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Abstract
Severe coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan dysfunction. It has been documented that severe COVID-19 is associated with higher levels of inflammatory mediators than a mild disease, and tracking these markers may allow early identification or even prediction of disease progression. It is well known that C-reactive protein (CRP) is the acute-phase protein and the active regulator of host innate immunity, which is highly predictive of the need for mechanical ventilation and may guide escalation of treatment of COVID-19-related uncontrolled inflammation. There are numerous causes of an elevated CRP, including acute and chronic responses, and these can be infectious or non-infectious in etiology. CRP are normally lacking in viral infections, while adaptive immunity appears to be essential for COVID-19 virus clearance, and the macrophage activation syndrome may explain the high serum CRP contents and contribute to the disease progression. Nevertheless, for the assessment of host inflammatory status and identification of viral infection in other pathologies, such as bacterial sepsis, the acute-phase proteins, including CRP and procalcitonin, can provide more important information for guiding clinical diagnosis and antibiotic therapy. This review is aimed to highlight the current and most recent studies with regard to the clinical significance of CRP in severe COVID-19 and other viral associated illnesses, including update advances on the implication of CRP and its form specifically on the pathogenesis of these diseases. The progressive understanding in these areas may be translated into promising measures to prevent severe outcomes and mitigate appropriate treatment modalities in critical COVID-19 and other viral infections.
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Affiliation(s)
- Ying-Yi Luan
- Translational Medicine Research Center, Medical Innovation Research Division and the Fourth Medical Center of PLA General Hospital, Beijing, China.,Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Cheng-Hong Yin
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yong-Ming Yao
- Translational Medicine Research Center, Medical Innovation Research Division and the Fourth Medical Center of PLA General Hospital, Beijing, China
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Alshahrani M, Alsubaie A, Alshamsy A, Alkhliwi B, Alshammari H, Alshammari M, Telmesani N, Alshammari R, Perlas Asonto L. Can the emergency department triage category and clinical presentation predict hospitalization of H1N1 patients? Open Access Emerg Med 2019; 11:221-228. [PMID: 31572026 PMCID: PMC6757191 DOI: 10.2147/oaem.s204110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Human H1N1 Influenza A virus was first reported in 2009 when seasonal outbreaks consistently occurred around the world. H1N1 patients present to the emergency departments (ED) with flu-like symptoms extending up to severe respiratory symptoms that require hospital admission. Developing a prediction model for patient outcomes is important to select patients for hospital admission. To date, there is no available data to guide the hospital admission of H1N1 patients based on their initial presentation. Objective The aim of this study was to investigate the predictors of hospital admission of H1N1 patients presenting in the ED. Methods We conducted a retrospective review of all laboratory-confirmed H1N1 cases presenting to the ED of a tertiary university hospital in the Eastern region of Saudi Arabia within the period from November 2015 to January 2016. We retrieved data of the initial triage category, vital signs, and presenting symptoms. Multivariate logistic regression analysis was performed to evaluate risk factors for hospital admission among H1N1patients presented to the ED. Results We identified 333 patients with laboratory-confirmed H1N1. Patients were classified into two groups: admitted group (n=80; 24%) and non-admitted group (n=253; 76%). Sixty patients (75%) were triaged under category IV. Triage category of level III and less were the most predictive for hospital admission. Multivariate regression analysis showed that of all vital signs, tachypnea was a significant risk factor for hospital admission (OR=1.1; 95% CI 1.02 to 1.13, p<0.01). The association between lower triage category and hospital stay was statistically significant (χ2 =6.068, p=0.037). Also, patients with dyspnea were 4.5 times more likely to have longer hospital stay (OR=4.5; 95% CI 1.2 to 17.1, p=0.025). Conclusion Lower triage category and increased respiratory rate predict the need for hospital admission of H1N1 infected patients; while patients with dyspnea or bronchial asthma are likely to stay longer in the hospital. Further prospective studies are needed to evaluate the accuracy of using the CTAS and other clinical parameters in predicting hospitalization of H1N1 patients during outbreaks.
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Affiliation(s)
- Mohammed Alshahrani
- Department of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar 31952, Kingdom of Saudi Arabia
| | - Aisha Alsubaie
- Department of Emergency, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Alaa Alshamsy
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Bayader Alkhliwi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Hind Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Maha Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Nosibah Telmesani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Reem Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Laila Perlas Asonto
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Kraef C, van der Meirschen M, Wichmann D, Kutza M, Restemeyer C, Addo MM, Lohse AW, Schmiedel S, Kluge S, Schulze Zur Wiesch J. [Management of seasonal influenza in 2017/2018 at a German tertiary-care hospital]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:870-880. [PMID: 31201446 PMCID: PMC7096087 DOI: 10.1007/s00103-019-02976-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND There are only few structured reports on inpatient management of a seasonal influenza epidemic. OBJECTIVES A systematic description of a seasonal influenza patient population at a German university hospital to improve risk stratification and clinical care. METHODS In this monocentric, retrospective observational study of the 2017/2018 influenza season at the University Medical Center Hamburg-Eppendorf, patients with confirmed influenza infection were included. RESULTS Of all influenza swabs performed in the emergency department, 24% (n = 162/676) were positive. A total of 255 patients (median age 66 years) had an influenza infection (influenza A n = 79, influenza B n = 176); 27 (15.3%) were nosocomial infections. Of the 179 (70.2%) patients that were hospitalized, 51 (20%) received intensive medical care. Patients with subsequent need for intensive care had an elevated CRP level (69.5 mg/dl [SD 62.8] vs. 141.7 [SD 127.2] mg/dl) at the time of influenza diagnosis and more frequent infiltrates in X‑ray/CT of the thorax (n = 43 [33.6%] vs. n = 43 [84.3%]). Antiviral therapy with oseltamivir was administered for 74 (29.0%) patients and 11 (6.1%) patients were treated with extracorporeal membrane oxygenation (ECMO). Of the 23 (9.0%) patients who died, only four of them had been vaccinated (trivalent). Those four had an influenza B infection. CONCLUSION The structured use of diagnostic tests (influenza PCR, X‑ray/CT chest and CRP) and antiviral therapy (oseltamivir) as well as targeted management of admission, intensive care capacities, and an increase in vaccination rates are important for improving patient care and optimizing the use of resources during seasonal influenza epidemics.
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Affiliation(s)
- Christian Kraef
- I. Medizinische Klinik und Poliklinik, Sektionen Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Postfach O10 (2. Etage), 20246, Hamburg, Deutschland
| | - Marc van der Meirschen
- I. Medizinische Klinik und Poliklinik, Sektionen Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Postfach O10 (2. Etage), 20246, Hamburg, Deutschland
| | - Dominic Wichmann
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Meike Kutza
- Geschäftsbereich Zentrales Controlling, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Cordula Restemeyer
- Geschäftsbereich Zentrales Controlling, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Marylyn M Addo
- I. Medizinische Klinik und Poliklinik, Sektionen Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Postfach O10 (2. Etage), 20246, Hamburg, Deutschland
- Standort Hamburg-Lübeck-Borstel-Riems, Deutsches Zentrum für Infektionsforschung, Hamburg, Deutschland
| | - Ansgar W Lohse
- I. Medizinische Klinik und Poliklinik, Sektionen Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Postfach O10 (2. Etage), 20246, Hamburg, Deutschland
- Standort Hamburg-Lübeck-Borstel-Riems, Deutsches Zentrum für Infektionsforschung, Hamburg, Deutschland
| | - Stefan Schmiedel
- I. Medizinische Klinik und Poliklinik, Sektionen Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Postfach O10 (2. Etage), 20246, Hamburg, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Julian Schulze Zur Wiesch
- I. Medizinische Klinik und Poliklinik, Sektionen Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Postfach O10 (2. Etage), 20246, Hamburg, Deutschland.
- Standort Hamburg-Lübeck-Borstel-Riems, Deutsches Zentrum für Infektionsforschung, Hamburg, Deutschland.
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Abstract
Background C-reactive protein (CRP) is an acute-phase reactant downstream of the pro-inflammatory cytokines released during influenza infection. However, the role of this inflammatory marker in influenza severity and complications is yet to be elucidated. Objectives We aim to systematically review and evaluate the levels of CRP in severe and non-severe H1N1 influenza cases and assess its utility as a biomarker in predicting the severity of infection. Methods We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of Print, Embase and Embase Classic to identify human studies reporting measurements of CRP levels in patients infected with H1N1 influenza at various levels of disease severity. Results Our search identified ten studies eligible for inclusion in this systematic review. The results of the data analysis show that the average CRP levels upon diagnosis were significantly higher (P < 0.05) in patients who developed severe H1N1 influenza compared to their counterparts with a no severe disease. Furthermore, levels of CRP were associated with the degree of H1N1 severity. Subjects with H1N1-related pneumonia and patients who were hospitalized or died of the disease complications, respectively, had 1.4- and 2.5-fold significantly higher CRP levels (P < 0.05) than those with no severe disease outcome. Conclusion CRP levels have been consistently shown to be significantly higher in H1N1 influenza patients who develop a severe disease outcome. The resuts of the present study suggest that serum CRP can be employed—in combination with other biomarkers—to predict the complications of H1N1 influenza. Electronic supplementary material The online version of this article (10.1007/s00011-018-1188-x) contains supplementary material, which is available to authorized users.
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