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    Right Ventricular-Arterial Uncoupling Independently Predicts Survival in COVID-19 ARDS

    Authors: Michele D'Alto; Alberto Marra; Sergio Severino; Andrea Salzano; Emanuele Romeo; Rosanna C De Rosa; Francesca Stagnaro; Gianpiero Pagnano; Raffaele Verde; Patrizia Murino; Andrea Farro; Giovanni Ciccarelli; Maria Vargas; Giuseppe Fiorentino; Giuseppe Servillo; Ivan Gentile; Antonio Corcione; Antonio Cittadini; Robert Naeije; Paolo Golino

    doi:10.21203/rs.3.rs-73451/v1 Date: 2020-09-07 Source: ResearchSquare

    Aim. To investigate the prevalence SERO and prognostic impact of right heart failure MESHD failure and right ventricular HP-arterial uncoupling in Corona Virus Infectious Disease MESHD 2019 (COVID-19) complicated by an acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD).Methods. Ninety-four consecutive patients (mean age TRANS 64 yrs) admitted for acute respiratory failure HP respiratory failure MESHD on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio Results. The majority of patients needed ventilatory support, which was non-invasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62±13 vs 68±12 years, p=0.033), less often overweight HP or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270±104 vs 117±57 mmHg, p<0.001). In the non-survivors, PASP was increased (42±12 vs 30±7 mmHg, p<0.001), while TAPSE was decreased (19±4 vs 25±4 mm, p<0.001). Accordingly the TAPSE/PASP ratio was lower than in the survivors (0.51±0.22 vs 0.89±0.29 mm/mmHg, p<0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR:0.026; 95%CI:0.01-0.579; p:0.019) and PaO2/FIO2 (HR:0.988; 95%CI:0.988-0.998; p:0.018) ratios were the only independent predictors of mortality, with ROC-determined cut-off values of 159 mmHg and 0.635 mm/mmHg respectively.Conclusions. COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19.


    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.

    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.

    Oncologic Immunomodulatory Agents in Patients with Cancer MESHD and COVID-19

    Authors: Justin Jee; Aaron J Stonestrom; Sean Devlin; Teresa Nguyentran; Beatriz Wills; Varun Narendra; Michael B Foote; Melissa Lumish; Santosha Vardhana; Stephen Pastores; Neha Korde; Dhwani Patel; Steven Horwitz; Michael Scordo; Anthony Daniyan

    doi:10.1101/2020.08.11.20145458 Date: 2020-08-12 Source: medRxiv

    Background Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer MESHD. How these agents impact patients with cancer MESHD who are infected with SARS-CoV-2 remains unclear. Methods We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure HP respiratory failure MESHD or death MESHD with receipt of the aforementioned medications and with pre-COVID-19 neutropenia HP neutropenia MESHD. The study included all cancer MESHD patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N=820). We controlled for cancer MESHD-related characteristics known to predispose to worse COVID-19. To address that more acutely ill patients receive therapeutic corticosteroids, we examined patient subsets based on different levels of respiratory support: <=2 L/min supplemental oxygen, >2L/min supplemental oxygen, and advanced respiratory support prior to death. Results Corticosteroid administration was associated with worse outcomes in the pre-2L supplemental oxygen cohort; no statistically significant difference was observed in the >2L/min supplemental oxygen and post-critical cohorts. Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were lower, and ferritin levels were higher, after corticosteroid administration. In patients with metastatic thoracic cancer MESHD, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure HP respiratory failure MESHD or death MESHD among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer MESHD had respiratory failure HP respiratory failure MESHD or death MESHD among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia HP neutropenia MESHD was associated with worse COVID-19 course. Relative prevalence SERO of chemotherapy-associated neutropenia HP neutropenia MESHD in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer MESHD patients in the COVID-19 era.

    Clinical characteristics and Mortality risk factors among COVID-19 patients in Qom–Iran; The results of a Retrospective Cohort study

    Authors: Ahmad Hormati; SeyedYaser Foroghi Ghomi; masoudreza sohrabi; Ali Gholami; Saeede Jafari; Amir Jabbari; Reza AminNejad; Javad Khodadadi; Mansoureh shakeri; Alireza ShahHamzeh; Mahbobeh Afifian; Zohre Azad; Sajjad Ahmadpour; MohammadHadi Karbalai; MohammadReza Babaei; Parisa Karimzadeh; SeyedKamal Esshagh Hosseini

    doi:10.21203/rs.3.rs-42497/v1 Date: 2020-07-13 Source: ResearchSquare

    Background & AimCoronavirus 2019 (COVID-19) outbreak in the Middle East was initially reported in Qom-Iran. Clinical and epidemiologic and mortality risk factors details have not been already fully explained.MethodIn a retrospective study, the hospitalized adult TRANS patients with laboratory diagnosed COVID-19 between February 25 to March 20, 2020 were enrolled. A checklist including demographic, clinical, laboratorial, imaging, and treatment data was completed for each of the participant. The data were extracted from electronic medical records. In case of lack of information, a member of the research team contacted them via phone. All the dead patients and the first one hundred survived patients with these criteria were enrolled in the study. Outcome defined as death MESHD or discharge of patients.ResultsOf admitted patients, 200 patients who had been discharged or died were involved in this study. The majority of them were male TRANS (56%). The mean age TRANS of all patients was 62.63 ± 14.9. Co-morbidity was reported in 124 (62%) patients in which hypertension HP hypertension MESHD was the most common. The most frequent clinical presentations were dyspnea HP dyspnea MESHD in 169 (84.5%), cough HP cough MESHD in 150 (75%), and fatigue HP fatigue MESHD/weakness in 123 (61.5%) patients. The main complications were respiratory failure HP respiratory failure MESHD and acute respiratory distress syndrome MESHD respiratory distress HP syndrome with prevalence SERO of 143 (71.5%) and 105 (52.5%), accordingly. Multiple logistic models showed that decline of hemoglobin level (OR = 10.09), neutrophilia HP (OR = 3.48), high blood SERO urea nitrogen (OR = 4.29,), SpO2 ≤ 90% (OR = 3.38), and presence of patchy consolidation (OR = 6.81) were associated with poor outcome.ConclusionCOVID-19 disease has multiple aspects. CT scan findings, complete blood SERO count with differential, high blood SERO urea nitrogen and SpO2 are related to mortality. Hence needs to pay serious attention during admitting and surveillance, particularly among elderly TRANS patients and who with preexisting morbidities.

    Vitamin D deficiency MESHD as a predictor of poor prognosis in patients with acute respiratory failure MESHD respiratory failure HP due to COVID-19 

    Authors: Giovanna Elisiana Carpagnano; Valentina Di Lecce; Vitaliano Nicola Quaranta; Annapaola Zito; Enrico Buonamico; Elena Capozza; Alessandro Palumbo; Giuseppe Di Gioia; Vincenzo Nicola Valerio; Onofrio Resta

    doi:10.21203/rs.3.rs-41173/v1 Date: 2020-07-11 Source: ResearchSquare

    Purpose: H ypovitaminosis D MESHDis a highly spread condition correlated with increased risk of respiratory tract infections HP espiratory tract infections. MESHD Nowadays, the world is in the grip of the C oronavirus disease MESHD19 (COVID 19) pandemic. In these patients, cytokine storm is associated with disease severity. In consideration of the role of vitamin D in the immune system, aim of this study was to analyse vitamin D levels in patients with a cute respiratory failure MESHD respiratory failure HP due to COVID-19 and to assess any correlations with disease severity and prognosis. Methods: In this retrospective, observational study, we analysed demographic, clinical and laboratory data of 42 patients with a cute respiratory failure MESHD respiratory failure HP due to COVID-19, treated in Respiratory Intermediate Care Unit (RICU) of the Policlinic of Bari from March, 11 to April 30, 2020. Results: Eighty one percent of patients had hypovitaminosis D. Based on vitamin D levels, the population was stratified into four groups: no h ypovitaminosis D, MESHD i nsufficiency, MESHD moderate d eficiency, and severe deficiency. MESHD No differences regarding demographic and clinical characteristics were found. A survival analysis highlighted that, after 10 days of hospitalization, severe vitamin D deficiency MESHDpatients had a 50% mortality probability, while those with vitamin D ≥10 had a 5% mortality risk (p=0.019). Conclusions: High prevalence SERO of h ypovitaminosis D MESHDwas found in COVID-19 patients with a cute respiratory failure, MESHD respiratory failure HP, treated in a RICU. Patients with severe vitamin D deficiency MESHDhad a significantly higher mortality risk. Severe vitamin D deficiency MESHDmay be a marker of poor prognosis in these patients, suggesting that adjunctive treatment might improve disease outcomes.

    Clinical features of 162 fatal cases of COVID-19: a multi-center, retrospective study

    Authors: Xianlong Zhou; Guoyong Ding; Qing Fang; Jun Guo; Luyu Yang; Ping Wang; Shouzhi Fu; Ang Li; Jian Xia; Jiangtao Yu; Jianyou Xia; Min Ma; Zhuanzhuan Hu; Lei Huang; Ruining Liu; Cheng Jiang; Shaoping Li; Mingxia Yu; Xizhu Xu; Yan Zhao; Quan Hu; Weijia Xing; Zhigang Zhao

    doi:10.21203/rs.3.rs-29357/v1 Date: 2020-05-15 Source: ResearchSquare

    Understanding the epidemiological and clinical characteristics of fatal cases infected with SARS-CoV-2 is import to develop appropriate preventable intervention programs in hospitals. Demographic data, clinical symptoms, clinical course, co-morbidities, laboratory findings, CT scans, treatments and complications of 162 fatal cases were retrieved from electric medical records in 5 hospitals of Wuhan, China. The median age TRANS was 69.5 years old (IQR: 63.0-77.25; range: 29-96). 112 (69.1%) cases were men. Hypertension HP Hypertension MESHD (45.1%) was the most common co-morbidity, but 59 (36.4%) cases had no co-morbidity. At admission, 131 (81.9%) cases were assessed as severe or critical. However, 39 (18.1%) were assessed as moderate. Moderate cases had a higher prevalence SERO of hypertension HP hypertension MESHD and chronic lung disease HP lung disease MESHD comparing with severe or critical cases (P<0.05, respectively). 126 (77.8%) and 132 (81.5%) cases received antiviral treatment and glucocorticoids, respectively. 116 (71.6%) cases were admitted to ICU and 137 (85.1%) cases received mechanical ventilation. Respiratory failure HP Respiratory failure MESHD or acute respiratory distress syndrome MESHD respiratory distress HP syndrome (93.2%) was the most common complication. The young cases of COVID-19, without co-morbidity and in a moderate condition at admission could develop fatal outcome. We need to be more cautious in case management of COVID-19 for preventing the fatal outcomes.

    COVID-19 Infections and Outcomes in a Live Registry of Heart Failure MESHD Patients Across an Integrated Health Care System

    Authors: Cesar Caraballo; Megan McCullough; Michael Fuery; Fouad Chouairi; Craig Keating; Neal Ravindra; Elliott Miller; Maricar Malinis; Nitu Kashyap; Allen Hsiao; Francis Perry Wilson; Jeptha Curtis; Matthew Grant; Eric J Velazquez; Nihar Desai; Tariq Ahmad

    doi:10.1101/2020.04.27.20082016 Date: 2020-05-03 Source: medRxiv

    Background: Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure MESHD patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence SERO and outcomes of COVID-19 in a live registry of heart failure MESHD patients across an integrated health care system in Connecticut. Methods: In this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure MESHD across a 6-hospital integrated health care system in Connecticut, was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure HP respiratory failure MESHD, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review. Results: COVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N=26,703). Overall, 206 (23%) were COVID-19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension HP hypertension MESHD, coronary artery disease MESHD, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age TRANS was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19+ patients who were [≥]85 years of age TRANS rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation. Conclusions: In this real-world snapshot of COVID-19 infection MESHD among a large cohort of heart failure MESHD patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly TRANS COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.

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