Association of Lower Antispike Antibody Levels with Mortality in ICU Patients with COVID-19 Disease.

Background: Though vaccines have been reported as highly efficacious in preventing severe COVID-19 disease, there is emerging data of severe infections, albeit a small number, in vaccinated individuals. We have conducted a retrospective observational study to assess the clinical characteristics, immunological response, and disease outcomes among the vaccinated and unvaccinated patients admitted to the ICU with severe COVID-19 disease. Methods: Study Design and Participants. We conducted a retrospective observational study in COVID ICU of a tertiary care hospital. Data were collected from the month of 1 April 2021 to 31 November 2021. All adult patients admitted to the ICU having severe COVID-19 disease were included in the study. Data were collected from the medical records database which included demographics, a clinical course in the ICU, laboratory and radiological parameters, and disease outcomes. In a subset of patients, cell-mediated immunity and S1S2-neutralising antibody assessment was done. Results: A total of 419 patients with severe COVID-19 were included in the study. Of the 419 patients, 90 (21.5%) were vaccinated, and 329 (78.5%) were unvaccinated. There was a significantly higher mortality in unvaccinated severe COVID 19 patients as compared to vaccinated severe COVID patients (46.2% vs 34.4%; P < 0.0455). The neutralizing antibody titre was significantly higher in survivors as compared to nonsurvivors (2139.8, SE ± 713.3 vs 471, SE ± 154.4); P < 0.026. Conclusion: Our study suggests the association of lower neutralizing antibody levels with mortality in ICU patients admitted with COVID-19 breakthrough infections.

Thrombolytic Therapy for Pulmonary Embolism in COVID 19 ARDS: A Case Series.

COVID 19 patients have a high incidence of vascular thrombosis which may result in pulmonary thromboembolism. Hence, anticoagulation is recommended as part of treatment strategy. Despite anticoagulation patients may develop PTE. These patients may benefit from thrombolysis. Here we report a study of six COVID 19 patients who had severe ARDS and moderate PTE who received thrombolytic therapy. All these patients recovered without the need for mechanical ventilation and without any bleeding complication.

Metabolic Resuscitation Using Hydrocortisone, Ascorbic Acid, and Thiamine: Do Individual Components Influence Reversal of Shock Independently?

AIMS AND OBJECTIVE: To study the effects of various components of "metabolic resuscitation" on the shock reversal among patients with septic shock. INTRODUCTION: Sepsis is characterized by dysregulated host response to infection. Mitochondrial dysfunction which occurs early in sepsis is associated with multiorgan dysfunction. Therapies such as adequate resuscitation, early administration of antibiotics, and aggressive monitoring reduced mortality substantially but it still remains high for those with septic shock. Combination of vitamin C, hydrocortisone, and thiamine improved outcome in a retrospective study, but how effective is this therapy in isolation compared to combination has to be known before implementation. MATERIALS AND METHODS: This study is single-center, prospective, randomized nonblinded trial done in septic shock patients admitted to the medical intensive care unit. Subjects were randomized to three groups of hydrocortisone (H), hydrocortisone, ascorbic acid (HA), hydrocortisone, ascorbic acid, thiamine (HAT). Following randomization, they received hydrocortisone 200 mg over 24 hours as infusion, intravenous ascorbic acid 1.5 g every 6 hours, thiamine 200 mg twice daily as allotted and continued till shock reversal or death. Primary outcome is time to shock reversal and secondary outcome is time to vasopressor dose reduction from hemodynamic SOFA score 4-3. RESULTS: Twenty seven subjects were randomized into 3 groups of 9 each, of which 17 (63%) patients met primary outcome and secondary outcome has been studied in 16 (59%) patients. Eight patients (29.5%) died and did not meet either outcome and two patients (7.5%) met secondary outcome but not primary outcome because of discharge to other hospital. There is no difference in time to shock reversal [mean, SD in H (7422, 8348), HA (2528, 3086), HAT (1860, 749), p value 0.17]. There is no difference in time to shock reversal from hemodynamic SOFA 4-3 [mean, SD in H (4935, 6406), HA (2310, 2515), HAT (1800, 1282), p value 0.35]. CONCLUSION: In patients with septic shock, there is no difference in time to shock reversal comparing individual components of metabolic resuscitation. HOW TO CITE THIS ARTICLE: Reddy PR, Samavedam S, Aluru N, Yelle S, Rajyalakshmi B. Metabolic Resuscitation Using Hydrocortisone, Ascorbic Acid, and Thiamine: Do Individual Components Influence Reversal of Shock Independently? Indian J Crit Care Med 2020;24(8):649-652.