Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3829
S. Nguyen, M. Gupta, G. Manek, D. Datta
Rationale: Respiratory Rate-Oxygenation Index (ROX index), defined as the ratio of oxygen saturation, fractional percentage of inspired oxygen (SpO2/FiO2) to respiratory rate (RR), has been found to be a predictor of patients who will improve with High-Flow Nasal Oxygen (HFNO) therapy. Limited information exists on ROX index in COVID-19 patients with acute respiratory failure. One study in such patients reported ROX-Index of ≥ 5.37 at four hours after admission was significantly associated with a lower risk for intubation after hour four. Objective: The objective of this study was to evaluate the ROX index at admission as an early marker of outcome in patients with COVID-19 pneumonia with acute respiratory failure. Methods: Seventy-one patients admitted to our hospital with COVID-19 and acute respiratory failure were retrospectively studied. Age, gender, admission ROX index, need for invasive mechanical ventilation (MV), hospital length of stay (LOS), and mortality were studied. Pearson's Correlation analysis was performed to determine the impact of ROX Index on need for MV, hospital LOS and mortality. p < 0.05 were deemed statistically significant. Results: Of the seventy-one (71) patients, fifty-two patients were male (71%) and mean age was 47.7 + 16.7 years. Nineteen percent (19%) of patients required MV;the mean LOS was 8.6 + 6 days, twenty-two (22%) patients expired. Mean Admission ROX index in subjects was 15 + 6.5 with ROX index 11.7 + 6 in non-survivors compared to 16 + 6 in survivors (p =0.018, independent t-test) [Figure 1]. Pearson's correlation analysis indicated a significant correlation between admission ROX index and survival (r = 0.28 ;p= 0.01), but not with hospital LOS (r=- 0.02, p=0.8). Admission ROX index in patients requiring MV was 11 + 7 and 15 + 6 in those not requiring MV (p =0.06, independent t-test). Conclusions: Higher ROX index at admission is associated with higher mortality and need for MV. Further studies are required to delineate if there is a specific value that can predict need for MV and mortality. Future studies are also needed to determine whether ROX index progression from admission in the first 48 hours can predict outcome in these patients.
{"title":"Admission Respiratory Rate-Oxygenation (ROX) Index and Outcome in COVID-19 Pneumonia with Acute Respiratory Failure","authors":"S. Nguyen, M. Gupta, G. Manek, D. Datta","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3829","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3829","url":null,"abstract":"Rationale: Respiratory Rate-Oxygenation Index (ROX index), defined as the ratio of oxygen saturation, fractional percentage of inspired oxygen (SpO2/FiO2) to respiratory rate (RR), has been found to be a predictor of patients who will improve with High-Flow Nasal Oxygen (HFNO) therapy. Limited information exists on ROX index in COVID-19 patients with acute respiratory failure. One study in such patients reported ROX-Index of ≥ 5.37 at four hours after admission was significantly associated with a lower risk for intubation after hour four. Objective: The objective of this study was to evaluate the ROX index at admission as an early marker of outcome in patients with COVID-19 pneumonia with acute respiratory failure. Methods: Seventy-one patients admitted to our hospital with COVID-19 and acute respiratory failure were retrospectively studied. Age, gender, admission ROX index, need for invasive mechanical ventilation (MV), hospital length of stay (LOS), and mortality were studied. Pearson's Correlation analysis was performed to determine the impact of ROX Index on need for MV, hospital LOS and mortality. p < 0.05 were deemed statistically significant. Results: Of the seventy-one (71) patients, fifty-two patients were male (71%) and mean age was 47.7 + 16.7 years. Nineteen percent (19%) of patients required MV;the mean LOS was 8.6 + 6 days, twenty-two (22%) patients expired. Mean Admission ROX index in subjects was 15 + 6.5 with ROX index 11.7 + 6 in non-survivors compared to 16 + 6 in survivors (p =0.018, independent t-test) [Figure 1]. Pearson's correlation analysis indicated a significant correlation between admission ROX index and survival (r = 0.28 ;p= 0.01), but not with hospital LOS (r=- 0.02, p=0.8). Admission ROX index in patients requiring MV was 11 + 7 and 15 + 6 in those not requiring MV (p =0.06, independent t-test). Conclusions: Higher ROX index at admission is associated with higher mortality and need for MV. Further studies are required to delineate if there is a specific value that can predict need for MV and mortality. Future studies are also needed to determine whether ROX index progression from admission in the first 48 hours can predict outcome in these patients.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74110265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3820
M. Samsonova, E. Pershina, D.J. Schekochikhin, A. Shilova, K.J. Mikhajlichenko, O. Zayratyants, E. Berezhnaya, V. Parshin, J. Omarova, A. Cherniaev
Introduction. In the context of the COVID-19 pandemic, one of the most important diagnostic methods is highresolution computed tomography of the lungs (HRCT), which is highly sensitive for diagnostics of viral pneumonia. Because of a variety of radiological changes in the lungs at different periods of the disease, it became necessary to compare the changes detected by HRCT with morphological features of the disease. The aim of the research is to compare the HRCT patterns and histological changes in the lungs in the deceased with COVID-19. Material and methods. We analyzed 45 pieces from 14 deceased with COVID-19 (7 men/7 women), with an average age of 77.1 ± 12.9 (49-90 years), which underwent HRCT no more than 5 days before death. On the fixed whole lungs, tissue sites were selected, according to the target localization selected by HRCT with 3- D reconstruction. The leading HRCT patterns such as 'ground glass' opacities, “crazy paving”, consolidation, and symptoms typical for organizing pneumonia were the points of interest. We performed routine hematoxylineosin stains for histopathologic evaluation. Results. “Ground glass” opacities in the majority of cases (57.1%) corresponded to an acute phase of diffuse alveolar damage (DAD) (intraalveolar edema, hyaline membranes, cellularity, interstitial infiltration). Mosaic histological changes with alternation of filled alveoli (intraalveolar edema, clusters of red blood cells, macrophages, lymphocytes, fibrin) and aerated alveoli were detected in the areas of “crazy paving” zones. Areas of consolidation were histologically represented by extensive intraalveolar hemorrhages and/or hemorrhagic infarcts in 45.5% of cases. Perilobular consolidation, subpleural cords, symptoms of “halo” and “reverse halo”, which we considered as part of the symptom complex of organizing pneumonia in 43% of cases morphologically corresponded to organizing pneumonia (the proliferative phase of DAD) and to distelectases. Conclusion. Herein, we established the correspondence of DAD histology phases with/ or without pulmonary intravascular coagulopathy to the main HRCT-patterns of viral pneumonia. The results obtained can be used to determine therapeutic tactics at different phases of viral pneumonia in COVID- 19.
{"title":"A Targeted Study of Pulmonary Pathology and Chest Computed Tomography (CT) Findings in COVID-19","authors":"M. Samsonova, E. Pershina, D.J. Schekochikhin, A. Shilova, K.J. Mikhajlichenko, O. Zayratyants, E. Berezhnaya, V. Parshin, J. Omarova, A. Cherniaev","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3820","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3820","url":null,"abstract":"Introduction. In the context of the COVID-19 pandemic, one of the most important diagnostic methods is highresolution computed tomography of the lungs (HRCT), which is highly sensitive for diagnostics of viral pneumonia. Because of a variety of radiological changes in the lungs at different periods of the disease, it became necessary to compare the changes detected by HRCT with morphological features of the disease. The aim of the research is to compare the HRCT patterns and histological changes in the lungs in the deceased with COVID-19. Material and methods. We analyzed 45 pieces from 14 deceased with COVID-19 (7 men/7 women), with an average age of 77.1 ± 12.9 (49-90 years), which underwent HRCT no more than 5 days before death. On the fixed whole lungs, tissue sites were selected, according to the target localization selected by HRCT with 3- D reconstruction. The leading HRCT patterns such as 'ground glass' opacities, “crazy paving”, consolidation, and symptoms typical for organizing pneumonia were the points of interest. We performed routine hematoxylineosin stains for histopathologic evaluation. Results. “Ground glass” opacities in the majority of cases (57.1%) corresponded to an acute phase of diffuse alveolar damage (DAD) (intraalveolar edema, hyaline membranes, cellularity, interstitial infiltration). Mosaic histological changes with alternation of filled alveoli (intraalveolar edema, clusters of red blood cells, macrophages, lymphocytes, fibrin) and aerated alveoli were detected in the areas of “crazy paving” zones. Areas of consolidation were histologically represented by extensive intraalveolar hemorrhages and/or hemorrhagic infarcts in 45.5% of cases. Perilobular consolidation, subpleural cords, symptoms of “halo” and “reverse halo”, which we considered as part of the symptom complex of organizing pneumonia in 43% of cases morphologically corresponded to organizing pneumonia (the proliferative phase of DAD) and to distelectases. Conclusion. Herein, we established the correspondence of DAD histology phases with/ or without pulmonary intravascular coagulopathy to the main HRCT-patterns of viral pneumonia. The results obtained can be used to determine therapeutic tactics at different phases of viral pneumonia in COVID- 19.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85909710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3858
K. Cervellione, G. Dadi, N. Hameedi, M. Pignanelli, B. Kuriakose, V. Zafonte, T. Ullah, J. Robitsek, G. Pena Fatule, H. Patel, D. Wisa, K. Gafoor, M. Walczyszyn, J. Shakil, F. Bagheri, A. Solinas, R. Mendelson
The COVID19 pandemic has pushed healthcare workers to utilize available therapeutics, often with limited evidence. Theoretically, IL6 inhibitors could help to stop or reverse the damage caused by COVID19 cytokine storm. Published evidence from the United States is conflicting and is largely from academic institutions and nonminority populations. This study assessed the clinical utility of open-label tocilizumab in two multiethnic community hospitals in Queens, NY.Tocilizumab (8mg/kg) was given to 114 patients for treatment of COVID19- related respiratory failure between April 4 and May 19 2020 (96% received 1 dose). A retrospective cohort study was performed to determine 28-day clinical success, defined as achieving a score of 1 using a 6-point scale (1=no O2 requirement or discharged home on 2L/min;2=low-flow O2 in hospital ≤6L/min;3=O2 >6 to ≤15L/min;4=high-flow, CPAP, or BiPAP;5=mechanically ventilated (MV);6=expired). The decision to administer tocilizumab was made by a committee based on unstable or worsening respiratory status. Mean patient age was 60 years (SD=11);77(67%) were male. 25% were Asian, 23% black (31% black Hispanic), 36% white (73% white Hispanic), and 14% other. A majority of patients had at least 1 significant comorbidity, including HTN 56%, DM 40%, HLD 43%, and COPD/asthma 16%. Median days of symptoms at dose was 14(IQR 10-19);SpO2 on RA at admission was 82%(IQR 67-88%). Baseline status by ordinal scale was as follows: 2= 9(8%);3=33(29%);4=38(33%);5=34(30%) (IQR 1-2 days on vent). Median CRP=19.9, d-dimer=1658, ferritin=593, and LDH=1561. 28-day success was achieved in 35(31%) patients;62(55%) patients expired or were MV on day 28. Of patients who were on high-flow, CPAP, BiPAP or MV at baseline, 80% expired or were on MV on day 28. Estimated mortality in all hospitalized patients during the time frame at these hospitals was 36%. No significant differences were seen in labs, comorbidities or age between patients who did and did not have clinical success. Higher baseline ordinal scale score was predictive of mortality.Tocilizumab provided little to no clinical utility, especially in those with high oxygenation needs at time of dosing (success rate <20%). The main limitation is lack of a control group;however mortality was strikingly high. This in part may be due to the demographic and clinical characteristics of our sample.
{"title":"Tocilizumab Has Limited Clinical Utility for COVID19 in Two Multiethnic Community Hospitals","authors":"K. Cervellione, G. Dadi, N. Hameedi, M. Pignanelli, B. Kuriakose, V. Zafonte, T. Ullah, J. Robitsek, G. Pena Fatule, H. Patel, D. Wisa, K. Gafoor, M. Walczyszyn, J. Shakil, F. Bagheri, A. Solinas, R. Mendelson","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3858","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3858","url":null,"abstract":"The COVID19 pandemic has pushed healthcare workers to utilize available therapeutics, often with limited evidence. Theoretically, IL6 inhibitors could help to stop or reverse the damage caused by COVID19 cytokine storm. Published evidence from the United States is conflicting and is largely from academic institutions and nonminority populations. This study assessed the clinical utility of open-label tocilizumab in two multiethnic community hospitals in Queens, NY.Tocilizumab (8mg/kg) was given to 114 patients for treatment of COVID19- related respiratory failure between April 4 and May 19 2020 (96% received 1 dose). A retrospective cohort study was performed to determine 28-day clinical success, defined as achieving a score of 1 using a 6-point scale (1=no O2 requirement or discharged home on 2L/min;2=low-flow O2 in hospital ≤6L/min;3=O2 >6 to ≤15L/min;4=high-flow, CPAP, or BiPAP;5=mechanically ventilated (MV);6=expired). The decision to administer tocilizumab was made by a committee based on unstable or worsening respiratory status. Mean patient age was 60 years (SD=11);77(67%) were male. 25% were Asian, 23% black (31% black Hispanic), 36% white (73% white Hispanic), and 14% other. A majority of patients had at least 1 significant comorbidity, including HTN 56%, DM 40%, HLD 43%, and COPD/asthma 16%. Median days of symptoms at dose was 14(IQR 10-19);SpO2 on RA at admission was 82%(IQR 67-88%). Baseline status by ordinal scale was as follows: 2= 9(8%);3=33(29%);4=38(33%);5=34(30%) (IQR 1-2 days on vent). Median CRP=19.9, d-dimer=1658, ferritin=593, and LDH=1561. 28-day success was achieved in 35(31%) patients;62(55%) patients expired or were MV on day 28. Of patients who were on high-flow, CPAP, BiPAP or MV at baseline, 80% expired or were on MV on day 28. Estimated mortality in all hospitalized patients during the time frame at these hospitals was 36%. No significant differences were seen in labs, comorbidities or age between patients who did and did not have clinical success. Higher baseline ordinal scale score was predictive of mortality.Tocilizumab provided little to no clinical utility, especially in those with high oxygenation needs at time of dosing (success rate <20%). The main limitation is lack of a control group;however mortality was strikingly high. This in part may be due to the demographic and clinical characteristics of our sample.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"2017 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86759612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.26226/morressier.60780408dc2fa1af56246950
A. Yugay
Introduction:Despite rapidly emerging data on all possible manifestations and complications of Coronavirus 19 (COVID19) disease, little evidence is available on patients presenting with acute hypoxic respiratory failure and a normal chest radiograph (CXR). The goal of our study was to evaluate outcomes of patients with normal CXR on admission and hypoxic respiratory failure due to COVID19 infection accordingly to their D-Dimer level on admission. Methods:We conducted a retrospective review of all adult patients with confirmed COVID19 infection presenting with acute hypoxic respiratory failure requiring supplemental oxygen and a normal CXR on admission, admitted to Bronx Care Health System between March and June 2020. A total of 115 patients were included and classified into 2 groups accordingly to their initial D-Dimer level: D-dimer level ≥ 4 times upper limit of normal (ULN) and a D-Dimer level ≤ 4 times ULN. Primary outcome was mortality and secondary outcomes were hospital length of stay (HLOS), need for mechanical ventilation, shock, acute kidney injury (AKI), electrolyte abnormalities. Results:115 patients were included and classified according to the initial D-Dimer level. 31 patients had a d-dimer level ≥ 4 times ULN and 84 had d-dimers ≤ 4 times ULN. Patients with d-dimer level ≥ 4 times ULN were older (mean age 65 vs 55 p<0.05, CI 3.4-16.7) and more likely to be African-American in comparison to any other race (58% vs 28.5%, p<0.05). Patients with initial normal CXR and a d-dimer level ≥ 4 times ULN had significantly higher mortality, higher requirement for mechanical ventilation, higher serum lactic dehydrogenase (LDH) and were more likely to have acute kidney injury (AKI) compared with patients with lower levels of ddimers. We found no differences in hospital or intensive care length of stay (LOS) among the groups. Conclusions:Patients with hypoxic respiratory failure with elevated d-dimers and normal admission CXR have higher mortality, more likely develop shock, renal failure and need for mechanical ventilation. Care must be taken in both triage and discharge planning in those patients, as they need close monitoring. This is especially important in African-American patients and those with increased serum LDH levels. A composite scoring system for this group of patients will be helpful.
尽管关于冠状病毒19 (covid - 19)疾病所有可能表现和并发症的数据迅速出现，但关于急性缺氧性呼吸衰竭和胸片正常(CXR)的患者的证据很少。我们的研究目的是根据入院时d -二聚体水平评估入院时CXR正常和covid - 19感染导致的缺氧呼吸衰竭患者的结局。方法:我们对2020年3月至6月期间在布朗克斯保健卫生系统(Bronx Care Health System)就诊的所有确诊为covid - 19感染、入院时出现急性缺氧呼吸衰竭、需要补充氧气和正常CXR的成年患者进行了回顾性研究。共纳入115例患者，根据初始d -二聚体水平分为2组:d -二聚体水平≥4倍正常上限(ULN)和d -二聚体水平≤4倍正常上限(ULN)。主要结局是死亡率，次要结局是住院时间(HLOS)、机械通气需求、休克、急性肾损伤(AKI)、电解质异常。结果:纳入115例患者，根据初始d -二聚体水平进行分类。d-二聚体≥4倍ULN的有31例，d-二聚体≤4倍ULN的有84例。d-二聚体水平≥4倍ULN的患者年龄较大(平均年龄65比55,CI 3.4-16.7;0.05)，与其他种族相比，非裔美国人的可能性更大(58%比28.5%，CI 3.4-16.7;0.05)。初始CXR正常且d-二聚体水平≥4倍ULN的患者与二聚体水平较低的患者相比，死亡率较高，机械通气需求较高，血清乳酸脱氢酶(LDH)较高，更容易发生急性肾损伤(AKI)。我们发现两组间住院时间或重症监护时间(LOS)没有差异。结论:低氧性呼吸衰竭伴d-二聚体升高且入院CXR正常的患者死亡率较高，更容易发生休克、肾功能衰竭和需要机械通气。在对这些患者进行分诊和出院计划时都必须注意，因为他们需要密切监测。这在非裔美国人和血清LDH水平升高的患者中尤为重要。对这组患者的综合评分系统将会有所帮助。
{"title":"Outcomes of patients with hypoxic respiratory failure due to Coronavirus 19 and a normal chest radiograph on admission based on initial D-Dimer level","authors":"A. Yugay","doi":"10.26226/morressier.60780408dc2fa1af56246950","DOIUrl":"https://doi.org/10.26226/morressier.60780408dc2fa1af56246950","url":null,"abstract":"Introduction:Despite rapidly emerging data on all possible manifestations and complications of Coronavirus 19 (COVID19) disease, little evidence is available on patients presenting with acute hypoxic respiratory failure and a normal chest radiograph (CXR). The goal of our study was to evaluate outcomes of patients with normal CXR on admission and hypoxic respiratory failure due to COVID19 infection accordingly to their D-Dimer level on admission. Methods:We conducted a retrospective review of all adult patients with confirmed COVID19 infection presenting with acute hypoxic respiratory failure requiring supplemental oxygen and a normal CXR on admission, admitted to Bronx Care Health System between March and June 2020. A total of 115 patients were included and classified into 2 groups accordingly to their initial D-Dimer level: D-dimer level ≥ 4 times upper limit of normal (ULN) and a D-Dimer level ≤ 4 times ULN. Primary outcome was mortality and secondary outcomes were hospital length of stay (HLOS), need for mechanical ventilation, shock, acute kidney injury (AKI), electrolyte abnormalities. Results:115 patients were included and classified according to the initial D-Dimer level. 31 patients had a d-dimer level ≥ 4 times ULN and 84 had d-dimers ≤ 4 times ULN. Patients with d-dimer level ≥ 4 times ULN were older (mean age 65 vs 55 p<0.05, CI 3.4-16.7) and more likely to be African-American in comparison to any other race (58% vs 28.5%, p<0.05). Patients with initial normal CXR and a d-dimer level ≥ 4 times ULN had significantly higher mortality, higher requirement for mechanical ventilation, higher serum lactic dehydrogenase (LDH) and were more likely to have acute kidney injury (AKI) compared with patients with lower levels of ddimers. We found no differences in hospital or intensive care length of stay (LOS) among the groups. Conclusions:Patients with hypoxic respiratory failure with elevated d-dimers and normal admission CXR have higher mortality, more likely develop shock, renal failure and need for mechanical ventilation. Care must be taken in both triage and discharge planning in those patients, as they need close monitoring. This is especially important in African-American patients and those with increased serum LDH levels. A composite scoring system for this group of patients will be helpful.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89641620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3849
T. Wolak, R. Kalaora, M. Hatan, S. Yarkoni, D. Greenberg, E. Bortey, S. Lisi, A. Avniel, A. Tal
RATIONALE: There is a growing population at increased risk of viral pneumonia;over 50,000 people in the United States died from pneumonia in 2015. RSV, influenza, and other viruses are common causes of severe viral lower respiratory tract infection (LRTI), and COVID-19 pneumonia is associated with high mortality rates. With limited treatment options currently available, viral COVID-19 LRTI in particular represents a significant unmet medical need. Inhaled nitric oxide (iNO) is a highly promising treatment option, given its documented antimicrobial and anti-inflammatory effects as well as beneficial effects on pulmonary vasculature. In particular, the antiviral effect of iNO on SARS-CoV-2 has been attributed to covalent binding to SARS-CoV-2 protease. In multiple clinical trials and compassionate use cases, intermittent exposure to 150 - 250 ppm iNO was well tolerated, resulted in improved physical and lung function, reduced bacterial load in patients with cystic fibrosis , and shortened time to improvement of clinical signs and time to fit for discharge in patients with acute bronchiolitis. Based on these data, we have initiated a prospective, randomized, open label, multi-center pilot clinical trial to evaluate the safety and efficacy of iNO for the treatment of viral pneumonia in adult patients. METHODS: In the current study, subjects (ages 18-80) with COVID-19 (COVID group) or other acute viral pneumonias (Viral LRTI group) requiring inpatient hospitalization are being randomized 1:1 to be treated with intermittent inhalations of 150 ppm iNO, given for 40 minutes 4 times daily for up to 7 days in addition to standard supportive treatment (SST), or to receive SST alone. iNO is being delivered by the LungFitTM, an innovative portable device under development (Beyond Air, NY, USA) that generates NO from room air. Study endpoints include safety, ICU admission, O2 supplementation requirement, and time to resolution of fever. RESULTS: The study will be conducted in up to 10 centers in Israel. To date, 6 subjects have been enrolled (COVID group), three have been randomized to iNO + SST and three to SST alone. All treatments have been well tolerated. CONCLUSIONS: Based on current data demonstrating the antiviral and anti-inflammatory effects of NO, in addition to its complex beneficial effect on oxygenation, iNO delivered by the LungFit system has the potential to treat viral pneumonias including COVID-19, thereby providing therapy for this currently unmet medical need.
{"title":"Inhaled Nitric Oxide for the Treatment of COVID-19 and Other Viral Pneumonias in Adults","authors":"T. Wolak, R. Kalaora, M. Hatan, S. Yarkoni, D. Greenberg, E. Bortey, S. Lisi, A. Avniel, A. Tal","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3849","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3849","url":null,"abstract":"RATIONALE: There is a growing population at increased risk of viral pneumonia;over 50,000 people in the United States died from pneumonia in 2015. RSV, influenza, and other viruses are common causes of severe viral lower respiratory tract infection (LRTI), and COVID-19 pneumonia is associated with high mortality rates. With limited treatment options currently available, viral COVID-19 LRTI in particular represents a significant unmet medical need. Inhaled nitric oxide (iNO) is a highly promising treatment option, given its documented antimicrobial and anti-inflammatory effects as well as beneficial effects on pulmonary vasculature. In particular, the antiviral effect of iNO on SARS-CoV-2 has been attributed to covalent binding to SARS-CoV-2 protease. In multiple clinical trials and compassionate use cases, intermittent exposure to 150 - 250 ppm iNO was well tolerated, resulted in improved physical and lung function, reduced bacterial load in patients with cystic fibrosis , and shortened time to improvement of clinical signs and time to fit for discharge in patients with acute bronchiolitis. Based on these data, we have initiated a prospective, randomized, open label, multi-center pilot clinical trial to evaluate the safety and efficacy of iNO for the treatment of viral pneumonia in adult patients. METHODS: In the current study, subjects (ages 18-80) with COVID-19 (COVID group) or other acute viral pneumonias (Viral LRTI group) requiring inpatient hospitalization are being randomized 1:1 to be treated with intermittent inhalations of 150 ppm iNO, given for 40 minutes 4 times daily for up to 7 days in addition to standard supportive treatment (SST), or to receive SST alone. iNO is being delivered by the LungFitTM, an innovative portable device under development (Beyond Air, NY, USA) that generates NO from room air. Study endpoints include safety, ICU admission, O2 supplementation requirement, and time to resolution of fever. RESULTS: The study will be conducted in up to 10 centers in Israel. To date, 6 subjects have been enrolled (COVID group), three have been randomized to iNO + SST and three to SST alone. All treatments have been well tolerated. CONCLUSIONS: Based on current data demonstrating the antiviral and anti-inflammatory effects of NO, in addition to its complex beneficial effect on oxygenation, iNO delivered by the LungFit system has the potential to treat viral pneumonias including COVID-19, thereby providing therapy for this currently unmet medical need.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81728619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3853
S. Patrucco Reyes, L. Mays, A. Hoq, K. Pivarnik, A. Geeti, Y. Adjepong
Rationale: Background: On December 29, 2019, the first 4 cases of the novel coronavirus (COVID-19) were identified in Wuhan, China. The northeastern United Sates experienced the first wave between March 1 and June 30, 2020. Poor, inner-city patients experienced the highest hospitalization and mortality rates. Many were elderly and had underlying medical conditions, including chronic kidney disease, morbid obesity and diabetes. The full impact of COVID-19 on the inner city patients has not been fully studied. The goal of this study is to describe the clinical characteristics and outcomes of patients from an inner-city residents run clinic hospitalized with COVID- 19 during the first wave of COVID-19 pandemic in Northeastern USA from March 1 through June 30, 2020. Methods: We identified hospitalized patients with COVID-19 from an inner-city, residents run primary care clinic by reviewing daily COVID-19 admissions and matching the list with the clinic database of the patients. Identified patients were prospectively followed during and after their hospital stay. Data abstracted included demographic characteristics, co-morbid conditions, intubations, durations of ICU and hospital stay and in-hospital mortality. Results: A total of 40 patients from the Bridgeport Hospital Primary Care Center were admitted to Bridgeport Hospital, Yale New Haven Health, between March 1 and June 30, 2020. They were 26 men and 14 women, between 21 and 88 years (Median 54 years). Most (60%) were Hispanics. About 32.5% were African-Americans and 7.5% were Caucasians. About 32.5% (13 out of 40) were aged 60 years or over. The predominant comorbid conditions were hypertension (45%), diabetes mellitus (35%), ischemic heart disease (22.5%), chronic kidney disease (11.6%), and lung diseases (9.3%). 25% (10/40) had BMI of 35 or over. About 31% (12 out of 40) were intubated for acute hypoxemic respiratory failure. The median duration of hospital stay was 9 days (range from 1 to 47 days). The in-hospital mortality rate was 22.5%. Age 60 years or older was the single best predictor for in-hospital mortality after adjusting for BMI and other co-morbid conditions (adjusted OR 35.6, 95% CI: 2.1, 605.7, p=0.01). Conclusion: The in-hospital mortality rate for the hospitalized inner-city clinic patients was 22.5%. Many of the patients had significant co-morbid conditions. Age 60 or more was the best predictor of mortality. The very high mortality rate among hospitalized inner city patients mandates that aggressive preventive strategies are implemented to slow the spread of COVID-19 in this patient population group.
{"title":"A Brief Overview of Hospitalized COVID-19 Patients from an Inner-City, Residents-Run Clinic","authors":"S. Patrucco Reyes, L. Mays, A. Hoq, K. Pivarnik, A. Geeti, Y. Adjepong","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3853","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3853","url":null,"abstract":"Rationale: Background: On December 29, 2019, the first 4 cases of the novel coronavirus (COVID-19) were identified in Wuhan, China. The northeastern United Sates experienced the first wave between March 1 and June 30, 2020. Poor, inner-city patients experienced the highest hospitalization and mortality rates. Many were elderly and had underlying medical conditions, including chronic kidney disease, morbid obesity and diabetes. The full impact of COVID-19 on the inner city patients has not been fully studied. The goal of this study is to describe the clinical characteristics and outcomes of patients from an inner-city residents run clinic hospitalized with COVID- 19 during the first wave of COVID-19 pandemic in Northeastern USA from March 1 through June 30, 2020. Methods: We identified hospitalized patients with COVID-19 from an inner-city, residents run primary care clinic by reviewing daily COVID-19 admissions and matching the list with the clinic database of the patients. Identified patients were prospectively followed during and after their hospital stay. Data abstracted included demographic characteristics, co-morbid conditions, intubations, durations of ICU and hospital stay and in-hospital mortality. Results: A total of 40 patients from the Bridgeport Hospital Primary Care Center were admitted to Bridgeport Hospital, Yale New Haven Health, between March 1 and June 30, 2020. They were 26 men and 14 women, between 21 and 88 years (Median 54 years). Most (60%) were Hispanics. About 32.5% were African-Americans and 7.5% were Caucasians. About 32.5% (13 out of 40) were aged 60 years or over. The predominant comorbid conditions were hypertension (45%), diabetes mellitus (35%), ischemic heart disease (22.5%), chronic kidney disease (11.6%), and lung diseases (9.3%). 25% (10/40) had BMI of 35 or over. About 31% (12 out of 40) were intubated for acute hypoxemic respiratory failure. The median duration of hospital stay was 9 days (range from 1 to 47 days). The in-hospital mortality rate was 22.5%. Age 60 years or older was the single best predictor for in-hospital mortality after adjusting for BMI and other co-morbid conditions (adjusted OR 35.6, 95% CI: 2.1, 605.7, p=0.01). Conclusion: The in-hospital mortality rate for the hospitalized inner-city clinic patients was 22.5%. Many of the patients had significant co-morbid conditions. Age 60 or more was the best predictor of mortality. The very high mortality rate among hospitalized inner city patients mandates that aggressive preventive strategies are implemented to slow the spread of COVID-19 in this patient population group.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"119 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80369125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3840
S.S.O. Aparece-Solis, R. Perez, A.L.Y. Ong, M. Cañete, A. Rafanan
Rationale. In the Philippines, Tocilizumab is an investigational drug and our guidelines had allowed its use in severe to critical patients with SARS-CoV-2. Tocilizumab was often given during or after intubation when the cytokine surge has already occurred. We hypothesized that the timing of administration of Tocilizumab may also affect its effectiveness as a treatment. Methods. We conducted a retrospective observational study of all patients admitted in our intensive care unit from March 1 to August 30, 2020 analyzing the effect of its timing relative to intubation (“early” or given prior to intubation or noninvasive ventilation vs “late” or given on the day or after) on 28-day mortality and survival post-intubation. Results. Ninety severe to critically ill patients were admitted at the ICU. The baseline characteristics are shown in Table 1. Tocilizumab was given to 68 (76%) and their mortality rate was 47.06% (n=32). This was comparable to the 54.54% (12/22) mortality rate of the patients not given Tocilizumab, (p=0.541). Both groups received similar standard of care, including the use of Dexamethasone, which was started in June, after the release of the Randomized Evaluation of COVID 19 Therapy (RECOVERY) trial results. Of the 68 patients who received Tocilizumab, 27 (30.7%) received the drug “early' with a mean day (±SD) of 3.96 ±3.46 prior to intubation or noninvasive ventilation while 41 received it “late” with a mean day (±SD) of 0.762 ± 3.18. The 28-day mortality in the early group was 29.63% (8/27) which was significantly lower than the 58.54%, (24/41) in the late group (p=0.019). Their mean days of survival post intubation was significantly better for the early group (26.21 vs. 19.56;p=0.0008). The hazards ratios (after adjusting for covariates) for early Tocilizumab alone is 0.2744268 (95% confidence interval, 0.0842749 to 0.8936242, p=0.032) while that of both Dexamethasone and Tocilizumab use is 0.3387582 (95% ci: 0.1327466 to 0.8644829, p=0.024). Conclusion. Tocilizumab may potentially ameliorate the inflammatory response as has been shown by early data and this may potentially prevent intubation. Our data is inherently limited by its retrospective nature but it shows that late administration of Tocilizumab after the cytokine storm when respiratory failure has ensued may be detrimental to patients. Our hazards ratios using Cox multiple regression did show that giving Tocilizumab to severely ill patients prior to respiratory failure may improve survival.
基本原理。在菲律宾，Tocilizumab是一种研究药物，我们的指导方针允许将其用于SARS-CoV-2重症至危重患者。当细胞因子激增已经发生时，托珠单抗通常在插管期间或之后给予。我们假设Tocilizumab的给药时间也可能影响其作为治疗的有效性。方法。我们对2020年3月1日至8月30日在重症监护病房住院的所有患者进行了回顾性观察研究，分析其插管时间(“早期”或插管前或无创通气与“晚期”或当日或之后)对插管后28天死亡率和生存率的影响。结果。重症监护室收治了90名重症至危重症患者。基线特征如表1所示。给予托珠单抗68例(76%)，死亡率为47.06% (n=32)。这与未给予Tocilizumab的患者的54.54%(12/22)死亡率相当，(p=0.541)。两组都接受了类似的标准治疗，包括使用地塞米松，在发布COVID - 19治疗(恢复)随机评估试验结果后，于6月开始使用地塞米松。在接受Tocilizumab治疗的68例患者中，27例(30.7%)患者“早期”接受药物治疗，插管或无创通气前平均天(±SD)为3.96±3.46,41例患者“较晚”接受药物治疗，平均天(±SD)为0.762±3.18。早期组28天死亡率为29.63%(8/27)，显著低于晚期组的58.54% (24/41)(p=0.019)。早期组插管后的平均生存天数明显更好(26.21 vs. 19.56;p=0.0008)。早期单独使用托珠单抗的风险比(调整协变量后)为0.2744268(95%置信区间，0.0842749至0.8936242,p=0.032)，而同时使用地塞米松和托珠单抗的风险比为0.3387582 (95% ci: 0.1327466至0.8644829,p=0.024)。结论。正如早期数据显示的那样，Tocilizumab可能潜在地改善炎症反应，这可能潜在地防止插管。我们的数据本身受其回顾性性质的限制，但它表明，在细胞因子风暴之后，当呼吸衰竭随之而来时，晚给药Tocilizumab可能对患者有害。我们使用Cox多元回归的风险比确实显示，在呼吸衰竭之前给予重症患者Tocilizumab可能会提高生存率。
{"title":"Tocilizumab Treatment in Severe to Critical Coronavirus Disease 2019 (COVID-19) Patients","authors":"S.S.O. Aparece-Solis, R. Perez, A.L.Y. Ong, M. Cañete, A. Rafanan","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3840","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3840","url":null,"abstract":"Rationale. In the Philippines, Tocilizumab is an investigational drug and our guidelines had allowed its use in severe to critical patients with SARS-CoV-2. Tocilizumab was often given during or after intubation when the cytokine surge has already occurred. We hypothesized that the timing of administration of Tocilizumab may also affect its effectiveness as a treatment. Methods. We conducted a retrospective observational study of all patients admitted in our intensive care unit from March 1 to August 30, 2020 analyzing the effect of its timing relative to intubation (“early” or given prior to intubation or noninvasive ventilation vs “late” or given on the day or after) on 28-day mortality and survival post-intubation. Results. Ninety severe to critically ill patients were admitted at the ICU. The baseline characteristics are shown in Table 1. Tocilizumab was given to 68 (76%) and their mortality rate was 47.06% (n=32). This was comparable to the 54.54% (12/22) mortality rate of the patients not given Tocilizumab, (p=0.541). Both groups received similar standard of care, including the use of Dexamethasone, which was started in June, after the release of the Randomized Evaluation of COVID 19 Therapy (RECOVERY) trial results. Of the 68 patients who received Tocilizumab, 27 (30.7%) received the drug “early' with a mean day (±SD) of 3.96 ±3.46 prior to intubation or noninvasive ventilation while 41 received it “late” with a mean day (±SD) of 0.762 ± 3.18. The 28-day mortality in the early group was 29.63% (8/27) which was significantly lower than the 58.54%, (24/41) in the late group (p=0.019). Their mean days of survival post intubation was significantly better for the early group (26.21 vs. 19.56;p=0.0008). The hazards ratios (after adjusting for covariates) for early Tocilizumab alone is 0.2744268 (95% confidence interval, 0.0842749 to 0.8936242, p=0.032) while that of both Dexamethasone and Tocilizumab use is 0.3387582 (95% ci: 0.1327466 to 0.8644829, p=0.024). Conclusion. Tocilizumab may potentially ameliorate the inflammatory response as has been shown by early data and this may potentially prevent intubation. Our data is inherently limited by its retrospective nature but it shows that late administration of Tocilizumab after the cytokine storm when respiratory failure has ensued may be detrimental to patients. Our hazards ratios using Cox multiple regression did show that giving Tocilizumab to severely ill patients prior to respiratory failure may improve survival.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79859160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3827
G. Moreira-Hetzel, G.D.S. Viana, Ricardo Canquerini da Silva, I. Benedetto, M. Basso Gazzana, D. Berton
Rationale: COVID-19 can progress to severe disease requiring hospitalization and oxygen support in around 14% of the cases and 5% require admission in intensive care unit. The consequences of severe COVID-19 on lung function and exercise capacity remain to be determined. Methods: A multicenter prospective cohort study that aims to evaluate the early (Visit 1: 2-6 months after acute disease) and late (Visit 2: 9-15 months and Visit 3: 18- 24 months) effects of severe acute respiratory syndrome on lung function, exercise capacity, respiratory symptoms and health related quality of life in patients with confirmed diagnosis of SARS-CoV-2 infection by PCRRT from nasal swab (ClinicalTrials.gov: NCT04410107). Severe disease was defined by respiratory rate > 30breaths/min, peripheral oxygen saturation ≤93% on room air and/or by the presence of infiltrates > 50% on chest imaging in the first two days after laboratorial confirmation. This is a preliminary report of spirometry, lung volumes by body plethysmography, lung diffusion capacity for carbon monoxide (DLCO), and performance during 6-minute walk test (6MWT) after 2-6 months (early evaluation) of severe COVID-19. Results: 51 patients were included: 54% male, 55.4±12.9 yrs-old, 23 (45%) were current or former smokers. Around half (45%) were admitted to the ICU and 26 (50%) received ventilatory support (invasive or non-invasive). The most frequent comorbidities were systemic hypertension (41%), obesity (29%), and 9% reported history of previous respiratory disease. Mean lung function parameters were (% predicted): FEV1= 85±18;FVC= 82±16;total lung capacity (TLC)= 87±14;residual volume= 93±40;DLCO= 74±17;6-min walk distance= 85±20. Mean pulse oximetry values post-6MWT were= 93%. Although mean values were within the normal limits, 14 (27%) patients presented with restrictive ventilatory defect (↓TLC), 5 (9%) patients presented with obstructive ventilatory defect (↓FEV1/FVC), 21 (41%) with abnormal resting gas exchange (↓DLCO), and 12 with significant desaturation during 6MWT. 37 (69%) walked a distance below lower limit of normality. Of note, 22/31 (70%) of the patients presenting with any functional abnormality(ies) had no previous report of respiratory diseases. Conclusions: A substantial proportion of severe COVID-19 survivors (43%) presented with respiratory functional abnormalities indicative of restrictive ventilatory defect and/or with altered gas exchange at rest or during exercise after 2-6 months of acute infection, even without previous report of any lung disease. Further information regarding remission, stabilization or progression of these findings will be possible in the follow-up of this cohort.
{"title":"Lung Function and Exercise Capacity After Severe COVID-19","authors":"G. Moreira-Hetzel, G.D.S. Viana, Ricardo Canquerini da Silva, I. Benedetto, M. Basso Gazzana, D. Berton","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3827","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3827","url":null,"abstract":"Rationale: COVID-19 can progress to severe disease requiring hospitalization and oxygen support in around 14% of the cases and 5% require admission in intensive care unit. The consequences of severe COVID-19 on lung function and exercise capacity remain to be determined. Methods: A multicenter prospective cohort study that aims to evaluate the early (Visit 1: 2-6 months after acute disease) and late (Visit 2: 9-15 months and Visit 3: 18- 24 months) effects of severe acute respiratory syndrome on lung function, exercise capacity, respiratory symptoms and health related quality of life in patients with confirmed diagnosis of SARS-CoV-2 infection by PCRRT from nasal swab (ClinicalTrials.gov: NCT04410107). Severe disease was defined by respiratory rate > 30breaths/min, peripheral oxygen saturation ≤93% on room air and/or by the presence of infiltrates > 50% on chest imaging in the first two days after laboratorial confirmation. This is a preliminary report of spirometry, lung volumes by body plethysmography, lung diffusion capacity for carbon monoxide (DLCO), and performance during 6-minute walk test (6MWT) after 2-6 months (early evaluation) of severe COVID-19. Results: 51 patients were included: 54% male, 55.4±12.9 yrs-old, 23 (45%) were current or former smokers. Around half (45%) were admitted to the ICU and 26 (50%) received ventilatory support (invasive or non-invasive). The most frequent comorbidities were systemic hypertension (41%), obesity (29%), and 9% reported history of previous respiratory disease. Mean lung function parameters were (% predicted): FEV1= 85±18;FVC= 82±16;total lung capacity (TLC)= 87±14;residual volume= 93±40;DLCO= 74±17;6-min walk distance= 85±20. Mean pulse oximetry values post-6MWT were= 93%. Although mean values were within the normal limits, 14 (27%) patients presented with restrictive ventilatory defect (↓TLC), 5 (9%) patients presented with obstructive ventilatory defect (↓FEV1/FVC), 21 (41%) with abnormal resting gas exchange (↓DLCO), and 12 with significant desaturation during 6MWT. 37 (69%) walked a distance below lower limit of normality. Of note, 22/31 (70%) of the patients presenting with any functional abnormality(ies) had no previous report of respiratory diseases. Conclusions: A substantial proportion of severe COVID-19 survivors (43%) presented with respiratory functional abnormalities indicative of restrictive ventilatory defect and/or with altered gas exchange at rest or during exercise after 2-6 months of acute infection, even without previous report of any lung disease. Further information regarding remission, stabilization or progression of these findings will be possible in the follow-up of this cohort.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81284295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3834
A. Sadigov
Background:IL-6 is an important pro-inflammatory cytokine and has been associated with more rapid disease progression and a higher complication rate in COVID-19 cases.Accumlated evidence so far has demonstrated cytokine storm syndrome is associated more severe disease and complications such as respiratory failure, ARDS, septic shock and muliorgan dysfunction. Objective:We aimed to investigate the relationship among IL-6 levels, severity of the disease ,and extention of radiological appearance in patients with COVID19.Methods and measurements:We have assessed 256 moderate-to-severe patients with COVID-19 who have been admitted to the pulmonary medicine and intensive care unit(ICU) departments of hospital clinic of Medical University, Baku city from 10-th April 2020 to 15 -th June 2020.All patients have examined on CT of lung, serum IL-6 levels and all others clinical and laboratory investigations which are included for the examination of the COVID19 patients.Results :Depends on the level of the IL-6 all hospitalized patients with COVID19 have divided in two groups:1)142 patients were with serum IL-6 level >-100 pg/ml;2)114 patients were with serum IL-6 <99 pg/ml.The high levels of serum IL-6( >-100 pg/ml) in patients was associated with more severe disease severity and respiratory failure was positive corellated with high IL-6 levels(OR,4.25[0.85-10.36],95%CI;p<0.001).Kidney failure was common in patients with high level of serum IL-6 compared to low serum IL-6 level(OR,3.71[092- 8.64] 95% CI;p=0.002).In the chest CT findings reviewed for extent of parenchymal involvement more extented involvement were found in patients with high levels of serum IL-6.In all patients with serum low IL-6 levels the domonant infiltration pattern was ground -glass compared(less than <50% involvement) to patients with high serum IL-6 level(OR,4.69[1.12-12.62] 95% CI;p=0.0004).In patients with high serum IL-6 levels the dominant and extented infiltration pattern(more than >50% involvement) were crazy-paving and consolidation( OR,3.58[079-11.34] 95%CI;p=0.002).Low serum IL-6 level in patients had significantly lower rate of pleural effusion compared to the patients with higher serum level of IL-6(p=0.015).On control chest CT, patients with high levels of IL-6 had significantly higher rate of progression and the development of ARDS(OR,6.87[1.75- 14.58] 95% CI;p=0.0001).ICU department admission rate was significantly higher in patients with high serum levels of IL-6(OR,3.65[098-8.43]95% CI;p<0.002) .Conclusions:In hospitalized patients with COVID-19 the high serum IL-6 levels are associated with more severe disease course .In patients the high serum level of IL-6 is associated with more extensive parenchymal involvement with dominant type of infiltration as consolidation and crazy-paving .The increased serum level of IL-6 in patients most commonly were associated with progression of the disease and develpment complication as ARDS.
{"title":"Relationship Among Disease Severity,Radiological Extention and Serum IL-6 in Patients with COVID19","authors":"A. Sadigov","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3834","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3834","url":null,"abstract":"Background:IL-6 is an important pro-inflammatory cytokine and has been associated with more rapid disease progression and a higher complication rate in COVID-19 cases.Accumlated evidence so far has demonstrated cytokine storm syndrome is associated more severe disease and complications such as respiratory failure, ARDS, septic shock and muliorgan dysfunction. Objective:We aimed to investigate the relationship among IL-6 levels, severity of the disease ,and extention of radiological appearance in patients with COVID19.Methods and measurements:We have assessed 256 moderate-to-severe patients with COVID-19 who have been admitted to the pulmonary medicine and intensive care unit(ICU) departments of hospital clinic of Medical University, Baku city from 10-th April 2020 to 15 -th June 2020.All patients have examined on CT of lung, serum IL-6 levels and all others clinical and laboratory investigations which are included for the examination of the COVID19 patients.Results :Depends on the level of the IL-6 all hospitalized patients with COVID19 have divided in two groups:1)142 patients were with serum IL-6 level >-100 pg/ml;2)114 patients were with serum IL-6 <99 pg/ml.The high levels of serum IL-6( >-100 pg/ml) in patients was associated with more severe disease severity and respiratory failure was positive corellated with high IL-6 levels(OR,4.25[0.85-10.36],95%CI;p<0.001).Kidney failure was common in patients with high level of serum IL-6 compared to low serum IL-6 level(OR,3.71[092- 8.64] 95% CI;p=0.002).In the chest CT findings reviewed for extent of parenchymal involvement more extented involvement were found in patients with high levels of serum IL-6.In all patients with serum low IL-6 levels the domonant infiltration pattern was ground -glass compared(less than <50% involvement) to patients with high serum IL-6 level(OR,4.69[1.12-12.62] 95% CI;p=0.0004).In patients with high serum IL-6 levels the dominant and extented infiltration pattern(more than >50% involvement) were crazy-paving and consolidation( OR,3.58[079-11.34] 95%CI;p=0.002).Low serum IL-6 level in patients had significantly lower rate of pleural effusion compared to the patients with higher serum level of IL-6(p=0.015).On control chest CT, patients with high levels of IL-6 had significantly higher rate of progression and the development of ARDS(OR,6.87[1.75- 14.58] 95% CI;p=0.0001).ICU department admission rate was significantly higher in patients with high serum levels of IL-6(OR,3.65[098-8.43]95% CI;p<0.002) .Conclusions:In hospitalized patients with COVID-19 the high serum IL-6 levels are associated with more severe disease course .In patients the high serum level of IL-6 is associated with more extensive parenchymal involvement with dominant type of infiltration as consolidation and crazy-paving .The increased serum level of IL-6 in patients most commonly were associated with progression of the disease and develpment complication as ARDS.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"283 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76838149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3810
C. McGroder, D. Zhang, A. Choudhury, B. D’souza, M. Salvatore, M. Baldwin, C. Garcia
Rationale: Over 60 million people have had coronavirus disease 2019 (COVID-19), but consequences of severe infection are unknown. We sought to characterize interstitial lung abnormalities (ILA) after COVID-19, and to identify risk factors for the development of lung fibrosis.Methods: We performed a prospective single-center cohort study with 4-month follow-up after COVID-19 hospitalization. We sequentially enrolled 76 community-dwelling adults who were hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and required supplemental oxygen between March and May 2020. Participants had no prior history of interstitial lung disease and were discharged to acute rehabilitation or home, with sampling weighted to include half who were mechanically ventilated. We used a radiologic scoring system to quantify non-fibrotic ILA (ground glass opacities alone) and fibrotic ILA (defined as presence of reticulations, traction bronchiectasis, or honeycombing) on chest high-resolution computed tomography scans four months after hospital admission. We assessed measures of severity of illness during hospitalization, as well as pulmonary function and leukocyte telomere length at followup. Results: Participants had a mean age of 54 (SD14) years;most were male (61%) and Hispanic (57%). Thirty-two (43%) required mechanical ventilation. After a median (IQR) of 4.4 (4.0-4.8) months following hospital admission, the most common ILAs were ground glass opacities, reticulations, and traction bronchiectasis, which correlated with lower diffusion capacity (ρ -0.34, - 0.64, and -0.49, respectively, all p<0.01). A total of 31 participants (41%) had no ILA, 13 (17%) had only non-fibrotic ILA, and 32 (42%) had fibrotic ILA. Fibrotic ILA was more common in mechanically ventilated patients (72%) than non-mechanically ventilated patients (20%), (p=0.001). In adjusted analyses, each 1 point increase in admission SOFA score, additional day of ventilator support, and 10% decrease in blood leukocyte telomere length were associated with fibrotic ILA [OR 1.49 (95%CI 1.17 - 1.89), 1.07 (95%CI 1.03-1.12), and 1.35 (95%CI 1.06 - 1.72), respectively].Conclusions: Radiographic evidence of lung fibrosis four months after severe COVID-19 infection is associated with initial severity of illness, duration of mechanical ventilation, and telomere length.
{"title":"Lung Fibrosis Four Months After COVID-19 Is Associated with Severity of Illness, Duration of Mechanical Ventilation and Blood Leukocyte Telomere Length","authors":"C. McGroder, D. Zhang, A. Choudhury, B. D’souza, M. Salvatore, M. Baldwin, C. Garcia","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3810","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3810","url":null,"abstract":"Rationale: Over 60 million people have had coronavirus disease 2019 (COVID-19), but consequences of severe infection are unknown. We sought to characterize interstitial lung abnormalities (ILA) after COVID-19, and to identify risk factors for the development of lung fibrosis.Methods: We performed a prospective single-center cohort study with 4-month follow-up after COVID-19 hospitalization. We sequentially enrolled 76 community-dwelling adults who were hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and required supplemental oxygen between March and May 2020. Participants had no prior history of interstitial lung disease and were discharged to acute rehabilitation or home, with sampling weighted to include half who were mechanically ventilated. We used a radiologic scoring system to quantify non-fibrotic ILA (ground glass opacities alone) and fibrotic ILA (defined as presence of reticulations, traction bronchiectasis, or honeycombing) on chest high-resolution computed tomography scans four months after hospital admission. We assessed measures of severity of illness during hospitalization, as well as pulmonary function and leukocyte telomere length at followup. Results: Participants had a mean age of 54 (SD14) years;most were male (61%) and Hispanic (57%). Thirty-two (43%) required mechanical ventilation. After a median (IQR) of 4.4 (4.0-4.8) months following hospital admission, the most common ILAs were ground glass opacities, reticulations, and traction bronchiectasis, which correlated with lower diffusion capacity (ρ -0.34, - 0.64, and -0.49, respectively, all p<0.01). A total of 31 participants (41%) had no ILA, 13 (17%) had only non-fibrotic ILA, and 32 (42%) had fibrotic ILA. Fibrotic ILA was more common in mechanically ventilated patients (72%) than non-mechanically ventilated patients (20%), (p=0.001). In adjusted analyses, each 1 point increase in admission SOFA score, additional day of ventilator support, and 10% decrease in blood leukocyte telomere length were associated with fibrotic ILA [OR 1.49 (95%CI 1.17 - 1.89), 1.07 (95%CI 1.03-1.12), and 1.35 (95%CI 1.06 - 1.72), respectively].Conclusions: Radiographic evidence of lung fibrosis four months after severe COVID-19 infection is associated with initial severity of illness, duration of mechanical ventilation, and telomere length.","PeriodicalId":23203,"journal":{"name":"TP92. TP092 CLINICAL ADVANCES IN SARS-COV-2 AND COVID-19","volume":"472 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75161413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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