Disfunção neurológica associada à COVID-19 / Neurological dysfunction associated with covid-19

RESUMO A COVID-19 foi declarada pandemia pela Organização Mundial de Saúde no dia 11 de março de 2020. O quadro clínico apresenta predominantemente sintomatologia respiratória, no entanto, na literatura atual, têm sido descritas diversas manifestações neurológicas associadas à infeção por SARS-CoV-2. Os autores apresentam o caso clínico de um homem de 45 anos internado por pneumonia com resultado positivo para SARS-CoV-2, sem antecedentes neurológicos, que, ao décimo sexto dia de internamento, apresentou alteração súbita do estado de consciência acompanhada de desvio conjugado do olhar para a direita e mioclonias da face e da região torácica à esquerda, seguidas de crise convulsiva tônico-clônica generalizada, associadas à hemiparesia esquerda persistente. Do estudo realizado salienta-se a existência de RT-PCR para SARS-CoV-2 no líquido cefalorraquidiano positiva. O doente apresentou evolução clínica com melhoria gradual, tendo o desfecho sido favorável.

ABSTRACT COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020. The clinical presentation is predominantly respiratory symptoms; however, in the current literature, several neurological manifestations associated with SARS-CoV-2 infection have been described. The authors present the clinical case of a 45-year-old man hospitalized for pneumonia with a positive test result for SARS-CoV-2, without a neurological history, who, on the sixteenth day of hospitalization, presented a sudden change in his state of consciousness accompanied by conjugated right gaze deviation and myoclonus of the face and thoracic region to the left, followed by generalized tonic-clonic seizures associated with persistent left hemiparesis. The present study highlights a positive RT-PCR test for SARS-CoV-2 in cerebrospinal fluid. The patient progressed with gradual improvement, and the outcome was favorable.

Development of simple and sensitive score to assess the risk of pneumonia in Covid-19 patients

ABSTRACT Background: Severe pneumonia is the most common cause of intensive care unit (ICU) admission and death due to novel coronavirus (SARS-CoV-2) respiratory disease (COVID-19). Due to its rapid outbreak, units for the evaluation of febrile patients in the pre-hospital setting were created. Objective: The objective of the study was to develop a sensitive and simple tool to assess the risk of pneumonia in COVID-19 patients and thus select which patients would require a chest imaging study. Materials and Methods: We conducted a cross-sectional study in a cohort of individuals with suspected COVID-19 evaluated in a public academic healthcare center in Buenos Aires city. All adult patients with positive RT-PCR assay for SARS-COV2 between April 24 and May 19 of 2020 were included in the study. Pneumonia was defined as the presence of compatible signs and symptoms with imaging confirmation. Univariate and multivariate logistic regression was performed. A risk indicator score was developed. Results: One hundred and forty-eight patients were included, 71 (48%) received the diagnosis of pneumonia. The final clinical model included four variables: age ≥ 40 years, cough, absence of sore throat, and respiratory rate ≥ 22. To create the score, we assigned values to the variables according to their ORs: 2 points for respiratory rate ≥ 22 and 1 point to the other variables. The AUC of the ROC curve was 0.80 (CI 95% 0.73-0.86). A cutoff value of 2 showed a sensitivity of 95.7% and a specificity of 43.24%. Conclusion: This sensible score may improve the risk stratification of COVID-19 patients in the pre-hospital setting. (REV INVEST CLIN. 2021;73(1):52-8)

Manual de laboratorio para el diagnóstico por PCR en tiempo real en laboratorios descentralizados y vigilancia genómica de SARS-CoV-2 / Laboratory manual for real-time PCR diagnosis in decentralized laboratories and genomic surveillance of SARS-CoV-2

En los antecedentes, brinda detalles técnicos de enfermedades previas al COVID-19 y sigue esta consigna internacional: "Sin embargo, a la luz de la posible introducción de un caso sospechoso relacionado con el 2019-nCoV en la Región de las Américas, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS / OMS) recomienda a los Estados Miembros garantizar su identificación oportuna, el envío de las muestras a laboratorios Nacionales o de referencia y la implementación del protocolo de detección molecular para 2019-nCoV, según la capacidad del laboratorio." Aborda las tres mutaciones del virus conocidas hasta la fecha del documento y las tres variantes conocidas: Reino Unido e Irlanda del Norte, República de Sudáfrica y Brasil, siendo la de mayor transmisibilidad, según el documento, la del Reino Unido. El primero de los objetivos del documento es: "Brindar los lineamientos generales para la toma de muestra, conservación, transporte y diagnóstico del SARS-Cov-2 en los laboratorios descentralizados bajo la técnica de Reacción en Cadena de la Polimerasa (PCR) en tiempo Real, en atención a pacientes que cumplen con la definición de caso y se tipifica como "sospechoso inusitado"." Incluye como anexo 2 el documento: "Lineamientos para el abordaje de casos positivos para SARS-COV-2 de viajeros que ingresan al país por el aeropuerto internacional "La Aurora" (AILA)"

Clinical and laboratory characteristics of sars-cov-2 infection in children and adolescents / Características clínicas e laboratoriais da infecção por sars-cov-2 em crianças e adolescentes

ABSTRACT Objective: To present the current evidence on clinical and laboratory characteristics of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during childhood and adolescence. Data source: This is a narrative review conducted in the databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature in the Virtual Health Library (LILACS/VHL), Scopus, Web of Science, Cochrane Library, portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used were SARS-CoV-2, COVID-19, novel coronavirus, child, newborn, and adolescent. Data synthesis: Unlike adults, most children infected by SARS-CoV-2 have mild or asymptomatic clinical presentations. Symptomatic children mainly have low fever and cough, with some associated gastrointestinal symptoms. Severe cases are rare and occur especially in infants under one year of age. Detection of viral particles in feces seems to be more persistent in children and can be used as a tool for diagnosis and control of the quarantine period. Different from adults, children can present distinct inflammatory responses, as has happened in new cases of Kawasaki-like syndrome associated with SARS-CoV-2 infection. Conclusions: Most children have asymptomatic or mild presentations, with a prevalence of fever, cough, and gastrointestinal symptoms. New cases with different systemic inflammatory reactions in children have been reported, with clinical manifestations distinct from those typically found in adults.

RESUMO Objetivo: Apresentar as atuais evidências sobre as características clínicas e laboratoriais da infecção pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) durante a infância e a adolescência. Fonte de dados: Revisão narrativa realizada nas bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde na Biblioteca Virtual em Saúde (LILACS/BVS), Scopus, Web of Science, Cochrane Library, portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect e Cumulative Index to Nursing and Allied Health Literature (CINAHL), com o uso dos termos SARS-CoV-2, COVID-19 e novo coronavírus e criança, recém-nascido e adolescente. Síntese dos dados: Diferentemente dos adultos, as crianças infectadas pelo SARS-CoV-2 apresentam formas clínicas leves ou assintomáticas na maior parte dos casos. As crianças sintomáticas apresentam predominantemente febre baixa e tosse, com alguns sintomas gastrointestinais associados. Casos graves são a minoria e ocorrem especialmente abaixo de um ano de idade. A detecção de partículas virais em fezes parece ser mais persistente em crianças, podendo servir como ferramenta diagnóstica e de controle do tempo de quarentena. Diferentemente dos adultos, as crianças podem apresentar respostas inflamatórias distintas, como tem ocorrido nos novos casos de síndrome de Kawasaki-like associada à infecção pelo SARS-CoV-2. Conclusões: Crianças, na sua maioria, apresentam quadros assintomáticos ou leves, com predomínio de febre, tosse e sintomas gastrointestinais. Novos relatos de diferentes reações sistêmicas inflamatórias em crianças têm sido notados, com manifestações clínicas distintas daquelas tipicamente observadas em adultos.

Resultados perinatales y serológicos en neonatos de gestantes seropositivas para SARS-CoV-2: estudio transversal descriptivo / Perinatal outcomes and serological results in neonates of pregnant women seropositive to SARS-CoV-2: a cross-sectional descriptive study

INTRODUCCIÓN: El SARS-CoV-2 tiene una rápida expansión por todo el mundo, sin embargo, su capacidad para causar enfermedad grave no es homogénea según sexo y edad. OBJETIVO: Determinar las características perinatales, morbilidad, mortalidad y resultados serológicos en neonatos de gestantes seropositivas para SARS-CoV-2. MÉTODOS: Estudio transversal, descriptivo y retrospectivo. Participaron todos los neonatos cuyas madres presentaron resultado seropositivo para SARS-CoV-2 antes del parto, entre el 15 de abril y 10 de mayo de 2020 en el Instituto Nacional Materno Perinatal de Perú. Se recogió información materna y neonatal a partir de sus historias clínicas. En el análisis se usó estadística descriptiva y prueba exacta de Fisher. RESULTADOS: Se identificaron 114 neonatos, el 36,8% presentó inmunoglobulinas M y G positivas para SARS-CoV-2; el 7% inmunoglobulinas G y 56,2% fue no reactivo. Las complicaciones obstétricas más frecuentes fueron rotura prematura de membranas (14,9%) y parto pretérmino (8,8%). El 8,8% de los neonatos presentaron un puntaje Apgar al minuto menor o igual a seis, y de ellos solo uno persistió a los cinco minutos; tres neonatos fallecieron. Se evidenció asociación entre el tipo de inmunoglobulina materna y la serología de su recién nacido (p < 0,05). No se observó asociación entre resultados perinatales y el tipo de inmunoglobulinas materna (p > 0,05), ni con los resultados serológicos en el neonato para SARS-CoV-2 (p > 0,05). CONCLUSIÓN: El 43,9% de neonatos de madre seropositiva a SARS-CoV-2 tuvo un resultado serológico positivo, siendo más frecuente de tipo Inmunoglobulinas M e Inmunoglobulinas G. El 10,5% de los neonatos presentó alguna morbilidad, siendo más frecuente prematuridad y bajo peso al nacer y el 2,6% falleció. Los resultados perinatales no estuvieron asociadas al tipo de inmunoglobulina de las madres seropositivas a SARS-CoV-2. De igual modo, los resultados perinatales no estuvieron asociados a los resultados serológicos en el neonato.

INTRODUCTION: SARS-CoV-2 has spread rapidly throughout the world. However, its ability to cause severe disease is not homogeneous according to sex and the different age groups. OBJECTIVE: To determine perinatal characteristics, morbidity, mortality, and serological results in neonates from seropositive pregnant women to SARS-CoV-2. METHODS: We did a retrospective, descriptive, cross-sectional study. We included all newborns from positive pregnant women to SARS-CoV-2, between April 15 and May 10, 2020, who delivered in the National Perinatal Maternal Institute of Peru. The study extracted maternal and neonatal variables collected from the medical charts. The data were analyzed using descriptive statistics and Fischer's exact test. RESULTS: One hundred fourteen neonates were identified, 36.8% IgM/IgG positive for SARS-CoV-2, 7% IgG, and 56.2% had negative serology. The obstetric complications were premature rupture of membranes (14.9%) and preterm birth (8,8%). 8.8% of newborns had an Apgar score of less than or equal to six minutes, and of those, only one persisted after five minutes; three newborns died. There was an association between the type of maternal immunoglobulin and the serology of the newborn (p < 0.05). No association was observed between perinatal results and maternal immunoglobulin type (p > 0.05) or serological results in the newborn for SARS-CoV-2 (p > 0.05). CONCLUSION: 43.9% of seropositive mothers' neonates to SARS-CoV-2 had a positive serological result, more frequently type IgM/IgG. 10.5% of the neonates had some morbidity, more frequent prematurity, low birth weight, and 2.6% died. Perinatal results were not associated with the type of immunoglobulin of mothers seropositive to SARS-CoV-2; similarly, perinatal results were not associated with serological results in the newborn.

Nuevo diagnóstico COVID-19: pruebas para la detección de antígenos / New COVID-19 diagnosis: tests for the detection of antigens

Las pruebas de antígenos, que examinan si una persona está infectada en este momento, utilizan normalmente muestras obtenidas con hisopos nasofaríngeos, en las que luego se analiza la presencia de proteínas del virus (antígenos). Se obtienen los resultados en un plazo de 15 a 30 minutos.

Coronavirus 2019, thrombocytopenia and HELLP syndrome: association or coincidence? / Coronavírus 2019, trombocitopenia e síndrome HELLP: Associação ou coincidência?

Abstract The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O2 saturation. Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.

Resumo O presente relato descreve o caso de uma gestante de 31 anos, gemelar dicoriônica com 31 semanas, com queixa de mialgia, icterícia e desconforto abdominal. A paciente não apresentava sintomas gripais como febre ou tosse e não tinha conhecimento de exposição ao COVID-19. Pressão arterial e saturação de oxigênio normais. Os exames laboratoriais apresentaram contagem de plaquetas de 218,000 mm3, ALT 558 IU e creatinina 2.3 mg/dl. Doppler compatível com centralização de um dos fetos. Síndrome de hemolysis, elevated liver enzymes, low platelet count (HELLP) parcial foi a hipótese diagnóstica inicial e a cesariana foi realizada. No segundo dia, a paciente apresentou leucócitos de 33.730 com queda do nível de consciência e desconforto respiratório leve. A tomografia revelou opacidade pulmonar em vidro fosco bilateralmente. A pesquisa de COVID-19 por polymerase chain reaction (PCR)/swab teve resultado positivo. Trombocitopenia em pacientes com COVID-19 é multifatorial, semelhante ao que ocorre na pré-eclâmpsia e na síndrome HELLP. Acreditamos que o sinergismo da fisiopatologia das doenças em questão pode acelerar o comprometimento materno e deve servir de alerta para a prática obstétrica.

Implementación de la prueba rápida de detección de antígenos para COVID-19: estudio piloto / Implementation of the rapid antigen detection test for COVID-19: pilot study

Este documento brinda consideraciones prácticas para la implementación de la prueba rápida de detección de antígenos (Ag-RDT) para COVID-19 en la Región de las Américas. Se han publicado consideraciones generales para el uso de las Ag-RDT en el diagnóstico de la infección por SARS-CoV-2 (1, 2), y varios ensayos se han evaluado de forma independiente y / o se han incluido en el Listado de Uso de Emergencia de la OMS. La evidencia científica y técnica sobre la detección de la infección por SARS-CoV-2 está evolucionando con rapidez; este documento se actualizará según sea necesario.

Orientaciones provisionales para la detección de casos de infección por SARS-CoV-2 / Interim Guidance for Detecting Cases of SARS-CoV-2 Infection

A través de este documento, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) alienta a los Estados Miembros a recopilar evidencia sobre los casos de reinfección por el SARS-CoV-2, con el fin de contribuir a ampliar el conocimiento de la COVID-19 y en consecuencia con su prevención, control y manejo clínico.

Sistematización de la respuesta de la Representación en la República Dominicana a la emergencia por la COVID-19 en el período de enero a septiembre de 2020 / Systematization of the response of the Representation in the Dominican Republic to the emergency due to COVID-19 in the period from January to September 2020

La Representación en la República Dominicana trabajó en coordinación con las autoridades nacionales desde la emisión de la alerta de emergencia sanitaria internacional emitida por la OMS el 30 de enero, colaborando en las acciones de preparación ante lo que en ese momento era una eventual epidemia. Para el 1 de marzo de 2020, el país reportó el primer caso de COVID-19, convirtiéndose en el cuarto país de América Latina en confirmar un caso en su territorio. Diez días después, el 11 de marzo, la OMS caracteriza la COVID-19 como una pandemia debido al incremento de casos confirmados y fallecidos en más de 100 países. En este contexto, los esfuerzos de cooperación técnica se concentraron en la elaboración del Plan de Contingencia ante Enfermedad por Coronavirus (COVID-19), el cual tuvo como referencia las líneas de acción planteadas en el Plan estratégico de preparación y respuesta para la enfermedad por coronavirus 2019 (COVID-19).

Clinical risk profile associated with SARS-CoV-2 infection and complications in the emergency area of a pediatric COVID-19 center / Perfil clínico de riesgo asociado a infección y complicaciones por SARS-CoV-2 en el área de urgencias de un centro pediátrico COVID-19

Abstract Background: In February 2020, the disease caused by the novel coronavirus (SARS-CoV-2), was classified as a pandemic. In the pediatric population, coronavirus disease (COVID)-19 has a reported mortality of less than 6% in complicated cases; however, the clinical characteristics and severity are not the same as those presented in the adult population. This study aimed to describe the clinical manifestations of patients younger than 18 years old and their association with the confirmation of the test and outcomes. Methods: We conducted an analytical cross-sectional study of symptoms suggestive for SARS-CoV-2 infection. All subjects with a confirmatory test for SARS-CoV-2 were included. Initial symptoms, history of influenza vaccination, and previous contact were documented, and mortality and the requirement for assisted mechanical ventilation were identified. The proportions of the variables were compared with the χ2 test. The odds ratio for a positive test and the requirement of intubation was calculated. Results: Of a total of 510 subjects, 76 (15%) were positive for SARS-CoV-2. The associated symptoms were chest pain, sudden onset of symptoms, and general malaise. The variable most associated with contagion was the exposure to a relative with a confirmed diagnosis of COVID-19. Infants and subjects without the influenza vaccine showed an increased risk for respiratory complications. Conclusions: The frequency of positivity in the test was 15% (infants and adolescents represented 64% of the confirmed cases), and the associated factors identified were contact with a confirmed case, sudden onset of symptoms, and chest pain.

Resumen Introducción: En 2019 se reportaron los primeros casos de SARS-CoV-2 (coronavirus tipo 2 del síndrome respiratorio agudo grave), causante de la COVID-19, que alcanzó el grado de pandemia en febrero de 2020. La presentación en la etapa pediátrica reporta una mortalidad menor del 6% en los casos complicados; sin embargo, las características clínicas y su gravedad no son iguales que en la población adulta. El objetivo de este estudio fue describir las manifestaciones clínicas de los pacientes menores de 18 años y su asociación con la confirmación de la prueba, la intubación endotraqueal y la muerte. Métodos: Estudio transversal analítico por cuadro sugestivo de infección por SARS-CoV-2. Se incluyeron sujetos positivos para SARS-CoV-2. Se documentaron los síntomas iniciales, los antecedentes de vacunación contra la influenza y los contactos previos, y se identificaron los desenlaces de mortalidad y requerimiento de ventilación mecánica asistida. Se compararon las proporciones de las variables con la prueba χ2 y se calculó la razón de momios para la presencia de una prueba positiva y requerir intubación. Resultados: De un total de 510 sujetos, 76 (15%) fueron positivos para SARS-CoV-2. Los síntomas asociados fueron dolor precordial, inicio súbito y malestar general. La variable asociada con mayor frecuencia el contagio fue la exposición a un familiar con COVID-19 confirmada. Los sujetos sin vacuna de la influenza presentaron un riesgo mayor de complicaciones respiratorias. Conclusiones: La frecuencia de positividad en la prueba fue del 15%. Se identificaron como factores asociados a prueba positiva el contacto con un caso confirmado de COVID-19, el inicio súbito de los síntomas y el dolor precordial.

Saliva as a promising biofluid for SARS-CoV-2 detection during the early stages of infection / La saliva como biofluido promisorio para la detección del SARS-CoV-2 durante las primeras etapas de la infección

Abstract Background: Diagnostic testing for coronavirus disease (COVID)-19 is performed using nasopharyngeal swabs. This type of sampling is uncomfortable for the patient, dangerous for health workers, and its high demand has led to a global shortage of swabs. One of the alternative specimens is saliva. However, the optimal conditions for the test have not been established. Methods: Reverse transcription-polymerase chain reaction was used to detect the viral genome in saliva samples kept at room temperature, in the fridge or frozen for 2 days. In addition, the influence of brushing teeth and feeding on the detection of the virus in saliva was addressed. Finally, the efficiency of saliva in revealing the presence of the virus during the hospitalization period was determined in children. Results: The viral genome was consistently detected regardless of the storage conditions of saliva samples. Brushing teeth and feeding did not influence the sensitivity of the test. In hospitalized children, positive results were obtained only during the early days. Conclusions: These results support the idea of the use of saliva as an alternative specimen for diagnostic testing for COVID-19. The viral genome is stable and endures perturbations in the oral cavity. However, clearance of the virus from the mouth during the infection may limit the use of the test only to the early stages of the disease.

Resumen Introducción: El diagnóstico de COVID-19 (enfermedad por coronavirus 2019) se realiza con un hisopado nasofaríngeo. El procedimiento de toma de muestra es molesto para el paciente y peligroso para el personal de salud, y la alta demanda de análisis ha conducido a la escasez de hisopos. Una alternativa es el uso de saliva, pero las condiciones óptimas para realizar el estudio no han sido establecidas. Métodos: Se usó la reacción en cadena de la polimerasa con transcriptasa reversa para detectar el genoma viral en muestras de saliva mantenidas a temperatura ambiente, en refrigeración o congeladas. Además, se evaluó la influencia del aseo bucal y de la ingesta de alimento en la detección del virus. Finalmente, se determinó el desempeño de la saliva para reportar la presencia del virus durante el periodo de hospitalización en niños. Resultados: El genoma viral fue estable durante 2 días a las diferentes temperaturas ensayadas. El aseo bucal y la ingesta de alimento no influyeron en la detección del virus. En los niños hospitalizados solo se obtuvieron resultados positivos durante los primeros días. Conclusiones: Los resultados coinciden con la idea del uso de la saliva como biofluido alternativo para el diagnóstico de COVID-19. El genoma viral es estable y no se ve afectado por perturbaciones en la cavidad oral; sin embargo, la dinámica de la infección puede provocar que el ensayo solo sea útil durante las primeras etapas de la enfermedad.

Reverse-transcriptase polymerase chain reaction versus chest computed tomography for detecting early symptoms of COVID-19. A diagnostic accuracy systematic review and meta-analysis

ABSTRACT BACKGROUND: A positive real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS CoV-2, from nasopharyngeal swabs, is the current gold standard diagnostic test for this virus and has sensitivity of 60-70%. Some studies have demonstrated a significant number of false-negative RT-PCR tests while displaying significant tomographic findings, in the early days of symptoms of COVID-19. OBJECTIVE: To compare accuracy between RT-PCR and computed tomography (CT) for detecting COVID-19 in the first week of its symptoms during the pandemic. DESIGN AND SETTING: Systematic review of comparative studies of diagnostic accuracy within the Evidence-based Health Program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL and LILACS databases, for articles published up to June 6, 2020, relating to studies evaluating the diagnostic accuracy of RT-PCR and chest CT for COVID-19 diagnoses. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: In total, 1204 patients with COVID-19 were evaluated; 1045 had tomographic findings while 755 showed positive RT-PCR for COVID-19. RT-PCR demonstrated 81.4% sensitivity, 100% specificity and 92.3% accuracy. Chest CT demonstrated 95.3% sensitivity, 43.8% specificity and 63.3% accuracy. CONCLUSION: The high sensitivity and detection rates shown by CT demonstrate that this technique has a high degree of importance in the early stages of the disease. During an outbreak, the higher prevalence of the condition increases the positive predictive value of CT. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/UNGHA in the Open Science Framework.

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19 / Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19

Resumo Fundamento: A COVID-19 causa grave acometimento pulmonar, porém o sistema cardiovascular também pode ser afetado por miocardite, insuficiência cardíaca e choque. A elevação de biomarcadores cardíacos tem sido associada a um pior prognóstico. Objetivos: Avaliar o valor prognóstico da Troponina T (TnT) e do peptídeo natriurético tipo B (BNP) em pacientes internados por Covid-19. Métodos: Amostra de conveniência de pacientes hospitalizados por COVID-19. Foram coletados dados dos prontuários com o objetivo de avaliar a relação da TnT e o BNP medidos nas primeiras 24h de admissão com o desfecho combinado (DC) óbito ou necessidade de ventilação mecânica. Análise univariada comparou os grupos com e sem DC. Modelo multivariado de Cox foi utilizada para determinar preditores independentes do DC. Resultados: Avaliamos 183 pacientes (idade=66,8±17 anos, sendo 65,6% do sexo masculino). Tempo de acompanhamento foi de 7 dias (1 a 39 dias). O DC ocorreu em 24% dos pacientes. As medianas de TnT e BNP foram 0,011 e 0,041 ng/dl (p<0,001); 64 e 198 pg/dl (p<0,001) respectivamente para os grupos sem e com DC. Na análise univariada, além de TnT e BNP, idade, presença de doença coronariana, saturação de oxigênio, linfócitos, dímero-D, proteína C reativa titulada (PCR-t) e creatinina, foram diferentes entre os grupos com e sem desfechos. Na análise multivariada boostraped apenas TnT (1,12[IC95%1,03-1,47]) e PCR-t (1,04[IC95%1,00-1,10]) foram preditores independentes do DC. Conclusão: Nas primeiras 24h de admissão, TnT, mas não o BNP, foi marcador independente de mortalidade ou necessidade de ventilação mecânica invasiva. Este dado reforça ainda mais a importância clínica do acometimento cardíaco da COVID-19. (AArq Bras Cardiol. 2020; 115(4):660-666)

Abstract Background: COVID-19 causes severe pulmonary involvement, but the cardiovascular system can also be affected by myocarditis, heart failure and shock. The increase in cardiac biomarkers has been associated with a worse prognosis. Objectives: To evaluate the prognostic value of Troponin-T (TNT) and natriuretic peptide (BNP) in patients hospitalized for Covid-19. Methods: This was a convenience sample of patients hospitalized for COVID-19. Data were collected from medical records to assess the association of TnT and BNP measured in the first 24 hours of hospital admission with the combined outcome (CO) of death or need for mechanical ventilation. Univariate analysis was used to compare the groups with and without the CO. Cox's multivariate model was used to determine independent predictors of the CO. Results: We evaluated 183 patients (age = 66.8±17 years, 65.6% of which were males). The time of follow-up was 7 days (range 1 to 39 days). The CO occurred in 24% of the patients. The median troponin-T and BNP levels were 0.011 and 0.041ng/dL (p <0.001); 64 and 198 pg/dL (p <0.001), respectively, for the groups without and with the CO. In the univariate analysis, in addition to TnT and BNP, age, presence of coronary disease, oxygen saturation, lymphocytes, D-dimer, t-CRP and creatinine, were different between groups with and without outcomes. In the bootstrap multivariate analysis, only TnT (1.12 [95% CI 1.03-1.47]) and t-CRP (1.04 [95% CI 1.00-1.10]) were independent predictors of the CO. Conclusion: In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation. This finding further reinforces the clinical importance of cardiac involvement in COVID-19. (Arq Bras Cardiol. 2020; 115(4):660-666)