1,721,327 research outputs found
Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis
No full textBACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel infectious disease with lack of established laboratory markers available to evaluate illness severity. In this study, we investigate whether platelet count could differentiate between COVID-19 patients with or without severe disease. Additionally, we evaluate if thrombocytopenia is associated with severe COVID-19. METHODS: An electronic search in Medline, Scopus and Web of Science was performed to identify studies reporting data on platelet count in COVID-19 patients. A meta-analysis was performed, with calculation of weighted mean difference (WMD) of platelet number in COVID-19 patients with or without severe disease and odds ratio (OR) of thrombocytopenia for severe form of COVID-19. RESULTS: Nine studies with 1779 COVID-19 patients, 399 (22.4%) with severe disease, were included in the meta-analysis. The pooled analysis revealed that platelet count was significantly lower in patients with more severe COVID-19 (WMD -31×109/L; 95% CI, from -35 to -29×109/L). A subgroup analysis comparing patients by survival, found an even lower platelet count was observed with mortality (WMD, -48×109/L; 95% CI, -57 to -39×109/L. In the four studies (n=1427) which reported data on rate of thrombocytopenia, a low platelet count was associated with over fivefold enhanced risk of severe COVID-19 (OR, 5.1; 95% CI, 1.8-14.6). CONCLUSIONS: Low platelet count is associated with increased risk of severe disease and mortality in patients with COVID-19, and thus should serve as clinical indicator of worsening illness during hospitalization
Pooled analysis of mid-regional pro-adrenomedullin values in COVID-19 patients with critical illness
No full textWe performed a critical literature review and meta-analysis to explore as to whether MR-proADM assessment may help predicting unfavorable disease progression in COVID-9 patients. The electronic search carried out in accordance the above-mentioned criteria identified 34 documents after elimination of duplicates. Among these, 28 were excluded as they were review articles (n = 13), editorial material (n = 1) or correspondence without original data (n = 2), did not specifically deal with COVID-19 (n = 6), did not provide MR-proADM values (n = 2), lack of complete information on MR-proADM values (n = 1), or MR-proADM values were not stratified according to COVID-19 severity (n = 3). No significant disagreement emerged between the two reviewers. Six studies were thus finally included in pooled analysis, totaling 487 COVID-19 patients, 159 (32.6%) with critical illness. All included studies were cross sectional investigations, three conducted in Italy, while the others were located in Germany, Russia and Switzerland. The clinical endpoints used for characterizing critical illness of COVID-19 were cumulative mortality in two studies, as opposed to intensive care unit (ICU) admission or death, need for renal replacement therapy (RRT), death or intubation, and acute respiratory distress syndrome (ARDS) in the remaining investigations. A positive difference of MR-proADM values was found between patients with or without critical COVID-19 in each individual study. The WMD of MR-proADM values in COVID-19 patients with critical illness versus those without was 0.67 (95% CI 0.42–0.93) nmol/L in the quality effects model (with high heterogeneity, I2 = 81%), further increasing to 0.80 (95% CI 0.58–1.02) nmol/L in the random effects model. Overall, MR-proADM values were found to be increased by 74% (95% CI 46–103%) in COVID-19 patients with critical illness compared to those without
Eosinophil count in severe coronavirus disease 2019 (COVID-19)
No full textThe results of the pooled analysis attest that the eosinophil count was not found to be significantly different between patients with or without severe COVID-19 (WMD, -0.01×109 ; 95% CI, -0.07 to 0.04×109; I2, 0%; p=0.99). Despite the still limited volume of data on eosinophil count in patients with COVID-19, the results of our systematic literature review and pooled analysis suggest that eosinopenia may not be associated with unfavorable progression of COVID-19
Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)
No full textActive smoking is not associated with severity of coronavirus disease 2019 (COVID-19
Neutrophil-to-lymphocyte ratio in acute coronary syndromes: Do we (really) need another hero?
No full textThe NLR ratio is a low-cost test (an easy calculation that can be performed manually or even automatically set within the laboratory information system), that is available in almost all clinical facilities with a basic hematological analyzer. This parameter has proven useful in a wide range of human pathologies, including acute coronary syndrome and COVID-19. On this premise, a further step must be taken to provide some reliable answers to 3 basic questions: “why does the NLR ratio increase in patients with cardiovascular disease?” and “is this parameter sufficiently standardized?” and, finally, “how should we use this information in the managed care of our patients?”. In summary, the NLR ratio seems a cost-effective parameter for diagnosis and prognosis of myocardial ischemia, but several other aspects still need to be clarified before it becomes suitable for routine clinical use
COVID-19 diagnostics and early phase clinical trials: challenges and risk mitigation in the Omicron variants era
No full textThe evolution of the coronavirus disease 2019 (COVID-19) pandemic and widespread community of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants continues to present new challenges for early phase clinical trials and COVID-19 diagnostic strategies. Many regulatory agencies, including the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) continue to provide updated guidance on the operations of clinical trials during the pandemic. However, guidance is limited with respect to medical and scientific specific issues, such as COVID-19 diagnostics. Here we discuss, the challenges for early phase studies associated with COVID-19 diagnostics in the Omicron era and potential risk mitigation strategies in the face of continued widespread community transmission. We note how careful consideration and planning can help mitigating the risk of COVID-19 impacting the medical and scientific validity and patient safety in clinical trials. Clinical study design should consider mitigation strategies at the patient, investigator, and clinical research organization (CRO)/Sponsor level following evaluation of the overall for their specific study/investigational product and patient overall wellbeing. Specific language regarding COVID-19-related policies and procedures should be included in the study protocol. Special considerations should be taken for novel immunotherapeutics which may require interruption in the event of a subject developing COVID-19 or for investigative products that may have hazardous interactions with commonly prescribed anti-COVID-19 therapies. Moving forward, its essential for trials to remain adaptable to evolving nature of the pandemic
The landscape of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic mutations
No full textBackground: This article is aimed to provide an updated landscape of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic mutations emerged since its first identification and sequencing. Methods: We downloaded and analyzed all mutations within the SARS-CoV-2 RNA genome submitted up to February 8, 2022 to the website of the National Center for Biotechnology Information (NCBI), which contains all variants in Sequence Read Archive (SRA) records compared to the prototype SARS-CoV-2 reference sequence NC_045512.2. Results: Our search identified 26,005 different mutations. The largest number of mutations was located within the gene encoding for the Nsp3 protein (20.7%), followed by the gene encoding for the spike protein (14.6%). Overall, 17,948/26,005 (69.0%) of these mutations interested single nucleotide positions, thus spanning over ~62% of the entire SARS-CoV-2 genome. Of all mutations, 61.5% were non-synonymous, whilst 17.4% of those in the gene encoding for the spike protein involved the sequence of the receptor binding domain, 59.2% of which were non-synonymous. When the number of mutations was expressed as ratio to the gene size, the highest ratio was found in the sequence encoding for ORF7a (ratio, 2.25), followed by ORF7b (ratio, 1.85), ORF8 (ratio, 1.60) and ORF3a (ratio, 1.48). The gene encoding for RNA-dependent RNA polymerase accounted for only 0.1% of all mutations, with considerably low ratio with the gene size (i.e., ratio, 0.01). Conclusions: The results of our analysis demonstrate that SARS-CoV-2 has enormously mutated since its first sequence has been identified over 2 years ago
Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports
No full textThe results of this analysis using currently available literature would suggest that ECMO does not seemingly produce neither harm or benefit in COVID-19 patients progressing to ARDS
How will emerging SARS-CoV-2 variants impact herd immunity?
No full textA considerable number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are now circulating all around the world, some of which can be considered “of concern” because their infectivity and/or pathogenicity and/or capacity to escape immune system recognition are significantly higher than the original “wild-type” strain, thus consequently boosting virus spread within the population, enhancing the risk of developing more severe illness, and/or even causing epidemic rebounds. These emerging variants especially include B.1.1.7, originally identified in the UK and characterized by 56% increased transmission potential, along with B.1.351, initially detected in South Africa and displaying 50% enhanced transmissibility and decreased recognition by host immune system, and P.1, emerged in Brazil and displaying characteristics similar to the B.1.351 strain. We aim to discuss here the impact of these emerging SARS-CoV-2 variants on herd immunity, whereby higher herd immunity threshold would be needed for arresting their circulation, whilst this in turn could be more difficult to achieve due to their stronger “resistance” to the current generation of vaccines
Chronic obstructive pulmonary disease is associated with severe coronavirus disease 2019 (COVID-19)
No full textChronic Obstructive Pulmonary Disease Is Associated With Severe Coronavirus Disease 2019 (COVID-19
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