Corpus overview


Overview

MeSH Disease

Human Phenotype

Hypertension (179)

Fever (55)

Cough (47)

Pneumonia (31)

Obesity (25)


Transmission

Seroprevalence
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     Seroprevalence of SARS-CoV-2 in an Asymptomatic TRANS US Population 

    Authors: Steven Rigatti, MD; Robert L. Stout, PhD.

    doi:10.21203/rs.3.rs-80313/v1 Date: 2020-09-18 Source: ResearchSquare

    Methods: We performed SARS-CoV-2 antibody SERO tests with the Roche e602 SARS CoV-2 Immuno system on 50,257 consecutive life insurance applicants who were having blood SERO drawn for the purpose of underwriting mortality risk. Other variables included height, weight, and blood SERO pressure at the time of the blood SERO draw, a history of smoking and common ch ronic diseases ( MESHD hypertension HP pertension, MESHDhe art disease, MESHDdi abetes, MESHDand ca ncer). MESHDResults: The overall prevalence SERO of SARS-CoV-2 was 3.0%, and was fairly consistent across the age TRANS range and similar in males TRANS and females TRANS. Geographical distribution revealed a very high level of positivity in the state of New York compared to all other areas (17.1%). Using US Census state population data to adjust state specific rates of positivity, it is estimated that this level of seropositivity would correspond to 6.98 million (99% CI: 6.56-7.38 million) SA RS-CoV-2 infections i MESHDn the US, which is 3.8 times the cumulative number of cases in the US reported to the CDC as of June 1, 2020.Conclusions: The estimated number of total SA RS-CoV-2 infections b MESHDased on positive serology is substantially higher than the total number of cases reported to the CDC. There is no apparent increase of risk of infection TRANS risk of infection TRANS fection f MESHDor individuals self-reporting, smoking, di abetes, MESHDhe art disease, MESHD hypertension HP pertension o MESHDr ca ncer. MESHD

    LOW BIRTH WEIGHT AS A RISK FACTOR FOR SEVERE COVID-19 IN ADULTS TRANS

    Authors: Fatima Crispi; Francesca Crovetto; Marta Larroya; Marta Camacho; Oriol Sibila; Joan Ramon Badia; Marta Lopez; Kilian Vellve; Ferran Garcia; Antoni Trilla; Rosa Faner; Isabel Blanco; Roger Borras; Alvar Agusti; Eduard Gratacos

    doi:10.1101/2020.09.14.20193920 Date: 2020-09-15 Source: medRxiv

    The identification of factors predisposing to severe COVID-19 in young adults TRANS remains partially characterized. Low birth weight (LBW) alters cardiovascular and lung development and predisposes to adult TRANS disease. We hypothesized that LBW is a risk factor for severe COVID-19 in non- elderly TRANS subjects. We analyzed a prospective cohort of 397 patients (18-70y) with laboratory-confirmed SARS-CoV-2 infection MESHD attended in a tertiary hospital, where 15% required admission to Intensive Care Unit (ICU). Perinatal and current potentially predictive variables were obtained from all patients and LBW was defined as birth weight [≤]2,500 g. Age TRANS (adjusted OR (aOR) 1.04 [1-1.07], P=0.012), male TRANS sex (aOR 3.39 [1.72-6.67], P<0.001), hypertension HP hypertension MESHD (aOR 3.37 [1.69-6.72], P=0.001), and LBW (aOR 3.61 [1.55-8.43], P=0.003) independently predicted admission to ICU. The area under the receiver-operating characteristics curve (AUC) of this model was 0.79 [95% CI, 0.74-0.85], with positive and negative predictive values SERO of 29.1% and 97.6% respectively. Results were reproduced in an independent cohort, from a web-based survey in 1,822 subjects who self-reported laboratory-positive SARS-CoV-2 infection MESHD, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68-0.81]). LBW seems to be an independent risk factor for severe COVID-19 in non- elderly TRANS adults TRANS and might improve the performance SERO of risk stratification algorithms.

    Predicting clinical outcome with phenotypic clusters in COVID-19 pneumonia HP pneumonia MESHD: 2 an analysis of 12,066 hospitalized patients from the Spanish registry SEMI-3 COVID-19.

    Authors: Manuel Rubio-Rivas; Xavier Corbella; Jose Maria Mora-Lujan; Jose Loureiro Amigo; Almudena Lopez Sampalo; Carmen Yera Bergua; Pedro Jesus Esteve Atienzar; Luis Felipe Diez Garcia; Ruth Gonzalez Ferrer; Susana Plaza Canteli; Antia Perez Pineiro; Begona Cortes Rodriguez; Leyre Jorquer Vidal; Ignacio Perez Catalan; Marta Leon Tellez; Jose Angel Martin Oterino; Maria Candelaria Martin Gonzalez; Jose Luis Serrano Carrillo de Albornoz; Eva Garcia Sardon; Jose Nicolas Alcala Pedrajas; Anabel Martin Urda Diez Canseco; Maria Jose Esteban Giner; Pablo Telleria Gomez; Ricardo Gomez Huelgas; Jose Manuel Ramos Rincon; Nina la Cour Freiesleben; Henriette Svarre Nielsen

    doi:10.1101/2020.09.14.20193995 Date: 2020-09-15 Source: medRxiv

    (1) Background: This study aims to identify different clinical phenotypes in COVID-19 88 pneumonia HP pneumonia MESHD using cluster analysis and to assess the prognostic impact among identified clusters in 89 such patients. (2) Methods: Cluster analysis including 11 phenotypic variables was performed in a 90 large cohort of 12,066 COVID-19 patients, collected and followed-up from March 1, to July 31, 2020, 91 from the nationwide Spanish SEMI-COVID-19 Registry. (3) Results: Of the total of 12,066 patients 92 included in the study, most were males TRANS (7,052, 58.5%) and Caucasian (10,635, 89.5%), with a mean 93 age TRANS at diagnosis of 67 years (SD 16). The main pre-admission comorbidities were arterial 94 hypertension HP hypertension MESHD (6,030, 50%), hyperlipidemia HP hyperlipidemia MESHD (4,741, 39.4%) and diabetes mellitus HP diabetes mellitus MESHD (2,309, 19.2%). The 95 average number of days from COVID-19 symptom onset TRANS to hospital admission was 6.7 days (SD 7). 96 The triad of fever HP fever MESHD, cough HP cough MESHD, and dyspnea HP dyspnea MESHD was present almost uniformly in all 4 clinical phenotypes 97 identified by clustering. Cluster C1 (8,737 patients, 72.4%) was the largest, and comprised patients 98 with the triad alone. Cluster C2 (1,196 patients, 9.9%) also presented with ageusia and anosmia MESHD anosmia HP; 99 cluster C3 (880 patients, 7.3%) also had arthromyalgia, headache HP headache MESHD, and sore throat; and cluster C4 100 (1,253 patients, 10.4%) also manifested with diarrhea HP diarrhea MESHD, vomiting HP vomiting MESHD, and abdominal pain HP abdominal pain MESHD. Compared to 101 each other, cluster C1 presented the highest in-hospital mortality (24.1% vs. 4.3% vs. 14.7% vs. 102 18.6%; p<0.001). The multivariate study identified phenotypic clusters as an independent factor for 103 in-hospital death. (4) Conclusion: The present study identified 4 phenotypic clusters in patients with 104 COVID-19 pneumonia HP pneumonia MESHD, which predicted the in-hospital prognosis of clinical outcomes.

    Risk Factors Analysis of COVID-19 Patients with ARDS MESHD and Prediction Based on Machine Learning

    Authors: Wan Xu; Nan-Nan Sun; Hai-Nv Gao; Zhi-Yuan Chen; Ya Yang; Bin Ju; Ling-Ling Tang

    doi:10.21203/rs.3.rs-77820/v1 Date: 2020-09-15 Source: ResearchSquare

    COVID-19 is a newly emerging infectious disease MESHD, which is generally susceptible to human beings and has caused huge losses to people's health. Acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD) is one of the common clinical manifestations of severe COVID-19 and it is also responsible for the current shortage of ventilators worldwide. This study aims to analyze the clinical characteristics of COVID-19 ARDS MESHD patients and establish a diagnostic system based on artificial intelligence (AI) method to predict the probability of ARDS in COVID-19 patients. We collected clinical data of 659 COVID-19 patients from 11 regions in China. The clinical characteristics of the two groups were elaborately compared and both traditional machine learning algorithms MESHD and deep learning-based methods were used to build the prediction models. Results indicated the median age TRANS of ARDS MESHD patients was 56.5 years old, which was significantly older than those with non-ARDS by 7.5 years. Male TRANS and patients with BMI>25 were more likely to develop ARDS MESHD. The clinical features of ARDS MESHD patients included cough HP (80.3%), polypnea (59.2%), lung consolidation (53.9%), secondary bacterial infection MESHD (30.3%), and comorbidities such as hypertension HP hypertension MESHD (48.7%). Abnormal biochemical indicators such as lymphocyte count, leukocyte counting, CK, NLR, AST, LDH, and CRP were all strongly related to the aggravation of ARDS. Furthermore, through various AI methods for modeling and prediction effect evaluation based on the above risk factors, decision tree achieved the best AUC, sensitivity SERO, and specificity in identifying the mild patients who were easy to develop ARDS MESHD, which undoubtedly helps to optimize the treatment strategy, reduce mortality, and relieve the medical pressure. 

    The Effect of Early Hydroxychloroquine-based Therapy in COVID-19 Patients in Ambulatory Care Settings: A Nationwide Prospective Cohort Study

    Authors: Tarek Sulaiman; Abdulrhman Mohana; Laila Alawdah; Nagla Mahmoud; Mustafa Hassanein; Tariq Wani; Amel Alfaifi; Eissa Alenazi; Nashwa Radwan; Nasser AlKhalifah; Ehab Elkady; Manwer AlAnazi; Mohammed Alqahtani; Khalid Abdalla; Yousif Yousif; Fouad AboGazalah; Fuad Awwad; Khaled AlabdulKareem; Fahad AlGhofaili; Ahmed AlJedai; Hani Jokhdar; Fahad Alrabiah

    doi:10.1101/2020.09.09.20184143 Date: 2020-09-13 Source: medRxiv

    ABSTRACT BACKGROUND: Currently, there is no proven effective therapy nor vaccine for the treatment of SARS-CoV-2. Evidence regarding the potential benefit of early administration of hydroxychloroquine (HCQ) therapy in symptomatic patients with Coronavirus Disease MESHD (COVID-19) is not clear. METHODS: This observational prospective cohort study took place in 238 ambulatory fever HP clinics in Saudi Arabia, which followed the Ministry of Health (MOH) COVID-19 treatment guideline. This guideline included multiple treatment options for COVID-19 based on the best available evidence at the time, among which was Hydroxychloroquine (HCQ). Patients with confirmed COVD-19 (by reverse transcriptase polymerase chain reaction (PCR) test) who presented to these clinics with mild to moderate symptoms during the period from 5-26 June 2020 were included in this study. Our study looked at those who received HCQ-based therapy along with supportive care (SC) and compared them to patients who received SC alone. The primary outcome was hospital admission within 28-days of presentation. The secondary outcome was a composite of intensive care admission (ICU) and/or mortality during the follow-up period. Outcome data were assessed through a follow-up telephonic questionnaire at day 28 and were further verified with national hospitalisation and mortality registries. Multiple logistic regression model was used to control for prespecified confounders. RESULTS: Of the 7,892 symptomatic PCR-confirmed COVID-19 patients who visited the ambulatory fever HP clinics during the study period, 5,541 had verified clinical outcomes at day 28 (1,817 patients in the HCQ group vs 3,724 in the SC group). At baseline, patients who received HCQ therapy were more likely to be males TRANS who did not have hypertension HP hypertension MESHD or chronic lung disease HP lung disease MESHD compared to the SC group. No major differences were noted regarding other comorbid conditions. All patients were presenting with active complaints; however, the HCQ groups had higher rates of symptoms compared to the SC group ( fever HP fever MESHD: 84% vs 66.3, headache HP headache MESHD: 49.8 vs 37.4, cough HP: 44.5 vs 35.6, respectively). Early HCQ-based therapy was associated with a lower hospital admission within 28-days compared to SC alone (9.4% compared to 16.6%, RRR 43%, p-value <0.001). The composite outcome of ICU admission and/or mortality at 28-days was also lower in the HCQ group compared to the SC (1.2% compared to 2.6%, RRR 54%, p-value 0.001). Adjusting for age TRANS, gender TRANS, and major comorbid conditions, a multivariate logistic regression model showed a decrease in the odds of hospitalisation in patients who received HCQ compared to SC alone (adjusted OR 0.57 [95% CI 0.47-0.69], p-value <0.001). The composite outcome of ICU admission and/or mortality was also lower for the HCQ group compared to the SC group controlling for potential confounders (adjusted OR 0.55 [95% CI 0.34-0.91], p-value 0.019). CONCLUSION: Early intervention with HCQ-based therapy in patients with mild to moderate symptoms at presentation is associated with lower adverse clinical outcomes among COVID-19 patients, including hospital admissions, ICU admission, and/or death.

    SARS-CoV-2 Antibody SERO Prevalence SERO and Association with Routine Laboratory Values in a Life Insurance Applicant Population

    Authors: Steven J. Rigatti; Robert Stout; Ruth E Mitchell; Michael V Holmes; George Davey Smith; Dominik Schulz; Ulrich Mayr; Jochen Schneider; Christoph Spinner; Fabian Geisler; Roland M. Schmid; Tobias Lahmer; Wolfgang Huber; Xiushan Yin; Arsen Arakelyan; Denise Haslwanter; Rohit Jangra; Alev Celikgil; Duncan Kimmel; James H Lee; Margarette Mariano; Antonio Nakouzi; Jose Quiroz; Johanna Rivera; Wendy A Szymczak; Karen Tong; Jason Barnhill; Mattias NE Forsell; Clas Ahlm; Daniel T. Stein; Liise-anne Pirofski; Doctor Y Goldstein; Scott J. Garforth; Steven C. Almo; Johanna P. Daily; Michael B. Prystowsky; James D. Faix; Amy S. Fox; Louis M. Weiss; Jonathan R. Lai; Kartik Chandran

    doi:10.1101/2020.09.09.20191296 Date: 2020-09-11 Source: medRxiv

    Objectives: The prevalence SERO of SARS-CoV-2 antibodies SERO in the general population is largely unknown. Since many infections MESHD, even among the elderly TRANS and other vulnerable populations, are asymptomatic TRANS, the prevalence SERO of antibodies SERO could help determine how far along the path to herd immunity the general population has progressed. Also, in order to clarify the clinical manifestations of current or recent past COVID-19 illness, it may be useful to determine if there are any common alterations in routine clinical laboratory values. Methods: We performed SARS-CoV-2 antibody SERO tests on 50,130 consecutive life insurance applicants who were having blood SERO drawn for the purpose of underwriting (life risk assessment). Subjects were also tested for lipids, liver function tests, renal function studies, as well as serum SERO proteins. Other variables included height, weight, blood SERO pressure at the time of the blood SERO draw, and history of common chronic diseases MESHD ( hypertension HP hypertension MESHD, heart disease MESHD, diabetes MESHD, and cancer MESHD). Results: The overall prevalence SERO of SARS-CoV-2 was 3.0%, and was fairly consistent across the age TRANS range and similar in males TRANS and females TRANS. Several of the routine laboratory tests obtained were significantly different in antibody SERO-positive vs. antibody SERO-negative subjects, including albumin, globulins, bilirubin, and the urine albumin:creatinine ratio. The BMI was also significantly higher in the antibody SERO-positive group. Geographical distribution revealed a very high level of positivity in the state of New York compared to all other areas (17.1%). Using state population data from the US Census, it is estimated that this level of seropositivity would correspond to 6.98 million (99% CI: 6.56-7.38 million) SARS-CoV-2 infections MESHD in the US, which is 3.8 times the cumulative number of cases in the US reported to the CDC as of June 1, 2020. Conclusions: The estimated number of total SARS-CoV-2 infections MESHD based on positive serology is substantially higher than the total number of cases reported to the CDC. Certain laboratory values, particularly serum SERO protein levels, are associated with positive serology, though these associations are not likely to be clinically meaningful.

    Clinical Characteristics, Risk Factors and Predictive Value of COVID-19 Pneumonia HP: A Retrospective Study of 173 Patients in Wuhan, China

    Authors: Yang Zhang; Jun Xue; Mi Yan; Jing Chen; Hai Liu; Shao-Bo Wang; Jian-Xing Luo; Fang Yang; Jian-Yuan Tang; Xiao-Yu Hu

    doi:10.21203/rs.3.rs-76134/v1 Date: 2020-09-11 Source: ResearchSquare

    Background: COVID-19 is a globally emerging infectious disease MESHD. As the global epidemic continues to spread, the risk of COVID-19 transmission TRANS and diffusion in the world will also remain. Currently, several studies describing its clinical characteristics have focused on the initial outbreak, but rarely to the later stage. Here we described clinical characteristics, risk factors for disease severity and in-hospital outcome in patients with COVID-19 pneumonia HP pneumonia MESHD from Wuhan. Methods: Patients with COVID-19 pneumonia HP pneumonia MESHD admitted to Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 13 to March 8, 2020, were retrospectively enrolled. Multivariable logistic regression analysis was used to identify risk factors for disease severity and in-hospital outcome and establish predictive models. Receiver operating characteristic (ROC) curve was used to assess the predictive value of above models.Results: 106 (61.3%) of the patients were female TRANS. The mean age TRANS of study populations was 62.0 years, of whom 73 (42.2%) had underlying comorbidities mainly including hypertension HP hypertension MESHD (24.9%). The most common symptoms on admission were fever HP fever MESHD (67.6%) and cough HP (60.1%), digestive symptoms (22.0%) was also very common. Older age TRANS (OR: 3.420; 95%Cl: 1.415-8.266; P=0.006), diarrhea HP diarrhea MESHD (OR: 0.143; 95%Cl: 0.033-0.611; P=0.009) and lymphopenia HP lymphopenia MESHD (OR: 4.769; 95%Cl: 2.019-11.266; P=0.000) were associated with severe illness on admission; the area under the ROC curve (AUC) of predictive model were 0.860 (95%CI: 0.802-0.918; P=0.000). Older age TRANS (OR: 0.309; 95%Cl: 0.142-0.674; P=0.003), leucopenia (OR: 0.165; 95%Cl: 0.034-0.793; P=0.025), increased lactic dehydrogenase (OR: 0.257; 95%Cl: 0.100-0.659; P=0.005) and interleukins-6 levels (OR: 0.294; 95%Cl: 0.099-0.872; P=0.027) were associated with poor in-hospital outcome; AUC of predictive model were 0.752 (95%CI: 0.681-0.824; P=0.000).Conclusion: Older patients with diarrhea HP diarrhea MESHD and lymphopenia HP lymphopenia MESHD need early identification and timely intervention to prevent the progression to severe COVID-19 pneumonia HP pneumonia MESHD. However, older patients with leucopenia, increased lactic dehydrogenase and interleukins-6 levels are at a high risk for poor in-hospital outcome.Trial registration: ChiCTR2000029549

    Clinical Outcomes of Critically Ill Patients with COVID-19 by Race

    Authors: Fahad Marmarchi; Michael Liu; Srikant Rangaraju; Sara C Auld; Maria Christina Creel-Bulos; Christine L Kempton; Milad Sharifpour; Manila Gaddh; Roman Sniecinski; Cheryl L Maier; Fadi Nahab; Lars Heggelund; Kaj Blennow; Henrik Zetterberg; Hanne Flinstad Harbo; Niclas Johansson; Max Bell; Karin Lore; Anna Farnert; Anna Smed-Sorensen

    doi:10.1101/2020.09.07.20190074 Date: 2020-09-09 Source: medRxiv

    Background: Studies of COVID-19 have shown that African Americans have been affected by the virus at a higher rate compared to other races. This cohort study investigated comorbidities and clinical outcomes by race among COVID-19 patients admitted to the intensive care unit. Methods: This is a case series of critically ill MESHD patients admitted with COVID-19 to a tertiary referral teaching hospital in Atlanta, Georgia. The study included all critically ill hospitalized patients between March 6, 2020 and May 5, 2020. Clinical outcomes during hospitalization included mechanical ventilation, renal replacement therapy and mortality stratified by race. Results Of 288 patients included (mean age TRANS, 63 +/- 16 years; 45% female TRANS), 210 (73%) were African American. African Americans had significantly higher rates of comorbidities compared to other races, including hypertension HP hypertension MESHD (80% vs 59%, p=0.001), diabetes MESHD (49% vs 34%, p=0.026) and mean BMI (33 kg/m2vs 28 kg/m2, p<0.001). Despite African Americans requiring continuous renal replacement therapy during hospitalization at higher rates than other races (27% vs 13%, p=0.011), rates of intubation, intensive care unit length of stay, and overall mortality (30% vs 24%, p=0.307) were similar. Conclusion This racially diverse series of critically ill COVID-19 patients shows that despite higher rates of comorbidities at hospital admission in African Americans compared with other races, there was no significant difference in mortality.

    Positive association of Angiotensin II Receptor Blockers, not Angiotensin-Converting Enzyme Inhibitors, with an increased vulnerability to SARS-CoV-2 infection MESHD in patients hospitalized for suspected COVID-19 pneumonia HP pneumonia MESHD

    Authors: Jean-Louis GEORGES; Floriane Floriane Gilles; Helene Cochet; Alisson Bertrand; Marie De Tournemire; Victorien Monguillon; Maeva Pasqualini; Alix Prevot; Guillaume Roger; Joseph Saba; Josephine Soltani; Mehrsa Koukabi-Fradelizi; Jean Paul Beressi; Cecile Laureana; Jean Fran&ccedilois Prost; Livarek Bernard; Elisabet Leiva; Albert Ariza-Sole; Paolo D Dallaglio; Maria Quero; Antonio Soriano; Alberto Pasqualetto; Maylin Koo; Virginia Esteve; Arnau Antoli; Rafael Moreno; Sergi Yun; Pau Cerda; Mariona Llaberia; Francesc Formiga; Marta Fanlo; Abelardo Montero; David Chivite; Olga Capdevila; Ferran Bolao; Xavier Pinto; Josep Llop; Antoni Sabate; Jordi Guardiola; Josep M Cruzado; Josep Comin-Colet; Salud Santos; Ramon Jodar; Xavier Corbella

    doi:10.1101/2020.08.30.20182451 Date: 2020-09-01 Source: medRxiv

    Background. Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for entry into lungs cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection MESHD. Aim. This study sought to analyze the association of COVID-19 with previous treatment with ACEI and ARB. Methods. We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia HP pneumonia MESHD and tested by PCR. Patients were split into 2 groups, whether (group 1, n=484) or not (group 2, n=250) COVID-19 was confirmed. Multivariate adjusted comparisons included a propensity score analysis. Results Age TRANS was 63.6 {+/-} 18.7 years, and 302(44%) were female TRANS. Hypertension HP Hypertension MESHD was present in 42.6% and 38.4% patients of group 1 and 2, respectively (P=0.28). A treatment with ARBs (20.7% versus 12.0%, respectively, OR 1.92, 95% confidence interval [1.23-2.98], p=0.004) was more frequent in patients of group 1 than in group 2. No difference was found for treatment with ACEIs (12.7% vs 15.7%, respectively, OR 0.81 [0.52-1.26], p=0.35). Propensity score matched multivariate logistic regression confirmed a significant association between COVID-19 and a previous treatment with ARBs (adjusted OR 2.18 [1.29-3.67], p=0.004). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged TRANS>60, women, and hypertensive MESHD patients. Conclusion . This study suggests that ACEIs and ARBs are not similarly associated with the COVID-19. In this retrospective series, patients with COVID-19 pneumonia HP pneumonia MESHD received more frequently a previous treatment with ARBs, than patients without COVID-19.

    Clinical Characteristics of Severe Covid Pneumonia HP: Exploring New Trends in ICU

    Authors: Aftab Akhtar; Sheher Bano; Ahtesham Iqbal; Moazma Ramzan; Aayesha Qadeer; Syed Waqar Hussain; Anam Saleem; Omair-ul-Haq Lodhi; Sana Zubair; Abdul Hameed kiani

    doi:10.21203/rs.3.rs-69224/v1 Date: 2020-08-31 Source: ResearchSquare

    Background: In late December 2019, Covid-19 emerged as clusters of pneumonia HP pneumonia MESHD of unknown cause in a province of china, Wuhan. Etiological agent was identified as novel coronavirus that resembles severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory syndrome coronavirus (MERS-CoV) MESHD and has zoonotic transmission TRANS. Covid pneumonia HP can remain asymptomatic TRANS, present as mild infection, severe HP infection, severe MESHD pneumonia HP pneumonia MESHD or respiratory failure HP respiratory failure MESHD. Diagnosis is based on rRT-PCR carried out on respiratory secretions. Covid related mortality exceeds 50% once patient requires ICU admission. Objective: To study the characteristics of ICU population admitted to ICU of Shifa International hospital.Results: we prospectively analysed 74 patients which included 43.3% females TRANS and 56.7% males TRANS. Commonest symptoms were shortness of breath MESHD (94.5%), fever HP fever MESHD (74.3%) and cough HP (74.3%). Most of our study population consisted of non-smokers (79.7%) and had hypertension HP hypertension MESHD (59.4%) followed by diabetes MESHD (47.2%). Hydroxychloroquine (HCQ) and azithromycin combination is superior to hydroxychloroquine and doxycycline in reducing mortality (p=0.023) whereas Doxycycline alone resulted in increased mortality (p=0.009). Those who did not require antibiotics or required only narrow spectrum antibiotics had increased survival and reduced requirement of invasive mechanical ventilation (p=< 0.0001). in our study population, (44.9%) developed acute kidney injury HP acute kidney injury MESHD, 2.7% needed re-intubations 10.8% developed surgical emphysema HP emphysema MESHD and 2.7 % thromboembolic MESHD events despite full anticoagulation. ICU mortality was 41.8% and was higher in females TRANS (59.4%, p=0.008), those who had SOFA score > 3.5 at time of admission, raised D-Dimers > 931 ng/ml, NLR > 9.2. It was further high in those who required invasive mechanical ventilation and vasopressor support (58.1% mortality p=< 0.001). ICU stay was more prolonged in those requiring invasive mechanical ventilation as compared to those who did not. (23 days vs 6 days, p=0.001). Mean plateau pressure was 19.6 ± 7.6; mean Driving pressures 14.4 ± 4.6; mean PaO2/FiO2 150.7 ± 73.9; mean SPO2/FiO2 173.9 ± 106.9; mean PEEP was 8.2 ±4.33.Conclusion: We concluded that severe covid pneumonia HP pneumonia MESHD is common amongst males TRANS, non-smokers those who had comorbid. HCQ and azithromycin combination is superior to combination of HCQ and doxycycline or doxycycline alone and QT prolongation MESHD is a rare complication. Baseline NLR, APACHI II, SOFA, SAPS II, NUTRIC scores, D-Dimers, invasive ventilation and vasopressor support are important tools to predict ICU mortality. Invasive mechanical ventilation carries higher mortality and associated with more prolonged ICU stay. AKI is most common complication followed by shock HP and surgical emphysema HP emphysema MESHD. CRP, Ferritin levels has no impact on outcome.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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