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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence

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    Tocilizumab and Thromboembolism HP Thromboembolism MESHD in COVID-19: A Retrospective Hospital-based Cohort Analysis

    Authors: Kok Hoe Chan; Bhavik Patel; Bishnu Podel; Maria E Szabela; Hamid S Shaaban; Gunwant Guron; Jihad Slim

    doi:10.21203/rs.3.rs-39943/v1 Date: 2020-07-02 Source: ResearchSquare

    Background:Tocilizumab, an IL-6 receptor antagonist has been used in patients with Coronavirus Disease MESHD 2019 (COVID-19) as an anti-cytokine agent. IL-6 also plays a complex role in hemostasis and thrombosis MESHD. We observed a transient elevation of D-dimer in our patients who received Tocilizumab, which triggered the current study.Methods:A retrospective hospital-based cohort analysis of patients with confirmed COVID-19 who received Tocilizumab during the study period of 03/15/2020 to 05/20/2020. We retrieved demographic, clinical and laboratory data, we excluded patients who were receiving therapeutic anticoagulation therapy prior to Tocilizumab administration.  Descriptive analysis was performed, the cause of death MESHD and trends of D-dimer and inflammatory markers were studied. Results: Out of the 436 confirmed COVID 19 patients admitted during the study period, 24 met the inclusion criteria. Their median age TRANS was 47.5 years old. They were 18 males TRANS and 6 females TRANS; 15 patients survived, and 9 expired. Of the group that survived, 12 received therapeutic anticoagulation. Of the 7 patients who did not receive therapeutic anticoagulation, 4 expired, 1 from sepsis HP sepsis MESHD and 3 probably from thromboembolic complications MESHD, compared to 5 deaths in the 17 patients who received therapeutic anticoagulation with 4 dying from sepsis HP sepsis MESHD, and one possibly from thromboembolic complications MESHD.Conclusions:The interplay between IL-6, IL-6 receptor antagonist and venous thromboembolism MESHD thromboembolism HP are complex. We observed a transient elevation of D-dimer in COVID-19 patients who received Tocilizumab, and a trend toward increased death secondary to thromboembolism HP thromboembolism MESHD. This observation is novel and highlights the potential thrombophilic side effects of Tocilizumab.

    The validation of the original and modified Caprini score in COVID-19 patients

    Authors: Sergey Tsaplin; Ilya Schastlivtsev; Kirill Lobastov; Sergey Zhuravlev; Victor Barinov; Joseph Caprini

    doi:10.1101/2020.06.22.20137075 Date: 2020-06-23 Source: medRxiv

    Objective. The study aimed to validate the original Caprini score and its modifications considering coronavirus disease MESHD (COVID-19) as a severe prothrombotic condition MESHD in patients admitted to the hospital with confirmed infection TRANS infection MESHD. Methods. The relevant data were extracted from the electronic medical records with the implemented Caprini score and were evaluated retrospectively. The score was calculated twice: by the physician at the admission and by the investigator at discharge or after death. The second calculation at discharge, considered additional risk factors that occurred during inpatient treatment. Besides the original Caprini score (a version of 2005), the modified version added the elevation of D-dimer and specific scores for COVID-19 as follows: 2 points for asymptomatic TRANS, 3 points for symptomatic and 5 points for symptomatic infection MESHD with positive D-dimer, were evaluated in a retrospective manner. The primary endpoint was symptomatic venous thromboembolism MESHD thromboembolism HP ( VTE MESHD) confirmed by appropriate imaging testing or dissection. The secondary endpoint included the unfavorable outcome as a combination of symptomatic VTE MESHD, admission to the intensive care unit, the requirement for invasive mechanical ventilation, and death MESHD. The association of eight different versions of the Caprini score with outcomes was evaluated. Results. Totally 168 patients (83 males TRANS and 85 females TRANS at the age TRANS of 58.3{+/-}12.7 years old) were admitted to the hospital between April 30 and May 29, 2020, and were discharged or died up to the time of data analysis. The original Caprini score varied between 2-12 (5.4{+/-}1.8) at the admission and between 2-15 (5.9{+/-}2.5) at discharge or death MESHD. The presence of the virus increased these scores and resulted in an increased score with the maximal value for those including COVID-19 points (10.0{+/-}3.0). Patients received prophylactic (2.4%), intermediate (76.8%), or therapeutic (20.8%) doses of enoxaparin. Despite this, the symptomatic VTE MESHD was detected in 11 (6.5%) and unfavorable outcomes in 31 (18.5%) patients. The Caprini score of all eight versions demonstrated a significant association with VTE MESHD with the highest predictability for the original scale when assessed at discharge. Supplementation of the original score by elevated D-dimer improved predictability only at the admission. Four versions of the Caprini score calculated at the admission had a significant correlation with the unfavorable outcome with the minor advantages of specific COVID-19 points. Conclusion. The study identified a significant correlation between the Caprini score and the risk of VTE MESHD or unfavorable outcomes in COVID-19 patients. All models, including specific COVID-19 scores, showed high predictability with minor differences.

    Incidence of Venous Thromboembolism MESHD Thromboembolism HP in Hospitalized Patients with COVID-19

    Authors: Saskia Middeldorp; Michiel Coppens; Thijs F. van Haaps; Merijn Foppen; Alexander P. Vlaar; Marcella C.A. Muller; Catherine C.S. Bouman; Ludo F.M. Beenen; Ruud S. Kootte; Jarom Heijmans; Loek P. Smits; Peter I. Bonta; Nick van Es

    id:10.20944/preprints202004.0345.v1 Date: 2020-04-19 Source: Preprints.org

    Coronavirus disease MESHD 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications MESHD. We investigated the incidence of objectively confirmed venous thromboembolism MESHD thromboembolism HP ( VTE MESHD) in 198 hospitalized patients with COVID-19 in a single-center cohort study. Seventy-four patients (37%) were admitted to the intensive care unit (ICU). At time of data collection, 58 (29%) were still hospitalized and 14% had died. During a median follow-up of 5 days (IQR, 3-9), 33 patients (17%) were diagnosed with VTE MESHD of whom 22 (11%) had symptomatic VTE MESHD, despite routine thrombosis MESHD prophylaxis. The cumulative incidences of VTE MESHD at 7 and 14 days were 15% (95% CI, 9.3-22) and 34% (95% CI, 23-46), respectively. For symptomatic VTE MESHD, these were 11% (95% CI, 5.8-17) and 23% (95% CI, 14-33). VTE MESHD appeared to be associated with death MESHD (adjusted HR, 2.9; 95% CI, 1.02-8.0). The cumulative incidence of VTE MESHD was higher in the ICU (25% at 7 days 95% CI, 15-36, and 48% at 14 days, 95% CI, 33-61) than on the wards (any VTE MESHD and symptomatic VTE MESHD 6.5 % at 7 days (95% CI, 1.5-17) and 10% at 14 days (95% CI, 2.9-24)).The observed risk for VTE MESHD in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE MESHD and potentially improve survival.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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