Predicting Severity and Intrahospital Mortality in COVID-19: The Place and Role of Oxidative Stress

SARS-CoV-2 virus causes infection which led to a global pandemic in 2020 with the development of severe acute respiratory syndrome. Therefore, this study was aimed at examining its possible role in predicting severity and intrahospital mortality of COVID-19, alongside with other laboratory and biochemical procedures, clinical signs, symptoms, and comorbidity. This study, approved by the Ethical Committee of Clinical Center Kragujevac, was designed as an observational prospective cross-sectional clinical study which was conducted on 127 patients with diagnosed respiratory COVID-19 viral infection from April to August 2020. The primary goals were to determine the predictors of COVID-19 severity and to determine the predictors of the negative outcome of COVID-19 infection. All patients were divided into three categories: patients with a mild form, moderate form, and severe form of COVID-19 infection. All biochemical and laboratory procedures were done on the first day of the hospital admission. Respiratory ( p < 0.001 ) and heart ( p = 0.002 ) rates at admission were significantly higher in patients with a severe form of COVID-19. From all observed hematological and inflammatory markers, only white blood cell count ( 9.43 ± 4.62 , p = 0.001 ) and LDH ( 643.13 ± 313.3 , p = 0.002 ) were significantly higher in the severe COVID-19 group. We have observed that in the severe form of SARS-CoV-2, the levels of superoxide anion radicals were substantially higher than those in two other groups ( 11.3 ± 5.66 , p < 0.001 ) and the nitric oxide level was significantly lower in patients with the severe disease ( 2.66 ± 0.45 , p < 0.001 ). Using a linear regression model, TA, anosmia, ageusia, O2−, and the duration at the ICU are estimated as predictors of severity of SARS-CoV-2 disease. The presence of dyspnea and a higher heart rate were confirmed as predictors of a negative, fatal outcome. Results from our study show that presence of hypertension, anosmia, and ageusia, as well as the duration of ICU stay, and serum levels of O2− are predictors of COVID-19 severity, while the presence of dyspnea and an increased heart rate on admission were predictors of COVID-19 mortality.

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The Association of 25 (OH) Vitamin D Levels and Severity and Outcome of COVID-19: A Cross-sectional Study

10.21203/rs.3.rs-141034/v1 ◽

2021 ◽

Author(s):

Maryam Vasheghani ◽

Nasrin Jannati ◽

Parvaneh Baghaei ◽

Mitra Rezaei ◽

Majid Marjani

Keyword(s):

Vitamin D ◽

Severe Disease ◽

Serum Levels ◽

Multivariate Regression Analysis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Icu Admission ◽

Vitamin D Levels ◽

25 Oh Vitamin D

Abstract BackgroundCoronavirus disease 2019 (COVID-19) is a pandemic disease. Experiments with influenza and severe acute respiratory syndrome (SARS) have shown supplemental vitamin D can reduce the risk of infection and death.AimThis study was performed to evaluate the relationship between vitamin D levels and the severity and outcome of admitted patients with COVID-19.Material and MethodsThis cross-sectional study was performed on COVID-19 cases diagnosed by examining RT-PCR assay for SARS-CoV-2 or a set of symptoms and typical findings in lung CT scan. Based on clinical and radiologic characteristics, the patients were categorized as mild, moderate, severe, and critical. Calcium, phosphorus, albumin, creatinine, and serum 25 hydroxy vitamin D were measured and their correlation with the severity and outcome were analyzed.ResultsFrom May 1 to June 31, 2020, 508 patients ((442 patients in general wards and 66 patients in intensive care unit (ICU)) were included in this study. The participants were 56±17 years old (mean ±SD) (range from 14 to 95 years) and 52% were male. According to the past medical history, 190 (37.4%) of them had comorbidity. Concerning severity, 13.2%, 42.3%, 35.4%, and 9.1% had the mild, moderate, severe, and critical disease, respectively. The in-hospital mortality rate was 10.8%. In the multivariate regression analysis, age had a positive correlation and use of vitamin D supplement, serum level of 25 OH vitamin D, calcium, and albumin had a negative correlation with disease severity and admission to ICU. Poor outcome was inversely related to serum levels of vitamin D, calcium, albumin, and renal function. Vitamin D deficiency increased the rate of ICU admission by 2.7 times (95%CI=1.288-5.91, P=0.009).ConclusionIn patients who are hospitalized due to COVID-19, low 25-hydroxyvitamin D, hypocalcemia, and hypoalbuminemia are associated with severe disease, ICU admission, and an increase in mortality.

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Efficacy of an inhibitor of adhesion molecule expression (GI270384X) in the treatment of experimental colitis

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00059.2007 ◽

2007 ◽

Vol 293 (4) ◽

pp. G739-G748 ◽

Cited By ~ 9

Author(s):

Julián Panés ◽

Montserrat Aceituno ◽

Fèlix Gil ◽

Rosa Miquel ◽

Josep M Piqué ◽

...

Keyword(s):

Adhesion Molecule ◽

Clinical Signs ◽

Experimental Colitis ◽

Serum Levels ◽

Experimental Models ◽

Severe Form ◽

Adhesion Molecule Expression ◽

Pathological Changes ◽

Amyloid A ◽

Deficient Mice

Modulation of adhesion molecule expression or function is regarded as a promising therapy for inflammatory conditions. This study evaluates the effects of an inhibitor of adhesion molecule expression (GI270384X) in two experimental models of colitis. Colitis of different severity was induced in C57BL/6J mice by administering 1, 2, or 3% dextran sulfate sodium (DSS). GI270384X (3, 10, or 25 mg·kg−1·day−1) was administered as pretreatment or started 3 days after colitis induction. In IL-10-deficient mice, the highest dose was given for 2 wk. The clinical course of colitis, pathological changes, serum inflammatory biomarkers, expression of adhesion molecules, and leukocyte-endothelial cell interactions in colonic venules were measured in mice treated with vehicle or with active drug. In the most severe forms of colitis (2% and 3% DSS and IL-10-deficient mice), the magnitude of colonic inflammation was not modified by treatment with GI270384X. In a less severe form of colitis (1% DSS), GI270384X treatment dose dependently ameliorated the clinical signs of colitis, colonic pathological changes, and serum levels of biomarkers (IL-6 and serum amyloid A). Administration of 25 mg·kg−1·day−1 GI270384X abrogated upregulation of ICAM-1 in the inflamed colon but had no effect on VCAM-1 or E-selectin expression. This was associated with a significant reduction in number of rolling and firmly adherent leukocytes in colonic venules. These results indicate that GI270384X is effective in the treatment of experimental colitis of moderate severity. Reduced adhesion molecule expression and leukocyte recruitment to the inflamed intestine contribute to this beneficial effect.

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CORRELATION BETWEEN SERUM C-REACTIVE PROTEIN LEVEL WITH SEVERITY OF THE DISEASE IN COVID-19 PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i11.2302 ◽

2021 ◽

Vol 5 (11) ◽

Author(s):

Sangeeta Gahlot ◽

Surendra Yadav ◽

Makkhan Lal Saini

Keyword(s):

Severe Disease ◽

Serum Levels ◽

Cross Sectional Study ◽

P Value ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Group I ◽

Moderate Disease ◽

Severity Of The Disease

Background: To find the levels of serum CRP in confirmed Covid-19 patients and to compare their levels in patients with mild to moderate disease and patients with severe disease who required ICU care for management. Methods: A Cross sectional study was carried out on 100 confirmed cases of Covid-19, in whom Serum levels of Random sugar (RBS), Creatinine, Urea, C- reactive protein (CRP) were measured. Results: The levels of serum Urea, Creatinine were significantly increased in group II when compared to group 1, and the levels of CRP were significantly increased with p value <0.0001 in group IIwhen compared to group I. Conclusion: Findings of our study suggest that determination of biochemical parameters like CRP at the time of hospitalization helps in predicting the severity of disease and need for ICU for better treatment management and prevention of adverse outcome. Keywords: Severe acute respiratory syndrome, Covid-19, C- reactive protein, Intensive care unit.

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Knowledge, attitude and practice towards anthrax in northern Ethiopia: a mixed approach study

BMC Infectious Diseases ◽

10.1186/s12879-020-05544-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Gebremedhin Romha ◽

Weldemelak Girmay

Keyword(s):

Local Community ◽

Negative Impact ◽

Severe Disease ◽

Clinical Signs ◽

Northern Ethiopia ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Household Level ◽

Prevention Method ◽

Mixed Approach

Abstract Background Anthrax is the second most highly prioritized zoonotic disease in Ethiopia due to its negative impact at the household level, causing disease and production losses in livestock and severe disease in humans. This study seeks to assess the knowledge of, attitudes towards, and practices addressing (KAPs) anthrax in the communities of Eastern Tigray, Northern Ethiopia. Methods A cross-sectional survey was conducted concurrently with focus group discussions (FGDs) and key informant interviews (KIIs) between May 2019 and April 2020. A total of 862 respondents participated in the questionnaire survey. Of these, 800 were local community members while 62 were professionals working at health service institutions. In addition, qualitative data were collected using six FGDs and 11 KIIs. Results Sixty-two percent (496/800) of the community respondents said that they were aware of anthrax while 38% (304/800) of them did not. Only 9.3% (74/800) of the respondents reported that the causative agent of anthrax is germs/microbial. About 56.5% (35/62) of professional respondents said that it is bacterial. More than 60% (64.1%, 513/800) of the respondents did not know that whether the disease was zoonotic or not. Regarding clinical signs, 26.3 (210/800) and 36.8% (294/800) of the respondents could identify at least one in animals and humans, respectively, while 21.3 (170/800) and 20.1% (161/800) knew one or more transmission routes in animals and humans, respectively. Moreover, 43.4% (347/800) and 45.6% (365/800) of the respondents mentioned one or more control/prevention method(s) in animals and humans, respectively. Regarding qualitative results, some of the participants knew the disease (in animals) by their local names: Lalish and Tafia (splenomegaly), and Gulbus (abdominal cramps and shivering). Some reported that anthrax was exclusively a human disease while others recognized its zoonotic potential after the clinical signs in both animals and humans were listed. Conclusion The KAP of the participants regarding anthrax was low. There was no consistent understanding of the disease among the participants. The study also revealed that the participants did not receive consistent, adequate, and continuous education regarding the disease.

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Serum Level of Endothelial Cell-Specific Molecule -1 (ESM -1) as a New Potential Biomarker for Rheumatoid Arthritis Disease Activity

The Open Rheumatology Journal ◽

10.2174/1874312901812010189 ◽

2018 ◽

Vol 12 (1) ◽

pp. 189-196

Author(s):

Noha Abdelsalam ◽

Ashraf Hussein Mohamed ◽

Sameh Abdellatif ◽

Eslam Eid ◽

Ehsan Mohamed Rizk ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Endothelial Cell ◽

Disease Activity ◽

Severe Disease ◽

Serum Levels ◽

Control Group ◽

Cross Sectional ◽

Das 28 ◽

Rheumatoid Arthritis Disease ◽

Potential Biomarker

Background:Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterized by destruction of the joint cartilage and bone. Endothelial dysfunction (ED) in RA may be related to disease activity. Our objective is to explore serum levels of endothelial cell-specific molecule-1 (ESM-1) as a biomarker for RA disease activity.Methods:A cross-sectional study was carried out and included 83 adult patients with RA, in addition to 20 healthy subjects (age and sex-matched) as a control group. Based on Disease Activity Score in 28 joints (DAS-28), the patient's group was subdivided into four subgroups(remission, mild, moderate and severe disease activity state). The demographic & clinical data, BMI, DAS-28 and Serological assessment [Erythrocyte Sedimentation Rate (ESR), CRP, Rheumatoid Factor (RF) and Anti-Citrullinated Peptide Antibody (ACPA)] were recorded. ESM-1was assayed for all participants.Results:Serum levels of ESM1 were significantly higher in the patient group than the control group (P< 0.0001). ESM-1 serum levels were significantly higher in patients with severe disease activity subgroup compared with patients with remission and mild disease activity subgroups (P< 0.0001). ESM-1 was positively and significantly correlated with DAS-28 score, The Health Assessment Questionnaire Disability Index (HAQ-DI) and modified Larsen score (P= 0.002, 0.0001 & 0.0001 respectively).Conclusion:ESM-1 could be a biomarker for RA disease activity.

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Knowledge, Attitude and Practice towards Anthrax in Northern Ethiopia: a mixed approach study

10.21203/rs.3.rs-33998/v2 ◽

2020 ◽

Author(s):

Gebremedhin Romha ◽

Weldemelak Girmay

Keyword(s):

Local Community ◽

Negative Impact ◽

Severe Disease ◽

Clinical Signs ◽

Northern Ethiopia ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Household Level ◽

Prevention Method ◽

Mixed Approach

Abstract Background: Anthrax is the second most highly prioritized zoonotic disease in Ethiopia due to its negative impact at the household level, causing disease and production losses in livestock and severe disease in humans. This study seeks to assess the knowledge of, attitudes towards, and practices addressing (KAPs) anthrax in the communities of Eastern Tigray, Northern Ethiopia. Methods : A cross-sectional survey was conducted concurrently with focus group discussions (FGD) and key informant interviews (KII) between May 2019 and April 2020. A total of 862 respondents participated in the questionnaire survey. Of these, 800 were local community members, while 62 were professionals working at health service institutions. In addition, qualitative data were collected using six FGDs and 11 KIIs. Results : Sixty-two percent (496/800) of the community respondents said that they were aware of anthrax while 38% (304/800) of them did not. Only 9.3% (74/800) of the respondents reported that the causative agent of anthrax is germs/microbial. About 56.5% (35/62) of professional respondents said that it is bacterial. More than sixty percent (64.1%, 513/800) of the respondents did not know that whether the disease was zoonotic or not. Regarding clinical signs, 26.3 (210/800) and 36.8% (294/800) of the respondents could identify at least one in animals and humans, respectively, while 21.3 (170/800) and 20.1% (161/800) knew one or more transmission routes in animals and humans, respectively. Moreover, 43.4% (347/800) and 45.6% (365/800) of the respondents mentioned one or more control/prevention method(s) in animals and humans, respectively. Regarding qualitative results, some of the participants knew the disease (in animals) by their local names: Lalish and Tafia (splenomegaly), and Gulbus (abdominal cramps and shivering). Some reported that anthrax was exclusively a human disease while others recognized its zoonotic potential after the clinical signs in both animals and humans were listed. Conclusion : The KAP of the participants regarding anthrax was low. There was no consistent understanding of the disease among the participants. The study also revealed that the participants did not receive consistent, adequate, and continuous education regarding the disease.

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Knowledge, Attitude and Practice towards Anthrax in Northern Ethiopia: a mixed approach study

10.21203/rs.3.rs-33998/v3 ◽

2020 ◽

Author(s):

Gebremedhin Romha ◽

Weldemelak Girmay

Keyword(s):

Local Community ◽

Negative Impact ◽

Severe Disease ◽

Clinical Signs ◽

Northern Ethiopia ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Household Level ◽

Prevention Method ◽

Mixed Approach

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Heparin-induced thrombocytopenia is associated with a high risk of mortality in critical COVID-19 patients receiving heparin-involved treatment

10.1101/2020.04.23.20076851 ◽

2020 ◽

Cited By ~ 12

Author(s):

Xuan Liu ◽

Xiaopeng Zhang ◽

Yongjiu Xiao ◽

Ting Gao ◽

Guangfei Wang ◽

...

Keyword(s):

Severe Disease ◽

Fatal Outcome ◽

Development Program ◽

High Dose ◽

Severe Thrombocytopenia ◽

Icu Patients ◽

Heparin Induced Thrombocytopenia ◽

Global Pandemic ◽

Potential Risk Factors ◽

High Level

SummaryBackgroundCoronavirus infectious disease 2019 (COVID-19) has developed into a global pandemic. It is essential to investigate the clinical characteristics of COVID-19 and uncover potential risk factors for severe disease to reduce the overall mortality rate of COVID-19.MethodsSixty-one critical COVID-19 patients admitted to the intensive care unit (ICU) and 93 severe non-ICU patients at Huoshenshan Hospital (Wuhan, China) were included in this study. Medical records, including demographic, platelet counts, heparin-involved treatments, heparin-induced thrombocytopenia-(HIT) related laboratory tests, and fatal outcomes of COVID-19 patients were analyzed and compared between survivors and nonsurvivors.FindingsSixty-one critical COVID-19 patients treated in ICU included 15 survivors and 46 nonsurvivors. Forty-one percent of them (25/61) had severe thrombocytopenia, with a platelet count (PLT) less than 50×109/L, of whom 76% (19/25) had a platelet decrease of >50% compared to baseline; 96% of these patients (24/25) had a fatal outcome. Among the 46 nonsurvivors, 52·2% (24/46) had severe thrombocytopenia, compared to 6·7% (1/15) among survivors. Moreover, continuous renal replacement therapy (CRRT) could induce a significant decrease in PLT in 81·3% of critical CRRT patients (13/16), resulting in a fatal outcome. In addition, a high level of anti-heparin-PF4 antibodies, a marker of HIT, was observed in most ICU patients. Surprisingly, HIT occurred not only in patients with heparin exposure, such as CRRT, but also in heparin-naïve patients, suggesting that spontaneous HIT may occur in COVID-19.InterpretationAnti-heparin-PF4 antibodies are induced in critical COVID-19 patients, resulting in a progressive platelet decrease. Exposure to a high dose of heparin may trigger further severe thrombocytopenia with a fatal outcome. An alternative anticoagulant other than heparin should be used to treat COVID-19 patients in critical condition.FundingThis investigation was supported by grants 2016CB02400 and 2017YFC1201103 from the National Major Research and Development Program of China.

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Immune Status of COVID-19 Patients with Reference to SARS and MERS

Journal of Pure and Applied Microbiology ◽

10.22207/jpam.14.spl1.18 ◽

2020 ◽

Vol 14 (suppl 1) ◽

pp. 817-821

Author(s):

Barani Karikalan ◽

Hari Kumar Darnal

Keyword(s):

Immune Status ◽

Severe Disease ◽

Alveolar Epithelium ◽

Serum Levels ◽

Multiple Organ ◽

Lung Damage ◽

Respiratory Syndrome Virus ◽

Cytokine Storm ◽

Global Pandemic ◽

Immunological Reactions

During this global pandemic of COVID-19 infection, it became well known that morbidity and mortality is especially high at the extreme of life especially in certain racial or ethnic groups like Americans and Africans. This is presumed due to low immunity associated with other comorbid conditions like diabetes, hypertension, cardiovascular disease, obesity and metabolic syndrome. But the information available on the immune status of COVID-19 patients is limited. Attempts must be made to enhance our understanding of the immune status of COVID-19 patients by revisiting our knowledge on the immune mechanisms of already known coronaviruses such as SARS-CoV and MERS-CoV. Early elevation of the serum levels of pro-inflammatory cytokines observed in SARS and MERS infection suggests a possible same type of cytokine storm-mediated lung damage in COVID-19 patients too. Dysregulation of interferon-1 response and downstream cascade in initial innate immune response at virus entry point has been related to lethal pneumonia in COVID-19 patients. Adaptive response of increased CD8+ levels in COVID-19 patients seems to be useful in mild cases where it causes deteriorating effects in progressed severe disease patients resulting in destruction of type 2 pneumocytes hence inability to regenerate the alveolar epithelium. A phenomenon called cytokine storm activates violent immunological reactions in the lung tissue resulting in ARDS followed by multiple organ system damages in COVID-19 patients. Several immune evading mechanisms are thought to be employed by severe respiratory syndrome virus-2 (SARS-CoV-2) that might have resulted in its extremely increased contagiousness probably related with its frequent RNA mutations. Failure to develop adequate virus limiting immune reactions by some cured patients warrant monitoring of all recovered patients. This rapid mini review is aimed to enhance our knowledge of the immune status of COVID-19 infected patients with reference to SARS-CoV and MERS-CoV.

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Serum Copper, Ceruloplasmin, Iron, Transferrin level in patients with Psoriasis and their relationship with severity of the disease

Journal of Dhaka Medical College ◽

10.3329/jdmc.v29i1.51173 ◽

2021 ◽

Vol 29 (1) ◽

pp. 59-68

Author(s):

Aziz Ahmed Khan ◽

Ponkaj Kanti Datta ◽

Abida Sultana ◽

Md Shahidullah Sikder ◽

Arif Ahmed Khan ◽

...

Keyword(s):

Trace Elements ◽

Severe Disease ◽

Psoriasis Patient ◽

Serum Levels ◽

Serum Copper ◽

Cross Sectional ◽

Female Ratio ◽

Serum Ceruloplasmin ◽

Severity Of The Disease ◽

Immunological System

Psoriasis is a common, chronic, immune mediated inflammatory disease that involves the innate immunological system (keratinocyte, dendritic cell, histiocytes, mast cells and endothelial cells) and acquired immunological system (T lymphocytes). Essential trace elements like iron (Fe), copper (Cu) undergo redox cycling and have physiological significance in inflammatory process. This study is aimed at measuring the level of copper, ceruloplasmin, iron and transferrin in psoriasis patient and to assess its relationship with the severity of the disease. This is an observational cross sectional study. It was conducted at the department of Dermatology and Venereology, BSMMU, Dhaka. Age range of the patient was 18 to 65 years. The mean age of the patients was 39.1±13.54 years, 57.9% patients were male and 42.1% were female. Male: female ratio was 1.4:1. Male patients were predominant. Mean duration of disease 5.36±4.05 years with range from 1.0 to 14 years. Most of the (76.3%) patients had mild disease followed by 23.7% had moderate to severe disease. Serum level of trace elements was compared between mild and moderate to severe group of psoriasis patients but difference were not statistically significant (p>0.05). Weak negative correlation was found between PASI score and serum levels of copper (r = “0.134, P = 0.423), iron (r = –0.080, p = 0.632), transferrin (r = –0.079, p = 0.638) and weak positive correlation was found with ceruloplasmin (r = 0.228, p = 0.168). The results of the present research provide valuable information and correlation between the measured biomarkers and severity of psoriasis. Serum Ceruloplasmin, copper, iron and serum transferrin could serve as a biomarker of psoriasis but not as a marker of psoriasis severity. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 59-68

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