Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection.

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Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: Case series.

Severe SARS-CoV-2 (COVID-19) infection has the potential for a high mortality rate. In this paper, we report the results of plasmapheresis treatment in a series of severely ill patients with COVID-19-related autoimmune meningoencephalitis in the Intensive Care Unit (ICU).

The usage of immunosuppressant agents and secondary infections in patients with COVID-19 in the intensive care unit: a retrospective study.

Although COVID-19 infection is an immunosuppressant disease, many immunosuppressant agents, such as pulse methylprednisolone (PMP), dexamethasone (DXM), and tocilizumab (TCZ), were used during the pandemic. Secondary infections in patients with COVID-19 have been reported recently. This study investigated these agents' effects on secondary infections and outcomes in patients with COVID-19 in intensive care units (ICUs). This study was designed retrospectively, and all data were collected from the tertiary intensive care units of six hospitals between March 2020 and October 2021. All patients were divided into three groups: Group I [GI, PMP (-), DXM (-) and TCZ (-)], Group II [GII, PMP (+), DXM (+)], and Group III [GIII, PMP (+), DXM (+), TCZ (+)]. Demographic data, PaO/FiO2 ratio, laboratory parameters, culture results, and outcomes were recorded. To compare GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters. Four hundred twelve patients with COVID-19 in the ICU were included in the study. The number of patients with microorganisms ≥ 2 was 279 (67.7%). After PSM, in GII and GIII, the number of (+) tracheal cultures and (+) bloodstream cultures detected different microorganisms ≥ 2 during the ICU period, neuropathy, tracheotomized patients, duration of IMV, and length of ICU stay were significantly higher than GI. The mortality rate was similar in GI and GII, whereas it was significantly higher in GIII than in GI. The use of immunosuppressant agents in COVID-19 patients may lead to an increase in secondary infections. In addition, increased secondary infections may lead to prolonged ICU stay, prolonged IMV duration, and increased mortality.

Sepsis biomarkers for early diagnosis of bacteremia in emergency department.

INTRODUCTION: We compared the diagnostic values of individual and composite biomarkers used in the prediction of bacteremia in adult emergency department patients. METHODOLOGY: First-hour blood levels of C- reactive protein, procalcitonin, interleukin-6, lactate, lipopolysaccharide-binding protein and white blood cell count were collected from a 30-person control group and 47 adult patients. Patients included in this study were admitted to the emergency department on suspicion of sepsis. We categorized patients according to presence/absence of sepsis and bacteremia. Our control group was categorized as S-B -, septic patients with bacteremia were S+B+, and septic patients without bacteremia were S+B-. RESULTS: All biomarkers showed a statistically significant elevation when S+B- and S+B+ groups were compared with the S-B-. When S+B+ group was compared with the S+B- group only procalcitonin and lactate levels had statistically significant elevation (p < 0.005). Regression analysis demonstrated that lactate and procalcitonin were independently associated with having bacteremia in the state of sepsis and Hosmer-Lemeshow score was 0.772. The areas under the curve (AUC) values of biomarkers procalcitonin, lactate, C-reactive protein, combined 1 (procalcitonin+ lactate), and combined 2 (procalcitonin + lactate + C-reactive protein) were 0.773, 0.744, 0.523, 0.806, and 0.829 respectively. CONCLUSIONS: Combination of tests such as combined 1 or combined 2 were highly predictive of bacteremia in adult septic patients. Combined 2 demonstrated the best predictive performance and could be utilized as a tool to assist diagnosis of bacteremia before culture results are available.

Is SARS-CoV-2 viral load a predictor of mortality in COVID-19 acute respiratory distress syndrome patients?

OBJECTIVE: Viral load varies during infection and is higher during the initial stages of disease. Given the importance of the intensive care unit (ICU) in the late stages of COVID-19 infection, analyzing cycle threshold values to detect viral load upon ICU admission can be a clinically valuable tool for identifying patients with the highest mortality risk. METHODS: This was a retrospectively designed study. Patients older than 18 years who tested positive for SARS-CoV-2 PCR and had a PaO2/FiO2 ratio <200 were included in the study. The patient population was divided into two groups: survivors and non-survivors. RESULTS: Two hundred patients were included in the study. In non-survivors, age, relevant ICU admission scores, and procalcitonin levels were significantly higher whereas PaO2/FiO2 ratios and cycle threshold levels were significantly lower than in survivors. CONCLUSION: Viral load at ICU admission has significant prognostic value. In combination with age, comorbidities, and severity scores, viral load may assist clinicians in identifying individuals who need more intensive monitoring. Increased awareness may improve outcomes by allowing the more effective monitoring and treatment of patients. More prospective studies are needed to determine how a high viral load worsens disease and how to avoid irreversible results.

Mesenchymal stem cell treatment in a critically ill COVID-19 patient: a case report.

An outbreak of a new coronavirus causing severe respiratory disease (COVID-19) was first reported in China and rapidly spread worldwide. Clinical spectrum changes from asymptomatic infection to severe illness and even death, and no specific treatment is currently available. A range of antiviral, antimalarial and antibiotic agents are being used. We report a case of a COVID-19 patient that progressed to severe disease requiring intubation and intensive care. We performed mesenchymal stem cell (MSC) transplantation considering the signs showing persistent excessive immune response and deterioration despite all supportive and drug therapies. The two rounds of transplantation did not result in any severe complications and was well-tolerated. Clinical signs were improved. The use of MSC therapy may be considered for compassionate use in selected patients.