Corpus overview


MeSH Disease

Human Phenotype


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    Association of D-dimer and fibrinogen magnitude with hypercoagulability HP by thromboelastography in severe COVID-19

    Authors: Abhimanyu Chandel; Saloni Patolia; Mary Looby; Heidi Dalton; Najeebah Bade; Vikramjit Khangoora; Mehul Desai; James Lantry; Erik Osborn; Svetolik Djurkovic; Daniel Tang; Steven D Nathan; Christopher S King

    doi:10.1101/2020.07.27.20162842 Date: 2020-07-29 Source: medRxiv

    Introduction: D-dimer concentration has been used to identify candidates for intensified anticoagulant treatment for both venous thromboembolism MESHD thromboembolism HP prevention and mitigation of the microthrombotic complications associated with COVID-19. Thromboelastography (TEG) maximum amplitude (MA) has been validated as an indicator of hypercoagulability HP and MA [≥] 68 mm has been utilized as a marker of hypercoagulability HP in other conditions. We evaluated the relationship between coagulation, inflammatory, and TEG parameters in patients with COVID-19 on extracorporeal membrane oxygenation (ECMO). Methods: We performed a single center retrospective analysis of consecutive patients that received ECMO for the treatment of COVID-19. TEG, inflammatory, and coagulation markers were compared in patients with and without thrombotic complications. Correlation tests were performed to identify the coagulation and inflammatory markers that best predict hypercoagulability HP as defined by an elevated TEG MA. Results: 168 TEGs were available in 24 patients. C-reactive protein and fibrinogen were significantly higher in patients that developed a thrombotic event versus those that did not (p=0.038 and p=0.043 respectively). D-dimer was negatively correlated with TEG MA (p<0.001) while fibrinogen was positively correlated (p<0.001). A fibrinogen > 441 mg/dL had a sensitivity SERO of 91.2% and specificity of 85.7% for the detection of MA [≥] 68 mm. Conclusions: In critically ill patients with COVID-19, D-dimer concentration had an inverse relationship with hypercoagulability HP as measured by TEG MA. D-dimer elevation may reflect severity of COVID-19 related sepsis MESHD sepsis HP rather than designate patients likely to benefit from anticoagulation. Fibrinogen concentration may represent a more useful marker of hypercoagulability HP in this population.

    COVID-19 induces a hyperactive phenotype in circulating platelets

    Authors: Shane P Comer; Sarah Cullivan; Paulina B Szklanna; Luisa Weiss; Steven Cullen; Sarah Kelliher; Albert Smolenski; Niamh Moran; Claire Murphy; Haidar Altaie; John Curran; Katherine O'Reilly; Aoife G Cotter; Brian Marsh; Sean Gaine; Patrick Mallon; Brian McCullagh; Fionnuala Ní Áinle; Barry Kevane; Patricia B Maguire

    doi:10.1101/2020.07.24.20156240 Date: 2020-07-26 Source: medRxiv

    Background Coronavirus disease MESHD 2019 (COVID-19), caused by novel coronavirus SARS-CoV-2, has to date affected over 13.3 million globally. Although high rates of venous thromboembolism MESHD thromboembolism HP and evidence of COVID-19-induced endothelial dysfunction have been reported, the precise aetiology of the increased thrombotic risk associated with COVID-19 infection MESHD remains to be fully elucidated. Objectives Here, we assessed clinical platelet parameters and circulating platelet activity in patients with severe and non-severe COVID-19. Methods An assessment of clinical blood SERO parameters in patients with severe COVID-19 disease MESHD (requiring intensive care), patients with non-severe disease MESHD (not requiring intensive care), general medical in-patients without COVID-19 and healthy donors was undertaken. Platelet function and activity were also assessed by secretion and specific marker analysis. Results We show that routine clinical blood SERO parameters including increased MPV and decreased platelet:neutrophil ratio are associated with disease MESHD severity in COVID-19 upon hospitalisation and intensive care unit admission. Strikingly, agonist-induced ADP release was dramatically higher in COVID-19 patients compared with non-COVID-19 hospitalized patients and circulating levels of PF4, sP-selectin and TPO were also significantly elevated in COVID-19. Conclusion Distinct differences exist in routine full blood SERO count and other clinical laboratory parameters between patients with severe and non-severe COVID-19. Moreover, we have determined that COVID-19 patients possess hyperactive circulating platelets. These data suggest that abnormal platelet reactivity may contribute to hypercoagulability HP in COVID-19. Further investigation of platelet function in COVID-19 may provide additional insights into the aetiology of thrombotic risk in this disease MESHD and may contribute to the optimisation of thrombosis MESHD prevention and treatment strategies.

    The 4C Initiative (Clinical Care for Cardiovascular disease MESHD in the COVID-19 pandemic): monitoring the indirect impact of the coronavirus pandemic on services for cardiovascular diseases MESHD in the UK

    Authors: - TC CVD-COVID-UK Consortium; Simon Ball; Amitava Banerjee; Colin Berry; Jonathan Boyle; Benjamin Bray; William Bradlow; Afzal Chaudhry; Rikki Crawley; John Danesh; Alastair Denniston; Florian Falter; Jonine Figueroa; Christopher Hall; Harry Hemingway; Emily Jefferson; Tom Johnson; Graham King; Ken Lee; Paul McKean; Suzanne Mason; Nicholas Mills; Ewen Pearson; Munir Pirmohamed; Michael TC Poon; Rouven Priedon; Anoop Shah; Reecha Sofat; Jonathan Sterne; Fiona Strachan; Cathie LM Sudlow; Zsolt Szarka; William Whiteley; Mike Wyatt

    doi:10.1101/2020.07.10.20151118 Date: 2020-07-11 Source: medRxiv

    Background: The coronavirus (COVID-19) pandemic affects cardiovascular diseases MESHD (CVDs) directly through infection MESHD and indirectly through health service reorganisation and public health policy. Real-time data are needed to quantify direct and indirect effects. We aimed to monitor hospital activity for presentation, diagnosis and treatment of CVDs during the pandemic to inform on indirect effects. Methods: We analysed aggregate data on presentations, diagnoses and treatments or procedures for selected CVDs ( acute coronary syndromes MESHD, heart failure MESHD, stroke MESHD stroke HP and transient ischaemic attack, venous thromboembolism MESHD thromboembolism HP, peripheral arterial disease MESHD and aortic aneurysm MESHD aortic aneurysm HP) in UK hospitals before and during the COVID-19 epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. Findings: Nine hospitals across England and Scotland contributed hospital activity data from 28 Oct 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown), and for the same weeks during 2018-2019. Across all hospitals, total admissions and emergency MESHD department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1-58.6%) and 52.9% (52.2-53.5%) respectively compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown, and fell HP by 31-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm MESHD aortic aneurysm HP repair and peripheral arterial disease MESHD procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases MESHD and specialties between the first case and lockdown (total ED attendances RR 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. Interpretation: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

    Tocilizumab and Thromboembolism MESHD Thromboembolism HP 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/ 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 MESHD sepsis HP and 3 probably from thromboembolic complications, compared to 5 deaths MESHD in the 17 patients who received therapeutic anticoagulation with 4 dying from sepsis MESHD sepsis HP, and one possibly from thromboembolic complications.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 MESHD secondary to thromboembolism MESHD thromboembolism HP. 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 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 MESHD. 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) confirmed by appropriate imaging testing or dissection. The secondary endpoint included the unfavorable outcome as a combination of symptomatic VTE, 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 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 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 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) Method: We performed a comprehensive literature search of several databases to find studies that assessed VTE 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 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) Method: We performed a comprehensive literature search of several databases to find studies that assessed VTE 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 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 also associated with older age TRANS (MD 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 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 in COVID-19 patients during hospitalization.

    High Incidence of Venous Thrombosis MESHD Venous Thrombosis HP 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 MESHD venous thrombosis HP 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) in patients with moderate to severe COVID-19 and to assess the prevalence SERO of DVT 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 was found in 15 pts (20%). The vast majority of those with DVT (13 pts, 86.7%) had thrombi only in calf veins and ileofemoral thrombosis MESHD was detected in 2 pts with DVT (13.3%). There was no significant observed difference between DVT and non-DVT patients with respect to age TRANS, underlying diseases, lung MESHD CT scores and SpaO2 at admission. There was also no significant observed difference between DVT and non-DVT 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 and patients without DVT respectably (Receiver operating characteristics (ROC) curve analysis revealed that the level of D-dimer >/= 0.69 mcg/mL is the predictor of DVT 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 and patients with D-dimer >/= 0.69 mcg/mL have odds ratio (OR) of developing DVT = 5.1 (confidence interval [CI] 1.9 - 13.5)). CONCLUSION Patients with moderate to severe COVID-19 show high incidence of DVT, 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.

    Acute Pulmonary Embolism MESHD Pulmonary Embolism HP in Critically Ill Patients with COVID-19

    Authors: Madhura Manjunath; Julio Miranda; Liana Fraenkel; Paul Manje Johansen; Blessing Phinney; Georgianne Valli-Harwood; Cynthia Callahan; Hafez Alsmaan; David Oelberg

    doi:10.1101/2020.05.22.20110270 Date: 2020-05-24 Source: medRxiv

    Since the discovery of the novel coronavirus (SARS-Co-V-2) in December 2019, multiple characteristics have been reported, as our understanding of this new disease MESHD unfolds. One such association is its tendency to cause thromboembolic events, particularly venous thromboembolism MESHD thromboembolism HP (1,2). In a four-week period during the initial spread of COVID-19 at a 300 bed community hospital in western Massachusetts, 23 patients who were PCR positive for SARS-CoV-2 RNA required treatment in either the intensive care unit (ICU) or intermediate/step-down unit (SDU). All patients were treated with standard DVT prophylaxis from the time of admission, except for two patients who were on full anticoagulation for chronic atrial fibrillation MESHD atrial fibrillation HP. Of the 23 patients, 7 (30%) were diagnosed with acute, clinically significant, pulmonary embolism MESHD pulmonary embolism HP (PE). Four of the 7 manifested evidence of acute cor pulmonale HP, one of whom succumbed as a direct consequence of a massive PE. Other markers were reviewed in the 7 patients to identify trends that could allow for early suspicion of PE in COVID-19 patients. Although D-dimer tended to rise during the hospitalization relative to the control group, the results were inconsistent, and there were no other meaningful distinguishing features between the groups at the time of admission.

    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 MESHD. 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 MESHD 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/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/ 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 MESHD fever HP, 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 MESHD fever HP gradually subsided with the alleviation of related symptoms. During her hospitalization, D-dimer level elevated with ultrasonographically detected thromboembolism MESHD thromboembolism HP in bilateral gastrocnemius veins, and low molecular weight heparin was thereby administrated for the prevention of pulmonary embolism MESHD pulmonary embolism HP. Conclusions: The experience of this case suggested that the timely screening and intervention of malnutrition MESHD malnutrition HP 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

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