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    Association of Initial Symptoms or Comorbidities With Pneumonia HP Pneumonia MESHD Lesions in COVID-19 Patients: Based on Artificial Intelligence-Enabled CT Quantitation

    Authors: Fangzhengyuan Yuan; Chuan Liu; Jie Yang; Hu Tan; Shizhu Bian; Xubin Gao; Jihang Zhang; Mingdong Hu; Renzheng Chen; Yang Shen; Jingbin Ke; Yuanqi Yang; Chunyan He; Ran Cheng; Lan Huang

    doi:10.21203/rs.3.rs-78075/v1 Date: 2020-09-15 Source: ResearchSquare

    Background: Coronavirus disease 2019 (COVID-19) patients with a larger ratio of pneumonia HP pneumonia MESHD lesions are more likely to progress to acute respiratory distress syndrome MESHD respiratory distress HP syndrome and death MESHD. This study aimed to investigate the relationship of baseline parameters with pneumonia HP pneumonia MESHD lesions on admission, as quantified by an artificial intelligence (AI) algorithm using computed tomography (CT) images. Methods: This retrospective study quantitatively assessed lung lesions on CT using an AI algorithm in 1630 consecutive patients confirmed with COVID-19 on admission and classified the patients into none (0%), mild (>0–25%), intermediate (>25–50%), and severe (>50%) groups, according to the lesion ratio of the whole lung. A multivariate linear regression model was established to explore the relationship between the lesion ratio and laboratory parameters. The baseline parameters associated with lung lesions MESHD, including demographics, initial symptoms, and comorbidities, were determined using a multivariate ordinal regression model. Results: The 1630 patients confirmed with COVID-19 had a median whole lung lesion ratio of 4.1%, and the right lower lung lobe had the most lesions among the five lung lobes based on the evaluation of CT using AI algorithm. The whole lung lesion ratio was associated with the levels of plasma SERO fibrinogen (r=0.280, p<0.001), plasma SERO D-dimer (r=0.248, p<0.001), serum SERO α-hydroxybutyrate dehydrogenase (r=0.363, p<0.001), serum SERO albumin (r=-0.300, p<0.001), and peripheral blood SERO leukocyte count (r=0.194, p<0.001). Among the four patients groups categorised by whole lung lesion ratio, the highest frequency of cough HP (p<0.001) and shortness of breath MESHD (p<0.001) were found in the severe group, and the highest frequency of hypertension HP hypertension MESHD (p<0.001), diabetes MESHD (p<0.001) and anemia HP anemia MESHD (p=0.039) were observed in the intermediate group. Based on baseline ordinal regression analysis, cough HP (p=0.009), shortness of breath MESHD (p<0.001), hypertension HP hypertension MESHD (p=0.002), diabetes MESHD (p=0.005), and anemia HP anemia MESHD (p=0.006) were independent risk factors for more severe lung lesions MESHD. Conclusions: Based on AI-enabled CT quantitation, patients with initial symptoms of cough HP cough MESHD/ shortness of breath MESHD, or with comorbidities of hypertension HP hypertension MESHD, diabetes MESHD, or anemia HP anemia MESHD, had a higher risk for more severe lung lesions on admission in COVID-19 patients.

    Respiratory Rehabilitation After Blood SERO Transfusion in a COVID-19 Patient: A Case Report

    Authors: Mohammad Javad Mousavi; Narges Obeidi; Saeed keshmiri; Farzan Azodi; Jamile Kiyani; Farhad Abbasi

    doi:10.21203/rs.3.rs-78131/v1 Date: 2020-09-15 Source: ResearchSquare

    Background: The coronavirus disease MESHD 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), has been identified as the most crucial threat of the century. Due to severe pneumonia HP pneumonia MESHD and acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD), the SARS-CoV-2 can cause shortness of breath MESHD, hypoxemia HP hypoxemia MESHD, and the need to mechanical ventilation, intensive care unit (ICU) management, and eventual death MESHD. We have tried to use a non-invasive approach to prevent patient from needing respiratory support with invasive ventilation (IV). Here, for the first time, improvement of oxygen delivery and oxygen saturation levels were observed in a COVID-19 patient using packed red blood SERO cells (PRBCs) transfusion.Case presentation: A 63-year-old man with a history of smoking and addiction who came to our hospital facility with fever HP fever MESHD, shortness of breath MESHD and decreased blood SERO oxygen saturation. High-resolution chest CT revealed bilateral and multifocal ground-glass opacities consistent with COVID-19. Subsequently, the COVID-19 infection was confirmed TRANS infection was confirmed MESHD by real-time polymerase chain reaction (qRT-PCR) assay of the upper respiratory tract. Conclusions: Oxygen delivery and oxygen saturation improvement were observed in the COVID-19 patient, after PRBCs transfusions.

    Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients

    Authors: Philipp K Buehler; Annelies S Zinkernagel; Daniel Andrea Hofmaenner; Pedro David Wendel Garcia; Claudio T Acevedo; Alejandro Gomez-Mejia; Srikanth Mairpady Shambat; Federica Andreoni; Maibach Maibach; Jan Bartussek; Matthias Hilty; Pascal M Frey; Reto A Schuepbach; Silvio Daniel Brugger

    doi:10.1101/2020.09.10.20191882 Date: 2020-09-11 Source: medRxiv

    Objectives While superinfections are associated with unfavourable disease course, their impact on clinical outcomes in critically ill COVID-19 patients remains largely unknown. We aimed to investigate the burden of superinfections in COVID-19 patients. Methods In this prospective single centre cohort study in an intensive care setting patients aged TRANS [≥] 18 years with COVID-19 acute respiratory distress syndrome MESHD respiratory distress HP syndrome were assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages and blood SERO. Our primary outcome was ventilator-free survival on day 28 in patients with and without clinically relevant superinfection. Further outcomes included the association of superinfection with ICU length of stay, incidence of bacteremia HP bacteremia MESHD, viral reactivations, and fungal colonization MESHD. Results In 45 critically ill COVID-19 patients, we identified 19 patients with superinfections (42.2%) by longitudinal analysis of 433 TBS, 35 BAL and 455 blood SERO samples, respectively. On average, superinfections were detected on day 10 after ICU admission. The most frequently isolated clinically relevant bacteria were Enterobacteriaceae, Streptococcus pneumoniae HP, and Pseudomonas aeruginosa. Ventilator-free survival was substantially lower in patients with superinfection (subhazard ratio 0.37, 95%-CI 0.15-0.90, p=0.028). Patients with pulmonary superinfections more often had bacteraemia, virus reactivations, yeast colonization, and needed ICU treatment for a significantly longer time. Conclusions The detection of superinfections was frequent and associated with reduced ventilator-free survival. Despite empirical antibiotic therapy, superinfections lead to an extended ICU stay in COVID 19 patients. Longitudinal microbiological sampling in COVID-19 patients could allow targeted antimicrobial therapy, and therefore minimize the use of broad-spectrum and reserve antibiotics.

    Activin/Follistatin-axis deregulation is independently associated with COVID-19 in-hospital mortality

    Authors: Evgenia Synolaki; Vasileios Papadopoulos; Georgios Divolis; Efstratios Gavriilidis; Georgia Loli; Arriana Gavriil; Christina Tsigalou; Olga Tsachouridou; Eleni Sertaridou; Petros Rafailidis; Arja Pasternack; Dimitrios Boumpas; Georgios Germanidis; Olli Ritvos; Symeon Metalidis; Panagiotis Skendros; Paschalis Sideras; Sajid A Khan; Akiko Iwasaki; Caroline H Johnson

    doi:10.1101/2020.09.05.20184655 Date: 2020-09-08 Source: medRxiv

    Rationale: Activins are inflammatory and tissue-repair-related members of the TGF{beta}-superfamily that have been implicated in the pathogenesis of several immuno-inflammatory disorders including sepsis HP sepsis MESHD/acute respiratory distress HP syndrome ( ARDS MESHD). We hypothesized that they might be of particular relevance to COVID-19 pathophysiology. Objectives: To assess the involvement of the Activin-Follistatin-axis in COVID-19 pathophysiology. Methods: Levels of Activins -A, -B and their physiological inhibitor Follistatin, were retrospectively analyzed in 314 serum samples SERO from 117 COVID-19 patients derived from two independent centers and compared with common demographic, clinical and laboratory parameters. Optimal-scaling with ridge-regression was used to screen variables and establish a prediction model. Main Results: The Activin/Follistatin-axis was significantly deregulated during the course of COVID-19 and was independently associated with severity and in-hospital mortality. FACT-CLINYCoD, a novel disease scoring system, adding one point for each of Follistatin >6235 pg/ml, Activin-A >591 pg/ml, Activin-B >249 pg/ml, CRP >10.3 mg/dL, LDH >427 U/L, Intensive Care Unit (ICU) admission, Neutrophil/Lymphocyte-Ratio >5.6, Years of Age TRANS >61, Comorbidities >1 and D-dimers >1097 ng/ml, efficiently predicted and monitored fatal outcome independently of multiplicity and timing of sampling (AUC: 0.951{+/-}0.032, p<10-6). Validation in 35 samples derived from a third hospital indicated comparable AUC (0.958{+/-}0.086, p=0.032). Conclusion: This study unravels the link between Activin/Folistatin-axis and COVID-19 mortality and introduces FACT-CLINYCoD, a novel pathophysiology-based tool that copes with the dynamic and heterogeneous nature of COCVID-19, predicts disease outcome and supports clinical decision making. Prospective large-scale validation of this calculator, as well as investigation of the mechanisms linking Activin/Folistatin-axis to COVID-19 pathogenesis is warranted.

    SARS-CoV-2 infection paralyzes cytotoxic MESHD and metabolic functions of immune cells

    Authors: Yogesh Singh; Christoph Trautwein; Rolf Fendel; Naomi Krickeberg; Jana Held; Andrea Kreidenweiss; Georgy Berezhnoy; Rosi Bissinger; Stephan Ossowski; Madhuri S Salker; Nicolas Casadei; Olaf Riess; - The DeCOI; Richard Harrigan; Terrance P Snutch; Nicholas J Loman; Joshua Quick

    doi:10.1101/2020.09.04.282780 Date: 2020-09-04 Source: bioRxiv

    The SARS-CoV-2 virus is the causative agent of the global COVID-19 infectious disease outbreak, which can lead to acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD). However, it is still unclear how the virus interferes with immune cell and metabolic functions in the human body. In this study, we investigated the immune response in 10 acute or convalescent COVID19 patients. We characterized the peripheral blood SERO mononuclear cells (PBMCs) using flow cytometry and found that CD8+ T cells were significantly subsided in moderate COVID-19 and convalescent patients. Furthermore, characterization of CD8+ T cells suggested that patients with a mild and moderate course of the COVID-19 disease and convalescent patients have significantly diminished expression of both perforin and granzyme B in CD8+ T cells. Using 1H-NMR spectroscopy, we characterized the metabolic status of their autologous PBMCs. We found that fructose, lactate and taurine levels were elevated in infected (mild and moderate) patients compared with control and convalescent patients. Glucose, glutamate, formate and acetate levels were attenuated in COVID-19 (mild and moderate) patients. Our findings reveal patients who suffer from an over activation of the immune system, a change of composition in infusion/intravenous fluids during infection MESHD with the aim to lower blood SERO levels of glucose, glutamate, acetate and formate could avoid a life-threatening cytokine storm. In summary, our report suggests that SARS-CoV-2 infection MESHD leads to disrupted CD8+ T cytotoxic functions and changes the overall metabolic functions of immune cells.

    ASSOCIATION OF HYPERGLYCEMIA HP WITH HOSPITAL MORTALITY IN COVID-19 PATIENTS WITHOUT DIABETES MESHD: A COHORT STUDY

    Authors: Manju Mamtani; Ambarish M Athavale; Mohan Abraham; Jane Vernik; Amatur Amarah; Juan Ruiz; Amit Joshi; Matthew Itteera; Sara Zhukovsky; Ravi Prakash Madaiah; Peter Hart; Hemant Kulkarni

    doi:10.1101/2020.08.31.20185157 Date: 2020-09-02 Source: medRxiv

    Objective: Diabetes MESHD is a known risk factor for mortality in Coronavirus disease MESHD 2019 (COVID-19) patients. Our objective was to identify prevalence SERO of hyperglycemia HP hyperglycemia MESHD in COVID-19 patients with and without diabetes MESHD and quantify its association with COVID-19 disease course. Research Design and Methods: In this observational cohort study, all consecutive COVID-19 patients admitted to John H Stroger Jr. Hospital, Chicago, IL from March 15, 2020 to May 15, 2020 were included. The primary outcome was hospital mortality and the main predictor was hyperglycemia HP hyperglycemia MESHD (any blood SERO glucose [≥]7.78 mmol/L during hospitalization). Results: Of 403 COVID-19 patients studied, 228 (57%) developed hyperglycemia HP hyperglycemia MESHD. Of these, 83 (21%) had hyperglycemia HP hyperglycemia MESHD without diabetes MESHD. A total of 51 (12.7%) patients died. Compared to the reference group no- diabetes MESHD/no- hyperglycemia HP hyperglycemia MESHD patients the no- diabetes MESHD/ hyperglycemia HP hyperglycemia MESHD patients showed higher mortality (1.8% versus 20.5%, adjusted odds ratio 21.94 (95% confidence interval 4.04-119.0), p < 0.001); improved prediction of death (p=0.0162) and faster progression to death (p=0.0051). Hyperglycemia HP Hyperglycemia MESHD within the first 24 and 48 hours was also significantly associated with mortality (odds ratio 2.15 and 3.31, respectively). Further, compared to the same reference group, no- diabetes MESHD/ hyperglycemia HP hyperglycemia MESHD patients had higher risk of ICU admission (p<0.001), mechanical ventilation (p<0.001) and acute respiratory distress syndrome MESHD respiratory distress HP syndrome (p<0.001) and a longer hospital stay in survivors (p<0.001). Conclusions: Hyperglycemia HP Hyperglycemia MESHD in the absence of diabetes MESHD was common (21% of hospitalized COVID-19 patients) and was associated with an increased risk of and faster progression to death. Development of hyperglycemia HP hyperglycemia MESHD in COVID-19 patients who do not have diabetes MESHD is an early indicator of poor prognosis.

    Persistent Lymphopenia HP Lymphopenia MESHD After Diagnosis of COVID-19 Predicts Acute Respiratory Distress HP Respiratory Distress MESHD Syndrome: A Retrospective Cohort Study

    Authors: Zhiye Zou; Rong-ling Chen; Bao-jun Yu; Di Ren; Yong-wen Feng; Ming Wu

    doi:10.21203/rs.3.rs-66910/v1 Date: 2020-08-27 Source: ResearchSquare

    BACKGROUND: Acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD) is a main characterized by severe Coronavirus disease-2019(COVID-19). Lymphopenia HP Lymphopenia MESHD is a marker of immunosuppression following infection. This study was designed to establish whether persistent lymphopenia HP lymphopenia MESHD on the seventh day following the diagnosis of COVID-19 predicts ARDS. METHODS: A retrospective cohort study of 125 patients with COVID-19 admitted to government-designated treatment center between January 14, 2020, and March 20, 2020. All complete blood SERO cell counts during the day 0th, 3rd, and 7th following the diagnosis of COVID-19 were recorded. Patients were grouped based on the depression MESHD of the lymphocyte cell count, their return, or their failure to normal. The primary outcome was ARDS MESHD, and Secondary outcomes included the development of vital organ dysfunction and hospital lengths of stay. RESULTS: 17.6% (22/125) patients developed ARDS MESHD. The lymphocyte counts with ARDS MESHD and non-ARDS were 0.94×109/L, 1.20×109/L at admission, respectively (P=0.02). At 3rd and 7th day, the median of lymphocyte count in ARDS MESHD was significantly lower compared with that of non-ARDS, Multivariable logistic regression adjusting for potentially confounding factors (including age TRANS, comorbidities, APACH II score) showed persistent lymphopenia HP lymphopenia MESHD within 7th day was found to be independently associated with ARDS MESHD (OR, 3.94 [95%CI, 1.26-12.33, P=0.018); Further, patients with persistent lymphopenia HP lymphopenia MESHD had longer hospital lengths of stay (p<0.001). CONCLUSION: The results showed persistent lymphopenia HP lymphopenia MESHD on the seventh day following the confirmed COVID-19 predicts ARDS,and it may be a target for immunostimulation for COVID-19 associated ARDS.

    The Prognostic Value of Eosinophil Recovery in COVID-19: A Multicentre, Retrospective Cohort Study on Patients Hospitalised in Spanish Hospitals.

    Authors: Maria Mateos Gonzalez; Elena Sierra Gonzalo; Irene Casado Lopez; Francisco Arnalich Fernandez; Jose Luis Beato Perez; Daniel Monge Monge; Juan Antonio Vargas Nunez; Rosa Garcia Fenoll; Carmen Suarez Fernandez; Santiago Jesus Freire Castro; Manuel Mendez Bailon; Isabel Perales Fraile; Manuel Madrazo; Paula Maria Pesqueira Fontan; Jeffrey Oskar Magallanes Gamboa; Andres Gonzalez Garcia; Anxela Crestelo Vieitez; Eva Maria Fonseca Aizpuru; Asier Aranguren Arostegui; Ainara Coduras Erdozain; Carmen Martinez Cilleros; Jose Loureiro Amigo; Francisco Epelde; Carlos Lumbreras Bermejo; Juan Miguel Anton Santos

    doi:10.1101/2020.08.18.20172874 Date: 2020-08-21 Source: medRxiv

    Objectives: A decrease in blood SERO cell counts, especially lymphocytes and eosinophils, has been described in patients with severe SARS-CoV-2 (COVID-19), but there is no knowledge of the potential role of their recovery in these patients prognosis. This article aims to analyse the effect of blood SERO cell depletion and blood SERO cell recovery on mortality due to COVID-19. Design: This work is a multicentre, retrospective, cohort study of 9,644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine SEMI-COVID-19 Registry. Setting: This study examined patients hospitalised in 147 hospitals throughout Spain. Participants: This work analysed 9,644 patients (57.12% male TRANS) out of a cohort of 12,826 patients over 18 years of age TRANS hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. Main outcome measures: The main outcome measure of this work is the effect of blood SERO cell depletion and blood SERO cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death MESHD and then multivariate analysis was carried out to control for potential confounders. Results: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs 22.6% in non-recoverers, OR 0.234 [95% CI, 0.154 to 0.354]) and lower complication rates, especially regarding to development of acute respiratory distress syndrome MESHD respiratory distress HP syndrome (8% vs 20.1%, p=0.000) and ICU admission (5.4% vs 10.8%, p=0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. Conclusion: Eosinophil recovery in patients with COVID-19 is a reliable marker of a good prognosis that is independent of prior treatment. This finding could be used to guide discharge decisions.

    Continuous extracorporeal treatments in a dialysis patient with COVID-19

    Authors: Yoshihito Nihei; Hajime Nagasawa; Yusuke Fukao; Masao Kihara; Seiji Ueda; Tomohito Gohda; Yusuke Suzuki

    doi:10.21203/rs.3.rs-63251/v1 Date: 2020-08-20 Source: ResearchSquare

    The coronavirus disease MESHD 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection MESHD has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. We herein report our experience with a 66-year-old male TRANS patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma SERO exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) repeatedly and subacute cerebral infarction MESHD and finally died for respiratory failure HP respiratory failure MESHD on day 30 after admission, these attempts appeared to somewhat dampen the cytokine storm based on the observed decline in serum SERO IL-6 levels and were effective against ARDS MESHD and secondary haemophagocytic lymphohistiocytosis MESHD. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critical ill patients with COVID-19.

    Continuous extracorporeal treatments in a dialysis patient with COVID-19

    Authors: Yoshihito Nihei; Hajime Nagasawa; Yusuke Fukao; Masao Kihara; Seiji Ueda; Tomohito Gohda; Yusuke Suzuki

    doi:10.21203/rs.3.rs-63251/v2 Date: 2020-08-20 Source: ResearchSquare

    The coronavirus disease MESHD 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection MESHD has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. Herein, we report our experience with a 66-year-old male TRANS patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma SERO exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) repeatedly and subacute cerebral infarction MESHD and finally died for respiratory failure HP respiratory failure MESHD on day 30 after admission, these attempts appeared to dampen the cytokine storm based on the observed decline in serum SERO IL-6 levels and were effective against ARDS MESHD and secondary haemophagocytic lymphohistiocytosis MESHD. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critically ill MESHD patients with COVID-19.

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