Does follow-up D-dimer level help in predicting oxygenation status, ventilatory support requirement, lung fibrosis, and thromboembolic events in coronavirus disease 2019 pneumonia? A prospective observational study in a tertiary care setting in India.

Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is a heterogeneous disease with variable effects on lung parenchyma, airways, and vasculature, leading to long-term effects on lung functions. Materials and Methods: This multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription-polymerase chain reaction. All cases were assessed with high-resolution computed tomography thorax, oxygen saturation, inflammatory marker as D-dimer at the entry point, and follow-up. Age, gender, comorbidity, use of bilevel positive airway pressure/noninvasive ventilation (BiPAP/NIV), and outcome as with or without lung fibrosis as per CT severity were key observations. In selected cases, we have performed lower limb venous Doppler and computed tomography (CT) pulmonary angiography to rule out deep-vein thrombosis (DVT) or pulmonary thromboembolism (PTE) respectively. Statistical analysis is performed by using Chi-square test. Observations and Analysis: Age (<50 and >50 years) and gender (male vs. female) has a significant association with D-dimer level (P < 0.00001 and P < 0.010, respectively). CT severity score at the entry point with the D-dimer level has a significant correlation (P < 0.00001). The D-dimer level has a significant association with the duration of illness before hospitalization (P < 0.00001). Comorbidities have a significant association with D-dimer levels (P < 0.00001). D-dimer level has a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement has a significant association with the D-dimer level (P < 0.00001). Timing of BIPAP/NIV requirement during hospitalization has a significant association with D-dimer level (P < 0.00001). Follow-up D-dimer titer during hospitalization as compared to normal and abnormal to entry point level has a significant association with post-COVID lung fibrosis, DVT, and PTE (P < 0.00001). Conclusions: D-dimer has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness and assessing response to treatment during hospitalization, and follow-up titers have a significant role in step-up or step-down interventions in a critical care setting.

Résumé Introducción: La neumonía por enfermedad por coronavirus 2019 (COVID 19) es una enfermedad heterogénea con efectos variables sobre el parénquima pulmonar, las vías respiratorias y la vasculatura, lo que lleva a efectos a largo plazo sobre las funciones pulmonares. Materiales y métodos: este estudio multicéntrico, prospectivo, observacional e intervencionista incluyó 1000 casos de COVID 19 confirmados con reacción en cadena de la polimerasa con transcriptasa inversa. Todos los casos fueron evaluados con tomografía computarizada de tórax de alta resolución, saturación de oxígeno, marcador inflamatorio como dímero D en el punto de entrada y seguimiento. La edad, el sexo, la comorbilidad, el uso de presión positiva en las vías respiratorias de dos niveles/ventilación no invasiva (BiPAP/NIV) y el resultado con o sin fibrosis pulmonar según la gravedad de la TC fueron observaciones clave. En casos seleccionados, hemos realizado Doppler venoso de miembros inferiores y angiografía pulmonar por tomografía computarizada (TC) para descartar trombosis venosa profunda (TVP) o tromboembolismo pulmonar (TEP) respectivamente. El análisis estadístico se realiza utilizando la prueba de Chi cuadrado. Observaciones y análisis: la edad (50 años) y el sexo (hombre vs. mujer) tienen una asociación significativa con el nivel de dímero D (P < 0,00001 y P < 0,010, respectivamente). La puntuación de gravedad de la TC en el punto de entrada con el nivel de dímero D tiene una correlación significativa (P < 0,00001). El nivel de dímero D tiene una asociación significativa con la duración de la enfermedad antes de la hospitalización (P < 0,00001). Las comorbilidades tienen una asociación significativa con los niveles de dímero D (P < 0,00001). El nivel de dímero D tiene una asociación significativa con la saturación de oxígeno (P < 0,00001). El requerimiento de BIPAP/NIV tiene una asociación significativa con el nivel de dímero D (P < 0.00001). El momento del requerimiento de BIPAP/NIV durante la hospitalización tiene una asociación significativa con el nivel de dímero D (P < 0.00001). El título de dímero D de seguimiento durante la hospitalización en comparación con el nivel normal y anormal al punto de entrada tiene una asociación significativa con la fibrosis pulmonar, la TVP y la TEP posteriores a la COVID (P < 0,00001). Conclusiones: el dímero D ha documentado un papel muy importante en la neumonía por COVID 19 para predecir la gravedad de la enfermedad y evaluar la respuesta al tratamiento durante la hospitalización, y los títulos de seguimiento tienen un papel importante en las intervenciones de aumento o reducción en un entorno de cuidados críticos. Mots-clés: Palabras clave: enfermedad por coronavirus 2019, neumonía, dímero D, trombosis venosa profunda, marcador inflamatorio, fibrosis pulmonar, embolia pulmonar.

"Serial ferritin titer" monitoring in COVID-19 pneumonia: valuable inflammatory marker in assessment of severity and predicting early lung fibrosis - prospective, multicentric, observational, and interventional study in tertiary care setting in India.

Introduction: The COVID-19 pneumonia is a heterogeneous disease with variable effect on lung parenchyma, airways, and vasculature leading to long-term effects on lung functions. Materials and methods: Multicentric, prospective, observational, and interventional study conducted during July 2020 to May 2021, in the MIMSR Medical College and Venkatesh Hospital Latur India, included 1000 COVID-19 cases confirmed with RT-PCR. All cases were assessed with lung involvement documented and categorized on HRCT thorax, oxygen saturation, inflammatory marker, ferritin at entry point, and follow-up during hospitalization. Age, gender, comorbidity, and use of BIPAP/NIV and outcome as with or without lung fibrosis as per CT severity were key observations. CT severity scoring is done as per universally accepted standard scoring tool as score < 7 as mild, 7-14 as moderate, and score > 15 as severe affection of the lung. Statistical analysis is done by using chi-square test. Observations and analysis: In study of 1000 COVID-19 pneumonia cases, age (< 50 and > 50 years) and gender (male versus female) have significant association with ferritin in predicting severity of COVID-19 pneumonia (p < 0.00001) and (p < 0.010), respectively. CT severity score at entry point with ferritin level has significant correlation in severity scores < 8, 8-15, and > 15 documented in normal and abnormal ferritin level as in 190/110, 90/210, and 40/360, respectively (p < 0.00001). Ferritin level has significant association with duration of illness, i.e., DOI < 7 days, 8-15 days, and > 15 days of onset of symptoms documented normal and abnormal ferritin levels in 30/310, 160/300, and 130/70 cases, respectively (p < 0.00001). Comorbidity as diabetes mellitus, hypertension, COPD, IHD, and obesity has significant association in COVID-19 cases with normal and abnormal ferritin level respectively (p < 0.00001). Ferritin level has significant association with oxygen saturation in COVID-19 pneumonia cases; cases with oxygen saturation > 90%, 75-90%, and < 75% are observed as normal and abnormal ferritin level in 110/100, 150/340, and 60/240 cases, respectively (p < 0.00001). BIPAP/NIV requirement during the course of COVID-19 pneumonia in critical care setting has significant association with ferritin level; cases received BIPAP/NIV during hospitalization were documented normal and abnormal ferritin level in 155/445 and 165/235 cases, respectively (p < 0.00001). Timing of BIPAP/NIV requirement during course of COVID-19 pneumonia in critical care setting has significant association with ferritin level; cases received BIPAP/NIV at entry point < 1 day, 3-7 days, and after 7 days of hospitalization were documented significance in fourfold raised ferritin level in 110/70, 150/160, and 30/80 cases, respectively (p < 0.00001). Follow-up of ferritin titer during hospitalization as compared to entry point abnormal ferritin has significant association in post-COVID lung fibrosis (p < 0.00001). Follow-up of ferritin titer during hospitalization as compared to entry point normal ferritin has significant association in post-COVID lung fibrosis (p < 0.00001). Conclusion: Ferritin is easily available, sensitive and reliable, cost-effective, and universally acceptable inflammatory marker in COVID-19 pandemic. Ferritin has very crucial role in COVID-19 pneumonia in predicting severity of illness and assessing response to treatment during hospitalization. Follow-up of ferritin titer during hospitalization and at discharge can be used as early predictor of post-COVID lung fibrosis.

COVID-19 pneumonia with pulmonary tuberculosis: Double trouble.

A 75-year-old male presented with acute febrile respiratory illness with hypoxia and anorexia of longer duration; computed tomography (CT) of the thorax was suggestive of cavitary lung disease, with sputum smear positive for acid-fast bacilli and also having classical COVID-19 pneumonia patterns in the CT thorax; and COVID-19 rapid antigen test was positive. He was treated for COVID-19 pneumonia and antituberculosis treatment was initiated at the discharge. He was recovered of both conditions, and we have documented the crucial role of chest CT in managing this case in this pandemic period.