1
|
Abdel-Salam Elgohary M, Ali A, J Alarfaj S, Shahin H, Ibrahim Zaki A, Medhat Hasan E, Emam Mohamed M, Mahmoud Elkholy A, El-Masry TA, Samir Kamal J, Ali AbdelRahim M, Wageh Saber A, Seadawy MG, Elshishtawy MHM, El-Bouseary MM. Even one dose of tocilizumab could hinder bad prognosis of cytokines storm in COVID-19 patients. Cytokine 2024; 173:156433. [PMID: 37972479 DOI: 10.1016/j.cyto.2023.156433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Severe COVID-19 pneumonia is a principal cause of death due to cascade of hyper inflammatory condition that leading to lung damage. Therefore, an effective therapy to countercurrent the surge of uncontrolled inflammation is mandatory to propose. Anti-interlukin-6 receptor antagonist monoclonal therapy, tocilizumab (TCZ) showed potential results in COVID-19 patients. This study aimed to emphasize the factors associated with mortality in COVID-19 patients that treated with tocilizumab and may influence the level of serum IL-6. A retrospective cohort study included all patients with clinical parameters that pointed to presence of cytokines storm and treated with one or more doses of TCZ beside the regular protocol of COVID-19 pneumonia. The factors that influence the mortality in addition to the level of serum IL-6 were analyzed. A total of 377 patients were included, 69.5 % of them received only one dose of TCZ which started mainly at the third day of admission. The mortality rate was 29.44 %. Regardless the time of starting TCZ, just one dose was fair enough to prevent bad consequence; OR = 0.04, P = 0.001.However, in spite of protective action of TCZ, older age and female sex were significant risk factors for mortality, P = 0.001 and 0.01 respectively, as well heart disease. Moreover, increasing the level of neutrophil, AST and IL-6 were associated with bad prognosis. In the same line, treatment with ivermectin, chloroquine and remdesivir inversely affect the level of IL-6. Early treatments of COVID-19 pneumonia with at least one dose of tocilizumab minimized the fatality rate.
Collapse
Affiliation(s)
| | - Asmaa Ali
- Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt; Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, PR China.
| | - Sumaiah J Alarfaj
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University. P.O. Box 84428, Riyadh 11671, Saudi Arabia.
| | - Hesham Shahin
- Chest Consultant, Manager of Military Chest Hospital, Cairo, Egypt.
| | | | | | | | | | - Thanaa A El-Masry
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Egypt.
| | | | | | - Ashgan Wageh Saber
- Chemistry Laboratory Department, Central Military Laboratories, Cairo, Egypt.
| | - Mohamed G Seadawy
- Biological Prevention Department, Ministry of Defense, Cairo, Egypt.
| | | | - Maisra M El-Bouseary
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| |
Collapse
|
2
|
Elgohary MA, Ali A, El-Masry TA, Faidah H, Bantun F, Elkholy AM, Fahim JS, Elgamal NN, Mohamed ME, Seadawy MG, Helal AM, De Waard M, Shishtawy HM, El-Bouseary MM. Development and validation of a predictive scoring system for in-hospital mortality in COVID-19 Egyptian patients: a retrospective study. Sci Rep 2022; 12:22352. [PMID: 36572690 PMCID: PMC9791155 DOI: 10.1038/s41598-022-26471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
SARS-CoV-2 virus has rapidly spread worldwide since December 2019, causing COVID-19 disease. In-hospital mortality is a common indicator for evaluating treatment outcomes. Therefore, the developing and validating a simple score system from observational data could assist in modulating the management procedures. A retrospective cohort study included all data records of patients with positive PCR for SARS-CoV-2. The factors that associated with mortality were analyzed, then allocation of potential predictors of mortality was executed using different logistic regression modeling, subsequently scoring system was developed from the most weighted predictors. The mortality rate of patients with COVID-19 pneumonia was 28.5% and 28.74%, respectively. The most significant factors that affected in-hospital mortality were old age (> 60 years), delay in hospital admission (> 4 days), high neutrophil/lymphocyte ratio "NLR" (> 3); higher computed tomography severity score; and CT-SS (> 20), in addition to using remdesivir and tocilizumab in the treatment protocol (P < 0.001 for all). The validity of the newly performed score was significant; the AUC was 85%, P < 0.001, and its prognostic utility was good; the AUC was 75%, P < 0.001. The prognostic utility of newly developed score system (EGY.Score) was excellent and could be used to adjust the treatment strategy of highly at-risk patients with COVID-19 pneumonia.
Collapse
Affiliation(s)
| | - Asmaa Ali
- Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt ,grid.440785.a0000 0001 0743 511XDepartment of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013 P. R. China
| | - Thanaa A. El-Masry
- grid.412258.80000 0000 9477 7793Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Hani Faidah
- grid.412832.e0000 0000 9137 6644Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Farkad Bantun
- grid.412832.e0000 0000 9137 6644Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ahmad M. Elkholy
- Department of Tropical Medicine, Almaza Military Fever Hospital, Cairo, Egypt
| | - Jaklin S. Fahim
- Department of Microbiology, Almaza Military Fever Hospital, Cairo, Egypt
| | - Nabila N. Elgamal
- Department of Tropical Medicine, Almaza Military Fever Hospital, Cairo, Egypt
| | | | | | - Amro M. Helal
- Department of Public Health, Almaza Military Fever Hospital, Cairo, Egypt
| | - Michel De Waard
- Smartox Biotechnology, 6 rue des Platanes, 38120 Saint-Egrève, France ,grid.4817.a0000 0001 2189 0784L’institut du Thorax, INSERM, CNRS, Univ Nantes, F-44007 Nantes, France ,grid.460782.f0000 0004 4910 6551Université de Nice Sophia-Antipolis, LabEx “Ion Channels, Science & Therapeutics”, F-06560 Valbonne, France
| | | | - Maisra M. El-Bouseary
- grid.412258.80000 0000 9477 7793Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| |
Collapse
|
3
|
Gopalan N, Senthil S, Prabakar NL, Senguttuvan T, Bhaskar A, Jagannathan M, Sivaraman R, Ramasamy J, Chinnaiyan P, Arumugam V, Getrude B, Sakthivel G, Srinivasalu VA, Rajendran D, Nadukkandiyil A, Ravi V, Hifzour Rahamane SN, Athur Paramasivam N, Manoharan T, Theyagarajan M, Chadha VK, Natrajan M, Dhanaraj B, Murhekar MV, Ramalingam SM, Chandrasekaran P. Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care-An experience from South India. PLoS One 2022; 17:e0263471. [PMID: 35113971 PMCID: PMC8812932 DOI: 10.1371/journal.pone.0263471] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
Background We retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission. Methods and findings Data on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among ‘survivors’ and ‘non-survivors’. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets. Among 746 COVID-19 patients hospitalised [487 “survivors” and 259 “non-survivors” (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40–70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO2<95%; 2.96 (1.71–5.18), Urea ≥50 mg/dl: 4.51 (2.59–7.97), Neutrophil-lymphocytic ratio (NLR) >3; 3.01 (1.61–5.83), Age ≥50 years;2.52 (1.45–4.43), Pulse Rate ≥100/min: 2.02 (1.19–3.47) and coexisting Diabetes Mellitus; 1.73 (1.02–2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO2<95–11, Urea ≥50 mg/dl-15, NLR >3–11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as ‘OUR-ARDs score’ showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85. Conclusions The ‘OUR ARDs’ risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.
Collapse
Affiliation(s)
- Narendran Gopalan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
- * E-mail:
| | - Sumathi Senthil
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Narmadha Lakshmi Prabakar
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Thirumaran Senguttuvan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Adhin Bhaskar
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | | | - Ravi Sivaraman
- MDRU, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Jayalakshmi Ramasamy
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Ponnuraja Chinnaiyan
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Vijayalakshmi Arumugam
- Department of Microbiology, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Banumathy Getrude
- Department of Community Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Gautham Sakthivel
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Vignes Anand Srinivasalu
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Dhanalakshmi Rajendran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
- Division of Epidemiology and Operational Research, ICMR-Vector Control Research Centre, Puducherry, India
| | - Arunjith Nadukkandiyil
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Vaishnavi Ravi
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | | | - Nirmal Athur Paramasivam
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Tamizhselvan Manoharan
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Maheshwari Theyagarajan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Vineet Kumar Chadha
- Central Leprosy Teaching & Research Institute, Chengalpattu, Tamil Nadu, India
| | - Mohan Natrajan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Baskaran Dhanaraj
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Manoj Vasant Murhekar
- ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Shanthi Malar Ramalingam
- Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
- Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | | |
Collapse
|
4
|
Radhakrishnan N, Sudarsan SS, Deepak Raj K, Krishnamoorthy S. Clinical Audit on Symptomatology of Covid-19 Healthcare Workers and Impact on Quality-of-Life (QOL) Due to Continuous Facemask Usage: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2021; 73:486-493. [PMID: 33842302 PMCID: PMC8019073 DOI: 10.1007/s12070-021-02530-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
Covid-19 due to Sars-Cov-2 infection has reached pandemic proportion. Many healthcare workers are involved in managing both COVID-suspected and confirmed cases. It is mandatory for healthcare workers to have droplet and contact precautions by means of Personal protective equipment (PPE), facemask, face shield or eye protection. Prolonged usage of medical mask results in various adverse effects. This study is an attempt to know the common effects of prolonged face mask in healthcare workers and its resultant quality-of-life (QOL). To study the common effects of prolonged face mask and its impact on QOL of healthcare workers during the COVID 19 crisis. This was a prospective cross-sectional study conducted over 6 months among 2750 healthcare workers. A questionnaire requesting demographic details and most common side effects after prolonged usage of face mask was circulated. We also attached a short form-12 (sf-12) questionnaire to assess its impact on QOL. Out of 2750 personnel, 299 were excluded. Male preponderance was noted. Study was conducted on candidates using 3ply mask or above. Age range was between 18 and 65 years with mean age being 37.61 ± 15.23 in mask users < 5 h per day, 32.2 ± 10.02 in 5–10 h group and 30.19 ± 8.15 in 10 h group. 8.48% (n = 174) had comorbidities. QOL impacted. The complaints with face mask use definitely are troublesome with increase in severity with duration of mask usage. This definitely has a proportional impact on the healthcare workers’ QOL.
Collapse
Affiliation(s)
- Nandhini Radhakrishnan
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Shyam Sudhakar Sudarsan
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - K Deepak Raj
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Srinivasan Krishnamoorthy
- Department of ENT-HNS, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| |
Collapse
|
5
|
Pathak DSK, Salunke DAA, Thivari DP, Pandey A, Nandy DK, Harish V K Ratna D, Pandey DS, Chawla DJ, Mujawar DJ, Dhanwate DA, Menon DV. No benefit of hydroxychloroquine in COVID-19: Results of Systematic Review and Meta-Analysis of Randomized Controlled Trials". Diabetes Metab Syndr 2020; 14:1673-1680. [PMID: 32905939 PMCID: PMC7462641 DOI: 10.1016/j.dsx.2020.08.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Coronavirus pandemic is currently a global public health emergency with no definitive treatment guidelines. We conducted a systematic review and meta-analysis of the literature evaluating the efficacy of hydroxychloroquine and its related formulations in COVID-19 patients. METHODS A systematic search of PubMed, Scopus, MedRxiv data and Cochrane Central Register of Clinical Trials for published articles that reported the outcomes of COVID-19 patients treated with hydroxychloroquine or its compounds was done. We identified 1071 published studies and 7 studies were included in the analysis. RESULTS The study population consisted of a total of 4984 patients, of which 1721 (34.5%) received hydroxychloroquine or its congeners (HCQ group) while 3091 (62.01%) received standard of care or had included antiviral medication (control group). The pooled estimate of successful treatment in the hydroxychloroquine group and the control group was 77.45% and 77.87% respectively, which indicated similar clinical outcomes in patients treated with hydroxychloroquine compared to the control group. The odds ratio of a favourable outcome with hydroxychloroquine was 1.11 (95 CI 0.72 to 1.69) (p = 0.20). The pooled risk difference of favourable outcome with hydroxychloroquine versus control group was 0.00 (95 CI -0.03 to 0.03) which was statistically not significant (p = 0.10). CONCLUSIONS The present evidence shows no benefit of hydroxychloroquine in patients affected by mild to moderate COVID-19 disease. However, now several trials on HCQ are ongoing and hopefully more data will be available soon. Hence, the management of COVID-19 is set to change for better in the future.
Collapse
Affiliation(s)
| | | | - Dr Praveen Thivari
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Apurva Pandey
- Department of Radiation Oncology, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Dr Kunal Nandy
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Dr Harish V K Ratna
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Dr Sanjay Pandey
- Respiratory Medicine Specialist, Chandrmohan Hospital, Varanasi, India.
| | - Dr Jasneet Chawla
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Dr Jalil Mujawar
- Department of Neonatology, Sahyadri Hospital, Pune, Maharashtra, India.
| | - Dr Anant Dhanwate
- Department of Anatomy, Government Medical College, Akola, Maharashtra, India.
| | - Dr Vivek Menon
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| |
Collapse
|
6
|
Salunke AA, Warikoo V, Kumar Pathak S, Nandy K, Mujawar J, Mendhe H, Shah A, Kottakota V, Menon V, Pandya S. A proposed ABCD scoring system for better triage of patients with COVID-19: Use of clinical features and radiopathological findings. Diabetes Metab Syndr 2020; 14:1637-1640. [PMID: 32892061 PMCID: PMC7448768 DOI: 10.1016/j.dsx.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND AIMS Currently there are limited tools available for triage of patients with COVID -19. We propose a new ABCD scoring system for patients who have been tested positive for COVID-19. METHODS The ABCD score is for patients who have been tested positive for COVID-19 and admitted in a hospital. This score includes age of the patient, blood tests included leukopenia, lymphocytopenia, CRP level, LDH level,D-Dimer, Chest radiograph and CT Scan, Comorbidities and Dyspnea. RESULTS The triage score had letters from alphabets which included A, B, C, D. The score was developed using these variables which outputs a value from 0 to 1. We had used the code according to traffic signal system; green(mild), yellow moderate) and red(severe). The suggestions for mild (green)category: symptomatic treatment in ward, in moderate (yellow) category: active treatment, semi critical care and oxygen supplementation, in severe (red) category: critical care and intensive care. CONCLUSIONS This study is, to our knowledge, is the first scoring tool that has been prepared by Indian health care processional's and used alphabets A, B,C,D as variables for evaluation of admitted patients with COVID-19. This triage tool will be helpful in better management of patients with COVID-19. This score component includes clinical and radiopathological findings.A multi-centre study is required to validate all available scoring systems.
Collapse
Affiliation(s)
| | - Vikas Warikoo
- Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Kunal Nandy
- Gujarat Cancer and Research Institue, Ahmedabad, Gujarat, India
| | | | - Harshal Mendhe
- Department of Preventive and Social Medicine, GMC, Rajandgaon, Chattisgarh, India
| | - Anand Shah
- Department of Preventive and Social Medicine, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Vivek Menon
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| |
Collapse
|