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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    The Incidence of Pulmonary Thromboembolism in Critically MESHD Thromboembolism HP in Critically Ill Patients With COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression of Observational Studies

    Authors: Jun Jie Ng; Zhen Chang Liang; Andrew MTL Choong

    doi:10.21203/rs.3.rs-74260/v1 Date: 2020-09-08 Source: ResearchSquare

    Purpose Coronavirus disease MESHD 2019 (COVID-19) infection is known to be associated with a hypercoagulable and prothrombotic state, especially in critically ill MESHD patients. Several observational studies have reported the incidence of thromboembolic MESHD events such as pulmonary thromboembolism MESHD thromboembolism HP ( PTE MESHD). We performed a meta-analysis to estimate the weighted average incidence of PTE MESHD in critically ill COVID-19 patients who are admitted to the intensive care unit.Methods We searched MEDLINE via PubMed, Embase and Web of Science for relevant studies from 31 December 2019 till 15 Aug 2020 onwards using the search terms “coronavirus”, “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “thrombus”, “thrombo*”, “ embolus MESHD” and “emboli*”. We included prospective and retrospective observational studies that reported the incidence of PTE MESHD in critically ill COVID-19 patients who required treatment in the intensive care unit. We identified 14 studies after two phases of screening and extracted data related to study characteristics, patient demographics and the incidence of PTE MESHD. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.Results We included 14 studies with a total of 1182 patients in this study. Almost 100% of patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE MESHD was 11.09% (95% CI 7.72% to 15.69%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression which identified the proportion of males TRANS as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to -0.09)Conclusion This is the only study that had specifically reported the weighted average incidence of PTE MESHD in critically ill COVID-19 patients using meta-analytic techniques. The weighted average incidence of PTE MESHD remains high even after prophylactic anticoagulation. This study is limited by incomplete data from included studies. More studies are needed to determine the optimal anticoagulation strategy in critically ill COVID-19 patients.

    Early initiation of Extracorporeal Blood SERO Purification using the AN69ST (oXiris®) hemofilter as a treatment modality for COVID - 19 patients: a single-centre case series

    Authors: Petar Ugurov; Dijana Popevski; Tanja Gramosli; Dashurie Neziri; Dragica Vuckova; Emil Stoicovski; Lidija Veljanovska-Kiridjievska; Katerina Ignevska; Sanja Mehandziska; Elena Ambarkova; Rodney Alexander Rosalia; Zan Mitrev

    doi:10.21203/rs.3.rs-44717/v1 Date: 2020-07-17 Source: ResearchSquare

    Introduction: Our understanding of the COVID-19 disease has been steadily evolving since the original outbreak in December 2019. Advanced disease is characterised by a hyperinflammatory state, systemic coagulopathies MESHD and multiorgan involvement, in particular respiratory distress HP. We here describe our initial experience with treating of COVID-19 patients based on early initiation of extracorporeal blood SERO purification, systemic heparinisation and respiratory support.Methods: 15 patients were included; 2 were females TRANS. We monitored real-time several biochemical, immunological and coagulation biomarkers associated with disease severity following admission to our dedicated COVID-19 intensive care unit. To guide personalised treatment, we monitored among others levels of IL-6, IL-8, TNF-α, C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte ratios, Thrombocyte counts, D-Dimers, Fibrinogen, and Activation Clotting time (ACT).Treatment consisted of individualised respiratory support supplemented with 1 - 4 cycles of 24-hour Extracorporeal Organ Support (ECOS) and Blood SERO Purification using the AN69ST (oXiris®) hemofilter. We administered heparin (300 U/kg) to counter suspected hypercoagulability HP hypercoagulability MESHD (= elevated Fibrinogen or D-dimers) states to maintain ACT ≥ 180 seconds.Results: N = 10 presented with severe to critical disease MESHD (= dyspnoea MESHD, hypoxia MESHD, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). A single case was admitted with a critical condition (= respiratory failure HP respiratory failure MESHD). One patient died after 5 days of hospitalisation after developing Acute Respiratory Syndrome MESHD. 8 Patients have been discharged - average ICU length-of-stay was 9.9 ± 2.4 days. Clinical improvement was associated with normalisation (increase) of thrombocytes, white blood SERO cells, stable levels of IL-6 (< 50 ng/mL) and a decrease of CRP and Fibrinogen. Conclusion: Means to monitor COVID-19 disease severity during hospitalisation are crucial to control disease progression and prevent hyperinflammation and irreversible multiorgan failure. We present here a real-time monitoring system accounting for biochemical, immunological, coagulation parameters and radiological imaging. The combination of systemic heparin anticoagulation regimens and blood SERO purification may prevent hyperinflammation, thromboembolism HP thromboembolism MESHD during hospitalisation and thus support clinical recovery. 

    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.

    Clinical Characteristics and Outcomes of Venous Thromboembolism MESHD Thromboembolism HP in Patients Hospitalized for COVID-19: Systematic Review and Meta-Analysis

    Authors: Joshua Henrina; Iwan Cahyo Santosa Putra; Irvan Cahyadi; Hoo Felicia Hadi Gunawan; Alius Cahyadi; Leonardo Paskah Suciadi

    doi:10.1101/2020.06.14.20130922 Date: 2020-06-16 Source: medRxiv

    Objective: To investigate the clinical characteristics and outcomes of Coronavirus Disease MESHD of 2019 (COVID-19) patients complicated with venous thromboembolism MESHD thromboembolism HP ( VTE MESHD) Method: We performed a comprehensive literature search of several databases to find studies that assessed VTE MESHD in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE MESHD sufferers. Objective: To investigate the clinical characteristics and outcomes of Coronavirus Disease MESHD of 2019 (COVID-19) patients complicated with venous thromboembolism MESHD thromboembolism HP ( VTE MESHD) Method: We performed a comprehensive literature search of several databases to find studies that assessed VTE MESHD in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE MESHD sufferers. Results: Eight studies have been included with a total of 1237 pooled subjects. Venous thromboembolism MESHD thromboembolism HP was associated with higher mortality (RR 2.48 (1.35, 4.55), p=0.003; I2 5%, p=0.35) after we performed sensitivity SERO analysis, ICU admission (RR 2.32 (1.53, 3.52), p<0.0001; I2 80%, p <0.0001), and mechanical ventilation need (RR 2.73 (1.56, 4.78), p=0.0004; I2 77%, p=0.001). Furthermore, it was also associated to male TRANS gender TRANS (RR 1.21 (1.08, 1.35), p=0.0007; I2 12%, p=0.34), higher white blood SERO cells count (MD 1.24 (0.08, 2.41), 0.04; I2 0%; 0.26), D-dimer (MD 4.49 (2.74, 6.25), p<0.00001; I2 67%, p=0.009) and LDH levels (MD 70.93 (19.33, 122.54), p<0.007; I2 21%, p=0.28). In addition, after sensitivity SERO analysis was conducted, VTE MESHD also associated with older age TRANS ( MD MESHD 2.79 (0.06, 5.53), p=0.05; I2 25%, p=0.24) and higher CRP levels (MD 2.57 (0.88, 4.26); p=0.003; I2 0%, p=0.96). Conclusion: Venous thromboembolism MESHD thromboembolism HP in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male TRANS gender TRANS, older age TRANS, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE MESHD in COVID-19 patients during hospitalization. Conclusion: Venous thromboembolism MESHD thromboembolism HP in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male TRANS gender TRANS, older age TRANS, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE MESHD in COVID-19 patients during hospitalization.

    High Incidence of Venous Thrombosis HP Venous Thrombosis MESHD in Patients with Moderate to Severe COVID-19

    Authors: Oleg B Kerbikov; Pavel Yu Orekhov; Ekaterina N Borskaya; Natalia S Nosenko

    doi:10.1101/2020.06.12.20129536 Date: 2020-06-14 Source: medRxiv

    COVID-19 predisposes to venous thromboembolism MESHD thromboembolism HP and there are multiple data regarding high incidence of venous thrombosis HP venous thrombosis MESHD in critical COVID-19 patients, however reports on this complication in less severe patients are not widely available. The aim of this study was to investigate the incidence of deep-vein thrombosis MESHD ( DVT MESHD) in patients with moderate to severe COVID-19 and to assess the prevalence SERO of DVT MESHD with lung computerized tomography (lung CT) exams, clinical information and lab data. This study examined 75 consecutive patients with moderate to severe COVID-19, with specific exclusions. METHODS Almost all patients (pts) admitted to our hospital in the first half of May underwent comprehensive vein ultrasonography. 75 pts ( aged TRANS 27-92 y, median - 63 y, 36 males TRANS and 39 females TRANS) with moderate to severe COVID-19 were included in our study. RESULTS Spontaneous echo contrast (decreased blood SERO velocity and blood SERO stasis) was detected in common femoral veins in 53 pts (70.7%). DVT MESHD was found in 15 pts (20%). The vast majority of those with DVT MESHD (13 pts, 86.7%) had thrombi only in calf veins and ileofemoral thrombosis MESHD was detected in 2 pts with DVT MESHD (13.3%). There was no significant observed difference between DVT MESHD and non- DVT MESHD patients with respect to age TRANS, underlying diseases, lung CT scores and SpaO2 at admission. There was also no significant observed difference between DVT MESHD and non- DVT MESHD patients with respect to both "time from symptoms onset TRANS to admission" and with respect to the majority of lab data. However, a significant difference was observed in D-dimer level (1.87 +/- 1.62 vs 0.51 +/- 0,4 mcg/mL p<0.0001) and C-reactive protein (116.9 +/- 83,6 and 65.1 +/- 64.98 mg/L, p = 0.014) for patients with DVT MESHD and patients without DVT MESHD respectably (Receiver operating characteristics (ROC) curve analysis revealed that the level of D-dimer >/= 0.69 mcg/mL is the predictor of DVT MESHD with a sensitivity SERO of 76.9%, a specificity of 77.6%, p < 0.001 (AUC area under curve = 0.7944). Logistic regression confirmed that D-dimer is an independent predictor of DVT MESHD and patients with D-dimer >/= 0.69 mcg/mL have odds ratio (OR) of developing DVT MESHD = 5.1 (confidence interval [CI] 1.9 - 13.5)). CONCLUSION Patients with moderate to severe COVID-19 show high incidence of DVT MESHD, indicating that moderate to severe COVID-19 patients may require an early administration of anticoagulation therapy as part of their treatment. Such therapy may be continued after hospital discharge. Based on these findings, these patients may also require a follow-up with vein ultrasonography after recovery to rule out DVT MESHD.

    Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom

    Authors: Robert A Fletcher; Thomas Matcham; Marta Tibúrcio; Arseni Anisimovich; Stojan Jovanović; Luca Albergante; Nadezda Lipunova; Anne Hancock; Lucy Mackillop; Lionel Tarassenko; Alex McCarthy; Marcela P Vizcaychipi; Rabia Tahir Khan

    doi:10.1101/2020.05.11.20093096 Date: 2020-05-15 Source: medRxiv

    Background: The novel coronavirus disease MESHD 2019 (COVID-19) outbreak presents a significant threat to global health. A better understanding of patient clinical profiles is essential to drive efficient and timely health service strategies. In this study, we aimed to identify risk factors for a higher susceptibility to symptomatic presentation with COVID-19 and a transition to severe disease. Methods: We analysed data on 2756 patients admitted to Chelsea & Westminster Hospital NHS Foundation Trust between 1st January and 23rd April 2020. We compared differences in characteristics between patients designated positive for COVID-19 and patients designated negative on hospitalisation and derived a multivariable logistic regression model to identify risk factors for predicting risk of symptomatic COVID-19. For patients with COVID-19, we used univariable and multivariable logistic regression to identify risk factors associated with progression to severe disease defined by: 1) admission to the hospital AICU, 2) the need for mechanical ventilation, 3) in-hospital mortality, and 4) at least one measurement of elevated D-dimer (equal or superior to 1,000 ug/L) indicative of increased risk of venous thromboembolism MESHD thromboembolism HP. Results: The patient population consisted of 1148 COVID-19 positive and 1608 COVID-19 negative patients. Age TRANS, sex, self-reported ethnicity, C-reactive protein, white blood SERO cell count, respiratory rate, body temperature, and systolic blood SERO pressure formed the most parsimonious model for predicting risk of symptomatic COVID-19 at hospital admission. Among 1148 patients with COVID-19, 116 (10.1%) were admitted to the AICU, 71 (6.2%) required mechanical ventilation, 368 (32.1%) had at least one record of D-dimer levels [≥]1,000 g/L, and 118 patients died. In the multivariable logistic regression, age TRANS (OR = 0.953 per 1 year, 95% CI: 0.937-0.968) C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.007), and white blood SERO cell counts (OR = 1.059 per 109/L, 95% CI: 1.010-1.111) were found to be associated with admission to the AICU. Age TRANS (OR = 0.973 per 1 year, 95% CI: 0.955-0.990), C-reactive protein (OR = 1.003 per 1 mg/L, 95% CI: 1.000-1.006) and sodium (OR = 0.915 per 1 mmol/L, 0.868-0.962) were associated with mechanical ventilation. Age TRANS (OR = 1.023 per 1 year, 95% CI: 1.004-1.043), CRP (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.006), and body temperature (OR = 0.723 per 1oC, 95% CI: 0.541-0.958) were associated with elevated D-dimer. For mortality, we observed associations with age TRANS (OR = 1.060 per 1 year, 95% CI: 1.040-1.082), female TRANS sex (OR = 0.442, 95% CI: 0.442, 95% CI: 0.245-0.777), Asian ethnic background (OR = 2.237 vs White ethnic background, 95% CI: 1.111-4.510), C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.001-1.006), sodium (OR = 1.038 per 1 mmol/L, 95% CI: 1.001-1.006), and respiratory rate (OR = 1.054 per 1 breath MESHD/min, 95% CI: 1.024-1.087). Conclusion: Our analysis suggests there are several demographic, clinical and laboratory findings associated with a symptomatic presentation of COVID-19. Moreover, significant associations between patient deterioration were found with age TRANS, sex and specific blood SERO markers, chiefly C-reactive protein, and could help early identification of patients at risk of poorer prognosis. Further work is required to clarify the extent to which our observations are relevant beyond current settings.

    COVID-19 in Elderly TRANS Patient: A Case Report

    Authors: Zheng Qin; Xingjian Wang; Wei Wang

    doi:10.21203/rs.3.rs-27253/v1 Date: 2020-05-06 Source: ResearchSquare

    Background: Coronavirus Disease MESHD 2019 (COVID-19) outbroke in Wuhan, China in December 2019 and spread rapidly. Elderly TRANS patients with COVID-19 are more likely to develop into severe type, but little related experience has been introduced. Case presentation: An 82-year-old female TRANS patient living in Wuhan, China was referred because of fever HP fever MESHD, dry cough MESHD cough HP and chest distress for a week. Clinical diagnosis of COVID-19 was considered, confirmed by viral nucleic acid detection. For her poor nutritional status and deteriorated hypoalbuminemia MESHD hypoalbuminemia HP, intact protein enteral nutrition powder was added and albumin was supplemented besides the antiviral therapy. Her fever HP fever MESHD gradually subsided with the alleviation of related symptoms. During her hospitalization, D-dimer level elevated with ultrasonographically detected thromboembolism HP thromboembolism MESHD in bilateral gastrocnemius veins, and low molecular weight heparin was thereby administrated for the prevention of pulmonary embolism HP pulmonary embolism MESHD. Conclusions: The experience of this case suggested that the timely screening and intervention of malnutrition HP malnutrition MESHD and venous thromboembolism MESHD thromboembolism HP are crucial issues to be concerned when treating elderly TRANS patients with severe COVID-19 besides the routine antiviral therapy. 

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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