Efficacy of early anti-inflammatory treatment with high doses of intravenous anakinra with or without glucocorticoids in patients with severe COVID-19 pneumonia.

BACKGROUND: IL-1 plays a pivotal role in the inflammatory response during cytokine storm syndromes. OBJECTIVE: Our aim was to analyze the efficacy and safety of early anti-inflammatory treatment (AIT) with intravenous anakinra with or without glucocorticoids in coronavirus disease 2019 (COVID-19) pneumonia. METHODS: We performed a retrospective single-center cohort study of patients admitted for COVID-19 pneumonia from February 26 to April 29, 2020, to assess the efficacy of early AIT with intravenous anakinra (100 mg every 8 hours for 3 days, with tapering) alone or in combination with a glucocorticoid (intravenous methylprednisolone, 1-2 mg/kg daily, with tapering). The standard of care (SOC) treatment was hydroxychloroquine and/or azithromycin with or without antivirals and anticoagulants. Late rescue AIT with anakinra or tocilizumab was also evaluated. Treatment effect on overall survival was assessed by a propensity score-adjusted Cox model. RESULTS: A total of 128 patients were analyzed; 63 patients received early AIT (30 received anakinra alone and 33 received anakinra plus a glucocorticoid) at admission, and 65 patients did not receive early AIT and were used as controls; of the latter 65 patients, 44 received the SOC treatment alone and 21 received the SOC treatment plus late rescue AIT. After adjustment for all the unbalanced baseline covariates, early AIT reduced the hazard of mortality by 74% (adjusted hazard ratio [HR] = 0.26; P < .001). The effect was similar in patients receiving anakinra alone (adjusted HR = 0.28; P = .04) and anakinra plus a glucocorticoid (adjusted HR = 0.33; P = .07). Late rescue treatment did not show a significant advantage over SOC treatment alone (adjusted HR = 0.82; P = .70). CONCLUSIONS: This study suggests, on a larger series of patients with COVID-19 pneumonia, the potential efficacy and safety of the early use of high doses of intravenous anakinra with or without glucocorticoids.

Pulmonary embolism prognostic factors and length of hospital stay: A cohort study.

INTRODUCTION: Patients with pulmonary embolism (PE) are commonly admitted to hospital for their initial treatment. We aimed to assess the association of length of hospital stay with commonly available clinical variables and their combinations. METHODS: A retrospective multicenter cohort study was conducted on consecutive PE patients admitted to eight Italian centers. Logistic regression analysis was performed to evaluate the association between the length of hospital stay and the Pulmonary Embolism Severity Index (PESI) parameters, National Early Warning Score (NEWS) and other possible determinants. RESULTS: We enrolled 391 patients, with a median hospital stay of 10days (IQR 7-14). Among PESI parameters, only oxygen saturation <90% was significantly associated with length of hospital stay at univariable analysis (OR 1.99; 95% CI 1.3-3.2). At multivariable analysis, NEWS ≥5 was associated with prolonged hospitalization (OR 3.14; 95% CI 1.2-8.3). A difference of median hospital stay was found between simplified PESI high and low risk groups (10 and 9days, respectively, p=0.027). DISCUSSION: The median duration of hospital stay was generally long and not influenced by single parameters of PESI or common prognostic factors. The difference of one day between the low- and high-risk groups according to simplified PESI was not clinically significant.

[The utility of assaying the N-terminal of brain natriuretic peptide precursor (NT pro-BNP) to predict the clinical outcome in patients with supraventricular tachyarrhythmias observed and treated in the emergency room]. / Utilità del dosaggio del precursore del peptide natriuretico cerebrale come predittore di cardioversione efficace nei pazienti con tachicardie e tachiaritmie sopraventricolari, osservati e trattati in Pronto Soccorso.

Many patients arrive at the emergency room (ER) with recent-onset atrial fibrillation or other forms of supraventricular tachyarrhythmia (SV Ta) or tachycardia. The restoration of sinus rhythm (SR) is always desirable and, in addition, can enable many hospitalisations to be avoided, thereby achieving considerable savings in financial and healthcare resources. Even in haemodynamically stable cases, it is clearly useful to be able to evaluate which subjects will benefit most from attempts to restore SR, even when few truly diagnostic means are on hand (such as echocardiography, which is not always promptly available in the ER setting). We evaluated the brain natriuretic peptide precursor (N terminal pro-BNP) in 105 patients arriving at the ER. We observed that SR was restored in a low percentage of patients with values > 4500, while the vast majority of those with values < 1500 was normalised even by means of antiarrhythmic drugs alone. It is therefore probable that a medium-low value of the hormone indicates only an acute response to the distension of the atrial tissue induced by the arrhythmia; by contrast, decidedly elevated values are probably also caused by ventricular dysfunction and therefore indicate a lesser likelihood of restoring SR. The routine evaluation of NT pro-BNP could be used as an alternative to echocardiography in order to rapidly select patients in whom cardioversion should be attempted in the ER or Brief Observation Unit.