scholarly journals Elevated HScore is Associated with Poor Clinical Outcomes in COVID-19, Even in the Absence of Secondary Hemophagocytic Lymphohistiocytosis

2021 ◽  
Author(s):  
Rafael Benavente ◽  
Camila Peña ◽  
Allyson Cid ◽  
Nicolás Cabello ◽  
Pablo Bustamante ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Clinical Outcome ◽  
Infectious Diseases ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Scoring System ◽  
Single Center ◽  
Poor Outcomes ◽  
The Relationship ◽  
Secondary Hemophagocytic Lymphohistiocytosis

AbstractIntroductionPatients with Coronavirus Disease 2019 (COVID-19) frequently experience a hyperinflammatory syndrome, that leads to unfavorable outcomes. This condition resembles Secondary Hemophagocytic Lymphohistiocytosis (sHLH) described in neoplastic, rheumatic and other infectious diseases. However, it has not been prospectively studied on these patients. A scoring system (HScore) has been validated for sHLH, and recently proposed to evaluate hyperinflammation in COVID-19.Methods143 patients aged ≥18 years admitted because of COVID-19 were enrolled in a prospective, single-center, cohort study. HScore was calculated within the 72 hours since admission. The incidence of sHLH during hospitalization was evaluated. Additionally, the relationship between HScore ≥130 points and either the requirement of mechanical ventilation or 60-days mortality was explored.ResultsThe median age of enrolled patients was 57 (21-100), and 63.6% were male. The median HScore was 96 (33-169). One patient was diagnosed with sHLH (incidence 0,7%), due to a HScore of 169. After adjusting for age, sex, comorbidities and obesity, HScore ≥130 was independently associated with the composite clinical outcome (HR 2.13, p=0.022).ConclusionsHLH is not frequent among COVID-19 patients. HScore can efficiently predict the risk for poor outcomes.

scholarly journals Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258095
Author(s):  
Abdallah S. Attia ◽  
Mohammad Hussein ◽  
Mohamed A. Aboueisha ◽  
Mahmoud Omar ◽  
Mohanad R. Youssef ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Mental Status ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Altered Mental Status ◽  
Neurological Manifestations ◽  
Icu Admission ◽  
Poor Outcomes

Introduction Several studies have described typical clinical manifestations, including fever, cough, diarrhea, and fatigue with COVID-19 infection. However, there are limited data on the association between the presence of neurological manifestations on hospital admission, disease severity, and outcomes. We sought to investigate this correlation to help understand the disease burden. Methods We delivered a multi-center retrospective study of positive laboratory-confirmed COVID-19 patients. Clinical presentation, laboratory values, complications, and outcomes data were reported. Our findings of interest were Intensive Care Unit (ICU) admission, intubation, mechanical ventilation, and in-hospital mortality. Results A total of 502 patients with a mean age of 60.83 ± 15.5 years, of them 71 patients (14.14%) presented with altered mental status, these patients showed higher odds of ICU admission (OR = 2.06, 95%CI = 1.18 to 3.59, p = 0.01), mechanical ventilation (OR = 3.28, 95%CI = 1.86 to 5.78, p < 0.001), prolonged (>4 days) mechanical ventilation (OR = 4.35, 95%CI = 1.89 to 10, p = 0.001), acute kidney injury (OR = 2.18, 95%CI = 1.28 to 3.74, p = 0.004), and mortality (HR = 2.82, 95%CI = 1.49 to 5.29, p = 0.01). Conclusion This cohort study found that neurological presentations are associated with higher odds of adverse events. When examining patients with neurological manifestations, clinicians should suspect COVID-19 to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

scholarly journals Clinical outcome of kidney transplantation after bariatric surgery: a single‐center, retrospective cohort study

2020 ◽  
Author(s):  
Loubna Outmani ◽  
Hendrikus J.A.N. Kimenai ◽  
Joke I. Roodnat ◽  
Marjolijn Leeman ◽  
Ulas L. Biter ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Cohort Study ◽  
Kidney Transplantation ◽  
Clinical Outcome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Single Center

scholarly journals Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiao Hou ◽  
Li Tian ◽  
Lei Zhou ◽  
Xinhua Jia ◽  
Li Kong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Adjuvant Therapy ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Intravenous Immunoglobulin ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Length Of Hospital Stay ◽  
Single Center

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

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