Multisystem inflammatory syndrome in neonates due to severe acute respiratory syndrome coronavirus 2: An emerging entity

Severe acute respiratory syndrome coronavirus 2 was declared as a pandemic in March 2020. The virus has affected more adults than children, with disease severity being lesser in children. We present a case of a neonate who tested positive for coronavirus disease 2019 infection on day of life 3, 6, and 15. The baby had fever, respiratory distress, and shock. Laboratory investigations showed raised inflammatory markers, raised D dimer suggesting coagulopathy, coronary dilatation on 2D echocardiogram, and raised N terminal pro-brain natriuretic peptide. The neonate was successfully treated with good supportive care, lung-protective ventilatory strategies, early intravenous immunoglobulin administration, corticosteroids, and remdesivir.

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The Inflammatory Markers of Multisystem Inflammatory Syndrome in children (MIS-C) and Adolescents During the COVID-19 Pandemic: A Meta-Analysis

10.21203/rs.3.rs-127768/v1 ◽

2021 ◽

Author(s):

Yan Zhao ◽

Li-juan Yin ◽

Jenil Patel ◽

Lei Tang ◽

Ying Huang

Keyword(s):

Inflammatory Markers ◽

Meta Analysis ◽

Absolute Lymphocyte Count ◽

Older Children ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Quality Check ◽

Inflammatory Syndrome ◽

D Dimer

Abstract As per the indicated need in literature, we conducted a systematic review and meta-analysis to characterize inflammatory markers of MIS-C patients with COVID-19, Kawasaki disease (KD), and coronary artery abnormalities. We searched nine databases for studies on inflammatory markers of MIS-C. After quality check, data were pooled using a fixed- or random-effects model. Inflammatory markers included white blood cell count (WBC) or leukocytes, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, lactate dehydrogenase (LDH), fibrinogen and erythrocyte sedimentation rate (ESR) for comparisons by severity and age. Twenty studies with 2,990 participants yielded 684 MIS-C patients. Compared to non-severe COVID-19 patients, MIS-C patients had lower ALC and higher ANC, CRP and D-dimer levels. Compared to severe COVID-19 patients, MIS-C patients had lower LDH and PLT counts and higher ESR levels. Compared to KD patients, MIS-C patients had lower ALC and PLT, and higher CRP and ferritin levels. Severe MIS-C patients had higher levels of WBC, CRP, D-dimer and ferritin. For MIS-C, younger children had lower CRP and ferritin levels than medium-aged/older children. Measurement of inflammatory markers might assist clinicians in accurate evaluation and diagnosis of MIS-C and the associated disorders.

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Gangguan Koagulasi Pada Pasien Covid-19

Jurnal Pengabdian Kedokteran Indonesia ◽

10.33096/jpki.v2i2.149 ◽

2021 ◽

Vol 2 (2) ◽

pp. 63-72

Author(s):

TUTIK HARJIANTI

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Venous Thromboembolism ◽

Middle East ◽

Severe Acute Respiratory Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Middle East Respiratory Syndrome ◽

D Dimer

Severe acute respiratory syndrome coronavirus (SARS-CoV-2) merupakan famili dari coronavirus, sudah dua kali menyababkan kejadian luar biasa yaitu di tahun 2003 dengan SARS (Severe Acute Respiratory Syndrome) dan tahun 2012 dengan penyakit MERS (Middle East Respiratory Syndrome). Pada tahun 2019 SARS-CoV-2 telah menyebabkan pandemi global kembali. Pertama kali diidentifikasi di Wuhan, Cina. Dan telah menyebar ke seluruh negara dengan jumlah kasus yang terus meningkat secara eksponensial diseluruh dunia. Pada Maret 2020 oleh WHO dinyatakan pandemic. (Covid-19), menyebabkan pneumonia dan beberapa kondisi dapat terjadi Acute Respiratory Distress Syndrome (ARDS) serta beberapa manifestasi ekstra paru, seperti kardiovaskular, saluran cerna, ginjal ,hematologi, sekuele akibat trombosis dan progresifitas disfungsi organ.1 Prognosis pada pasien Covid-19 salah satu tanda ,gejalanya adalah terjadinya gangguan koagulasi, yang ditandai dengan meningkatnya nilai D dimer sebagai tanda awal kondisi thrombosis dan salah satunya dapat bermanifestasi sebagai Venous Thromboembolism (VTE). Pada pasien dengan Covid-19, kondisi koagulopati adalah salah satu kunci dan tanda persisten yang terkait dengan outcome yang buruk.1,2

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Anticardiolipin Antibodies in COVID-19 – Report of Three Cases

Internal Medicine ◽

10.2478/inmed-2021-0151 ◽

2021 ◽

Vol 18 (1) ◽

pp. 59-67

Author(s):

Alina Dima ◽

Ruxandra Valentina Moroti ◽

Daniela Nicoleta Popescu ◽

Ioana Berza ◽

Delia Adriana Pârvu ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Inflammatory Response ◽

Antiphospholipid Antibodies ◽

Laboratory Tests ◽

Viral Infections ◽

Pulmonary Involvement ◽

Anticardiolipin Antibodies ◽

Activated Partial Thromboplastin Time ◽

Inflammatory Syndrome ◽

D Dimer

Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is prone to thrombotic events with pathogenic mechanism that are still incompletely understood. Occurrence of antiphospholipid antibodies, especially anticardiolipin antibodies, was described in many viral infections and could be part of the chain in micro-thrombosis occurrence in COVID-19. We herein present three cases of COVID-19 patients without any known immune background. For two of the patients, the laboratory tests show neither inflammatory syndrome, nor elevated D-dimer. Even if pauci-symptomatic patients, pulmonary involvement in as much as 10 - 25% was identified on chest computer tomography exam. In addition, a third patient, with more important pulmonary involvement (25-50%), inflammatory response and elevated D-dimer levels is presented. None of the patients had prolonged activated partial-thromboplastin time. IgM and/ or IgG anticardiolipin antibodies were found positives in all three cases.

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Acute Respiratory Distress Syndrome in Confirmed and Suspected Cases of Covid-19:A Cross Sectional Study

10.53350/pjmhs211561176 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1176-1179

Author(s):

F. Sadiq ◽

K. Ayoub ◽

F. Riaz ◽

S. Razzaq ◽

A. Farooq ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Inflammatory Markers ◽

Distress Syndrome ◽

Shortness Of Breath ◽

Cross Sectional ◽

X Ray ◽

Bilateral Lung ◽

D Dimer

Aim: To observe the frequency, severity and susceptibility to develop the severe symptoms of acute respiratory distress syndrome in confirmed and suspected cases of COVID-19. Study design: Cross sectional observational study. Place and duration of study: Lahore General Hospital, Lahore. Methodology: After Ethical Committee approval in 164 patients of confirmed or suspected COVID-19 who underwent the complication of ARDS were enrolled, admitted in department of Medicine and Intensive Care Unit at Lahore General Hospital, Lahore. After taking consent we studied different features in these patients like age, gender, comorbidities, symptoms, their radiological findings, SATS, PO2/FIO2 ratio, serum ferritin, CRP, LDH and d-dimer levels, and results were analyzed. Result: Out of 164 patients, 103 were COVID-19 positive. Mostly middle aged to old males developed the complications of ARDS. The most common symptoms observed were fever, cough and shortness of breath. Most common comorbidities present in the patients were diabetes and hypertension. HRCT was done in severe cases and 25 out of 35 patients had either unilateral or bilateral lung opacities. On chest X-ray 76% patients had bilateral lung infiltrates and 12% patients were having unilateral infiltrates. Inflammatory markers such as CRP, serum LDH, serum Ferritin, D-dimers were raised in most of the patients who developed moderate to severe ARDS. Conclusion: We concluded that the middle aged to old males with comorbidities like diabetes and hypertension are more likely to undergo ARDS. They can present with shortness of breath alone or in combination with fever and cough. Their X-ray usually showed bilateral patchy infiltrates and their ferritin, CRP, LDH and d- dimer levels are usually high. Keywords: ARDS, COVID-19, Inflammatory Markers

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Thrombose und COVID-19

hautnah ◽

10.1007/s12326-021-00438-6 ◽

2021 ◽

Author(s):

Stanislava Tzaneva

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Antithrombotische Therapie ◽

D Dimer

ZusammenfassungDie Prävalenz der venösen thromboembolischen (VTE) Ereignisse ist bei Coronavirus diesease 2019 (COVID-19) -Patienten hoch, insbesondere bei schwer Erkrankten. Patienten mit schwerer COVID-19 und VTE haben eine signifikant höhere Mortalität im Vergleich zu Patienten ohne VTE. Die Manifestation einer schweren Infektion mit Severe acute respiratory syndrome coronavirus-2 (SARS-CoV‑2) entspricht einem systemischen proinflammatorischen und prokoagulatorischen Phänotyp, der mit vaskulären Thrombosen nicht nur in den Venen, sondern auch in den Arterien, Kapillaren sowie mit einer Inflammation der Gefäße assoziiert ist. Ein erhöhter D‑Dimer-Spiegel kann als Indikator für VTE bei Patienten mit COVID-19 verwendet werden. Die meisten medizinischen Gesellschaften empfehlen eine VTE-Prophylaxe vorzugsweise mit niedermolekularen Heparinen (LMWH) bei allen stationären Patienten. Weitere Daten von randomisierten kontrollierten Studien (RCTs) über die optimale Antikoagulation und antithrombotische Therapie werden in der nahen Zukunft erwartet.

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The prognostic role of inflammatory markers in COVID 19 patients – A retrospective analysis.

10.21203/rs.3.rs-1121729/v1 ◽

2021 ◽

Author(s):

Shivkumar Gopalakrishnan ◽

sangeetha kandasamy ◽

S.Malini ◽

S.Peer Mohamed ◽

k.velmurugan

Keyword(s):

Inflammatory Markers ◽

Severe Disease ◽

Radiation Hazard ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Group Iii ◽

Group I ◽

Group Ii ◽

D Dimer

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.

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Role of Brain Natriuretic Peptide assay in identifying children with pneumonia complicated by congestive cardiac failure

Annals of Health Research ◽

10.30442/ahr.0402-10-21 ◽

2018 ◽

Vol 4 (2) ◽

pp. 182-188

Author(s):

Wilson E. Sadoh ◽

Wilson O. Osarogiagbon

Keyword(s):

Developing Countries ◽

Respiratory Distress ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Failure ◽

Congestive Cardiac Failure ◽

Morbidity And Mortality

Background: Pneumonia in children is a leading cause of morbidity and mortality in developing countries. It is often complicated by Congestive Cardiac Failure (CCF), with some of the symptoms similar to those of pneumonia. Brain Natriuretic Peptide (BNP) assay can differentiate cardiac from respiratory-related causes of respiratory distress. Objective: To determine the role of BNP in differentiating isolated pneumonia from pneumonia complicated by CCF. Methods: Over a 12-month period, consecutive children with radiologically-confirmed pneumonia were recruited for the study. Those with complicating CCF were noted. All the children had blood BNP assay done by ELISA, prior to treatment. Biodata was obtained and the children were grouped into those with isolated pneumonia and those with pneumonia complicated by CCF. Results: Fifty children were recruited; of these 26 (52.0%) had isolated pneumonia while 24 (48.0%) had pneumonia with CCF. The median age of the children was 6 months. The median BNP values for the isolated pneumonia group (229.4 ng/l), was significantly lower than that of pneumonia complicated by CCF group (917.3 ng/l); (p = 0.007). ROC showed that a BNP value >550ng/l could identify children with pneumonia complicated with CCF from those with isolated pneumonia with a sensitivity of 70.4% and specificity of 63.4%. Conclusion: A BNP assay prior to treatment of >550ng/l can differentiate children with pneumonia complicated with CCF from those without CCF.

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Antirheumatic therapy is not associated with changes in circulating N-terminal pro-brain natriuretic peptide levels in patients with autoimmune arthritis

PLoS ONE ◽

10.1371/journal.pone.0253793 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253793

Author(s):

Thao H. P. Nguyen ◽

Morten Wang Fagerland ◽

Gia Deyab ◽

Gunnbjørg Hjeltnes ◽

Ivana Hollan ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Inflammatory Markers ◽

Heart Function ◽

Autoimmune Arthritis ◽

Antirheumatic Therapy ◽

Modest Improvement ◽

Reactive Protein ◽

Increased Risk ◽

The Impact

Background Patients with autoimmune arthritis (AA) are at increased risk for impaired cardiac function and heart failure. This may be partly due to the effect of inflammation in heart function. The impact of antirheumatic drugs on cardiac dysfunction in AA remains controversial. Therefore, we aimed to examine effects of antirheumatic treatment on serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in AA patients and its relationship to inflammatory markers. Methods We examined 115 patients with AA (64 rheumatoid arthritis (RA), 31 psoriatic arthritis and 20 ankylosis spondylitis) starting with methotrexate (MTX) monotherapy or tumor necrosis factor inhibitors (TNFi) with or without MTX co-medication. NT-proBNP (measured in serum by ECLIA from Roche Diagnostics), and other clinical and laboratory parameters were evaluated at baseline, after 6 weeks and 6 months of treatment. Results NT-proBNP levels did not change significantly after 6 weeks and 6 months of antirheumatic therapy (pbaseline-6weeks = 0.939; pbaseline-6months = 0.485), although there was a modest improvement from 6 weeks to 6 months in the MTX only treatment group (median difference = -18.2 [95% CI = -32.3 to -4.06], p = 0.013). There was no difference in the effects of MTX monotherapy and TNFi regimen on NT-proBNP levels. The changes in NT-proBNP after antirheumatic treatment positively correlated with changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Baseline NT-proBNP levels were related to baseline CRP and ESR levels, and some other established markers of disease activities in crude analyses. Conclusion Circulating levels of NT-proBNP were related to established inflammatory markers at baseline, and the changes in NT-proBNP after antirheumatic treatment were positively related to these markers. Nevertheless, antirheumatic therapy did not seem to affect NT-proBNP levels compared to baseline, even though inflammatory markers significantly improved.

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Methylprednisolone Treatment Versus Standard Supportive Care for Adult Covid19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients

10.21203/rs.3.rs-609419/v1 ◽

2021 ◽

Author(s):

Masood Ur Rahman ◽

Satish Chandra Nair ◽

Mehraj Ud Din ◽

Mohd Dar ◽

Murriam Masood ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Length Of Stay ◽

Respiratory Distress Syndrome ◽

Supportive Care ◽

Respiratory Distress ◽

Distress Syndrome ◽

Hospital Length Of Stay ◽

Care Group ◽

Mechanically Ventilated ◽

Methylprednisolone Treatment

Abstract A myriad of symptoms presented by severely ill mechanically ventilated Covid19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. Covid19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for Covid19, the aim of the current study was to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID19 patients with severe covid pneumonia. Data was collected retrospectively from the electronic patient medical records, and inter-rater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome and the Chi-Square test used to determine association between the outcomes and other independent variables. Patients. Sixty-one percent (43/70) of the Covid19 ARDS patients received standard supportive care, and the remainder were administered. methylprednisolone (40 mg daily to 40 mg q 6 hours). A 28-day all-cause mortality rate, in the methylprednisolone group was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU-length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone treated group was significantly lower (p < 0.01), when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU LOS, and ventilator days in mechanically ventilated Covid 19 patients with respiratory distress syndrome.

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Distorted TCR repertoires define multisystem inflammatory syndrome in children

10.1101/2021.04.12.21255098 ◽

2021 ◽

Author(s):

Amna Malik ◽

Eszter N. Tóth ◽

Michelle S. Teng ◽

Jacob Hurst ◽

Eleanor Watt ◽

...

Keyword(s):

T Cell ◽

Severe Acute Respiratory Syndrome ◽

Severe Disease ◽

Clinical Manifestations ◽

High Confidence ◽

T Cell Clones ◽

Severity Of Disease ◽

Cell Clones ◽

Inflammatory Syndrome ◽

Independent Expansion

While the majority of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) display mild or no symptoms, rare individuals develop severe disease presenting with multisystem inflammatory syndrome (MIS-C). The reason for variable clinical manifestations is not understood. Here, we carried out TCR sequencing and conducted comparative analyses of TCR repertoires between children with severe (n=12) or mild (n=8) COVID-19. We compared these repertoires with unexposed individuals (samples collected pre-COVID-19 pandemic: n=8) and with the Adaptive Biotechnologies MIRA dataset, which includes over 135,000 high-confidence SARS-CoV-2-specific TCRs. We show that the repertoires of severely ill children are characterised by the expansion of TRBV11-2 chains with high junctional and CDR3 diversity. Moreover, the CDR3 sequences of TRBV11-2 clones shift away from SARS-CoV-2 specific T cell clones, resulting in distorted TCR repertoires. In conclusion, our study reports that CDR3-independent expansion of TRBV11-2+ cells, lacking SARS-CoV-2 specificity, defines severity of disease in children.

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