Coexisting illness and COVID-19

Abstract Background: Coronavirus disease 2019 (COVID-19) has rapidly spread throughout worldwide. Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease were the most common coexisting illness among patients with severe SARS-CoV-2 infection. We aim to analyze the effect of them on the result of laboratory finding in patients with severe or critical SARS-CoV-2 infection.Methods: The date of a total of 49 patients who met the inclusion criteria from January 12 to March 20, 2020, from the first affiliated hospital of Harbin medical university were analyzed in our study.Results: Compared with patients without any coexisting illness, we found that PT levels were decreased in patients with cerebrovascular disease, hypertension or cardiovascular disease, and D-Dimer levels were decreased in patients with cerebrovascular disease, hypertension or diabetes. Similarly, LDH and ALT levels were lower in patients with cerebrovascular disease than that without any coexisting illness.Conclusions: Hypertension, diabetes, cardiovascular disease, and cerebrovascular disease are associated with an increased disease severity and risk of death in patients with COVID-19. Recently study also reported that the levels of PT, D-dimer, and LDH were increased and predicted the deterioration of disease in severe patients with SARS-CoV-2 infection. Interestingly, our results demonstrate that the levels of laboratory indicators such as PT, D-dimer, LDH and ALT were decreased in patients with coexisting illness than without any coexisting illness. It may give us the inaccurate result when we use those laboratory indicators to predict the deterioration of the patients and we need to pay more attention to it.

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The urgency of severity and mortality risk assessments for COVID-19: A summary from death cases in Wuhan, China

10.21203/rs.3.rs-21792/v1 ◽

2020 ◽

Author(s):

Feihong Yang ◽

Jiaohong Gan ◽

Hao Zou ◽

Zhongxiang Zhang ◽

Yan Zhao ◽

...

Keyword(s):

Disease Severity ◽

Mortality Risk ◽

Apache Ii ◽

Risk Levels ◽

Risk Of Death ◽

Potential Factors ◽

Medical Histories ◽

Critical Patients ◽

Death Cases ◽

D Dimer

Abstract Background To investigate the clinical characteristics of 21 death cases and evaluate potential factors of disease severity and mortality risk in COVID-19. Methods Retrospective analysis was used to study the clinical data of 21 death cases with COVID-19. The assessment of disease severity and mortality risk were conducted by APACHE II, SOFA, MuLBSTA and PSI scores. Results The age was 66±14 years-old and 15 (71.4%) were men. 16 (76.2%) patients had chronic medical illnesses. 12 (57.1%) patients were overweight. Decreased lymphocytes were observed in 17 (81.0%) patients on admission. Elevated D-dimer levels were noticed in 11 (52.4%) patients and increased much more when pneumonia deteriorated. The initial APACHE II and SOFA scores demonstrated 18 (85.7%) and 13 (61.9%) patients in middle-risk levels, respectively. MuLBSTA and PSI scores after admission showed high-risk mortality in 13 (61.9%) patients. Most patients developed sequent organ failure and finally caused death. Conclusion Older, male, overweight patients, combined with chronic medical histories, continuous decreased lymphocyte proportion and increased D-dimer might have a higher risk of death. The combination of general scoring (SOFA) and pneumonia specific scoring (MuLBSTA and PSI) after admission might be more sensitive to assess the mortality risk for critical patients in COVID-19.

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D-Dimer as a Prognostic Indicator in Critically Ill Patients Hospitalized With COVID-19 in Leishenshan Hospital, Wuhan, China

Frontiers in Pharmacology ◽

10.3389/fphar.2020.600592 ◽

2020 ◽

Vol 11 ◽

Author(s):

Jinpeng Li ◽

Zeming Liu ◽

Gaosong Wu ◽

Meilin Yi ◽

Yongfeng Chen ◽

...

Keyword(s):

Disease Severity ◽

Early Warning ◽

Prognostic Indicator ◽

Underlying Disease ◽

Protein Fragment ◽

Risk Of Death ◽

Increased Risk ◽

High Flow Oxygen ◽

D Dimer

Background: D-dimer is a small protein fragment and high levels of D-dimer have been associated with increased mortality in patients presenting to emergency departments with infection. Previous studies have reported increased levels of D-dimer in COVID-19; however, it is unclear whether an increased D-dimer level provides early warning of poor prognosis. Therefore, this study aimed to assess the usefulness of D-dimer as an early indicator of prognosis in patients with coronavirus disease (COVID-19).Methods: We conducted a retrospective study of patients with COVID-19 admitted to Leishenshan Hospital in Wuhan, China, from February 15 to March 30, 2020. The final date of follow-up was April 11, 2020.Results: Of the 1,643 patients with COVID-19, 691 had elevated D-dimer levels. Their median age was 65 years. Of the patients with elevated D-dimer levels, 45% had comorbidities, with cardiovascular disease (205 [29.7%]) being the most common. Patients with elevated D-dimer were more likely to require treatment with high-flow oxygen, anticoagulation, antibiotics, and admission to the intensive care unit They were also more likely to have increased interleukin-6, monocytes, and lymphocytes. Patients with elevated D-dimer levels had significantly higher mortality than those with normal or low D-dimer levels.Conclusion: In patients with COVID-19, elevated D-dimer was associated with abnormal immunity, underlying disease, increased disease severity, and increased mortality. Taken together, D-dimer may be a marker for the early warning of disease severity and increased risk of death. These findings provide insights into the potential risk of elevated D-dimer in patients with COVID-19.

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Serum biomarkers of cardiovascular complications in COVID-19

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4456 ◽

2021 ◽

Vol 26 (2S) ◽

pp. 4456

Author(s):

R. M. Gumerov ◽

D. F. Gareeva ◽

P. A. Davtyan ◽

R. F. Rakhimova ◽

T. I. Musin ◽

...

Keyword(s):

Internal Medicine ◽

Endothelial Dysfunction ◽

Disease Severity ◽

Creatine Phosphokinase ◽

Evidence Base ◽

Cardiovascular Complications ◽

Serum Biomarkers ◽

Risk Of Death ◽

Cardiovascular Biomarkers ◽

D Dimer

The coronavirus disease 2019 (COVID-19) affects not only the respiratory system, but also the cardiovascular system in 20-28% of cases, causing endothelial dysfunction, vasculitis, hyper- and hypocoagulation, myocarditis, endothelial dysfunction and other adverse effects. The presence of cardiovascular risk factors and diseases has been shown to worsen the disease severity and increase mortality from COVID-19. Recent studies have also found that elevations in some serum cardiovascular biomarkers can stratify the disease severity, in particular rates of hospitalizations to an internal medicine or intensive care unit, intubation, and mortality. They can be divided into markers of damage (TnT/I, creatine phosphokinase (CPK) and CPK-MB, myoglobin, NT-proBNP), coagulation (prothrombin time, fibrinogen and D-dimer), as well as prospective biomarkers for which the available evidence base is limited but there is a pathophysiological rationale (homocysteine and sST2). This review presents studies on the use of above serum biomarkers to stratify the risk of death in patients with COVID-19.

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Association of Increased Fibrin Turnover and Defective Fibrinolytic Capacity with Leg Atherosclerosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648855 ◽

1994 ◽

Vol 72 (02) ◽

pp. 292-296 ◽

Cited By ~ 24

Author(s):

M Cortellaro ◽

E Cofrancesco ◽

C Boschetti ◽

L Mussoni ◽

M B Donati ◽

...

Keyword(s):

Arterial Disease ◽

Venous Stasis ◽

Stepwise Discriminant Analysis ◽

Predisposing Factor ◽

Risk Of Death ◽

Peripheral Arterial ◽

Fibrinolytic Potential ◽

Fibrinolytic Capacity ◽

Control Study ◽

D Dimer

SummaryPatients with peripheral arterial disease have a high risk of death from cardiovascular events. As defective fibrinolysis associated with leg atherosclerosis has been suggested as a predisposing factor, we sought a relation among decreased fibrinolysis, the presence of leg atherosclerosis and the incidence of thrombotic events in a case control study nested in the PLAT.Fifty-eight patients with coronary and/or cerebral atherothrombotic disease, free of leg atherosclerosis at Doppler examination, were compared with 50 atherosclerotic patients with leg involvement. High D-dimer (153.0 vs 81.3 ng/ml, p <0.001) and tPA antigen before venous stasis (14.4 vs 11.8 ng/ml, p <0.03), and low tPA antigen (6.7 vs 15.6 ng/ml, p <0.01) and fibrinolytic activity released after venous stasis (fibrinolytic capacity: 113.2 vs 281.4 mm2, p <0.001) were found in patients with leg atherosclerosis. D-dimer and fibrinolytic capacity, in addition to age, were selected by stepwise discriminant analysis as characterizing patients with leg atherosclerosis. Moreover, higher D-dimer and tPA inhibitor characterized patients with leg atherosclerosis who subsequently experienced thrombotic events.These findings constitute evidence of high fibrin turnover and impaired fibrinolytic potential in patients with leg atherosclerosis. Thus impaired fibrinolysis may contribute to the prothrombotic state in these patients.

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D-Dimer, Disease Severity, and Deaths (3D-Study) in Patients with COVID-19: A Systematic Review and Meta-Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3696621 ◽

2020 ◽

Author(s):

Seshadri Reddy Varikasuvu ◽

Naveen Dutt ◽

Saurabh Varshney ◽

Shahir Asfahan ◽

Paresh P. Kulkarni ◽

...

Keyword(s):

Systematic Review ◽

Disease Severity ◽

Meta Analysis ◽

D Dimer

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Benefits of tafamidis in patients with advanced transthyretin amyloid cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.2115 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Rapezzi ◽

A.V Kristen ◽

B Gundapaneni ◽

M.B Sultan ◽

M Hanna

Keyword(s):

Disease Severity ◽

Nyha Class ◽

Funding Source ◽

Class Iii ◽

Private Company ◽

Risk Of Death ◽

6Mwt Distance ◽

All Cause Mortality ◽

Amyloid Cardiomyopathy

Abstract Background In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), tafamidis was shown to be an effective treatment for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Further assessment of the efficacy of tafamidis in patients with more advanced ATTR-CM would aid treatment decisions. Purpose To characterize the benefits of tafamidis in patients with advanced ATTR-CM. Methods In ATTR-ACT, ATTR-CM patients were randomized to tafamidis (n=264) or placebo (n=177) for 30 months. Efficacy outcomes included all-cause mortality and frequency of cardiovascular (CV)-related hospitalisations. Key secondary endpoints were change from baseline to Month 30 in 6MWT distance and KCCQ-OS score. Efficacy assessments in NYHA Class III patients at baseline (n=141) were a pre-specified analysis. In a post-hoc analysis, mortality and CV-related hospitalizations were assessed in all patients grouped into quartiles of increasing disease severity based on 6MWT distance at baseline. Longer-term all-cause mortality (as of 1 Aug 2019) was assessed in NYHA Class III patients utilizing data from ATTR-ACT patients who enrolled in a long-term, extension study (LTE) and continued treatment with higher dose tafamidis (n=55; median treatment duration 51.6 months); or, if previously treated with placebo, started tafamidis treatment (placebo/tafamidis; n=63 [50.1 months]). Results In advanced ATTR-CM patients (NYHA Class III), tafamidis reduced the risk of death (HR [95% CI] 0.837, [0.541, 1.295], P=0.4253), and the decline in 6MWT distance (LS mean [SE], 31.6 (22.1) m; P=0.1526) and KCCQ-OS score (LS mean [SE], 13.1 (5.0); P=0.0090), vs placebo. Paradoxically, there was a higher frequency of CV-related hospitalizations with tafamidis (RR [95% CI] vs placebo, 1.411 [1.048, 1.900]). In all patients by 6MWT quartile, CV-related hospitalizations/year with tafamidis and placebo increased with disease severity, with the exception that placebo-treated patients in the highest severity quartile had fewer CV-related hospitalisations (0.73) than those in the third quartile (0.92). Mortality with tafamidis and placebo increased, and was greater with placebo, in every quartile (Figure). Survival (NYHA Class III patients in ATTR-ACT and LTE) was improved with high dose tafamidis with longer term follow-up (HR vs placebo/tafamidis [95% CI], 0.6569 [0.4175, 1.0336]; P=0.0692). Conclusions These analyses, including longer-term follow-up, demonstrate that patients with advanced ATTR-CM benefit from tafamidis. The decrease in CV-related hospitalisations in more severe patients treated with placebo suggests that the comparatively greater hospitalisation frequency in NYHA Class III patients treated with tafamidis is a consequence of their lower mortality rate. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was sponsored by Pfizer

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Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study

Thrombosis Journal ◽

10.1186/s12959-021-00281-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Runzhen Chen ◽

Chen Liu ◽

Peng Zhou ◽

Yu Tan ◽

Zhaoxue Sheng ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Coronary Intervention ◽

Prognostic Value ◽

Coronary Intervention ◽

Risk Scores ◽

Risk Of Death ◽

Clinical Risk ◽

Percutaneous Coronary ◽

D Dimer

Abstract Background Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. Results During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). Conclusions For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.

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CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00389-7 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aya Yassin ◽

Maryam Ali Abdelkader ◽

Rehab M. Mohammed ◽

Ahmed M. Osman

Keyword(s):

Pulmonary Embolism ◽

Disease Severity ◽

Laboratory Data ◽

Pulmonary Angiography ◽

Significant Relation ◽

Ct Pulmonary Angiography ◽

Laboratory Results ◽

Severity Of The Disease ◽

The Relationship ◽

D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

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Abstract TP208: Sleep Disordered Breathing (SDB) - An Overlooked Modifiable Risk Factor in Acute Stroke Care

Stroke ◽

10.1161/str.48.suppl_1.tp208 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Vishal Shah ◽

Ashrai Gudlavalleti ◽

Julius G Latorre

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Modifiable Risk Factor ◽

Inclusion Criteria ◽

Risk Of Death ◽

Disordered Breathing

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

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COMPARISON OF MORTALITY RELATED RISK FACTORS OF COVID-19 AND SARI DEATH DURING THE PEAK OF PANDEMIC IN A TERTIARY CARE CENTRE.

10.36106/gjra/2712341 ◽

2021 ◽

pp. 136-139

Author(s):

K. Anbananthan ◽

A. Manimaran ◽

A. Ramasamy ◽

S. A. Natesh ◽

AnuSree. S. C

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Cerebrovascular Disease ◽

Lung Disease ◽

Chronic Lung Disease ◽

Poor Prognosis ◽

Severe Acute Respiratory Infection ◽

Viral Infectious Disease ◽

Study Population ◽

D Dimer

Background: COVID-19 is a viral infectious disease caused by the SARS CoV-2 virus which causes severe respiratory distress in a certain number of patients with specic risk factors. This study compares the mortality risk factors of COVID 19 and Severe Acute Respiratory Infection (SARI) deaths and also determines the most likely causes that lead to such a poor prognosis Objectives: To evaluate the risk factors of COVID 19 and SARI causing mortality. To compare the most likely risk factors that lead to such a poor prognosis Materials And Methods: This was a Cross sectional study done on 190 patients which includes all cases of covid 19 and SARI deaths within the peak of pandemic period (August 2020). Patient datas were collected from MRD registry at Thanjavur Medical College. Results: Among the study population of 190, age distribution of the patients died due to covid-19 was minimum 26 years to maximum 89 years and mean age of 61years. Most commonly affected were in the age around 60years. Distribution of male is around 72.1%.This study showed 47.9% were covid positive and 42.1% were suspected based on CT chest nding and clinical features. Around 84.7% were diabetic and 56.3% were hypertensive. There is no signicant difference between the exposure rate of diabetes, hypertension, CKD, chronic lung disease, cerebrovascular disease, liver disease, malignancy among covid and SARI group. Among these study population 94.7% had elevated d-dimer level. Conclusion: This study showed various comorbidities, complications, and demographic variables including diabetes, hypertension, chronic kidney disease,, chronic lung disease,liver disease, Cerebrovascular disease, cancer, increased D-dimer, male gender, older age(>50), smoking, and obesity are clinical risk factors for a fatal outcome associated with COVID 19.

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