Corpus overview


MeSH Disease

Human Phenotype


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    Superior anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study

    Authors: Frederic Arnold; Lukas Westermann; Siegbert Rieg; Elke Neumann-Haefelin; Paul Biever; Gerd Walz; Johannes Kalbhenn; Yakup Tanriver

    doi:10.1101/2020.06.26.20140699 Date: 2020-07-01 Source: medRxiv

    Background Coronavirus disease MESHD 2019 (COVID-19) patients who are admitted to intensive care units (ICU) have a high risk of requiring renal replacement therapy (RRT) due to acute kidney injury HP acute kidney injury MESHD ( AKI MESHD). Concomitantly, COVID-19 patients exhibit a state of hypercoagulability HP hypercoagulability MESHD that can affect circuit lifespan. An optimal anticoagulation strategy is therefore needed in order to maintain circuit patency and therapeutic efficiency of RRT. Methods Retrospective single-centre cohort study on 71 critically ill COVID-19 patients at the University of Freiburg Medical Center. Included were all patients aged TRANS 18 years and older with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD that were admitted to ICU between February 26 and May 21, 2020. We collected data on the COVID-19 disease course, AKI MESHD, RRT, thromboembolic MESHD events and anticoagulation. Primary outcome of the study was the effect of different anticoagulation strategies during RRT on extracorporeal circuit lifespans. Results Anticoagulation during continuous veno-venous haemodialysis ( CVVHD MESHD) was performed with unfractionated heparin (UFH) or citrate. Mean treatment time in the UFH group was 21.3h (SEM: {+/-}5.6h). Mean treatment time in the citrate group was 45.6h (SEM: {+/-}2.7h). Citrate anticoagulation prolonged treatment duration significantly by 24.4h (p=0.0014). Anticoagulation during sustained low-efficiency daily dialysis ( SLEDD MESHD) was performed with UFH, argatroban or low molecular weight heparin (LMWH). Mean dialysis time with UFH was 8.1h (SEM: {+/-}1.3h), argatroban 8.0h (SEM: {+/-}0.9h) and LMWH 11.8h (SEM: {+/-}0.5h). Compared to UFH and argatroban, LMWH significantly prolonged treatment times by 3.7h (p=0.0082) and 3.8h (p=0.0024), respectively. Conclusions UFH fails to prevent early clotting events in dialysis circuits. For patients, who do not require an effective systemic anticoagulation, regional citrate dialysis is the most effective strategy in our cohort. For patients, who require an effective systemic anticoagulation treatment, the usage of LMWH results in the longest circuit life spans.

    Cytokine Release Syndrome-Associated Encephalopathy MESHD Encephalopathy HP in Patients with COVID-19

    Authors: Peggy Perrin; Nicolas Collongues; Seyyid Baloglu; Dimitri Bedo; Xavier Bassand; Thomas Lavaux; Gabriela Gautier; Nicolas Keller; Stephane Kremer; Samira Fafi-Kremer; Bruno Moulin; Ilies Benotmane; Sophie Caillard

    id:10.20944/preprints202006.0103.v1 Date: 2020-06-07 Source:

    Severe disease MESHD and uremia MESHD are risk factors for neurological complications of coronavirus disease MESHD-2019 (COVID-19). An in-depth analysis of a case series was conducted to describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights that may guide clinical decision-making – especially with respect to the cytokine release syndrome (CRS). Extensive clinical, laboratory, and imaging phenotyping was performed in five patients. Neurological presentation included confusion HP confusion MESHD, tremor HP tremor MESHD, cerebellar ataxia MESHD ataxia HP, behavioral alterations, aphasia HP aphasia MESHD, pyramidal syndrome, coma HP coma MESHD, cranial nerve palsy MESHD, dysautonomia MESHD, and central hypothyroidism HP hypothyroidism MESHD. Neurological disturbances MESHD were remarkably accompanied by laboratory evidence of CRS. SARS-CoV-2 was undetectable in the cerebrospinal fluid. Hyperalbuminorachy and increased levels of the astroglial protein S100B were suggestive of blood SERO-brain barrier (BBB) dysfunction. Brain MRI findings comprised evidence of acute leukoencephalitis MESHD (n = 3, of whom one with a hemorrhagic form), cytotoxic edema HP edema MESHD mimicking ischemic stroke HP ischemic stroke MESHD (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted – resulting in rapid recovery from neurological disturbances MESHD in two cases. Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory, and imaging similarities with those of chimeric antigen receptor-T cell-related encephalopathy HP encephalopathy MESHD. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.

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MeSH Disease
Human Phenotype

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