Vascular Abnormalities Detected with Chest CT in COVID-19: Spectrum, Association with Parenchymal Lesions, Cardiac Changes, and Correlation with Clinical Severity (COVID-CAVA Study)

Although vascular abnormalities are thought to affect coronavirus disease 2019 (COVID-19) patients’ outcomes, they have not been thoroughly characterized in large series of unselected patients. The Swiss national registry coronavirus-associated vascular abnormalities (CAVA) is a multicentric cohort of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who underwent a clinically indicated chest computed tomography (CT) aiming to assess the prevalence, severity, distribution, and prognostic value of vascular and non-vascular-related CT findings. Clinical outcomes, stratified as outpatient treatment, inpatient without mechanical ventilation, inpatient with mechanical ventilation, or death, will be correlated with CT and biological markers. The main objective is to assess the prevalence of cardiovascular abnormalities–including pulmonary embolism (PE), cardiac morphology, and vascular congestion. Secondary objectives include the predictive value of cardiovascular abnormalities in terms of disease severity and fatal outcome and the association of lung inflammation with vascular abnormalities at the segmental level. New quantitative approaches derived from CT imaging are developed and evaluated in this study. Patients with and without vascular abnormalities will be compared, which is supposed to provide insights into the prognostic role and potential impact of such signs on treatment strategy. Results are expected to enable the development of an integrative score combining both clinical data and imaging findings to predict outcomes.

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1583. The Utility of the Immunodeficiency Scoring Index (ISI) to Predict Outcomes of Coronavirus (HCoV) Infections in Hematopietic Cell Transplant (HCT) Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1411 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S495-S495

Author(s):

Fareed Khawaja ◽

Terri Lynn Shigle ◽

Shashank S Ghantoji ◽

Marjorie Batista ◽

Ella Ariza-Heredia ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Tract ◽

Viral Infections ◽

Fatal Outcome ◽

High Morbidity ◽

Cell Transplant ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections ◽

Overall Mortality

Abstract Background Respiratory viral infections in HCT recipients are associated with high morbidity and mortality, especially after progression from upper respiratory tract infection (URI) to lower respiratory tract infections (LRI). Data on risk factors (RF) for LRI and mortality is lacking for HCoV infections after HCT. We aimed to validate our ISI in HCoV infections. Methods All adult HCT recipients with HCoV infection from 2015 to 2017 were evaluated. An ISI based on RF was used to classify patients as low (0–2), moderate (3–6), or high (7 or higher) risk for progression to LRI or death. We defined LRI as HCoV detected in nasal wash and/or bronchoalveolar lavage and new lung infiltrates on diagnostic imaging. Clinical parameters were collected and ISI were calculated for comparison. Results A total of 144 adult HCT recipients with 166 episodes of HCoV infections were analyzed. The most common HCoV serotype for LRI and URI was 229E (42.4%) and OC43 (37.6%), respectively, and most patients were infected between November and March each year (Figures 1 and 2). When compared with URI, patients with LRI were more likely in the pre-engraftment period, had multiple respiratory viruses infections, had nosocomially acquired HCoV, required hospitalization, ICU transfer, and mechanical ventilation (all, P < 0.05). Overall mortality rate was 4% at Day 30 from diagnosis and all patients who died had LRI with an 18% mortality. Among those who died, 33% had nosocomial infection, 67% were co-infected with another respiratory virus and 67% required mechanical ventilation. Using an ISI cut off of <4, the negative predictive value (NPV) for progression to LRI was 86% with a specificity of 76%. Conclusion HCT recipients with HCoV LRI were more likely to have a fatal outcome. The NPV of the ISI for progression to LRI was high and could be used as a prognostic tool for future studies and for therapeutic clinical trials. Disclosures All authors: No reported disclosures.

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A novel haemocytometric COVID-19 prognostic score developed and validated in an observational multicentre European hospital-based study

eLife ◽

10.7554/elife.63195 ◽

2020 ◽

Vol 9 ◽

Cited By ~ 1

Author(s):

Joachim Linssen ◽

Anthony Ermens ◽

Marvin Berrevoets ◽

Michela Seghezzi ◽

Giulia Previtali ◽

...

Keyword(s):

Cell Activation ◽

Validation Cohort ◽

Complete Blood Count ◽

Prognostic Score ◽

Fatal Outcome ◽

Activation Parameters ◽

Clinical Severity ◽

Symptom Duration ◽

Individual Parameter ◽

Hospital Days

COVID-19 induces haemocytometric changes. Complete blood count changes, including new cell activation parameters, from 982 confirmed COVID-19 adult patients from 11 European hospitals were retrospectively analysed for distinctive patterns based on age, gender, clinical severity, symptom duration, and hospital days. The observed haemocytometric patterns formed the basis to develop a multi-haemocytometric-parameter prognostic score to predict, during the first three days after presentation, which patients will recover without ventilation or deteriorate within a two-week timeframe, needing intensive care or with fatal outcome. The prognostic score, with ROC curve AUC at baseline of 0.753 (95% CI 0.723–0.781) increasing to 0.875 (95% CI 0.806–0.926) on day 3, was superior to any individual parameter at distinguishing between clinical severity. Findings were confirmed in a validation cohort. Aim is that the score and haemocytometry results are simultaneously provided by analyser software, enabling wide applicability of the score as haemocytometry is commonly requested in COVID-19 patients.

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ENVIRONMENTAL SAFETY EVALUATION OF THE PROTECTION AND ISOLATION SYSTEM FOR PATIENTS WITH COVID-19.

10.1101/2020.06.04.20122838 ◽

2020 ◽

Author(s):

Claudio Almeida Quadros ◽

Maria Carolina BDM Leal ◽

Carlos A Baptista-Sobrinho ◽

Carolina KV Nonaka ◽

Bruno SF Souza ◽

...

Keyword(s):

Mechanical Ventilation ◽

Healthcare Professionals ◽

High Flow ◽

Invasive Ventilation ◽

High Flow Nasal Cannula ◽

Rt Pcr ◽

Isolation System ◽

Non Invasive ◽

Non Invasive Ventilation ◽

And Biological Markers

Background SARS-CoV-2 has high transmissibility through respiratory droplets and aerosol, making COVID-19 a worldwide pandemic. In its severe form, patients progress to respiratory failure. Non-invasive mechanical ventilation restrictions and early orotracheal intubation have collapsed health systems due to insufficient intensive care unit beds and mechanical ventilators. COVID-19 dedicated healthcare professionals have high infection rates. This publication describes experimental testing of the Protection and Isolation System for Patients with COVID-19 (PISP/COVID-19). Method PISP/COVID-19 is a disposable transparent polyethylene plastic that covers the patient's entire hospital bed, with its internal air aspirated by the hospital's vacuum system attached to a microparticle filter. Experiments validated PISP/COVID-19's ability to block aerosolized microparticles dissemination. Caffeine was used as a molecular marker, with leakage evaluation through sensors analysis using nuclear magnetic resonance spectroscopy. The biological marker was synthetic SARS-CoV-2 RNA, using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the detection method. Results PISP/COVID-19 was effective against molecular and biological markers environmental dispersion in simulations of non-invasive ventilation, high-flow nasal cannula oxygen and mechanical ventilation isolation. Caffeine was not detected in any of the sensors positioned at points outside the PISP/COVID-19. The ability of PISP/COVID-19 to retain virus particles and protect the surrounding environment was confirmed by detection and gradients quantification of synthetic SARS-CoV-2 RNA by RT-PCR. Conclusion PISP/COVID-19 was effective in the retention of the molecular and biological markers in all tested simulations. Considering the current pandemic, PISP/COVID-19 might increase the use of non-invasive ventilation, high-flow nasal cannula oxygen and provide additional protection to healthcare professionals.

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Are Guidelines Needed for the Diagnosis and Management of Incipient Alzheimer's Disease and Mild Cognitive Impairment?

International Journal of Alzheimer s Disease ◽

10.4061/2010/417615 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Katie Palmer ◽

Massimo Musicco ◽

Carlo Caltagirone

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Early Stage ◽

Healthcare Providers ◽

Diagnosis And Management ◽

Preclinical Phase ◽

Clinical Syndromes ◽

Dementia Syndrome ◽

Potential Impact ◽

And Biological Markers

Current research is aiming to push the boundaries of the point at which a diagnosis of Alzheimer Disease (AD) can be made. Clinical syndromes such as Mild Cognitive Impairment (MCI) and various clinical and biological markers of AD may help to identify people in the early stage of AD, before a full dementia syndrome is present. In the first part of this paper, we discuss whether MCI represents incipient AD, and examine some of the methods currently used in research to identify AD patients in the preclinical phase. In the second part, we discuss whether specific guidelines are needed for the diagnosis and management of MCI and incipient AD, and consider the potential impact of this on clinical practice and public health from the perspective of patients, caregivers, and healthcare providers.

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Correlation of retinopathy of prematurity with bronchopulmonary dysplasia

Open Medicine ◽

10.1515/med-2018-0012 ◽

2018 ◽

Vol 13 (1) ◽

pp. 67-73 ◽

Cited By ~ 9

Author(s):

Wojciech Podraza ◽

Beata Michalczuk ◽

Karolina Jezierska ◽

Hanna Domek ◽

Agnieszka Kordek ◽

...

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Significant Role ◽

Retinopathy Of Prematurity ◽

Clinical Severity ◽

Control Group ◽

Study Group ◽

Blood Transfusions ◽

Advanced Stages

AbstractRetinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD.MethodologyInfants were divided into two groups: the BPD+ study group and BPD- control group. Parameters including the incidence of ROP and its severity were compared.ResultsIn neonates with BPD, more severe forms of ROP occurred significantly more frequently than in infants without BPD. Newborns with BPD required significantly longer use of mechanical ventilation; moreover, the number of days in which the concentration of oxygen in the respiratory mixture exceeded 50% was greater in BPD+ children . Children with BPD also received more blood transfusions compared to children without BPD.ConclusionsNewborns in the BPD+ study group showed advanced stages of ROP more often than newborns in the BPD- control group. The etiology of ROP and BPD is multifactorial; however, our findings suggest oxygen plays a significant role in the development of these diseases.

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Considerations in the deployment of novel universal vaccines against epidemic and pandemic influenza

10.1101/19002485 ◽

2019 ◽

Author(s):

N Arinaminpathy ◽

S Riley ◽

W.S Barclay ◽

C Saad-Roy ◽

B Grenfell

Keyword(s):

Seasonal Influenza ◽

Unintended Consequences ◽

Clinical Severity ◽

Population Immunity ◽

Modelling Studies ◽

Optimal Deployment ◽

Potential Impact ◽

Combined Vaccine ◽

Induced Immunity ◽

Antigenic Targets

AbstractThere is increasing interest in the development of new, ‘universal’ influenza vaccines (UIV) that - unlike current vaccines - are effective against a broad range of seasonal influenza strains, as well as against novel pandemic viruses. Even where these vaccines do not block infection, they can moderate clinical severity, reducing morbidity and mortality while potentially also reducing opportunities for transmission. Previous modelling studies have illustrated the potential epidemiological benefits of UIVs, including their potential to mitigate pandemic burden. However, these new vaccines could shape population immunity in complex ways. Here, using mathematical models of influenza transmission, we illustrate two types of unintended consequences that could arise from their future deployment. First, by reducing the amount of infection-induced immunity in a population without fully replacing it, a seasonal UIV programme may permit larger pandemics than in the absence of vaccination. Second, the more successful a future UIV programme is in reducing transmission of seasonal influenza, the more vulnerable the population could become to the emergence of a vaccine-escape variant. These risks could be mitigated by optimal deployment of any future UIV vaccine: namely, the use of a combined vaccine formulation (incorporating conventional as well as multiple universal antigenic targets), and by achieving sufficient population coverage to compensate for reductions in infection-induced immunity. As early candidates of UIVs approach advanced clinical trials, there is a need to monitor their characteristics in such a way that is focused on their potential impact. This work offers a first step in this direction.

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Monocyte Distribution Width (MDW) as Novel Inflammatory Marker with Prognostic Significance in COVID-19 Patients

10.21203/rs.3.rs-221351/v2 ◽

2021 ◽

Author(s):

Giovanni Riva ◽

Sara Castellano ◽

Vincenzo Nasillo ◽

Anna Maria Ottomano ◽

Giuliano Bergonzini ◽

...

Keyword(s):

Inflammatory Marker ◽

Fatal Outcome ◽

Prognostic Significance ◽

Cell Subset ◽

Clinical Severity ◽

Inflammatory Disorder ◽

Distribution Width ◽

Life Threatening ◽

Early Biomarker ◽

Macrophage Subsets

Abstract Monocyte Distribution Width (MDW), a new cytometric parameter correlating with cytomorphologic changes occurring upon massive monocyte activation, has recently emerged as promising early biomarker of sepsis. Similar to sepsis, monocyte/macrophage subsets are considered key mediators of the life-threatening hyper-inflammatory disorder characterizing severe COVID-19. In this study, we longitudinally analyzed MDW values in a cohort of 87 COVID-19 patients consecutively admitted to our hospital, showing significant correlations between MDW and common inflammatory markers, namely CRP (p<0.001), fibrinogen (p<0.001) and ferritin (p<0.01). Moreover, high MDW values resulted to be prognostically associated with fatal outcome in COVID-19 patients (AUC=0.76, 95% CI: 0.66-0.87, sensitivity 0.75, specificity 0.70, MDW threshold 26.4; RR=4.91, 95% CI: 1.73-13.96; OR=7.14, 95% CI: 2.06-24.71). This pilot study shows that MDW can be useful in the monitoring of COVID-19 patients, as this innovative hematologic biomarker is: (i) easy to obtain, (ii) directly related to the activation state of a fundamental inflammatory cell subset (i.e. monocytes, pivotal in both cytokine storm and sepsis immunopathogenesis), (iii) well correlated with clinical severity of COVID-19-associated inflammatory disorder, and, in turn, (iv) endowed with relevant prognostic significance. Additional studies are needed to define further the clinical impact of MDW testing in the management of COVID-19 patients.

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Factors Associated with the Occurrence of Death Outcome in Children with Neonatal Respiratory Distress Syndrome

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2019-0031 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Aleksandar G. Kočović ◽

Gordana D. Kostić ◽

Dragana M. Savić ◽

Milica M. Stanojević ◽

Miloš N. Milosavljević ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Apgar Score ◽

Distress Syndrome ◽

Fatal Outcome ◽

Neonatal Respiratory Distress Syndrome ◽

Factors Associated ◽

Neonatal Respiratory Distress ◽

Duration Of Hospitalization

Abstract Neonatal respiratory distress syndrome (NRDS) is a consequence of immaturity at birth and it is still associated with relatively high mortality rate. The aim of this study was to identify the factors associated with the occurrence of fatal outcome in newborns with neonatal respiratory distress syndrome.The research was designed as a case-control study nested in a retrospective cohort, and it enrolled newborns treated during 2015 at Pediatric Clinic of Clinical Center in Kragujevac. Diagnosis of NRDS and decision about the treatment were left at the discretion of attending pediatricians. The cases were patients with fatal outcome, while controls were randomly selected from the pool of survivors and matched with each case by gender in a ratio of 4:1. The study included 371 newborns, of whom 201 (54.2%) were male and 170 (45.8%) female. Lethal outcome occurred in 36 newborns (9,7%). Significant association was found between death and APGAR score (ORadjusted: 0.516, 95% CI: 0.322-0.827), weight on delivery (ORadjusted: 0.996, 95% CI: 0.993-0.999), duration of hospitalization (ORadjusted: 0.901, 95% CI: 0.835-0.972) and mechanical ventilation (ORadjusted: 165.256, 95% CI: 7.616-3585.714). Higher gestational age, higher birth weight, higher APGAR score and longer duration of hospitalization were singled out as protective factors, while use of mechanical ventilation increased the risk of death. Major limitations of the study were retrospective nature and relatively small number of identified cases. Postponing delivery and delivery in institution with neonatal intensive care unit are crucial for survival of newborns with NRDS.

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MO521OUTCOME OF CHRONIC KIDNEY DISEASE PATIENTS WITH SARS COV-2 INFECTION- A SINGLE CENTRE EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0041 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jelena Bjedov ◽

Ana Bulatovic ◽

Vesna Maslarevic Radovic ◽

Nada Dimkovic ◽

Radomir Naumovic

Keyword(s):

Chronic Kidney Disease ◽

Mechanical Ventilation ◽

Kidney Disease ◽

Adverse Outcome ◽

Statistical Significance ◽

Fatal Outcome ◽

Chronic Dialysis ◽

Average Value ◽

Clinical Center ◽

Single Centre Experience

Abstract Background and Aims Since the outbreak of COVID 19 there have been 88.1 million confirmed cases and 1,9 million deaths in 218 countries, while in Serbia we have had 39.867 cases of COVID 19 and 3479 deaths with approximate death rate of 1%. Fatality rate worldwide vary widely, from 0% in Singapore to 8,8% in Mexico with the average value of 3%. Although there are many published studies about COVID 19, influence of chronic kidney disease and chronic dialysis on outcome of patients with the coronavirus infection is still not clear. The aim of this study was to explore whether the presence of CKD including ESRD and chronic dialysis treatment increases COVID 19 patients’ risk for adverse clinical outcome. Method This retrospective study included 88 patients who were hospitalized at the Nephrology department in Zvezdara University Clinical Center which was transformed into a COVID hospital at the time. These patients were treated from 01.04.2020. to 01.06.2020. and 37 (42%) of them had CKD, while 51 (58%) had no signs of kidney disease. We analysed data collection from the patients’ history, including age, sex, comorbidities, symptoms, blood and radiology findings, therapy and outcome. We compared outcome (fatal and need for mechanical ventilation) between CKD and non CKD group and also analized dialysis as a risk factor for adverse outcome. Statistical analysis has been performed using SPSS software version 20 and OR was calculated using Logistic Regression. Results We analysed 88 patients, a mean age of 62+15 years, 59.1% males. Out of 88 patients, 37 had CKD, while 27 of them were on hemodialysis and 2 on peritoneal dialysis (CAPD). At the end of follow-up, 46 patients (52.3%) was discharged home, 27 (30.7%) was transferred to another hospital and 14 (15.9%) died. Regarding influence of CKD on COVID-19 patients’ outcome it was shown that patients with CKD had 3-fold higher chances for discharge than for the fatal outcome (p=0.05) and 4-fold less risk for use of the mechanical ventilation (ns) as compared to non CKD patients. We also found that ESRD and chronic dialysis affect outcome with statistical significance (p=0.01) in a way that it doubles the risk for the adverse outcome. Conclusion Patients with CKD, especially those with ESRD had significantly higher risk for the lethal outcome and higher chances to require the mechanical ventilation.

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Paediatric intensive care admissions for respiratory syncytial virus bronchiolitis in France: results of a retrospective survey and evaluation of the validity of a medical information system programme

Epidemiology and Infection ◽

10.1017/s0950268811001208 ◽

2011 ◽

Vol 140 (4) ◽

pp. 608-616 ◽

Cited By ~ 14

Author(s):

A.-L. SOILLY ◽

C. FERDYNUS ◽

O. DESPLANCHES ◽

M. GRIMALDI ◽

J. B. GOUYON

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Syncytial Virus ◽

Medical Information ◽

National Registry ◽

Paediatric Intensive Care ◽

Medical Information System ◽

Retrospective Survey ◽

Syncytial Virus ◽

Systèmes D’Information

SUMMARYThe purpose of this study was to describe the characteristics of patients with bronchiolitis admitted to a paediatric intensive care unit (PICU), and to evaluate a national registry of hospitalizations (Programme de Médicalisation des Systèmes d'Information; PMSI) as a potential source of epidemiological data. Of the 49 French PICUs invited to take part in a retrospective survey of children aged <2 years who were hospitalized during the 2005–2006 epidemic season, 24 agreed to participate. Overall, 467 children were enrolled: 75% were aged <2 months, 76% had positive respiratory syncytial virus (RSV) tests, 34·9% required non-invasive ventilation, 36·6% were mechanically ventilated, and six infants died. The main neonatal characteristics were: prematurity (31·9%), respiratory disease (16·5%), congenital heart disease (6·4%), receiving mechanical ventilation (11·6%), and bronchopulmonary dysplasia at day 28 (3·8%). For bronchiolitis episode, the kappa coefficient between the survey and PMSI data was good only for mechanical ventilation (0·63) and the death rate (0·86).

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