Case Report: Potential Role of Corticosteroids in the Management of Post-COVID-19 Pneumonia

Certain patients who recover from severe pneumonia due to coronavirus disease 2019 (COVID-19) remain symptomatic in the post-infectious period, either clinically, radiologically, or respiratory. The post-COVID-19 period is characterized by clinical symptoms of varying duration from one subject to another and does not seem to depend on the severity of initial pneumonia. The persisting inflammatory and/or immune reactions in the post-COVID-19 period may play a role in the development of pulmonary lesions. Here, we report the case of a 61-year-old man with severe COVID-19 pneumonia, complicated by acute respiratory distress syndrome and pulmonary embolism, which required the patient's admission to the intensive care unit and high-flow oxygen therapy. The patient was hospitalized for 23 days for the management of his severe COVID-19 pneumonia. Afterwards, he was discharged home following a negative SARS-CoV-2 PCR test. The post-COVID-19 period was characterized by a complex respiratory symptomatology associating cough, resting dyspnea, and exertional dyspnea requiring oxygen therapy for several weeks. Surprisingly, the follow-up chest CT scan performed 4 weeks after discharge revealed bilateral interstitial lung lesions. After ruling out pulmonary superinfection, the patient was treated with oral corticosteroid for 3 months at a digressive dose. In our case, the use of corticosteroid therapy in the post-COVID19 phase had improved the outcome of the lung disease. These benefits are characterized by a rapid symptomatic improvement, accelerated repair of pulmonary images, rapid oxygen withdrawal, and rapid return to daily activities.

Impact of Cardiovascular Failure in Intensive CareUnit-Acquired Pneumonia: A Single-Center, Prospective Study

Background: Cardiovascular failure (CVF) may complicate intensive care unit-acquired pneumonia (ICUAP) and radically alters the empirical treatment of this condition. The aim of this study was to determine the impact of CVF on outcome in patients with ICUAP. Methods: A prospective, single-center, observational study was conducted in six medical and surgical ICUs at a University Hospital. CVS was defined as a score of 3 or more on the cardiovascular component of the Sequential Organ Failure Assessment (SOFA) score. At the onset of ICUAP, CVF was reported as absent, transient (if lasting ≤ 3 days) or persistent (>3 days). The primary outcome was 90-day mortality modelled through a Cox regression analysis. Secondary outcomes were 28-day mortality, hospital mortality, ICU length of stay (LOS) and hospital LOS. Results: 358 patients were enrolled: 203 (57%) without CVF, 82 (23%) with transient CVF, and 73 (20%) with persistent CVF. Patients with transient and persistent CVF were more severely ill and presented higher inflammatory response than those without CVF. Despite having similar severity and aetiology, the persistent CVF group more frequently received inadequate initial antibiotic treatment and presented more treatment failures than the transient CVF group. In the persistent CVF group, at day 3, a bacterial superinfection was more frequently detected. The 90-day mortality was significantly higher in the persistent CVF group (62%). The 28-day mortality rates for patients without CVF, with transient and with persistent CVF were 19, 35 and 41% respectively and ICU mortality was 60, 38 and 19% respectively. In the multivariate analysis chronic pulmonary conditions, lack of Pa02/FiO2 improvement at day 3, pulmonary superinfection at day 3 and persistent CVF were independently associated with 90-day mortality in ICUAP patients. Conclusions: Persistent CVF has a significant impact on the outcome of patients with ICUAP. Patients at risk from persistent CVF should be promptly recognized to optimize treatment and outcomes.

POS1000 COMORBIDITIES ASSOCIATED TO SPONDYLOARTHRITIS

Background:In contrast to other chronic rheumatic diseases such as rheumatoid arthritis, comorbidities associated to spondyloarthritis (SpA) and their impact on disease outcomes are less well studied.Objectives:The aim of our study was to investigate the prevalence of comorbidities among SpA patients and to determine factors influencing their appearance.Methods:We conducted a retrospective study including patients meeting the Assessment of SpondyloArthritis International Society (ASAS) criteria between 2000 and 2020.The following comorbidities were collected: cardiovascular pathologies and their risk factors (smoking, arterial hypertension, diabetes, dyslipidemia and obesity), neoplasms, osteoporosis, depression, infections, gastrointestinal and pulmonary disorders.Results:We included 138 patients. Sixty-eight per cent of them were males. The mean age was 45.73 ± 12.66 years. The mean age at the disease onset was 28.89 ± 12.54 years. The mean CRP was 33.38 ± 39.65 mg/dL. The mean BASDAI and ASDAS-CRP were 4.21 ±2.23 and 3.06 ± 1.26, respectively. The mean BASFI was 4.77 ± 2.58.Sixty patients had at least one comorbidity (43.5%): 53 patients had one comorbidity (38.4%), 21 accumulated two types of comorbidities (15.2%) and 7 patients accumulated three types or more (5%).Osteoporosis was the most frequent comorbidity, it was present in 23.1% of the cases (n=32), followed by tuberculosis 8.7% (n=12), stomach ulcers 5.1% (n=7), pulmonary superinfection 2.9% (n=4), neoplasia 2.2% (n=3) and then depression 1.4% (n=2).Cardiovascular risk factors were noted in 44 patients (31.9%): hypertension (15.9%), diabetes (12.3%), dyslipidemia (9.4%) and obesity (8.7%).Thirty-seven per cent of our patients were smokers.SpA patients with comorbidities were significantly older than those without (50.2±11.07 versus 42.3±12.8 years, p<0.0001).The presence of comorbidities was significantly associated to a higher disease activity evaluated by BASDAI (p=0.005) and ASDAS-CRP (p=0.002). Furthermore, BASFI was significantly higher among patients with comorbidities (5.47±2.38 versus 4.31±2.62, p=0.028).However, no association was found between presence of comorbidities and smocking or CRP.Conclusion:Our results show that more than 40% of our SpA patients presented with at least one comorbidity. Remarkably, the presence of comorbidities was associated with high disease activity, suggesting that that inflammation might promotes comorbidities. For optimal management of SpA, a systemic screening for comorbidities is essential.Disclosure of Interests:None declared.

Pulmonary superinfection with multidrug-resistant germs in a patient with immunocompromised status

Infection with multidrug-resistant germs occurs in certain population at risk, usually in patients admitted in intensive care and is characterized by a high mortality. This paper presents the case of a patient with immunocompromised status witch associate a community lung infection with multiresistant gram-negative bacteria pneumonia. Fast bacteriological identification of the germs involved in lung infection allowed modification of antibiotic approach and a favorable outcome.