (4C), Spanish Society of Infectious Diseases and Clinical Microbiology score (COVID-SEIMC), and COVID Intubation Risk Score (COVID-IRS) were assessed in patients hospitalized for COVID-19 in 2020 and 2021. Predictive accuracy for severe course (defined as all-cause in-hospital death or invasive mechanical ventilation (IMV)) was evaluated using receiver operating characteristic curves and the area under the curve (AUC). The new 'COVID-COMBI' score, combining parameters from the top two scores, was also validated. This study included 1,051 patients (mean age 65 years, 60% male), with 162 (15%) experiencing severe course. Among the established scores, 4C had the best accuracy for predicting severe course (AUC 0.76), followed by COVID-IRS (AUC 0.72). COVID-COMBI showed significantly higher accuracy than all established scores (AUC 0.79, p = 0.001). For predicting in-hospital death, 4C performed best (AUC 0.83), and, for IMV, COVID-IRS performed best (AUC 0.78). The 4C and COVID-IRS scores were robust predictors of severe COVID-19 course, while the new COVID-COMBI showed significantly improved accuracy but requires further validation.

Blood cytokines as potential predictors of the development of SARS-CoV-2 associated pneumonia in patients with stage II ESSENTIAL hypertension

The search for predictors of the severe course of COVID-19 was relevant both during the pandemic and at the present time. The aim of the study was to analyze the relationship of cytokine levels in patients with EН before SARS-CoV-2 infection with the incidence of coronavirus pneumonia. Materials and methods. From the database of 290 patients with stage II EAG who have been under observation for 8–12 years with annual blood sampling to determine cytokine levels, COVID-19 survivors were selected (mild without pneumonia and moderate to severe, pneumonia CT 1–2, CT-3). Anamnestic levels of IL-1β, IL-1α, IL-1ra, IL-18, IL-18 BP, IL-37, IL-6, sIL-6r, M-CSF, VEGF-A, IL-34 and HMGB1) in the blood serum of patients with stage II EH were analyzed (method ELISA). The analysis of the obtained results was carried out using Stat Soft Statistica 13.5. Results and discussion. Patients with EH and COVID-19 with pneumonia (CT I-II) after SARS-CoV-2 infection 2–6 months before the infectious disease had significantly higher serum levels: IL-1α (p 0.05) and a decrease in IL-37 (p 0.001). During multivariate correlation analysis, a statistically independent relationship between an increase in the incidence of viral pneumonia in patients with stage II EН was confirmed only for IL-37 with a blood level of less than 60.2 pg/ml (regression coefficient — 2.21, standard error — 0.28, t criterion — 6.12, relative risk — 2.52, criterion Walda — 7.92, p = 0.006). When studying circadian rhythms of cytokine content in blood serum in patients of the analyzed groups, calculating the strength of correlations of anamnestic evening IL-37 levels in patients with stage II EР at 19.00–20.00 with the frequency of pneumonia against the background of SARS-CoV-2 infection, it has greater specificity and sensitivity (specificity — 0.75, sensitivity — 0.82) than morning concentrations. Considering that data on circadian rhythms were obtained in a limited number of patients, further monitoring is necessary, which is carried out by our scientific group. It should be noted that patients with essential hypertension are pathogenetically heterogeneous, including in terms of cytokine regulation. The study of this area will make it possible to personalize cytokine phenotypes of the disease and develop new methods for calculating the prognosis of both cardiovascular complications and features of the course of infectious diseases.

Identification of important clinical variables for the severe course of COVID-19 in hospitals: A systematic review

Infection with the new coronavirus transformed the world from 2019 onwards. The severity of this respiratory syndrome caused by SARS-Cov-2 has divergent opinions on the causes of injuries and deaths. The objective of this study was to identify factors in the sociodemographic and clinical profile that are possibly related to COVID-19 cases that lead to hospitalization. This is a systematic review, in which the search strategy was defined by the acronym PECOS. The search was carried out in the scientific reference databases: MEDLINE via PubMed, Cochrane Library of Cochrane and; in specific databases: EMBASE via Elsevier and LILACS. Observational studies of the prospective cohort type without the use of filters were included. Exposure was considered as hospitalization for COVID-19 with a positive test and the individuals not exposed were those hospitalized with unconfirmed suspicion. The monitoring of the cohorts carried out by the studies lasted an average of 77.6±54.8 days. The mean time of infection of the patients was 9.5±22.32 days with a mean isolation period of 9.5±4.81 days. The symptoms commonly presented by the exposure group were: fever 787 (2.84%) cases, headache 658 (2.37%) cases, cough, sore throat, decreased appetite, headache, diarrhea. Factors such as age, 41.16±11.27 years; Non-essential occupation (79.79%) and medium and low education were evident in the exposure group. Respiratory diseases (0.22%), p= 0.045 and chronic kidney disease (0.08%), p= 0.038 were characteristics of the clinical profile for the exposed individuals. It is concluded that individuals with characteristic flu-like symptoms and diarrhea, with a profile of non-elderly adulthood, lower education, with non-essential occupation and who have characteristics of respiratory diseases and chronic kidney disease are more likely to be hospitalized for COVID-19.

Acute kidney injury of mild to moderate severity in patients with COVID-19

THE AIM: to study the incidence of mild to moderate acute kidney injury in patients with COVID-19.PATIENTS AND METHODS. The data of the case histories of 200 patients hospitalized in the infectious diseases department of the Naro-Fominsk Regional Hospital of the Moscow region for COVID-19 were analyzed, mainly with mild to moderate severity of lung damage according to computed tomography, which do not require respiratory support and renal replacement therapy.RESULTS. Despite the fact that the analyzed group of patients did not have the most severe course of COVID-19, the first stage of acute kidney injury was detected in 22.5% of patients, which was manifested by a temporary decrease in hourly diuresis, increased creatinine, urea, proteinuria and erythrocyturia.CONCLUSION. The development of acute kidney injury was most often associated with older age, coronary heart disease, arterial hypertension, diabetes mellitus and obesity.

Ophthalmic assessment of an intensive care ward patients in the first and last wave of the COVID-19. Do they have a difference?

BACKGROUND: The new coronavirus infection (COVID-19) gained the pandemic status in 2020, and despite the fact that since then the virus has become less pathogenic, its virulence has increased by 2023. Well-vascularized organs and tissues, including the retina, represent the target for coronavirus. The etiopathogenesis of COVID-associated retinopathy, first described in 2021, still remains poorly understood, and its forms and occurrence frequency during different periods of the infectious process vary greatly. AIM: To identify the main characteristics of the COVID-associated retinopathy in patients with moderate and severe COVID-19 course during the acute period of the disease. MATERIALS AND METHODS: The study, conducted in 2021 (group 1) and 2023 (group 2), included patients with confirmed COVID-19 of moderate to severe course during the first 7 days from the onset of symptoms. Group 1 included 46 people, mean age 65.5 years, and group 2 included 55 people, mean age 69.3 years. The ophthalmologic examination was carried out in the “red zone” and intensive care unit, and included examination of the anterior segment of the eye, indirect ophthalmoscopy, and fundus photography using a portable hand-held digital fundus camera (Smartscope M5, Optomed, Finland). Hypertension, diabetes mellitus, volume of lung damage, invasive mechanical ventilation, and anticoagulant therapy were considered as conditions affecting retinal microcirculation. RESULTS: The observation groups were homogeneous in terms of gender, age, and concomitant diseases. The incidence of ophthalmoscopic findings in group 1 was 17.3%, and in group 2 — 12.7%. Most often, during the first 7 days of the disease, signs of angiopathy were observed: dilatation of blood vessels, irregularity of their diameter and tortuosity. Among focal changes, there were multiple retinal hemorrhages (6.5% and 3.6%) and cotton wool spots (4.3% and 5.4%). In patients with fundus changes, diabetes mellitus was significantly less common (in group 1, 25% vs. 39%, p 0.001; in group 2, 28% vs. 44%, p 0.001), as well as arterial hypertension (in group 1, 55% vs. 66%, p = 0.003; in group 2 28% vs. 83%, p 0.001). In group 1, there was a higher proportion of patients treated in intensive care unit, as in group 2 (37% vs. 17%, p 0.001), but in group 2, patients with identified retinal changes were more likely to receive therapeutic doses of anticoagulants (33% vs. 12%, p 0.001). CONCLUSION: The main characteristics of COVID-associated retinopathy in patients with moderate to severe COVID-19 during the acute period of the disease are dilatation and pathological tortuosity of the retinal arteries and veins, intraretinal hemorrhages and cotton wool spots. The connection between COVID-associated retinopathy and concomitant to the infectious process cardiovascular conditions has not been established. Retinopathy associated with coronavirus infection, with absolute similarity of clinical manifestations, was significantly more common in 2021 than in 2023.

The effect of Vitamin D levels on the course of COVID-19 in hospitalized patients – a 1-year prospective cohort study

Background: The aim of the current study was to assess the patients with COVID-19 and the impact of vitamin D supplementation on the course of COVID-19. Methods: This prospective cohort study included patients hospitalized due to COVID-19 between December 2020 and December 2021. Patients' demographic, clinical, and laboratory parameters were analysed. Results: 301 participants were enrolled in the study. 46 (15,3%) had moderate, and 162 (53,8%) had severe COVID-19. 14 (4,7%) patients died, and 30 (10,0%) were admitted to the ICU due to disease worsening. The majority needed oxygen therapy (n=224; 74,4%). Average vitamin 25(OH)D3 levels were below optimal at the admittance, and vitamin D deficiency was detected in 205 individuals. More male patients were suffering from vitamin D deficiency. Patients with the more severe disease showed lower levels of vitamin 25(OH)D3 in their blood. The most severe group of patients had more symptoms that lasted significantly longer with progressing disease severity. This group of patients also suffered from more deaths, ICU admissions, and treatments with dexamethasone, remdesivir, and oxygen. Conclusion: Patients with the severe course of COVID-19 were shown to have increased inflammatory parameters, increased mortality, and higher incidence of vitamin D deficiency. The results suggest that the vitamin D deficiency might represent a significant risk factor for a severe course of COVID-19.

Determining the optimal frequency of SARS-CoV-2 regular asymptomatic testing: A randomized feasibility trial in a home care setting.

The SARS-CoV-2 pandemic presented a challenge for caregiving relatives in the home care setting. Caregivers can transmit SARS-CoV-2 to their relatives who are often at high risk for a severe course of COVID-19. Regular testing of asymptomatic caregivers for SARS-CoV-2 may reduce the risk of transmission. The optimal method and frequency of regular asymptomatic testing is unknown. We conducted a prospective, randomised trial to assess the feasibility, recruitment and acceptance of different testing frequencies. This serves to inform a future definitive randomised controlled trial. We carried out a parallel three-armed feasibility trial, enrolling adult participants who provided home-based care for a relative at least twice a week. Participants were randomly assigned using sealed envelopes to either conduct saliva-based antigen self-testing at a frequency of once a week (group I), twice a week (group II), or every two days (group III). The participants completed questionnaires on a weekly basis. Main outcome measures were feasibility of recruitment, adherence to self-tests and distress caused by self-testing. We further collected data on the use of mouth-nose mask. From 25 March to 7 May 2021 we assessed 27 participants and randomised 26 in the study: 8 participants in group I, 8 in group II and 10 in group III. All participants completed the study. In group I 48/48 (100.0%; 95% CI 92.6% to 100.0%), in group II 93/96 (96.9%; 95% CI 91.2% to 98.9%) and in group III 209/210 (99.5%; 95% CI 97.4% to 99.9%) self-tests were carried out at home. Participants did not perceive regular self-testing as burdensome in any of the study arms. We did not observe any infection with SARS-CoV-2. During the study, mask adherence decreased from 35% to 19% in all groups. Conducting such a study was feasible. The participants tolerated regular self-testing well, which was reflected in a high level of test adherence. However, regular self-testing may have led to decreased protective behaviour. To demonstrate that regular asymptomatic testing reduces infection transmission, a future definitive trial should be performed at a time of a high prevalence of SARS-CoV-2 and be implemented as a multicentre study. The trial is registered with the German Clinical Trials Register, DRKS00026234.

Prophylactic antibodies inhibit spike-specific T and B cell responses after COVID-19 vaccination.

Active and passive immunization is used in high-risk patients to prevent severe courses of COVID-19, but the impact of prophylactic neutralizing antibodies on the immune reaction to the mRNA vaccines has remained enigmatic. Here we show that CD4 T and B cell responses to Spikevax booster immunization are suppressed by the therapeutic antibodies Casirivimab and Imdevimab. B cell and T cell responses were significantly induced in controls but not in antibody-treated patients. The data indicates that humoral immunity, i. e. high levels of antibodies, negatively impacts reactive immunity, resulting in blunted cellular responses upon boosting. This argues for temporal separation of vaccination efforts; with active vaccination preferably applied before prophylactic therapeutic antibody treatment.

The Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in COPD and Non-COPD Cohorts.

Patients with chronic obstructive pulmonary disease (COPD) infected with SARS-CoV-2 indicate a higher risk of severe COVID-19 course, which is defined as the need for hospitalization in the intensive care unit, mechanical ventilation, or death. However, simple tools to stratify the risk in patients with COPD suffering from COVID-19 are lacking. The current study aimed to evaluate the predictive value of the C2HEST score in patients with COPD. A retrospective analysis of medical records from 2184 patients hospitalized with COVID-19 at the University Hospital in Wroclaw from February 2020 to June 2021, which was previously used in earlier studies, assessed outcomes such as mortality during hospitalization, all-cause mortality at 3 and 6 months, non-fatal discharge, as well as adverse clinical incidents. This re-analysis specifically examines the outcomes using a COPD split. In the COPD group, 42 deaths were recorded, including 18 in-hospital deaths. In-hospital mortality rates at 3 and 6 months did not significantly differ among C2HEST strata, nor did their impact on subsequent treatment. However, a notable association between the C2HEST score and prognosis was observed in the non-COPD cohort comprising 2109 patients. The C2HEST score's predictive ability is notably lower in COPD patients compared to non-COPD subjects, with COPD itself indicating a high mortality risk. However, C2HEST effectively identifies patients at high risk of cardiac complications during COVID-19, especially in non-COPD cases.

CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH CORONAVIRUS INFECTION COVID-19 AND ITS COMORBIDITY

Introduction. The coronavirus disease has reached an alarming epidemic scale with extraordinary morbidity and mortality rates for the entire world population. The majority of patients with COVID–19 note damage to the respiratory tract and state a more severe course of the disease with the development of systemic damage. A more severe course of COVID-19 is associated with the presence of comorbid diseases. Aim. To investigate and analyze clinical and laboratory manifestations and to determine the main comorbidities of patients with COVID-19 infection. Materials and methods. The research was carried out in accordance with bioethical norms and rules. 179 patients with COVID-19 (the main group) and 42 people of the control group were examined. Diagnosis and treatment of the COVID-19 coronavirus infection was carried out taking into account the relevant national recommendations. The average value and standard deviation were statistically determined. The probability of differences was performed using the Mann-Whitney U-test and the Wilcoxon W-test of signed ranks. The threshold value of the level of statistical significance of all calculated features was taken as 0.05 (p=0.05). Results. A high comorbidity with cardiovascular system pathology was found – 40.2%, type 2 diabetes – 22.3%, respiratory system diseases – 20.7%. Disorders of the functional state of the cardiovascular system were determined: pulse values – 91.01±13.44, systolic (127.9±15.19) and diastolic (79.3±11.6) blood pressure. Changes in clinical blood analysis were noted: erythrocytes – 4.38±0.65 x1012/l, hemoglobin – 127.6±21.2 g/l, hematocrit – 0.37±0.07, leukocytes – 10.7±7, 32 x109/l, segmented (65.4±14.8%) and rod-nuclear (9.03±9.99%) neutrophils, platelets – 226.1±90.6 x109/l, lymphocytes – 20.24±12.43%, monocytes – 6.60±4.37% and erythrocyte sedimentation rate (ESR) – 25.4±14.9 mm/h. Significant (almost fourfold) increases in IL-6 levels (24.56±22.9 pg/ml) and blood glucose concentrations (7.40±3.42 mmol/l) were determined. Conclusions. A significant comorbidity of COVID-19 was determined and a significant prevalence of indicators of the functional state of the cardiovascular system and a decrease in the average levels of the quantitative composition of erythrocytes and indicators of hemoglobin and hematocrit were established. Significant leukocytosis, neutrophilia, lymphocytosis and monocytosis, significant excesses of ESR and IL-6 and blood serum glucose were determined, which confirmed the presence of a significant inflammatory reaction in response to infection with COVID-19.

The effect of levilimab on the clinical presentations and changes in inflammatory biomarkers in outpatients with mild to moderate COVID-19

Introduction. It is now well known that a proportion of patients with COVID-19 develop a pathological systemic inflammatory response with complications resulting in multiple organ failure. The severity and prognosis of the disease, as well as the effectiveness of the treatment provided should be assessed as early as possible. For this purpose, a number of laboratory markers are used, such as C-reactive protein (CRP), IL-6, fibrinogen, ferritin, and changes in these parameters serve as a basis for the disease prognosis.Aim. To evaluate the effectiveness of levilimab in outpatients with COVID-19 based on the analysis of changes in laboratory markers of blood inflammatory activity.Material and methods. A total of 120 patients with COVID-19 receiving standard therapy (ST) were included in the study. The patients were divided into 2 groups: the treatment group of patients who received 2 injections of levilimab, IL-6 receptor blocker, included 47 men and 29 women (average age 46.7 years); the control group, who only received CT, included 21 men and 23 women (average age 46.3 ± 2 years).Results. The treatment group demonstrated a faster normalization of laboratory markers of inflammatory activity. After 14 days of follow-up, the CRP levels in the treatment group decreased significantly by 18.9 (67%) (p &lt; 0.05), and in the control group by 14.3 (46.9%) (p &lt; 0.05). The IL-6 level significantly decreased in patients of the control group, but did not change in the levilimab group. The changes in fibrinogen levels showed that the group of patients, who received levilimab, had a significant decrease in fibrinogen by 35% from baseline (p &lt; 0.05), in contrast to the control group, in which fibrinogen levels virtually did not change (3.8% decrease) (p &lt; 0.05).Conclusion. Levilimab therapy carried out at onset of coronavirus infection results in a faster normalization of laboratory markers of inflammatory activity and helps prevent the severe course of COVID-19.

Vaccination against COVID-19 among healthcare workers as a cocoon strategy for people living with HIV

IntroductionHealthcare professionals working in infectious disease units are often engaged in the care of patients with HIV infection. A cocoon vaccination strategy may protect those who are immunocompromised from a severe course of COVID-19. MethodsThe research was conducted between January 2021 and June 2022. The study participants were 450 healthcare workers (HCWs) from the Hospital for Infectious Diseases in Warsaw who were vaccinated against COVID-19 with the BNT162b2 mRNA vaccine (Pfizer-BioNTech) –, thefirst available type of vaccine in Poland. Sera were collected according to the schedule of the study. Statistical analyses were performed with non-parametric tests: Wilcoxon's test was used to compare dependent numerical variables, and Fisher's exact test and the Chi-squared test to compare categorical variables. A p value of <0.05 was considered statistically significant. ResultsAmong the 450 HCWs working in the Hospital for Infectious Diseases in Warsaw 412 (91,5 %) were vaccinated against COVID-19. In total 170 (41,3 %) vaccinated HCWs were included in the final analysis. Their median age was 51 years [interquartile range (IQR): 41–60 years] and median body mass index (BMI) was 25.10 [IQR: 22.68–29.03]. Most of the cohort consisted of women (n = 137, 80.59 %), with the majority working directly with patients (n = 137, 73.21 %). It was found that as early as 14 days after the second dose of the vaccine, 100 % of the study participants achieved a positive result for SARS CoV-2 S-RBD antibodies. There were 168 subjects who had had a COVID-19 diagnosis before entering study and after vaccination 65 HCWs was diagnosed with COVID-19. ConclusionsDue to the fact that people living with HIV with severe immunodeficiency may have an incomplete immune response to COVID vaccination and be at risk of a severe course of the disease, the cocoon strategy of vaccinating medical personnel may be beneficial for these patients.