Role of HRCT Chest in Diagnosing Covid-19 Disease in Initially RT-PCR Negative Patients

Objective: To analyze CTSS score in clinically symptomatic COVID-19 patients having initial negative RT-PCR report. Design of the Study: It’s a retrospective cross sectional descriptive study. Study Settings: This study was carried out at Radiology Department, CMH Lahore from July to December 2021. Material and Methods: A total of 1000 patients presented with suspected clinical symptoms of covid-19. 770 were male patients (average of 52±15yrs) and 230 were female patients (49±15 years).Out of which 235 (23.5%) patients had initial negative PCR report & 765 patients had initial PCR positive report. 235 initial PCR negative patients got positive PCR report on subsequent repeat testing. All the patients underwent HRCT chest. Results of the Study: CTSS score of 765 PCR positive patients was determined as 545 (71.2%) having mild to moderate disease (<19.5 CTSS) and 220 (28.7%) as having severe disease (>19.5 CTSS).CTSS score of 235 PCR negative patients was determined on HRCT chest and classified as 210 (89.3%) having mild to moderate disease (<19.5 CTSS) and 25 (10.6%) as having severe disease (>19.5 CTSS). CO-RADS scoring were done and HRCT pattern analyzed in all the patients according to the standard protocol. Multivariate analysis was performed and showed significant correlation between CTSS score and initial PCR negative patients. Sensitivity and specificity of CT chest in determining covid-19 findings was 89.3% and 28.7%.PPV was 89.8% and NPV was 27.8%. Conclusion: HRCT with CTSS scoring is an important tool for diagnosis of COVID-19 infection despite initial negative PCR, having sensitivity and specificity of 89.3% and 28.7% respectively. Timely identification and isolation of COVID-19 patients is helpful in preventing the spread of infection and also aid in prompt symptomatic management. Keywords: COVID-19, Computed Tomography, Ground-Glass Opacity, Reverse Transcriptase Polymerase Chain Reaction.

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Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

BMC Infectious Diseases ◽

10.1186/s12879-021-06214-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Israel Júnior Borges do Nascimento ◽

Dónal P. O’Mathúna ◽

Thilo Caspar von Groote ◽

Hebatullah Mohamed Abdulazeem ◽

Ishanka Weerasekara ◽

...

Keyword(s):

Systematic Reviews ◽

Troponin I ◽

Clinical Symptoms ◽

Meta Analysis ◽

Severe Disease ◽

Ground Glass Opacity ◽

Cochrane Library ◽

Reactive Protein ◽

Overview Of Systematic Reviews ◽

The Impact

Abstract Background Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic. Methods Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes. Results Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%. Conclusions In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

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O-104 Low SARS-CoV-2 positivity rate in women included in ART programs following the recommendations of the Spanish scientific societies on reproduction (SEF/ASEBIR)

Human Reproduction ◽

10.1093/humrep/deab126.008 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

D Mataro ◽

I Cuevas-Saiz ◽

J A Castilla ◽

J A Dominguez ◽

N Prados ◽

...

Keyword(s):

Clinical Symptoms ◽

Intrauterine Insemination ◽

Cross Sectional Study ◽

Screening Strategy ◽

Clinical Interview ◽

The Other ◽

Medical Procedure ◽

Rt Pcr ◽

Cross Sectional ◽

Aggregated Data

Abstract Study question What is the SARS-CoV-2 positivity rate following the Spanish Fertility Society (SEF)/Association for the Study of Reproductive Biology (ASEBIR) screening recommendations? Summary answer The SARS-CoV-2 positivity rate in the centers following the SEF/ASEBIR screening recommendations was 0.316% after the first survey and 0.364% after the second one What is known already Due to the Sars-Cov-2 pandemic, all the Medical Assisted Reproduction (MAR) centers in Spain had to interrupt their activity most of the time during the first pandemic wave. On April 27th activity was restarted, and SEF and ASEBIR jointly elaborated a guide describing their SARS-CoV-2 screening recommendations for MAR centers. This document aims to achieve a safe environment for patients and staff. It includes the possibility of screening patients through a targeted clinical interview and the use of reverse-transcriptase polymerase chain reaction (RT-PCR). The aim of this study is to quantify the SARS-CoV-2 positivity rate based on these recommendations. Study design, size, duration National multicenter cross-sectional study. Information was gathered from centers using an anonymous survey asking for aggregated data about the number of positive cases among screened patients, sent twice. The first survey covered the period April 27th - June 30th. Second survey covered July 1st - August 31st. Response rates among centres were 9% (29/319) and 6% (20/319), respectively. This study includes 2,695 and 4,068 screenings performed in the first and the second survey, respectively. Participants/materials, setting, methods The SEF/ASEBIR recommendations describe two screening strategies. Strategy (a) consists in a targeted clinical interview (TCI) evaluating clinical symptoms and exposure risk, first before starting the cycle, and before egg-retrieval, intrauterine insemination (IUI), and/or embryo transfer (ET). Suspicious cases could be confirmed by further RT-PCR testing. Strategy (b) consists in conducting the same first TCI, and a systematic RT-PCR testing before the medical procedure in all patients. All patients in both strategies have a TCI. Main results and the role of chance In the 1st survey, 1,177 screenings and 919 RT-PCR (78.07%) were performed before the egg-retrieval. One patient with a negative TCI and positive RT-PCR was detected, and the cycle was cancelled. 1,518 screenings and 1,161 RT-PCRs (76.48%) were performed before the ET/IUI. Two patients with a positive TCI were detected, one did not perform a RT-PCR, while the other resulted in a positive RT-PCR. Both cycles were cancelled. Besides, 5 patients with negative TCI performed a RT-PCR with a positive result; all 5 were cancelled. Overall, the SARS-CoV-2 positivity rate was 8/2533 (0.316%), of which 7/2533 (0.276%) were identified by RT-PCR testing. The 2nd survey included 1,376 screenings and 1,009 RT-PCR (73.32%) performed before the egg-retrieval. Four patients with negative TCI and further positive RT-PCR were detected, and their cycle was cancelled. 2,692 screenings and 2,134 RT-PCR (79.27%) were performed before ET/IUI. Two patients had a positive TCI, one with a negative, the other with a positive RT-PCR testing; both cycles were cancelled. Besides, 8 patients with negative TCI, but positive RT-PCR testing, were detected and their cycles cancelled. Overall, the SARS-CoV-2 positivity rate was 14/3846 (0.364%), of which 13/3846 (0.338%) after positive RT-PCR testing. Limitations, reasons for caution The criteria for performing the RT-PCR testing were not the same in all MAR Centres or even in the same centre at different times. Due to the low response rate of the study, we should not extend these results to all the MAR Centres in Spain. Wider implications of the findings The results of the surveys suggest that the SEF/ASEBIR recommendations could be a good screening strategy for SARS-Cov-2 at MAR Centres. Further survey collected at different times of the pandemic are warranted, including new strategies for screening as antigen tests or vaccination status. Trial registration number Not applicable

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A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias

Clinical Infectious Diseases ◽

10.1093/cid/ciaa247 ◽

2020 ◽

Vol 71 (15) ◽

pp. 756-761 ◽

Cited By ~ 95

Author(s):

Dahai Zhao ◽

Feifei Yao ◽

Lijie Wang ◽

Ling Zheng ◽

Yongjun Gao ◽

...

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Severe Pneumonia ◽

Ground Glass Opacity ◽

Chest Ct ◽

Rt Pcr ◽

Bilateral Involvement ◽

Radiological Features ◽

History Of ◽

Novel Coronavirus

Abstract Background A novel coronavirus (COVID-19) has raised world concern since it emerged in Wuhan, China in December 2019. The infection may result in severe pneumonia with clusters of illness onsets. Its impacts on public health make it paramount to clarify the clinical features with other pneumonias. Methods Nineteen COVID-19 and 15 other patients with pneumonia (non-COVID-19) in areas outside of Hubei were involved in this study. Both COVID-19 and non-COVID-19 patients were confirmed to be infected using throat swabs and/or sputa with/without COVID-2019 by real-time RT-PCR. We analyzed the demographic, epidemiological, clinical, and radiological features from those patients, and compared the differences between COVID-19 and non-COVID-19. Results All patients had a history of exposure to confirmed cases of COVID-19 or travel to Hubei before illness. The median (IQR) duration was 8 (6–11) and 5 (4–11) days from exposure to onset in COVID-19 and non-COVID-19 cases, respectively. The clinical symptoms were similar between COVID-19 and non-COVID-19. The most common symptoms were fever and cough. Fifteen (78.95%) COVID-19 but 4 (26.67%) non-COVID-19 patients had bilateral involvement while 17 COVID-19 patients (89.47%) but 1 non-COVID-19 patient (6.67%) had multiple mottling and ground-glass opacity on chest CT images. Compared with non-COVID-19, COVID-19 presents remarkably more abnormal laboratory tests, including AST, ALT, γ-GT, LDH, and α-HBDH. Conclusions The COVID-19 infection has onsets similar to other pneumonias. CT scan may be a reliable test for screening COVID-19 cases. Liver function damage is more frequent in COVID-19 than non-COVID-19 patients. LDH and α-HBDH may be considerable markers for evaluation of COVID-19.

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Haemophagocytosis in a patient with Crimean–Congo haemorrhagic fever

Journal of Medical Microbiology ◽

10.1099/jmm.0.46910-0 ◽

2007 ◽

Vol 56 (8) ◽

pp. 1126-1128 ◽

Cited By ~ 15

Author(s):

Atahan Cagatay ◽

Mahir Kapmaz ◽

Asli Karadeniz ◽

Seniha Basaran ◽

Mustafa Yenerel ◽

...

Keyword(s):

Clinical Symptoms ◽

Severe Disease ◽

Case Fatality ◽

Haemorrhagic Fever ◽

Rt Pcr ◽

Patient History ◽

Endemic Region ◽

Cchf Virus ◽

History Of ◽

Crimean Congo Haemorrhagic Fever

Crimean–Congo haemorrhagic fever (CCHF) is a severe disease with a case fatality of 2.8 to 80 %. A patient dwelling in an endemic region for CCHF was admitted with fever preceding bleeding diathesis and pancytopenia. Despite no history of tick exposure, CCHF was highly suspected. With an oral ribavirin therapy, clinical and laboratory improvements were obtained. The diagnosis was confirmed by detection of IgM antibody to CCHF virus and positive RT-PCR. Although the main pathogenesis of CCHF infection is not elucidated yet, haemophagocytosis, a symptom rarely reported in viral haemorrhagic fevers, was observed in this case. Haemophagocytosis is suggested to have a role in the development of pancytopenia in CCHF, the mechanism of which still needs to be investigated, probably with cytokine studies. Together with clinical symptoms and patient history, haemophagocytosis may be an indicator for CCHF.

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Coronavirus Disease (COVID-19) Pandemic: An Overview of Systematic Reviews

10.1101/2020.04.16.20068213 ◽

2020 ◽

Cited By ~ 1

Author(s):

Israel Júnior Borges do Nascimento ◽

Dónal P. O’Mathúna ◽

Thilo Caspar von Groote ◽

Hebatullah Mohamed Abdulazeem ◽

Ishanka Weerasekara ◽

...

Keyword(s):

Systematic Reviews ◽

Troponin I ◽

Clinical Symptoms ◽

Meta Analysis ◽

Severe Disease ◽

Ground Glass Opacity ◽

Open Science ◽

Frequent Pattern ◽

Cochrane Library ◽

The Impact

AbstractBackgroundNavigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging and ongoing critical appraisal of this output is essential. We aimed to collate and summarize all published systematic reviews on the coronavirus disease (COVID-19).MethodsNine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS and Epistemonikos) were searched from December 1, 2019 to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory and radiological findings) and quality assessment (AMSTAR 2). Meta-analysis on prevalence of clinical outcomes was performed.ResultsEighteen systematic reviews were included; one was empty. Using AMSTAR 2, confidence in the results of 13 reviews was rated as “critically low”, one as “low”, one as “moderate” and two as “high”. Symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8– 12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein (associated with lymphocytopenia) and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. Chest imaging described a frequent pattern of uni- or bilateral multilobar ground-glass opacity. Only one review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3% to 14%.ConclusionsConfidence in the results of most reviews was “critically low”. Future studies and systematic reviews should adhere to established methodologies. The majority of included systematic reviews were hampered by imprecise search strategy and no previous protocol submission.Protocol registrationThis is an extension of a PROSPERO protocol (CRD42020170623); protocol available on Open Science Framework (https://osf.io/6xtyw).

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Efficacy and Safety of Indomethacin in Covid -19 patients

10.22541/au.161000568.81171409/v1 ◽

2021 ◽

Author(s):

Rajan Ravichandran ◽

Prasanna Purna ◽

Sivakumar Vijayaraghavalu ◽

Ravi Kalavakollu ◽

Shilpa Gaidhane ◽

...

Keyword(s):

Mechanical Ventilation ◽

Severe Disease ◽

Symptomatic Relief ◽

Blood Chemistry ◽

Efficacy And Safety ◽

Rt Pcr ◽

Disease Group ◽

Matched Group ◽

Moderate Disease ◽

Number Of Patients

Background Indomethacin, a well-known non-steroidal anti-inflammatory drug (NSAID), with effective broad spectrum anti-viral activity, was evaluated for efficacy and safety of indomethacin in treating RT-PCR positive covid-19 patients Materials and Methods Patients with RT-PCR positive covid-19 who were admitted to hospital were offered the option to receive indomethacin 50 to 75mg daily in addition to the Indian council of medical research (ICMR) standard covid-19 treatment. Patients who declined the indomethacin option were offered paracetamol for pain and fever. The endpoint was the development of hypoxia. Secondary endpoints were time to become afebrile and time to resolution of cough and myalgia. Propensity Score Matching was used to compare indomethacin and paracetamol treatments. A separate group of severely ill patients who were admitted with hypoxia were treated with indomethacin 75mg; the endpoint was the requirement for mechanical ventilation or admission to the intensive care unit (ICU). Blood chemistry was collected before and after the treatment. The patients were monitored every day for clinical parameters. . Results A total of 104 patients received indomethacin, 82 with mild-moderate disease and 22 with severe disease. Matching reduced the number of patients to 72. In the indomethacin mild-moderate disease group, one patient out of 72 in the matched group developed hypoxia and required oxygen compared with 28 out of 72 patients in the matched group who received paracetamol. Patients who received indomethacin also experienced more rapid symptomatic relief compared to paracetamol arm. In the indomethacin severe disease group no patient deteriorated enough to require mechanical ventilation. There were no adverse reactions to indomethacin or deterioration of renal or liver function. Conclusion The use of indomethacin compared with paracetamol, in addition to the standard ICMR treatment in hospitalised covid-19 patients was associated with marked reductions in the severity and duration of illness, without any adverse effects.

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A laboratory-based study of COVID-19 in Casablanca, Morocco

Journal of Public Health in Africa ◽

10.4081/jphia.2021.1458 ◽

2020 ◽

Author(s):

Idrissa Diawara ◽

Houda Benrahma ◽

Nida Meskaouni ◽

Jalila Rahoui ◽

Fatima-Zahra Moujid ◽

...

Keyword(s):

Clinical Symptoms ◽

Laboratory Diagnosis ◽

University Hospital ◽

Reference Laboratory ◽

Rt Pcr ◽

Exposure Risk ◽

Cross Sectional ◽

Risk Zone ◽

Laboratory Confirmation ◽

One Step

Background: Given the spread of coronavirus disease 2019 (COVID-19) and its impact on human health, laboratory confirmation of diagnosis is essential. Objective: This study examined the contribution of laboratory diagnosis to the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the diagnosis of COVID- 19, taking into account patient risk of exposure to SARS-CoV-2, clinical symptoms and comorbidities. Methods: A cross-sectional, laboratory-based study was carried out from 1 April 2020 to 30 April 2020 at the National Reference Laboratory in Morocco using nasopharyngeal samples from patients admitted to the Cheikh Khalifa International University Hospital or other hospitals in Casablanca. A one-step reverse transcription real-time polymerase chain reaction (RT-PCR) was used to detect the presence of the SARS-CoV-2 genome. A national epidemiological investigation form was used to analyze patient exposure risk, clinical symptoms and comorbidities. Results: A total of 793 samples from 375 patients were analyzed and 1150 RT-PCR tests were conducted; 116 patients (30.93%) were COVID-19 positive. Travel to a risk zone, contact with a confirmed COVID-19 case and contact with a person who had been in a risk zone were significantly associated with being positive for COVID-19. Fever and cough were the main symptoms; 7.76 % of positive patients were asymptomatic. Conclusion: This is the first laboratory-based study in Morocco for the diagnosis of COVID- 19. Laboratory diagnosis of COVID-19 by RT-PCR associated with knowledge of exposure risk factors and clinical symptoms and comorbidities remains essential for clinicians for early, appropriate medical management COVID-19 patients.

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CLINICAL PROFILE OF COVID-19 PATIENTS ADMITTED IN A TERTIARY CARE COVID HOSPITAL-AN OBSERVATIONAL STUDY

10.36106/ijar/3007073 ◽

2020 ◽

pp. 15-16

Author(s):

S. Durga Prasad ◽

K.V. Seshaiah ◽

K.S.S.S.Surya Prakash ◽

N. Lavanya ◽

Ch.Akhil Reddy ◽

...

Keyword(s):

Observational Study ◽

Viral Infections ◽

Clinical Symptoms ◽

Severe Disease ◽

Tertiary Care ◽

Care Hospital ◽

Cross Sectional ◽

Multiple Systems ◽

Mild Disease ◽

System Methodology

BACKGROUND: Since the origin of Covid-19, a plethora of symptoms have been described in the past few months, which indicate involvement of multiple systems with much more impact on the respiratory system. METHODOLOGY: We retrospectively evaluated from the medical records of 100 Covid-19 patients diagnosed with RT-PCR. It was a cross-sectional observational study of Covid-19 patients admitted in our tertiary COVID care hospital, Vijayawada, Andhra Pradesh during the period of two months i.e.,01-04-2020 to 31-05-2020. RESULTS: We observed the different clinical symptoms with varying frequency in Covid-19 patients. In our study the clinical symptoms in the descending order of frequency were fever (59%), cough (48%), diarrhoea (6%), dyspnoea (4%), running nose (3%), headache (3%), chest pain (1%). These symptoms are not specific to covid-19 but similar to those found in other viral infections. CONCLUSION: Based on clinical picture, disease has been classified as mild, moderate and severe. More than 80% patients have mild disease and will recover.14% will have severe disease and 5% will progress to respiratory failure, shock and multiorgan dysfunction.1-2% are fatal.

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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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Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.123273 ◽

2010 ◽

Vol 69 (11) ◽

pp. 1951-1957 ◽

Cited By ~ 61

Author(s):

Lijana Krause ◽

Mike O Becker ◽

Claudia S Brueckner ◽

Christina-Julia Bellinghausen ◽

Corinna Becker ◽

...

Keyword(s):

Systemic Sclerosis ◽

Nutritional Status ◽

Clinical Symptoms ◽

Energy Requirement ◽

Severe Disease ◽

Cell Mass ◽

Bioelectrical Impedance ◽

Cross Sectional ◽

Nutritional Treatment ◽

Healthy Donors

ObjectiveTo assess and analyse nutritional status in patients with systemic sclerosis (SSc) and identify possible associations with clinical symptoms and its prognostic value.MethodsBody mass index (BMI) and parameters of bioelectrical impedance analysis (BIA) were assessed in 124 patients with SSc and 295 healthy donors and matched for sex, age and BMI for comparisons. In patients with SSc, BMI and BIA values were compared with clinical symptoms in a cross-sectional study. In a prospective open analysis, survival and changes in the nutritional status and energy uptake induced by nutritional treatment were evaluated.ResultsPatients with SSc had reduced phase angle (PhA) values, body cell mass (BCM), percentages of cells, increased extracellular mass (ECM) and ECM/BCM values compared with healthy donors. Malnutrition was best reflected by the PhA values. Of the patients with SSc, 69 (55.7%) had malnutrition that was associated with severe disease and activity. As assessed by multivariate analysis, low predicted forced vital capacity and high N-terminal(NT)-proBNP values discriminated best between good and bad nutritional status. Among different clinical parameters, low PhA values were the best predictors for SSc-related mortality. BMI values were not related to disease symptoms or mortality. Fifty per cent of patients with SSc had a lower energy uptake related to their energy requirement, 19.8% related to their basal metabolism. Nutritional treatment improved the patients' nutritional status.ConclusionsIn patients with SSc, malnutrition is common and not identified by BMI. BIA parameters reflect disease severity and provide best predictors for patient survival. Therefore, an assessment of nutritional status should be performed in patients with SSc.

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