Assessing Humoral Immuno-Inflammatory Pathways Associated with Respiratory Failure in COVID-19 Patients.

All severe cases of SARS-CoV-2 infections are characterized by a high risk of disease progression towards ARDS, leading to a bad outcome. Respiratory symptoms in COVID-19 patients often do not correspond to disease's worsening. In our sample, median age was 74 years (72-75) and 54% were men. The median period of hospitalization was 9 days. Firstly, we observed a significant asynchronous trend of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in 764 selected among 963 patients, who were consecutively recruited in two hospitals (Cannizzaro, S. Marco) in Catania, Italy. NLR values in deceased patients showed an increase from baseline over time. By contrast, CRP tended to fall from baseline to median day of hospitalization in all three subgroups, but steeply increased at the end of hospitalization only in ICU-admitted patients. Then, we evaluated the relationships between NLR and CRP as continuous variables with PaO2/FiO2 ratio (P/F). NLR was an independent predictor of mortality (HR: 1.77, p < 0.0001), while ICU admission was more significantly associated with CRP (HR: 1.70, p < 0.0001). Finally, age, neutrophils, CRP, and lymphocytes are significantly and directly linked to P/F, while the influence of inflammation on P/F, reflected by CRP, was also mediated by neutrophils.

Sclerosing cholangitis may mimic radiological pattern of cholangiocarcinoma: Differential diagnosis and review of literature.

IgG4 related sclerosing cholangitis (IgG4-SC) is a chronic cholestatic autoimmune liver disease, characterized by obstruction of the biliary tract due to IgG4-positive plasma cell infiltrations associated with fibrosis, phlebitis and presence of eosinophils. The diagnosis of the disease is supported by elevation in serum IgG4, radiological imaging and histology. In most of the cases IgG4-SC is associated with a wide spectrum of symptoms and manifestations summarized by the definition of IgG4-related disease (IgG4-RD). When the IgG4-SC causes an interruption of the biliary tract, differential diagnosis with cholangiocarcinoma may become challenging, due to the anatomical difficulty to get an appropriate histological pattern of the disease. Here we are describing a case of a male patient admitted to our hospital for jaundice. The stenosis of biliary ducts shown by radiologic imaging suggested Cholangiocarcinoma but, in the patient, IgG4-SC was definitely diagnosed.