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Liu X, Liu T, Wan R. Clinical presentation of severe COVID‑19 with heart failure: A single‑center retrospective study. Exp Ther Med 2024; 27:193. [PMID: 38590575 PMCID: PMC11000051 DOI: 10.3892/etm.2024.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic has led to a global transformation in public health interventions. The present study aimed to evaluate the clinical features as well as the outcomes of severe heart failure (HF) among patients with severe COVID-19. A single-center observational study was carried out at The 904th Hospital of Joint Logistic Support Force (Wuxi, China) from November 2022 to April 2023, and a total of 210 patients diagnosed with severe HF were included. Among these patients, 128 patients had COVID-19 whereas the remaining patients were not diagnosed with COVID-19. The analysis entailed investigated pre-existing medical records, that is, admission and discharge, laboratory values, neuroimaging, length of hospitalization, mortality and costs incurred by patients throughout the COVID-19 pandemic from the records. All the 210 incorporated patients accomplished the follow-up and it was established that there was no significant differences in baseline characteristics between HF combined with COVID-19 and HF without COVID-19 were affirmed (P>0.05). HF coupled with COVID-19 infection demonstrated an increased risk of 30-day mortality (28.91 vs. 14.63%; P=0.017), extended length of hospital stays (22.54±6.73 vs. 19.35±5.69; P<0.001) and higher expenses for hospitalization (P<0.001). Complications related to hospitalization, including pneumonia (76.56 vs. 35.37%; P=1.0x10-4), respiratory failure (47.66 vs. 24.39%; P=0.001), pulmonary embolism (8.59 vs. 2.44%; P=0.031), deep vein thrombosis (30.47 vs. 14.63%; P=0.009), 7 days delirium (60.16 vs. 45.12%; P=0.033), multiple organ dysfunction syndrome (32.81 vs. 18.29%; P=0.021) and neurological deficits (30.47% vs. 17.07%, P=0.029) increased significantly. In conclusion, HF combined with COVID-19, treatment and prognosis are getting worse. Enhancing preparedness for future COVID-19 and other similar pandemics necessitates the comprehension of this to refine care provided to patients with HF (registration no. THH-IPR-20221101 on 01 November 2022).
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Affiliation(s)
- Xinling Liu
- Department of Quality Management, The 904th Hospital of Joint Logistic Support Force (Wuxi Taihu Hospital), Wuxi, Jiangsu 214044, P.R. China
| | - Tingting Liu
- Department of Quality Management, The 904th Hospital of Joint Logistic Support Force (Wuxi Taihu Hospital), Wuxi, Jiangsu 214044, P.R. China
| | - Rong Wan
- Department of Quality Management, The 904th Hospital of Joint Logistic Support Force (Wuxi Taihu Hospital), Wuxi, Jiangsu 214044, P.R. China
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Cha S, Kostibas MP. Echocardiographic and Point-of-Care Ultrasonography (POCUS) Guidance in the Management of the ECMO Patient. J Clin Med 2024; 13:2630. [PMID: 38731160 PMCID: PMC11084171 DOI: 10.3390/jcm13092630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
Veno-arterial (V-A) and Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support is increasingly utilized for acute cardiogenic shock and/or respiratory failure. Echocardiography and point-of-care ultrasonography (POCUS) play a critical role in the selection and management of these critically ill patients, however, there are limited guidelines regarding their application. This comprehensive review describes current and potential application of echocardiography and POCUS for pre-ECMO assessment and patient selection, cannulation guidance with emphasis on dual-lumen configurations, diagnosis of ECMO complications and trouble-shooting of cannula malposition, diagnosis of common cardiac or pulmonary pathologies, and assessment of ECMO weaning appropriateness including identification of the aortic mixing point in V-A ECMO.
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Affiliation(s)
- Stephanie Cha
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street Suite 6216, Baltimore, MD 21287, USA;
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Millington SJ, Narasimhan M, Mayo PH, Vieillard-Baron A. Ten Influential Point-of-Care Ultrasound Papers: 2023 in Review. J Intensive Care Med 2024:8850666241233556. [PMID: 38374613 DOI: 10.1177/08850666241233556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
In an effort to help keep busy clinicians up to date with the latest ultrasound research, our group of experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.
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Affiliation(s)
- Scott J Millington
- Critical Care, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Mangala Narasimhan
- Critical Care, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paul H Mayo
- Critical Care, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Tsolaki V, Zakynthinos GE, Karavidas N, Vazgiourakis V, Papanikolaou J, Parisi K, Zygoulis P, Makris D, Zakynthinos E. Comprehensive temporal analysis of right ventricular function and pulmonary haemodynamics in mechanically ventilated COVID-19 ARDS patients. Ann Intensive Care 2024; 14:25. [PMID: 38345712 PMCID: PMC10861421 DOI: 10.1186/s13613-024-01241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cardiac injury is frequently reported in COVID-19 patients, the right ventricle (RV) is mostly affected. We systematically evaluated the cardiac function and longitudinal changes in severe COVID-19 acute respiratory distress syndrome (ARDS) admitted to the intensive care unit (ICU) and assessed the impact on survival. METHODS We prospectively performed comprehensive echocardiographic analysis on mechanically ventilated COVID-19 ARDS patients, using 2D/3D echocardiography. We defined left ventricular (LV) systolic dysfunction as ejection fraction (EF) < 40%, or longitudinal strain (LS) > - 18% and right ventricular (RV) dysfunction if two indices among fractional area change (FAC) < 35%, tricuspid annulus systolic plane excursion (TAPSE) < 1.6 cm, RV EF < 44%, RV-LS > - 20% were present. RV afterload was assessed from pulmonary artery systolic pressure (PASP), PASP/Velocity Time Integral in the right ventricular outflow tract (VTIRVOT) and pulmonary acceleration time (PAcT). TAPSE/PASP assessed the right ventriculoarterial coupling (VACR). RESULTS Among 176 patients included, RV dysfunction was common (69%) (RV-EF 41.1 ± 1.3%; RV-FAC 36.6 ± 0.9%, TAPSE 20.4 ± 0.4mm, RV-LS:- 14.4 ± 0.4%), usually accompanied by RV dilatation (RVEDA/LVEDA 0.82 ± 0.02). RV afterload was increased in most of the patients (PASP 33 ± 1.1 mmHg, PAcT 65.3 ± 1.5 ms, PASP/VTIRVOT, 2.29 ± 0.1 mmHg/cm). VACR was 0.8 ± 0.06 mm/mmHg. LV-EF < 40% was present in 21/176 (11.9%); mean LV-EF 57.8 ± 1.1%. LV-LS (- 13.3 ± 0.3%) revealed a silent LV impairment in 87.5%. A mild pericardial effusion was present in 70(38%) patients, more frequently in non-survivors (p < 0.05). Survivors presented significant improvements in respiratory physiology during the 10th ICU-day (PaO2/FiO2, 231.2 ± 11.9 vs 120.2 ± 6.7 mmHg; PaCO2, 43.1 ± 1.2 vs 53.9 ± 1.5 mmHg; respiratory system compliance-CRS, 42.6 ± 2.2 vs 27.8 ± 0.9 ml/cmH2O, all p < 0.0001). Moreover, survivors presented significant decreases in RV afterload (PASP: 36.1 ± 2.4 to 20.1 ± 3 mmHg, p < 0.0001, PASP/VTIRVOT: 2.5 ± 1.4 to 1.1 ± 0.7, p < 0.0001 PAcT: 61 ± 2.5 to 84.7 ± 2.4 ms, p < 0.0001), associated with RV systolic function improvement (RVEF: 36.5 ± 2.9% to 46.6 ± 2.1%, p = 0.001 and RV-LS: - 13.6 ± 0.7% to - 16.7 ± 0.8%, p = 0.001). In addition, RV dilation subsided in survivors (RVEDA/LVEDA: 0.8 ± 0.05 to 0.6 ± 0.03, p = 0.001). Day-10 CRS correlated with RV afterload (PASP/VTIRVOT, r: 0.535, p < 0.0001) and systolic function (RV-LS, 0.345, p = 0.001). LV-LS during the 10th ICU-day, while ΔRV-LS and ΔPASP/RVOTVTI were associated with survival. CONCLUSIONS COVID-19 improvements in RV function, RV afterload and RV-PA coupling at day 10 were associated with respiratory function and survival.
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Affiliation(s)
- Vasiliki Tsolaki
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | | | - Nikitas Karavidas
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Vasileios Vazgiourakis
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - John Papanikolaou
- Department of Cardiology, General Hospital of Trikala, Karditsis 56, 42131, Trikala, Thessaly, Greece
| | - Kyriaki Parisi
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Paris Zygoulis
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Demosthenes Makris
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Epaminondas Zakynthinos
- Critical Care Department, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110, Larissa, Greece.
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Levitt CV, Williams CA, Ahari J, Pourmand A. Approach to Decompensated Right Heart Failure in the Acute Setting. J Clin Med 2024; 13:869. [PMID: 38337563 PMCID: PMC10856072 DOI: 10.3390/jcm13030869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and being associated with a higher risk of mortality. This condition underscores the importance of effective cardiac care and timely intervention to manage its complications and improve patient outcomes. Diagnosing ARHF involves a comprehensive approach that includes a physical examination to evaluate the patient's fluid status and heart-lung function, blood tests to identify potential triggers and help forecast patient outcomes and various imaging techniques. These imaging techniques include electrocardiograms, point-of-care ultrasounds, computed tomography, cardiac magnetic resonance imaging, and other advanced monitoring methods. These diagnostic tools collectively aid in a detailed assessment of the patient's cardiac and pulmonary health, essential for effective management of ARHF. The management of ARHF focuses on addressing the underlying causes, regulating fluid balance, and enhancing cardiac function through pharmacological treatments or mechanical support aimed at boosting right heart performance. This management strategy includes the use of medications that modulate preload, afterload, and inotropy; vasopressors; anti-arrhythmic drugs; ensuring proper oxygenation and ventilation; and the utilization of heart and lung assist devices as a bridge to potential transplantation. This review article is dedicated to exploring the pathophysiology of ARHF, examining its associated morbidity and mortality, evaluating the various diagnostic tools available, and discussing the diverse treatment modalities. The article seeks to provide a comprehensive understanding of ARHF, its impact on health, and the current strategies for its management.
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Affiliation(s)
- Catherine V. Levitt
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA (C.A.W.)
| | - Caitlin A. Williams
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA (C.A.W.)
| | - Jalil Ahari
- Pulmonary and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA (C.A.W.)
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Jozwiak M, Dupuis C, Denormandie P, Aurenche Mateu D, Louchet J, Heme N, Mira JP, Doyen D, Dellamonica J. Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up. Ann Intensive Care 2024; 14:14. [PMID: 38261092 PMCID: PMC10805901 DOI: 10.1186/s13613-024-01248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay. METHODS Prospective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days. The different patterns of RV injury were isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). The different RV injury patterns were described and their association with Day-28 mortality was investigated. RESULTS Of 118 patients with complete echocardiographic follow-up who underwent 393 TTE examinations during ICU stay, 73(62%) had at least one RV injury pattern during one or several TTE examinations: 29(40%) had isolated RV dilation, 39(53%) had RV dysfunction without RV dilation, 10(14%) had RV dysfunction with RV dilation and 2(3%) had ACP. Patients with RV injury were more likely to have cardiovascular risk factors, to be intubated and to receive norepinephrine and had a higher Day-28 mortality rate (27 vs. 7%, p < 0.01). RV injury was isolated in 82% of cases, combined with left ventricular systolic dysfunction in 18% of cases and 10% of patients with RV injury experienced several patterns of RV injury during ICU stay. The number of patients with de novo RV injury decreased over time, no patient developed de novo RV injury after Day-14 regardless of the RV injury pattern and 20(31%) patients without RV injury on ICU admission developed RV injury during ICU stay. Only the combination of RV dysfunction with RV dilation or ACP (aHR = 3.18 95% CI(1.16-8.74), p = 0.03) was associated with Day-28 mortality. CONCLUSION RV injury was frequent in COVID-19 patients, occurred within the first two weeks after ICU admission and was most often isolated. Only the combination of RV dysfunction with RV dilation or ACP could potentially be associated with Day-28 mortality. Clinical trial registration NCT04335162.
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Affiliation(s)
- Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
- Université Paris Cité, Paris, France.
- UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
| | - Claire Dupuis
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- IAME Université Paris Cité, U 1137, 75018, Paris, France
| | - Pierre Denormandie
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Didac Aurenche Mateu
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Jean Louchet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Nathan Heme
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Denis Doyen
- UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Jean Dellamonica
- UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
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Alsagaff MY, Wardhani LFK, Nugraha RA, Putra TS, Khrisna BPD, Al-Farabi MJ, Gunadi RI, Azmi Y, Budianto CP, Fagi RA, Luthfah N, Subagjo A, Oktaviono YH, Lefi A, Dharmadjati BB, Alkaff FF, Pikir BS. Quantification of hs-Troponin Levels and Global Longitudinal Strain among Critical COVID-19 Patients with Myocardial Involvement. J Clin Med 2024; 13:352. [PMID: 38256486 PMCID: PMC10816186 DOI: 10.3390/jcm13020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Background. Myocardial involvement among critically ill patients with coronavirus disease 2019 (COVID-19) often has worse outcomes. An imbalance in the oxygen supply causes the excessive release of pro-inflammatory cytokines, which results in increased ventilation requirements and the risk of death in COVID-19 patients. Purpose. We evaluated the association between the hs-troponin I levels and global longitudinal strain (GLS) as evidence of myocardial involvement among critical COVID-19 patients. Methods. We conducted a prospective cohort study from 1 February to 31 July 2021 at RSUD Dr. Soetomo, Surabaya, as a COVID-19 referral center. Of the 65 critical COVID-19 patients included, 41 (63.1%) were men, with a median age (interquartile range) of 51.0 years (20.0-75.0). Subjects were recruited based on WHO criteria for severe COVID-19, and myocardial involvement in the form of myocarditis was assessed using CDC criteria. Subjects were examined using echocardiography to measure the GLS, and blood samples were taken to measure the hs-troponin. Subjects were then followed for their need for mechanical ventilation and in-hospital mortality. Results. Severe COVID-19 patients with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was a relationship between the use of intubation and the risk of death in patients (66.7% vs. 33.3%, p-value < 0.001). Decreased GLS and increased hs-troponin were associated with increased myocarditis (p values < 0.001 and 0.004, respectively). Decreased GLS was associated with a higher need for mechanical ventilation (12.17 + 4.79 vs. 15.65 + 4.90, p-value = 0.02) and higher mortality (11.36 + 4.64 vs. 14.74 + 4.82; p-value = 0.005). Elevated hs-troponin was associated with a higher need for mechanical ventilation (25.33% vs. 3.56%, p-value = 0.002) and higher mortality (34.57% vs. 5.76%, p-value = 0.002). Conclusions. Critically ill COVID-19 patients with myocardial involvement and elevated cardiac troponin levels are associated with a higher need for mechanical ventilation and higher mortality.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Louisa Fadjri Kusuma Wardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Tony Santoso Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Bagus Putra Dharma Khrisna
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Ruth Irena Gunadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Yusuf Azmi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Christian Pramudita Budianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Rosi Amrilla Fagi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Nadya Luthfah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Agus Subagjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Achmad Lefi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | | | - Budi Susetyo Pikir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
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8
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Spadaro S, Jimenez-Santana JD, La Rosa R, Spinazzola G, Argente Navarro P, Volta CA, Scaramuzzo G. Prone Positioning and Molecular Biomarkers in COVID and Non-COVID ARDS: A Narrative Review. J Clin Med 2024; 13:317. [PMID: 38256451 PMCID: PMC10816213 DOI: 10.3390/jcm13020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
Prone positioning (PP) represents a therapeutic intervention with the proven capacity of ameliorating gas exchanges and ventilatory mechanics indicated in acute respiratory distress syndrome (ARDS). When PP is selectively applied to moderate-severe cases of ARDS, it sensitively affects clinical outcomes, including mortality. After the COVID-19 outbreak, clinical application of PP peaked worldwide and was applied in 60% of treated cases, according to large reports. Research on this topic has revealed many physiological underpinnings of PP, focusing on regional ventilation redistribution and the reduction of parenchymal stress and strain. However, there is a lack of evidence on biomarkers behavior in different phases and phenotypes of ARDS. Patients response to PP are, to date, decided on PaO2/FiO2 ratio improvement, whereas scarce data exist on biomarker tracking during PP. The purpose of this review is to explore current evidence on the clinical relevance of biomarkers in the setting of moderate-severe ARDS of different etiologies (i.e., COVID and non-COVID-related ARDS). Moreover, this review focuses on how PP may modulate biomarkers and which biomarkers may have a role in outcome prediction in ARDS patients.
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Affiliation(s)
- Savino Spadaro
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Jose Daniel Jimenez-Santana
- Department of Anaesthesiology, Hospital Universitari i Politécnic la Fe, 46026 Valencia, Spain; (J.D.J.-S.); (P.A.N.)
| | - Riccardo La Rosa
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Giorgia Spinazzola
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Gemelli, IRCSS, 00168 Rome, Italy;
| | - Pilar Argente Navarro
- Department of Anaesthesiology, Hospital Universitari i Politécnic la Fe, 46026 Valencia, Spain; (J.D.J.-S.); (P.A.N.)
| | - Carlo Alberto Volta
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Gaetano Scaramuzzo
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (C.A.V.); (G.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
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9
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Trongtrakul K, Tajarernmuang P, Limsukon A, Theerakittikul T, Niyatiwatchanchai N, Surasit K, Glunriangsang P, Liwsrisakun C, Bumroongkit C, Pothirat C, Inchai J, Chaiwong W, Chanayat P, Deesomchok A. The National Early Warning Score 2 with Age and Body Mass Index (NEWS2 Plus) to Determine Patients with Severe COVID-19 Pneumonia. J Clin Med 2024; 13:298. [PMID: 38202305 PMCID: PMC10780151 DOI: 10.3390/jcm13010298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767-0.830) and 0.821 (95% CI, 0.791-0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (p = 0.012). Utilizing a cut-off point of five, NEWS2 Plus exhibited better sensitivity and negative predictive value than the traditional NEWS2, with values of 99.7% vs. 83.7% and 98.9% vs. 80.7%, respectively. (4) Conclusions: The incorporation of age and BMI into the traditional NEWS2 score enhanced the efficacy of determining severe COVID-19 pneumonia. Physicians can rely on NEWS2 Plus (NEWS2 + Age + BMI) as a more effective decision-making tool for triaging COVID-19 patients during early hospitalization.
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Affiliation(s)
- Konlawij Trongtrakul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Atikun Limsukon
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Nutchanok Niyatiwatchanchai
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | | | | | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Chaiwat Bumroongkit
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Juthamas Inchai
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Panida Chanayat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.T.); (P.T.); (A.L.); (T.T.); (N.N.); (C.L.); (C.B.); (C.P.); (J.I.); (W.C.); (P.C.)
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10
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Zhang SJ, He SZ, Wu JJ, Chen YJ, Lyu GR. Evaluation of extravascular lung water and cardiac function in normal vaginal delivery by intrapartum bedside ultrasound. BMC Pregnancy Childbirth 2024; 24:13. [PMID: 38166871 PMCID: PMC10759567 DOI: 10.1186/s12884-023-06201-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Healthy parturients may experience pulmonary edema and disturbed cardiac function during labor. We aimed to evaluate the extravascular lung water (EVLW), intravascular volume, and cardiac function of normal parturients during spontaneous vaginal delivery by bedside ultrasound. And to explore the correlation between EVLW and intravascular volume, cardiac function. METHODS This was a prospective observational study including 30 singleton-term pregnant women undergoing spontaneous vaginal delivery. Bedside ultrasound was performed at the early labor, the end of the second stage of labor, 2 and 24 h postpartum, and 120 scanning results were recorded. EVLW was evaluated by the echo comet score (ECS) obtained by the 28-rib interspaces technique. Inferior vena cava collapsibility index (IVC-CI), left ventricle ejection fraction, right ventricle fractional area change, left and right ventricular E/A ratio, and left and right ventricular index of myocardial performance (LIMP and RIMP) were measured. Measurements among different time points were compared, and the correlations between ECS and other measurements were analyzed. RESULTS During the spontaneous vaginal delivery of healthy pregnant women, 2 had a mild EVLW increase at the early labor, 8 at the end of the second stage of labor, 13 at 2 h postpartum, and 4 at 24 h postpartum (P < 0.001). From the early labor to 24 h postpartum, ECS first increased and then decreased, reaching its peak at 2 h postpartum (P < 0.001). IVC-CI first decreased and then increased, reaching its minimum at the end of the second stage of labor (P < 0.001). RIMP exceeded the cut-off value of 0.43 at the end of the second stage of labor. ECS was weakly correlated with IVC-CI (r=-0.373, P < 0.001), LIMP (r = 0.298, P = 0.022) and RIMP (r = 0.211, P = 0.021). CONCLUSIONS During spontaneous vaginal delivery, the most vital period of perinatal care is between the end of the second stage of labor and 2 h postpartum, because the risk of pulmonary edema is higher and the right ventricle function may decline. IVC-CI can be used to evaluate maternal intravascular volume. The increase in EVLW may be related to the increase in intravascular volume and the decrease in ventricular function.
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Affiliation(s)
- Shi-Jie Zhang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Shao-Zheng He
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Jing-Jing Wu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yong-Jian Chen
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Guo-Rong Lyu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian Province, China.
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11
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Alevroudis I, Kotoulas SC, Tzikas S, Vassilikos V. Congestion in Heart Failure: From the Secret of a Mummy to Today's Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review. J Clin Med 2023; 13:12. [PMID: 38202020 PMCID: PMC10779505 DOI: 10.3390/jcm13010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach.
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Affiliation(s)
- Ioannis Alevroudis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
- Intensive Care Medicine Clinic, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
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12
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Dadon Z, Steinmetz Y, Levi N, Orlev A, Belman D, Butnaru A, Carasso S, Glikson M, Alpert EA, Gottlieb S. Artificial Intelligence-Powered Left Ventricular Ejection Fraction Analysis Using the LVivoEF Tool for COVID-19 Patients. J Clin Med 2023; 12:7571. [PMID: 38137638 PMCID: PMC10743829 DOI: 10.3390/jcm12247571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
We sought to prospectively investigate the accuracy of an artificial intelligence (AI)-based tool for left ventricular ejection fraction (LVEF) assessment using a hand-held ultrasound device (HUD) in COVID-19 patients and to examine whether reduced LVEF predicts the composite endpoint of in-hospital death, advanced ventilatory support, shock, myocardial injury, and acute decompensated heart failure. COVID-19 patients were evaluated with a real-time LVEF assessment using an HUD equipped with an AI-based tool vs. assessment by a blinded fellowship-trained echocardiographer. Among 42 patients, those with LVEF < 50% were older with more comorbidities and unfavorable exam characteristics. An excellent correlation was demonstrated between the AI and the echocardiographer LVEF assessment (0.774, p < 0.001). Substantial agreement was demonstrated between the two assessments (kappa = 0.797, p < 0.001). The sensitivity, specificity, PPV, and NPV of the HUD for this threshold were 72.7% 100%, 100%, and 91.2%, respectively. AI-based LVEF < 50% was associated with worse composite endpoints; unadjusted OR = 11.11 (95% CI 2.25-54.94), p = 0.003; adjusted OR = 6.40 (95% CI 1.07-38.09, p = 0.041). An AI-based algorithm incorporated into an HUD can be utilized reliably as a decision support tool for automatic real-time LVEF assessment among COVID-19 patients and may identify patients at risk for unfavorable outcomes. Future larger cohorts should verify the association with outcomes.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Daniel Belman
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Adi Butnaru
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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13
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Jacquier M, Labruyère M, Ecarnot F, Roudaut JB, Andreu P, Voizeux P, Save Q, Pedri R, Rigaud JP, Quenot JP. Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2. J Clin Med 2023; 12:7509. [PMID: 38137578 PMCID: PMC10743400 DOI: 10.3390/jcm12247509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen therapy was crucial. In this article, we discuss tracheal intubation to provide mechanical ventilation in patients with hypoxaemic acute respiratory failure due to SARS-CoV-2. We first describe the pathophysiology of respiratory anomalies leading to acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2, and then briefly review management, focusing particularly on the ventilation strategy. Overall, the ventilatory management of ARDS due to SARS-CoV-2 infection is largely the same as that applied in ARDS from other causes, and lung-protective ventilation is recommended. The difference lies in the initial clinical presentation, with profound hypoxaemia often observed concomitantly with near-normal pulmonary compliance.
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Affiliation(s)
- Marine Jacquier
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21000 Dijon, France
| | - Marie Labruyère
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, 25030 Besançon, France;
- EA3920, University of Franche-Comté, 25000 Besançon, France
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Pierre Voizeux
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Quentin Save
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Romain Pedri
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, 76202 Dieppe, France;
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, 14000 Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21000 Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, 21000 Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), University of Burgundy, 21000 Dijon, France
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Sanfilippo F, Messina A, Scolletta S, Bignami E, Morelli A, Cecconi M, Landoni G, Romagnoli S. The "CHEOPS" bundle for the management of Left Ventricular Diastolic Dysfunction in critically ill patients: an experts' opinion. Anaesth Crit Care Pain Med 2023; 42:101283. [PMID: 37516408 DOI: 10.1016/j.accpm.2023.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
The impact of left ventricular (LV) diastolic dysfunction (DD) on the outcome of patients with heart failure was established over three decades ago. Nevertheless, the relevance of LVDD for critically ill patients admitted to the intensive care unit has seen growing interest recently, and LVDD is associated with poor prognosis. Whilst an assessment of LV diastolic function is desirable in critically ill patients, treatment options for LVDD are very limited, and pharmacological possibilities to rapidly optimize diastolic function have not been found yet. Hence, a proactive approach might have a substantial role in improving the outcomes of these patients. Recalling historical Egyptian parallelism suggesting that Doppler echocardiography has been the "Rosetta stone" to decipher the study of LV diastolic function, we developed a potentially useful acronym for physicians at the bedside to optimize the management of critically ill patients with LVDD with the application of the bundle. We summarized the bundle under the acronym of the famous ancient Egyptian pharaoh CHEOPS: Chest Ultrasound, combining information from echocardiography and lung ultrasound; HEmodynamics assessment, with careful evaluation of heart rate and rhythm, as well as afterload and vasoactive drugs; OPtimization of mechanical ventilation and pulmonary circulation, considering the effects of positive end-expiratory pressure on both right and left heart function; Stabilization, with cautious fluid administration and prompt fluid removal whenever judged safe and valuable. Notably, the CHEOPS bundle represents experts' opinion and are not targeted at the initial resuscitation phase but rather for the optimization and subsequent period of critical illness.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy; Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - Antonio Messina
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, 20089, Rozzano, Milan, Italy.
| | - Sabino Scolletta
- Anesthesia and Intensive Care Unit, University Hospital of Siena, University of Siena, Siena, Italy.
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Roma, Italy.
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, 20089, Rozzano, Milan, Italy.
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Department of Anetshesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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15
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Liu G, Du C, Du W, You D. The clinical features of severe COVID-19 with respiratory failure: A Chinese single-center retrospective study. Medicine (Baltimore) 2023; 102:e36110. [PMID: 38050298 PMCID: PMC10695532 DOI: 10.1097/md.0000000000036110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/24/2023] [Indexed: 12/06/2023] Open
Abstract
The global pandemic of COVID-19, caused by the novel coronavirus SARS-CoV-2, has resulted in widespread alterations to public health measures worldwide. This observational study aimed to assess the clinical features and results of respiratory failure in patients with severe COVID-19. A single-center observational study was performed at a Chinese hospital between November 1, 2022, and February 31, 2023. All 182 enrolled patients were diagnosed with respiratory failure, 84 patients were infected with COVID-19, and the other 98 patients were not infected. A review of available medical records at admission and discharge, including neuroimaging, laboratory values at admission, mortality, length of hospitalization, and hospital costs, was conducted during the COVID-19 pandemic. All 182 eligible patients completed the follow-up. There was no significant difference in baseline characteristics between respiratory failure combined with COVID-19 (P > .05). Respiratory failure combined with COVID-19 infection may lead to higher 30-day mortality (16.36% vs 7.14%, P = .005), longer hospital stays (22.5 ± 5.9 vs 12.8 ± 4.2, P < .001), larger hospitalization costs (P < .001), and increased hospitalization complications, such as pulmonary embolism (10.30% vs 4.76%, P = .039), deep vein thrombosis (33.33% vs 18.57%, P = .001), incidence of 7-day delirium (69.70% vs 46.19%, P < .001), and respiratory failure (38.18% vs 24.77%, P = .005). If respiratory failure occurs while the patient is infected with COVID-19, treatment and prognosis worsen. Our understanding of COVID-19 and the care we provide to patients with respiratory failure is crucial to better prepare for a potential pandemic.
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Affiliation(s)
- Guosheng Liu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University’s, Quanzhou, China
| | - Chunhong Du
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University’s, Quanzhou, China
| | - Weicheng Du
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University’s, Quanzhou, China
| | - Deyuan You
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University’s, Quanzhou, China
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Morillas-Blasco P, Guedes-Ramallo P, Vicente-Ibarra N, Martínez-Moreno M, Romero-Valero A, García-Honrubia A, Castilla-Cabanes E, Viedma-Contreras JA, Masiá-Canuto M, Castillo-Castillo J, Santos-Martínez S. Subclinical Left Ventricular Systolic Dysfunction in Hospitalized Patients with COVID-19 by Strain: A 30-Day Echocardiographic Follow-Up. Medicina (Kaunas) 2023; 59:2065. [PMID: 38138168 PMCID: PMC10744515 DOI: 10.3390/medicina59122065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Available studies confirm myocardial injury and its association with mortality in patients with COVID-19, but few data have been reported from echocardiographic studies. The aim of this study was to identify subclinical left ventricular dysfunction by global longitudinal strain (GLS) and its evolution in the short term in hospitalized patients with COVID-19. Materials and Methods: Thirty-one consecutive noncritical patients admitted for COVID-19 were included. Information on demographics, laboratory results, comorbidities, and medications was collected. Transthoracic echocardiograms were performed using a Philips Affinity 50, at the acute stage and at a 30-day follow-up. Automated left ventricular GLS was measured using a Philips Qlab 13.0. A GLS of <-15.9% was defined as abnormal. Results: The mean age was 65 ± 15.2 years, and 61.3% of patients were male. Nine patients (29%) had elevated levels of high-sensitivity troponin I. Left ventricular ejection fraction was preserved in all; however, 11 of them (35.5%) showed reduced GLS. These patients had higher troponin levels (median, 23.7 vs. 3.2 ng/L; p < 0.05) and NT-proBNP (median, 753 vs. 81 pg/mL; p < 0.05). The multivariate analysis revealed that myocardial injury, defined as increased troponin, was significantly associated with GLS values (coefficient B; p < 0.05). Follow-up at 30 days showed an improvement in GLS values in patients with subclinical left ventricular dysfunction (-16.4 ± 2.07% vs. -13.2 ± 2.40%; p < 0.01), without changes in the normal GLS group. Conclusions: Subclinical left ventricular dysfunction is common in noncritical hospitalized patients with COVID-19 (one in every three patients), even with preserved left ventricular ejection fraction. This impairment tends to be reversible on clinical recovery.
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Affiliation(s)
- Pedro Morillas-Blasco
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Paula Guedes-Ramallo
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Nuria Vicente-Ibarra
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Marina Martínez-Moreno
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Andrea Romero-Valero
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Antonio García-Honrubia
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Elena Castilla-Cabanes
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | | | - Mar Masiá-Canuto
- Infectious Disease Unit, Hospital General Universitario Elche, 03203 Elche, Spain
| | - Jesús Castillo-Castillo
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
| | - Sandra Santos-Martínez
- Department of Cardiology, Hospital General Universitario Elche, 03203 Elche, Spain; (P.M.-B.); (A.G.-H.); (E.C.-C.)
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17
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Jozwiak M, Doyen D, Denormandie P, Goury A, Marey J, Pène F, Cariou A, Mira JP, Dellamonica J, Nguyen LS. Impact of sex differences on cardiac injury in critically ill patients with COVID-19. Respir Res 2023; 24:292. [PMID: 37986157 PMCID: PMC10662091 DOI: 10.1186/s12931-023-02581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND COVID-19 infections are associated with accrued inflammatory responses which may result in cardiac injury. Immune response to infection appears different between men and women, suggesting that COVID-19 patients' outcomes may differ according to biological sex. However, the impact of biological sex on the occurrence of cardiac injury during intensive care unit (ICU) stay in COVID-19 patients remain unclear. METHODS In this multicenter and prospective study, we included consecutive patients admitted to ICU for severe COVID-19 pneumonia, during the first two pandemic waves. Biological, electrocardiogram (ECG) and echocardiographic variables were collected on ICU admission. Cardiac injury was defined by increased troponin above 99th percentile of upper norm value and newly diagnosed ECG and/or echocardiographic abnormalities. The primary endpoint was the proportion of patients with cardiac injury during ICU stay according to biological sex. The impact of biological sex on other subsequent clinical outcomes was also evaluated. RESULTS We included 198 patients with a median age of 66 (56-73) years, 147 (74%) patients were men and 51 (26%) were women. Overall, 119 (60%) patients had cardiac injury during ICU stay and the proportion of patients with cardiac injury during ICU stay was not different between men and women (60% vs. 61%, p = 1.00). Patients with cardiac injury during ICU stay showed more cardiovascular risk factors and chronic cardiac disease and had a higher ICU mortality rate. On ICU admission, they had a more marked lymphopenia (0.70 (0.40-0.80) vs. 0.80 (0.50-1.10) × 109/L, p < 0.01) and inflammation (C-Reactive Protein (155 (88-246) vs. 111 (62-192) mg/L, p = 0.03); D-Dimers (1293 (709-2523) vs. 900 (560-1813) µg/L, p = 0.03)). Plasmatic levels of inflammatory biomarkers on ICU admission correlated with SAPS-2 and SOFA scores but not with the different echocardiographic variables. Multivariate analysis confirmed cardiovascular risk factors (OR = 2.31; 95%CI (1.06-5.02), p = 0.03) and chronic cardiac disease (OR = 8.58; 95%CI (1.01-73.17), p = 0.04) were independently associated with the occurrence of cardiac injury during ICU stay, whereas biological sex (OR = 0.88; 95%CI (0.42-1.84), p = 0.73) was not. Biological sex had no impact on the occurrence during ICU stay of other clinical outcomes. CONCLUSIONS Most critically ill patients with COVID-19 were men and experienced cardiac injury during ICU stay. Nevertheless, biological sex had no impact on the occurrence of cardiac injury during ICU stay or on other clinical outcomes. Clinical trial registration NCT04335162.
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Affiliation(s)
- Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
- Université Paris Cité, Paris, France.
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
| | - Denis Doyen
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Pierre Denormandie
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Antoine Goury
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Reims, Rue du Général Koenig, 51092, Reims, France
| | - Jonathan Marey
- Unité de Soins Intensifs Pneumologiques, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Frédéric Pène
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Alain Cariou
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Jean Dellamonica
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Lee S Nguyen
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Recherche et Innovation, Groupe hospitalier privé Ambroise Paré, Hartmann, 48Ter Bd Victor Hugo, 92200, Neuilly-Sur-Seine, France
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18
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Evrard B, Woillard JB, Legras A, Bouaoud M, Gourraud M, Humeau A, Goudelin M, Vignon P. Diagnostic, prognostic and clinical value of left ventricular radial strain to identify paradoxical septal motion in ventilated patients with the acute respiratory distress syndrome: an observational prospective multicenter study. Crit Care 2023; 27:424. [PMID: 37919787 PMCID: PMC10623720 DOI: 10.1186/s13054-023-04716-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute cor pulmonale (ACP) is prognostic in patients with acute respiratory distress syndrome (ARDS). Identification of paradoxical septal motion (PSM) using two-dimensional echocardiography is highly subjective. We sought to describe feature-engineered metrics derived from LV radial strain changes related to PSM in ARDS patients with ACP of various severity and to illustrate potential diagnostic and prognostic yield. METHODS This prospective bicentric study included patients under protective ventilation for ARDS related to COVID-19 who were assessed using transesophageal echocardiography (TEE). Transgastric short-axis view at mid-papillary level was used to visually grade septal motion, using two-dimensional imaging, solely and combined with LV radial strain: normal (grade 0), transient end-systolic septal flattening (grade 1), prolonged end-systolic septal flattening or reversed septal curvature (grade 2). Inter-observer variability was calculated. Feature engineering was performed to calculate the time-to-peak and area under the strain curve in 6 LV segments. In the subset of patients with serial TEE examinations, a multivariate Cox model analysis accounting for new-onset of PSM as a time-dependent variable was used to identify parameters associated with ICU mortality. RESULTS Overall, 310 TEE examinations performed in 182 patients were analyzed (age: 67 [60-72] years; men: 66%; SAPSII: 35 [29-40]). Two-dimensional assessment identified a grade 1 and grade 2 PSM in 100 (32%) and 48 (15%) examinations, respectively. Inter-rater reliability was weak using two-dimensional imaging alone (kappa = 0.49; 95% CI 0.40-0.58; p < 0.001) and increased with associated LV radial strain (kappa = 0.84, 95% CI 0.79-0.90, p < 0.001). The time-to-peak of mid-septal and mid-lateral segments occurred significantly later in systole and increased with the grade of PSM. Similarly, the area under the strain curve of these segments increased significantly with the grade of PSM, compared with mid-anterior or mid-inferior segments. Severe acute cor pulmonale with a grade 2 PSM was significantly associated with mortality. Requalification in an upper PSM grade using LV radial strain allowed to better identify patients at risk of death (HR: 6.27 [95% CI 2.28-17.2] vs. 2.80 [95% CI 1.11-7.09]). CONCLUSIONS In objectively depicting PSM and quantitatively assessing its severity, TEE LV radial strain appears as a valuable adjunct to conventional two-dimensional imaging.
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Affiliation(s)
- Bruno Evrard
- Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000, Limoges, France.
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.
- Réanimation Polyvalente, CHU Dupuytren, 87042, Limoges Cedex, France.
| | - Jean-Baptiste Woillard
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
- Pharmacology & Transplantation, INSERM U1248, University of Limoges, Limoges, France
- Faculty of Medicine, University of Limoges, 87000, Limoges, France
- Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Annick Legras
- Intensive Care Unit, Tours Teaching Hospital, Tours, France
| | | | - Maeva Gourraud
- Intensive Care Unit, Tours Teaching Hospital, Tours, France
| | - Antoine Humeau
- Pharmacology & Transplantation, INSERM U1248, University of Limoges, Limoges, France
| | - Marine Goudelin
- Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000, Limoges, France
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Philippe Vignon
- Medical-Surgical ICU, Dupuytren Teaching Hospital, 87000, Limoges, France
- Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
- Faculty of Medicine, University of Limoges, 87000, Limoges, France
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Galas A, Krzesiński P, Banak M, Gielerak G. Hemodynamic Differences between Patients Hospitalized with Acutely Decompensated Chronic Heart Failure and De Novo Heart Failure. J Clin Med 2023; 12:6768. [PMID: 37959233 PMCID: PMC10648284 DOI: 10.3390/jcm12216768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Heart failure (HF) is associated with high mortality, morbidity, and frequent hospitalizations due to acute HF (AHF) and requires immediate diagnosis and individualized therapy. Some differences between acutely decompensated chronic heart failure (ADCHF) and de novo HF (dnHF) patients in terms of clinical profile, comorbidities, and outcomes have been previously identified, but the hemodynamics related to both of these clinical states are still not well recognized. PURPOSE To compare patients hospitalized with ADCHF to those with dnHF, with a special emphasis on hemodynamic profiles at admission and changes due to hospital treatment. METHODS This study enrolled patients who were at least 18 years old, hospitalized due to AHF (both ADCHF and dnHF), and who underwent detailed assessments at admission and at discharge. The patients' hemodynamic profiles were assessed by impedance cardiography (ICG) and characterized in terms of heart rate (HR), blood pressure (BP), systemic vascular resistance index (SVRI), cardiac index (CI), stroke index (SI), and thoracic fluid content (TFC). RESULTS The study population consisted of 102 patients, most of whom were men (76.5%), with a mean left ventricle ejection fraction (LVEF) of 37.3 ± 14.1%. The dnHF patients were younger than the ADCHF group and more frequently presented with palpitations (p = 0.041) and peripheral hypoperfusion (p = 0.011). In terms of hemodynamics, dnHF was distinguished by higher HR (p = 0.029), diastolic BP (p = 0.029), SVRI (p = 0.013), and TFC (only numeric, p = 0.194) but lower SI (p = 0.043). The effect of hospital treatment on TFC was more pronounced in dnHF than in ADCHF, and this was also true of N-terminal pro-brain natriuretic peptide (NT-proBNP) and body mass. Some intergroup differences in the hemodynamic profile observed at admission persisted until discharge: higher HR (p = 0.002) and SVRI (trend, p = 0.087) but lower SI (p < 0.001) and CI (p = 0.023) in the dnHF group. CONCLUSIONS In comparison to ADCHF, dnHF is associated with greater tachycardia, vasoconstriction, depressed cardiac performance, and congestion. Despite more effective diuretic therapy, other unfavorable hemodynamic features may still be present in dnHF patients at discharge.
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Affiliation(s)
- Agata Galas
- Department of Cardiology and Internal Diseases, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland; (P.K.); (M.B.); (G.G.)
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20
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Orea-Tejeda A, Robles-Hernández R, González-Islas D, Jimenez-Gallardo L, Gochicoa-Rangel L, Castorena-Maldonado A, Hernández-Zenteno R, Montañez-Orozco A, Valderrábano-Salas B. Dynapenia and Sarcopenia in Post-COVID-19 Syndrome Hospitalized Patients Are Associated with Severe Reduction in Pulmonary Function. J Clin Med 2023; 12:6466. [PMID: 37892604 PMCID: PMC10607104 DOI: 10.3390/jcm12206466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND After hospital discharge, post-COVID-19 syndrome has been observed to be associated with impaired diffusing capacity, respiratory muscle strength, and lung imaging abnormalities, in addition to loss of muscle mass/strength, sarcopenia, and obesity impact exercise tolerance, pulmonary functions, and overall prognosis. However, the relationship between lung function and the coexistence of obesity with low muscle strength and sarcopenia in post-COVID-19 patients remains poorly investigated. Therefore, our aim was to evaluate the association between lung function and the coexistence of obesity with dynapenia and sarcopenia in post-COVID-19 syndrome patients. METHODS This cross-sectional study included subjects who were hospitalized due to moderate to severe COVID-19, as confirmed by PCR testing. Subjects who could not be contacted, declined to participate, or died before the follow-up visit were excluded. RESULTS A total of 711 subjects were evaluated; the mean age was 53.64 ± 13.57 years, 12.4% had normal weight, 12.6% were dynapenic without obesity, 8.3% had sarcopenia, 41.6% had obesity, 21.2% had dynapenic obesity, and 3.8% had sarcopenic obesity. In terms of pulmonary function, the dynapenic subjects showed decreases of -3.45% in FEV1, -12.61 cmH2O in MIP, and -12.85 cmH2O in MEP. On the other hand, the sarcopenic subjects showed decreases of -6.14 cmH2O in MIP and -11.64 cmH2O in MEP. The dynapenic obesity group displayed a reduction of -12.13% in PEF. CONCLUSIONS In post-COVID-19 syndrome, dynapenia and sarcopenia-both with and without obesity-have been associated with lower lung function.
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Affiliation(s)
- Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Robinson Robles-Hernández
- Department of Research in Tobacco Smoking and COPD at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas” 2, Mexico City 14080, Mexico;
| | - Dulce González-Islas
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Luz Jimenez-Gallardo
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Laura Gochicoa-Rangel
- Department of Pulmonary Physiology at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Armando Castorena-Maldonado
- Direction for Medical Care in Pneumology at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas” 4, Mexico City 14080, Mexico
| | - Rafael Hernández-Zenteno
- COPD Clinic at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Alvaro Montañez-Orozco
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Benigno Valderrábano-Salas
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
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Vivan MA, Hirakata VN, Arteche MAT, de Araujo DM, Fuchs SC, Fuchs FD. Comparison of Incidence and Prognosis of Myocardial Injury in Patients with COVID-19-Related Respiratory Failure and Other Pulmonary Infections: A Contemporary Cohort Study. J Clin Med 2023; 12:6403. [PMID: 37835047 PMCID: PMC10573433 DOI: 10.3390/jcm12196403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Myocardial injury (MI) is frequent in critically ill patients with COVID-19, but its pathogenesis remains unclear. We hypothesized that MI is not solely due to viral infection by SARS-CoV-2 but rather due to the common pathophysiological mechanisms associated with severe pulmonary infections and respiratory failure. This contemporary cohort study was designed to compare the incidence of MI in patients with acute respiratory failure caused by COVID-19 to patients with other pulmonary infections. In addition, we aimed to investigate whether MI was a distinct risk factor for in-hospital mortality in patients with COVID-19 compared to those with non-COVID-19 infections. This study included 1444 patients with COVID-19 (55.5% men; age 58 (46;68) years) and 182 patients with other pulmonary infections (46.9% men; age 62 (44;73) years). The incidence of MI at ICU admission was lower in COVID-19 patients (36.4%) compared to non-COVID-19 patients (56%), and this difference persisted after adjusting for age, sex, coronary artery disease, heart failure, SOFA score, lactate, and C-reactive protein (RR 0.84 (95% CI, 0.71-0.99)). MI at ICU admission was associated with a 59% increase in mortality (RR 1.59 (1.36-1.86); p < 0.001), and there was no significant difference in the mortality between patients with COVID-19 and those with other pulmonary infections (p = 0.271). We concluded that MI is less frequent in patients with critical COVID-19 pneumonia and respiratory failure compared to those with other types of pneumonia. The occurrence of MI is a significant risk factor for in-hospital mortality, regardless of the etiology of the pulmonary infection.
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Affiliation(s)
- Manoela Astolfi Vivan
- Graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (V.N.H.); (S.C.F.); (F.D.F.)
- Divison of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (M.A.T.A.); (D.M.d.A.)
| | - Vania Naomi Hirakata
- Graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (V.N.H.); (S.C.F.); (F.D.F.)
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
- Research Board, Diretoria de Pesquisa, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Maria Antônia Torres Arteche
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (M.A.T.A.); (D.M.d.A.)
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Débora Marques de Araujo
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (M.A.T.A.); (D.M.d.A.)
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Sandra C. Fuchs
- Graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (V.N.H.); (S.C.F.); (F.D.F.)
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (M.A.T.A.); (D.M.d.A.)
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Flávio D. Fuchs
- Graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (V.N.H.); (S.C.F.); (F.D.F.)
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, RS, Brazil; (M.A.T.A.); (D.M.d.A.)
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
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Carpio C, Qasem A, Buño A, Borobia AM, Arnalich F, Rey V, Lázaro T, Mariscal P, Laorden D, Salgueiro G, Moreno A, Peiró C, Lorenzo Ó, Álvarez-Sala R. Krebs von den Lungen-6 (KL-6) Levels in Post-COVID Follow-Up: Differences According to the Severity of COVID-19. J Clin Med 2023; 12:6299. [PMID: 37834944 PMCID: PMC10573402 DOI: 10.3390/jcm12196299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
To evaluate KL-6 levels in medium-term post-COVID and to compare them in three groups categorised by the severity of COVID-19, we conducted a real-world, retrospective, cohort study. Data from the COVID-19 episode and follow-up during the post-COVID phase were extracted from the COVID@HULP and POSTCOVID@HULP databases, respectively. For the post-COVID period we included demographics, medical history, symptoms, quality of life, physical activity, anxiety and depression status and laboratory results. Patients were categorised into three groups based on the severity of COVID-19: Group 1 (inpatient critical), Group 2 (inpatient non-critical) and Group 3 (hospitalised at home). KL-6 was measured during the follow-up of the three groups. In all, 802 patients were included (Group 1 = 59; Group 2 = 296; Group 3 = 447 patients). The median age was 59 years (48-70), and 362 (45.2%) were males. At admission, fibrinogen and ferritin levels were lower in Group 3 than in the other groups (p < 0.001). Follow-up data were obtained 124 days (97-149) after the diagnosis of COVID-19. The median levels of fibrinogen, ferritin and KL-6 at follow-up were 336 mg/dL (276-413), 80.5 ng/mL (36-174.3) and 326 U/mL (240.3-440.3), respectively. KL-6 levels were lower in Group 3 than in the other groups (298 U/mL (231.5-398) vs. 381.5 U/mL (304-511.8) (Group 1) and 372 U/mL (249-483) (Group 2) (p < 0.001)). KL-6 was associated with ferritin (p < 0.001), fibrinogen (p < 0.001), D-dimer (p < 0.001) and gamma-glutamyl transferase (p < 0.001). KL-6 levels are less elevated at medium-term post-COVID follow-up in patients with mild COVID-19 than in those with moderate or severe disease. KL-6 is associated with systemic inflammatory, hepatic enzyme and thrombosis biomarkers.
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Affiliation(s)
- Carlos Carpio
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Ana Qasem
- Clinical Analytics Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Antonio Buño
- Clinical Analytics Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Alberto M. Borobia
- Clinical Pharmacology Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.M.B.); (V.R.)
| | - Francisco Arnalich
- Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.A.); (G.S.); (A.M.)
| | - Vega Rey
- Clinical Pharmacology Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.M.B.); (V.R.)
| | - Teresa Lázaro
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Pablo Mariscal
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Daniel Laorden
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Giorgina Salgueiro
- Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.A.); (G.S.); (A.M.)
| | - Alberto Moreno
- Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.A.); (G.S.); (A.M.)
| | - Concepción Peiró
- Pharmacology Department. Universidad Autónoma de Madrid, IdiPAZ, 28049 Madrid, Spain;
| | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular pathology, IIS, Fundación Jiménez Díaz, CIBERDEM, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Rodolfo Álvarez-Sala
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
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Santiago González N, García-Hernández MDL, Cruz-Bello P, Chaparro-Díaz L, Rico-González MDL, Hernández-Ortega Y. Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease. Healthcare (Basel) 2023; 11:2654. [PMID: 37830691 PMCID: PMC10572652 DOI: 10.3390/healthcare11192654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
The objective was to evaluate the Modified Early Warning Score in patients hospitalized for COVID-19 plus chronic disease. METHODS Retrospective observational study, 430 hospitalized patients with COVID-19 and chronic disease. Instrument, Modified Early Warning Score (MEWS). Data analysis, with Cox and logistic regression, to predict survival and risk. RESULTS Of 430 patients, 58.6% survived, and 41.4% did not. The risk was: low 53.5%, medium 23.7%, and high 22.8%. The MEWS score was similar between survivors 3.02, p 0.373 (95% CI: -0.225-0.597) and non-survivors 3.20 (95% CI: -0.224-0.597). There is a linear relationship between MEWS and mortality risk R 0.920, ANOVA 0.000, constant 4.713, and coefficient 4.406. The Cox Regression p 0.011, with a risk of deterioration of 0.325, with a positive coefficient, the higher the risk, the higher the mortality, while the invasive mechanical ventilation coefficient was negative -0.757. By providing oxygen and ventilation, mortality is lower. CONCLUSIONS The predictive value of the modified early warning score in patients hospitalized for COVID-19 and chronic disease is not predictive with the MEWS scale. Additional assessment is required to prevent complications, especially when patients are assessed as low-risk.
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Affiliation(s)
- Nicolás Santiago González
- Hospital Regional de Alta Especialidad Ixtapaluca (HRAEI), Universidad Autónoma del Estado de México (UAEMex), Ixtapaluca 56530, Mexico;
| | - María de Lourdes García-Hernández
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
| | - Patricia Cruz-Bello
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
| | - Lorena Chaparro-Díaz
- Nursing Department, Faculty of Nursing, Universidad Nacional de Colombia, Sede Bogotá, Bogotá 111321, Colombia;
| | - María de Lourdes Rico-González
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
| | - Yolanda Hernández-Ortega
- Facultad de Enfermería y Obstetricia, Universidad Autónoma del Estado de México (UAEMéx), Toluca 50000, Mexico; (P.C.-B.); (M.d.L.R.-G.); (Y.H.-O.)
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Matera-Witkiewicz A, Krupińska M, Doroszko A, Trocha M, Giniewicz K, Kujawa K, Rabczyński M, Obremska M, Kuznik E, Lubieniecki P, Adamik B, Kaliszewski K, Kiliś-Pstrusińska K, Pomorski M, Protasiewicz M, Madziarski M, Sokołowski J, Jankowska EA, Madziarska K. Usefulness of the Veterans Health Administration COVID-19 (VACO) Index for Predicting Short-Term Mortality among Patients of the COLOS Study. J Clin Med 2023; 12:6262. [PMID: 37834908 PMCID: PMC10573968 DOI: 10.3390/jcm12196262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Advanced age is known to be a predictor with COVID-19 severity. Understanding of other disease progression factors may shorten the time from patient admission to applied treatment. The Veterans Health Administration COVID-19 (VACO index) was assumed to additionally anticipate clinical results of patients hospitalized with a proven infection caused by the SARS-CoV-2 virus. METHODS The medical records of 2183 hospitalized patients were retrospectively analyzed. Patients were divided into four risk-of-death categories: low risk, medium risk, high-risk, and extreme risk depending on their VACO index calculation. RESULTS Significant differences in the mortality at the hospital after three months of discharge and six months after discharge were noticed. For the patients in the extreme-risk group, mortality reached 37.42%, 62.81%, and 78.44% for in-hospital, three months of discharge, and six months of discharge, respectively. The mortality marked as high risk reached 20.38%, 37.19%, and 58.77%. Moreover, the secondary outcomes analysis acknowledged that patients classified as extreme risk were more likely to suffer from cardiogenic shock, myocardial infarction, myocardial injury, stroke, pneumonia, acute kidney injury, and acute liver dysfunction. Patients at moderate risk were more often admitted to ICU when compared to other patients. CONCLUSIONS The usage of the VACO index, combined with an appropriate well-defined medical interview and past medical history, tends to be a helpful instrument in order to predict short-term mortality and disease progression based on previous medical records.
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Affiliation(s)
- Agnieszka Matera-Witkiewicz
- Screening of Biological Activity Assays and Collection of Biological Material Laboratory, Wroclaw Medical University Biobank, Faculty of Pharmacy, Wroclaw Medical University, Borowska Street 221A, 50-556 Wroclaw, Poland
| | - Magdalena Krupińska
- Screening of Biological Activity Assays and Collection of Biological Material Laboratory, Wroclaw Medical University Biobank, Faculty of Pharmacy, Wroclaw Medical University, Borowska Street 221A, 50-556 Wroclaw, Poland
| | - Adrian Doroszko
- Clinical Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Małgorzata Trocha
- Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland (M.R.); (E.K.); (P.L.); (K.M.)
| | - Katarzyna Giniewicz
- Statistical Analysis Centre, Wroclaw Medical University, K. Marcinkowski Street 2-6, 50-368 Wroclaw, Poland; (K.G.); (K.K.)
| | - Krzysztof Kujawa
- Statistical Analysis Centre, Wroclaw Medical University, K. Marcinkowski Street 2-6, 50-368 Wroclaw, Poland; (K.G.); (K.K.)
| | - Maciej Rabczyński
- Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland (M.R.); (E.K.); (P.L.); (K.M.)
| | - Marta Obremska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland; (M.O.); (M.P.); (E.A.J.)
| | - Edwin Kuznik
- Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland (M.R.); (E.K.); (P.L.); (K.M.)
| | - Pawel Lubieniecki
- Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland (M.R.); (E.K.); (P.L.); (K.M.)
| | - Barbara Adamik
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Krzysztof Kaliszewski
- Clinical Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Katarzyna Kiliś-Pstrusińska
- Clinical Department of Paediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Michał Pomorski
- Clinical Department of Gynecology and Obstetrics, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Marcin Protasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland; (M.O.); (M.P.); (E.A.J.)
| | - Marcin Madziarski
- Clinical Department of Rheumatology and Internal Medicine, University Hospital, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Janusz Sokołowski
- Department of Emergency Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland;
| | - Ewa A. Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland; (M.O.); (M.P.); (E.A.J.)
| | - Katarzyna Madziarska
- Clinical Department of Diabetology and Internal Disease, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland (M.R.); (E.K.); (P.L.); (K.M.)
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Almuqbil M, Almoteer AI, Suwayyid AM, Bakarman AH, Alrashed RF, Alrobish M, Alasalb F, Alhusaynan AA, Alnefaie MH, Altayar AS, Alobid SE, Almadani ME, Alshehri A, Alghamdi A, Asdaq SMB. Characteristics of COVID-19 Patients Admitted to Intensive Care Unit in Multispecialty Hospital of Riyadh, Saudi Arabia: A Retrospective Study. Healthcare (Basel) 2023; 11:2500. [PMID: 37761697 PMCID: PMC10530388 DOI: 10.3390/healthcare11182500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
During the early stages of the COVID-19 pandemic, infection rates were high and symptoms were severe. Medical resources, including healthcare experts and hospital facilities, were put to the test to ensure their readiness to deal with this unique event. An intensive care unit (ICU) is expected to be required by many hospitalized patients. Many hospitals worldwide lacked resources during the pandemic's peak stages, particularly in critical care treatment. Because of this, there were issues with capacity, as well as an excessive influx of patients. Additionally, even though the research location provides medical care to a sizable population, there is a paucity of scientific data detailing the situation as it pertains to COVID-19 patients during the height of the outbreak. Therefore, this study aimed to identify and describe the features of COVID-19 patients hospitalized in the ICU of one of the multispecialty hospitals in Riyadh, Saudi Arabia. An observational retrospective study was conducted using a chart review of COVID-19 patients admitted to the ICU between March 2020 and December 2020. To characterize the patients, descriptive statistics were utilized. An exploratory multivariate regression analysis was carried out on the study cohort to investigate the factors that were shown to be predictors of death and intubation. Only 333 (29.33%) of the 1135 samples from the hospital's medical records were used for the final analysis and interpretation. More than 76% of the patients in the study were male, with a mean BMI of 22.07 and an average age of around 49 years. The most frequent chronic condition found among the patients who participated in the study was diabetes (39.34%), followed by hypertension (31.53%). At the time of admission, 63 of the total 333 patients needed to have intubation performed. In total, 22 of the 333 patients died while undergoing therapy. People with both diabetes and hypertension had a 7.85-fold higher risk of death, whereas those with only diabetes or hypertension had a 5.43-fold and 4.21-fold higher risk of death, respectively. At admission, intubation was necessary for many male patients (49 out of 63). Most intubated patients had hypertension, diabetes, or both conditions. Only 13 of the 63 patients who had been intubated died, with the vast majority being extubated. Diabetes and hypertension were significant contributors to the severity of illness experienced by COVID-19 participants. The presence of multiple comorbidities had the highest risk for intubation and mortality among ICU-admitted patients. Although more intubated patients died, the fatality rate was lower than in other countries due to enhanced healthcare management at the ICU of the study center. However, large-scale trials are needed to determine how effective various strategies were in preventing ICU admission, intubation, and death rates.
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Affiliation(s)
- Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ali Ibrahim Almoteer
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Alwaleed Mohammed Suwayyid
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Abdulaziz Hussain Bakarman
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Raed Fawaz Alrashed
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Majed Alrobish
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Fahad Alasalb
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Abdulaziz Abdulrahman Alhusaynan
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Mohammed Hadi Alnefaie
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Abdullah Saud Altayar
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Saad Ebrahim Alobid
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Moneer E. Almadani
- Department of Clinical Medicine, College of Medicine, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia;
| | - Ahmed Alshehri
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam 31441, Saudi Arabia;
| | - Adel Alghamdi
- Department of Pharmaceutical Chemistry, Faculty of Clinical Pharmacy, Al Baha University, P.O. Box 1988, Al Baha 65779, Saudi Arabia;
| | - Syed Mohammed Basheeruddin Asdaq
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
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Cozzolino D, Romano C, Sardu C, Nevola R, Umano GR, Rinaldi L, Adinolfi LE, Catalini C, Marrone A, Municinò M, Sasso FC, Marfella R. Long-Term Prognosis among COVID-19 Patients: The Predictive Role Played by Hyperinflammation and Arrhythmic Disorders in Fatal Outcome. J Clin Med 2023; 12:5691. [PMID: 37685758 PMCID: PMC10488327 DOI: 10.3390/jcm12175691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Limited data are available on outcomes among COVID-19 patients beyond the acute phase of the disease. All-cause mortality among our COVID-19 patients one year after hospital discharge and factors/conditions associated with death were evaluated. All patients discharged from our COVID center were periodically evaluated by clinical assessment and by digital healthcare registry consultation. All findings acquired on discharge day represented the baseline data and were utilized for statistics. Of the 208 patients admitted, 187 patients were discharged. Among these, 17 patients died within 12 months (non-survivors). Compared to survivors, non-survivor patients were significantly (p < 0.05) older, exhibited significantly greater comorbidities and prevalence of active malignancy, heart failure, and arrhythmias, and showed significantly higher circulating levels of B-type natriuretic peptide, troponin, C-reactive protein, and d-dimer, as well as a longer heart-rate-corrected QT interval and significantly lower values for the glomerular filtration rate. Following multivariate analysis, cancer, arrhythmias, and high C-reactive protein levels were found to be factors independently associated with death. At the one-year follow-up, about 9% of patients discharged from our COVID center had a fatal outcome. Ageing, myocardial injury, impaired renal function, and, in particular, cancer, hyperinflammation, and arrhythmias represented strong predictors of the worst long-term outcome among COVID-19 patients.
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Affiliation(s)
- Domenico Cozzolino
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Ciro Romano
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Giuseppina Rosaria Umano
- Department of the Woman and the Child and of General and Specialized Surgery, University of Campania L. Vanvitelli, 80138 Naples, Italy;
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Christian Catalini
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Maurizio Municinò
- Department of Forensic, Evaluative and Necroscopic Medicine, ASL Napoli 2 Nord, 80027 Naples, Italy;
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy; (D.C.); (C.R.); (C.S.); (L.R.); (L.E.A.); (C.C.); (A.M.); (F.C.S.); (R.M.)
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