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Background: There is sparse information to describe the clinical features and outcomes of patients infected with coronavirus disease 2019 (COVID-19). Methods: In a single-center retrospective observational study, 50 patients infected with COVID-19 were studied. Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Results: The mean age of the patients was 48.8 years, with male predominance. Dry cough, fever, and dyspnea were the most complaining symptoms on admission. Chronic medical illnesses before admission were present in 56% of the patients. The most common laboratory abnormalities were lymphopenia, neutrophilia, thrombocytopenia, increased aspartate aminotransferase, high serum creatinine level, elevated lactate dehydrogenase, and increasing ESR and CRP levels. Bilateral mixed ground-glass opacity and consolidation were observed in chest CT scan of most patients. Some patients required supplemental oxygen and some needed invasive mechanical ventilation. Blood oxygen saturation was different between survivors and nonsurvivors. 10% of patients died, of whom 60% were men. 40% of dead cases had chronic medical illnesses; 60% underwent invasive mechanical ventilation. Conclusion: Among the patients diagnosed with COVID-19 infection, the frequent clinical presentation was with a wide range of signs and symptoms. The laboratory changes suggest that COVID-19 infection may be related to cellular immune deficiency, myocardial, hepatic, and kidney injury. Additional research is needed to elucidate COVID-19 pathogenesis.
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Background: The clinical characteristics of COVID-19 are diverse from a simple common cold symptom to acute respiratory distress syndrome (ARDS). In the present study, we attempted to identify the associated factors in surviving COVID-19 intensive care unit (ICU) patients based on their clinical characteristics. Materials and Methods: This retrospective study was performed on 114 laboratory-confirmed COVID-19 patients admitted to the intensive care units of Hormozgan University of Medical Sciences, Iran. Demographic, medical, clinical manifestations at admission time, and outcome data were obtained from the patient's medical records. Results: Of 114 participants included in this study, 64.9% were men. Their mean age was approximately 54 years old, 69.3% of them died and 30.7% of them were discharged. The mortality rate was 2.96 times higher in people who had ARDS compared to their counterparts, 1.37 times higher in people under non-invasive ventilation, and 3.56 times higher in people under invasive mechanical ventilation.Three common underlying diseases among them were hypertension in 34.2%, diabetes in 23.7%, and cardiovascular diseases in 17.5% of them. Alive and dead patients significantly differed only in the following laboratory tests: D-dimer, urea, troponin, Procalcitonin, and ferritin. Conclusion: The mortality rate among COVID-19 patients admitted to ICU is generally high. Dyspnea, as the initial presentation and comorbidity, especially hypertension, diabetes, and cardiovascular diseases, may be associated with a higher risk of developing severe disease and consequent mortality. Therefore, D-dimer, urea, troponin, Procalcitonin, and ferritin at the time of hospital admission could predict the severity of the disease and its probable mortality.
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The new pandemic Coronavirus Disease 2019 (COVID-19) causes a wide range of clinical consequences, from asymptomatic infection to acute respiratory failure, and it is very heterogeneous. The renin-angiotensin system (RAS) is well recognized as a key regulating system in circulatory homeostasis that plays prominent roles in pathophysiological processes in abnormal activation, for instance, renal and cardiovascular diseases, obesity, and stroke. Angiotensin-converting enzyme 2(ACE2) is a component of the RAS system. However, unlike the ACE, its activity is not inhibited by the ACE inhibitors. The major product of ACE2 is Ang1-7, known as a vasodilator peptide and part of the depressant arm of the RAS. There are two forms of ACE2; Transmembrane ACE2 and soluble ACE2. Coronavirus is covered with some proteins in order to help viral attachment to the cell membrane ACE2 as a receptor and then fuse and enter the cells. ACE2 was expressed in the oral cavity, salivary glands of the mouth, esophagus, myocardial cells, kidney, and enterocytes, along with all the respiratory tract, intestine, and blood vessels. In this article, the renin- angiotensin system and its components have been explained. Moreover, the organs involved in COVID-19 disease, and the possible causes of damage to these organs have also been discussed. The probable mechanism of using ACE2 in viral attachment and the probable treatment processes will also be reviewed based on the surface proteins of the virus and ACE2. In addition, we briefly discuss anti-angiotensin drugs and why patients with chronic diseases are more susceptible to COVID-19 infection and show worse progression.