Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    The case series of 34 patients with COVID-19 diagnosed with HIV infection MESHD from Central and Eastern European Countries - Euroguidelines in Central and Eastern Europe Network Group data

    Authors: Kerstin Kase; Agata Skrzat-Klapaczynska; Anne Vassilenko; Arjan Harxhi; Botond Lakatos; Gordana Dragovic Lukic; David Jilich; Antonija Verhaz; Nina Yancheva; Florentina Dumitrescu; Raimonda Matulionyte; Andrzej Horban; Justyna Dominika Kowalska; Michela Sali; Massimiliano Papi; Jayashree Kalpathy-Cramer; Fredrik Nyberg; Jose D Posada; Martina Recalde; Elena Roel; Karishma Shah; Nigam Shah; Lisa M Schilling; Vignesh Subbian; David Vizcaya; Lin Zhang; Ying Zhang; Hong Zhu; Li Liu; Peter Rijnbeek; George Hripcsak; Jennifer C.E Lane; Edward Burn; Christian Reich; Marc A Suchard; Talita Duarte-Salles; Krisitn Kosta; Patrick B Ryan; DANIEL PRIETO-ALHAMBRA; Christoph Lange; Georg Laue; Clemes Lier; Matthias Lindner; Georgios Marinos; Robert Markewitz; Jacob Nattermann; Rainer Noth; Peter Pickkers; Klaus F. Rabe; Alina Renz; Christoph Roecken; Jan Rupp; Annika Schaffarzyk; Alexander Scheffold; Jonas Schulte-Schrepping; Domagoj Schunck; Dirk Skowasch; Thomas Ulas; Klaus-Peter Wandinger; Michael Wittig; Johannes Zimmermann; Hauke Busch; Bimba F. Hoyer; Christoph Kaleta; Jan Heyckendorf; Matthijs Kox; Jan Rybniker; Stefan Schreiber; Joachim Schultze; Philip Rosenstiel; - HCA Lung Biological Network; - Deutsche COVID-19 Omics Initiative (DeCOI)

    doi:10.1101/2020.09.16.20191528 Date: 2020-09-18 Source: medRxiv

    Background: A novel coronavirus (SARS-CoV-2) causing coronavirus disease MESHD (COVID-19) was detected at the end of 2019 in China. There are many COVID-19 studies in progress however, little is known about the course of COVID-19 in people living with HIV MESHD (PLWH). The aim of our study was to describe epidemiology and clinical characteristics of PLWH diagnosed with COVID-19 reported form Central and Eastern European Countries. Methods: On-line survey was sent to Euroguidelines in Central and Eastern Europe (ECEE) Network Group. Analysis included all confirmed COVID-19 cases between March 11 and June 26 2020 among PLWH in 12 countries: Albania, Belarus, Bosnia and Herzegovina, Bulgaria, Czech Republic, Estonia, Hungary, Lithuania, Poland , Romania, Russia MESHD, and Serbia. Results: In total 34 cases were reported. The mean age TRANS of those patients was 42.7 years (IQR=35.8-48.5) and most of the patients were male TRANS (70.6% vs 29.4%). The mean CD4+ T-cell count prior COVID-19 diagnosis was 558 cells/mm3 (IQR=312-719) and HIV MESHD RNA viral load (VL) was undetectable in 18 of 34 (53%) cases, the data about most recent HIV RNA VL was not available in three cases (8,8%). Comorbidities were observed in 19 (55.9%) patients, mostly cardiovascular disease MESHD (27,8%), and in 10 (29.4%) patients had coinfection, mostly chronic hepatitis HP chronic hepatitis MESHD C (87.5%). The clinical course of COVID-19 was asymptomatic TRANS in 4 (12%) cases, mild disease without hospitalization was reported in 11 (32%) cases. Stable patients with respiratory and/or systemic symptoms have been documented in 14 (41%) cases; 5 (15%) patients were clinically unstable with respiratory failure HP respiratory failure MESHD. Full recovery was reported in 31 (91%) cases, two patients died. In one case the data was not available. Conclusion: This study from 12 countries in Central and Eastern Europe region indicates no alarming signals of increased morbidity or mortality from COVID-19 among HIV-positive persons there is a need for further research.

    Early Anti-SARS-CoV-2 Convalescent Plasma SERO in Patients Admitted for COVID-19: A Randomized Phase II Clinical Trial

    Authors: María Elvira Balcells; Luis Rojas; Nicole Le Corre; Constanza Martínez-Valdebenito; María Elena Ceballos; Marcela Ferrés; Mayling Chang; Cecilia Vizcaya; Sebastián Mondaca; Álvaro Huete; Ricardo Castro; Mauricio Sarmiento; Luis Villarroel; Alejandra Pizarro; Patricio Ross; Jaime Santander; Bárbara Lara; Marcela Ferrada; Sergio Vargas-Salas; Carolina Beltrán-Pavez; Ricardo Soto-Rifo; Fernando Valiente-Echeverría; Christian Caglevic; Mauricio Mahave; Carolina Selman; Raimundo Gazitúa; José Luis Briones; Franz Villarroel-Espindola; Carlos Balmaceda; Manuel A. Espinoza; Jaime Pereira; Bruno Nervi

    doi:10.1101/2020.09.17.20196212 Date: 2020-09-18 Source: medRxiv

    Background: Convalescent plasma SERO (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. Methods: Open-label, single-center, randomized clinical trial performed in an academic center in Santiago, Chile from May 10, 2020, to July 18, 2020, with final follow-up August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptoms onset TRANS, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted in immediate CP (early plasma SERO group) versus no CP unless developing pre-specified criteria of deterioration (deferred plasma SERO group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days or death MESHD. Key secondary outcomes included: time to respiratory failure HP respiratory failure MESHD, days of mechanical ventilation, hospital length-of-stay, mortality at 30 days, and SARS-CoV-2 RT-PCR clearance rate. Results: Of 58 randomized patients (mean age TRANS, 65.8 years, 50% male TRANS), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma SERO based on clinical aggravation. We found no benefit in the primary outcome (32.1% vs 33.3%, OR 0.95, 95% CI 0.32-2.84, p>0.99) in the early versus deferred CP group. In-hospital mortality rate was 17.9% vs 6.7% (OR 3.04, 95% CI 0.54-17.2, p=0.25), mechanical ventilation 17.9% vs 6.7% (OR 3.04, 95% CI 0.54-17.2, p=0.25), and prolonged hospitalization 21.4% vs 30% (OR 0.64, 95%CI, 0.19-2.1, p=0.55) in early versus deferred CP group, respectively. Viral clearance rate on day 3 (26% vs 8%, p=0.20) and day 7 (38% vs 19%, p=0.37) did not differ between groups. Two patients experienced serious adverse events within 6 or less hours after plasma SERO transfusion. Conclusion: Immediate addition of CP therapy in early stages of COVID-19 -compared to its use only in case of patient deterioration- did not confer benefits in mortality, length of hospitalization or mechanical ventilation requirement.

    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.

    Evaluation of the Efficacy of Methylprednisolone Pulse Therapy in Treatment of Covid-19 Adult TRANS Patients with Severe Respiratory Failure MESHD Respiratory Failure HP: Randomized, Clinical Trial

    Authors: Ramin Hamidi Farahani; Reza Mosaed; Amir Nezami-Asl; Mohsen chamanara; Saeed Soleiman-Meigooni; Shahab Kalantar; Mojtaba Yousefi zoshk; Ebad Shiri Malekabad; Ebrahim Hazrati

    doi:10.21203/rs.3.rs-66909/v1 Date: 2020-08-27 Source: ResearchSquare

    Background: Covid-19 is now global concern and widely spread to the world due to high mortality among the nations we tried to evaluate the efficacy of methylprednisolone pulse in COVID-19 patients with severe respiratory failure HP respiratory failure MESHD.Methods: This study was phase2, double-blind, randomized, clinical trial in adults TRANS with COVID-19 ( aged TRANS ≥18 years old) admitted to the intensive care unit (ICU) of *. Patients with intermediate or severe COVID-19 with PaO2/FiO2 less than 300 and progressive disease unresponsive to standard treatments admitted to ICU. Patients were randomly allocated in either control or investigation group. The control group received recommended regimen for COVID-19. The investigation group received the recommended regimen plus Methylprednisolone (1000mg/day for three days) and oral prednisolone 1mg/kg with tapering of dose within ten days. Results: A total of 29 ICU patients with intermediate or severe COVID-19 pneumonia HP pneumonia MESHD recruited in this study. Fourteen patients (4 female TRANS, ten male TRANS) allocated in the investigation group, and 15 patients (6 female TRANS, nine male TRANS) assigned to the control group. The participant’s average age TRANS was 64.03±13.545 (case: 61.07±12.83, control: 66.80±14.03). The patients with methylprednisolone pulse had significantly higher systolic (P=0.018) and diastolic (P=0.001) blood SERO pressure, meanwhile, the Glasgow coma HP coma MESHD scale (GCS) of methylprednisolone group was considerably (P<0.001) higher, and by the improvement in SpO2 of methylprednisolone group none of these patients needed mechanical ventilation.Conclusion: This study demonstrated methylprednisolone pulse in COVID-19 severe respiratory failure HP respiratory failure MESHD dramatically improves the clinical condition of patients including, GCS, and SpO2 of patients.Clinical Trial Registration Number: IRCT20200406046963N1

    Lung Ultrasound Score: A Potential Prediction Tool In Covid-19

    Authors: Julio Cesar Garcia de Alencar; Julio Flavio Meirelles Marchini; Lucas Oliveira Marino; Sabrina Correa da Costa Ribeiro; Cauê Gasparotto Bueno; Victor Paro da Cunha; Felippe Lazar Neto; Fernando Salvetti Valente; Hassan Rahhal; Juliana Batista Rodrigues Pereira; Eduardo Messias Hirano Padrão; Rodrigo Antonio Brandão Neto; Heraldo Possolo Souza; COVID USP Team COVID USP Team

    doi:10.21203/rs.3.rs-66764/v1 Date: 2020-08-27 Source: ResearchSquare

    1. Background:During the COVID-19 pandemic, adequate management of available resources may be key to overcoming the excess of seriously ill patients and saving lives. Creating tools to assess disease severity is one of the most important aspects for reducing the burden on emergency departments. Lung ultrasound has high accuracy for diagnosis of pulmonary diseases MESHD; however, there are no prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19. We hypothesized that Lung Ultrasound Score (LUSS) at hospital admission would be able to predict the outcomes of patients with COVID-19.2. Methods:Prospective cohort study conducted from 14 March through 6 May 2020 in the Emergency Department (ED) of an urban, academic, level I trauma MESHD center. This 2,200-bed hospital has been designated exclusive for COVID-19 patients for the duration of the pandemic. Patients aged TRANS 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUSS, which was tested for correlation with outcomes.3. Results: Primary endpoint was death MESHD from any cause. Secondary endpoints were ICU admission and endotracheal intubation for respiratory failure HP respiratory failure MESHD. Among 180 patients with confirmed COVID-19 who were enrolled (mean age TRANS, 60 years; 105 male TRANS), the average LUSS was 18.7 ± 6.8. LUSS correlated with findings on chest CT and was able to predict the estimated extent of parenchymal involvement (mean LUSS with < 50% involvement on chest CT, 15±6.7 vs. 21±6.0 with >50% involvement, p<0.001), death MESHD (AUC 0.71, OR 1.13, 95%CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.75, OR 1.17, 95%CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95%CI 1.07 to 1.21; p < 0.001). 4. Conclusion:LUSS was a good predictor of death MESHD, ICU admission, and endotracheal intubation in COVID-19 patients. 5. Trial RegistrationThis protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068).

    CLINICAL COURSE, RISK FACTORS FOR TRANSFER TO ICU AND MORTALITY IN MESHD PATIENTS WITH COVID-19 AFFECTED BY ACUTE RESPIRATORY FAILURE HP REFERRED TO A RESPIRATORY INTERMEDIATATE CARE UNIT.

    Authors: Enrico Buonamico; Vitaliano Nicola Quaranta; Esterina Boniello; Michela Dimitri; Marco Majorano; Luciana Labate; Paola Pierucci; Federica Barratta; Giovanna Elisiana Carpagnano; Onofrio Resta; Anil Hormis; Neil Todd; Antoanela Colda; Ian Reckless; Tim Brooks; Andre Charlett; Matthew Hickman; Isabel Oliver; David Wyllie

    doi:10.1101/2020.08.19.20178350 Date: 2020-08-22 Source: medRxiv

    Introduction There are no clear guidelines as yet for the selection of patients affected by COVID-19 who can be treated in intermediate RICU, neither shared criteria for their intubation and transfer in ICU. In the present study we described the clinical course and risk factors for transfer to ICU and mortality of SARS-Cov-2 positive patients affected by acute respiratory failure HP respiratory failure MESHD, hospitalized in a Respiratory Intermediate Care Unit in the south of Italy. Methods In this retrospective, observational single centre study we evaluated 96 laboratory confirmed COVID-19 patients affected by acute respiratory failure MESHD respiratory failure HP ( ARF MESHD). We compared demographic data, laboratory data and clinical outcomes between deceased and survived patients, aiming to identify risk factors for transfer to ICU and mortality, and possible gender TRANS-related differences. Results Of 96 patients, 51 (53.1%) survived and 45 (46.9 %) died. Among those who died, 23 (51.1%) deceased in RICU. Twenty-nine (30.2%) were transferred to ICU, of whom 22 (75.9%) died in ICU. Patients affected by COPD MESHD have a higher mortality compared to patients without this comorbidity (p=0.002). Lower baseline P/F ratio (p=0,014) and neurologic comorbidities (p=0,008) emerged as risk factors for death MESHD. Male TRANS were younger than female TRANS patients (66 vs 80 y.o.; p=0.042). In female TRANS patients, lower peripheral blood SERO lymphocyte count (p=0.007) is a risk factor for death MESHD, characteristic gender TRANS-related in our sample. Female TRANS sex was a protective parameter against transfer to ICU (p=0,036) and P/F ratio was not a significant predictor of transfer to ICU (p=0,227). Only higher baseline CRP (p=0,034) has shown a predictive role for transfer to ICU in our sample. Patients deceased after a transfer to ICU had younger age TRANS (p=0,000), lower median comorbidity number (p=0,000), lower D-dimer (p=0,029) and lower prevalence SERO of female TRANS sex (p=0,029). Discussion Mortality in our study was similar to that found in other studies involving patients in non-invasive ventilation. In our study older age TRANS and comorbidities play as predictors of death in COVID-19 patients. COPD MESHD, despite presenting low prevalence SERO, is a risk factor for death MESHD, both in men and women. In female TRANS patients chronic ischemic heart disease MESHD and congestive heart failure HP congestive heart failure MESHD are death MESHD predictors. High CRP and lymphopenia HP lymphopenia MESHD, linked to inflammatory status, are predictors of transfer to ICU. Patients transferred to ICU higher mortality than the others, and patients who die in ICU are mostly men, younger and have less comorbidities. Baseline P/F ratio is not a good predictor of transfer to ICU, while in our sample is a sensible predictor of death MESHD. More studies need to be performed on COVID-19 patients, in the urgency of COVID-19 pandemic persistence.

    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.

    Robust, reproducible clinical patterns in hospitalised patients with COVID-19

    Authors: Jonathan E Millar; Lucile Neyton; Sohan Seth; Jake Dunning; Laura Merson; Srinivas Murthy; Clark D Russell; Sean Keating; Maaike Swets; Carole H Sudre; Timothy D Spector; Sebastien Ourselin; Claire J Steves; Jonathan Wolf; - ISARIC4C Investigators; Annemarie B Docherty; Ewen M Harrison; Peter JM Openshaw; Malcolm G Semple; J Kenneth Baillie

    doi:10.1101/2020.08.14.20168088 Date: 2020-08-16 Source: medRxiv

    Severe COVID-19 is characterised by fever HP fever MESHD, cough HP cough MESHD, and dyspnoea MESHD. Symptoms affecting other organ systems have been reported. The clinical associations of different patterns of symptoms can influence diagnostic and therapeutic decision-making: for example, significant differential therapeutic effects in sub-groups of patients with different severities of respiratory failure HP respiratory failure MESHD have already been reported for the only treatment so far shown to reduce mortality in COVID-19, dexamethasone. We obtained structured clinical data on 68914 patients in the UK (the ISARIC Coronavirus Clinical Characterisation Consortium, 4C) and used a principled, unsupervised clustering approach to partition the first 33468 cases according to symptoms reported at recruitment. We validated our findings in a second group of 35446 cases recruited to ISARIC-4C, and in separate cohort of community cases. A core symptom set of fever HP fever MESHD, cough HP cough MESHD, and dyspnoea co MESHD-occurred with additional symptoms in three patterns: fatigue HP fatigue MESHD and confusion HP confusion MESHD, diarrhoea and vomiting MESHD vomiting HP, or productive cough HP. Presentations with a single reported symptom of dyspnoea MESHD or confusion HP confusion MESHD were common, and a subgroup of patients reported few or no symptoms. Patients presenting with gastrointestinal symptoms MESHD were more commonly female TRANS, had a longer duration of symptoms before presentation, and had lower 30-day mortality. Patients presenting with confusion HP confusion MESHD, with or without core symptoms, were older and had a higher unadjusted mortality. Symptom clusters were highly consistent in replication analysis using a further 35446 individuals subsequently recruited to ISARIC-4C. Similar patterns were externally verified in 4445 patients from a study of self-reported symptoms of mild disease. The large scale of ISARIC-4C study enabled robust, granular discovery and replication of patient clusters. Clinical interpretation is necessary to determine which of these observations have practical utility. We propose that four patterns are usefully distinct from the core symptom groups: gastro-intestinal disease MESHD, productive cough HP, confusion HP confusion MESHD, and pauci-symptomatic presentations. Importantly, each is associated with an in-hospital mortality which differs from that of patients with core symptoms. These observations deepen our understanding of COVID-19 and will influence clinical diagnosis, risk prediction, and future mechanistic and clinical studies.

    Obesity HP Obesity MESHD and Smoking as Risk Factors for Invasive Mechanical Ventilation in COVID-19: a Retrospective, Observational Cohort Study

    Authors: Ana Carolina Costa Monteiro; Rajat Suri; Ileanacho Obi Emeruwa; Robert J Stretch; Roxana Y Cortes Lopez; Alexander Sherman; Catherine C Lindsay; Jennifer A Fulcher; David Goodman-Meza; Anil Sapru; Russell G Buhr; Steven Y Chang; Tisha Wang; Nida Qadir; Rachel Vreeman; Joseph Masci; Nick A Maskell; Shaney Barratt

    doi:10.1101/2020.08.12.20173849 Date: 2020-08-14 Source: medRxiv

    Purpose: To describe the trajectory of respiratory failure HP respiratory failure MESHD in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). Materials and Methods: A retrospective, observational cohort study of 112 inpatient adults TRANS diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum SERO markers and the outcome of IMV. Results: Our cohort had median age TRANS of 61 (IQR 45-74) and was 66% male TRANS. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity HP (OR 5.82, CI 1.74-19.48), former (OR 8.06, CI 1.51-43.06) and current smoking status (OR 10.33, CI 1.43-74.67) were associated with IMV after adjusting for age TRANS, sex, and high prevalence SERO comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11-0.96), procalcitonin (OR 1.27, CI 1.02-1.57), IL-6 (OR 1.17, CI 1.03-1.33), ferritin (OR 1.05, CI 1.005-1.11), LDH (OR 1.57, 95% CI 1.13-2.17) and CRP (OR 1.13, CI 1.06-1.21), were associated with IMV by univariate analysis. Conclusions: Obesity HP, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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