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1.
J Infect Chemother ; 27(1): 76-82, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33051144

RESUMO

INTRODUCTION: The severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. METHODS: All patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients' records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. RESULTS: Data from 61 patients (16 Pt-CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt-CSI were significantly older and had hypertension or diabetes than Pt-MMI (P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt-CSI than in Pt-MMI (P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt-CSI than in Pt-MMI (P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt-CSI than in Pt-MMI (P = 0.013). Among the 16 Pt-CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. CONCLUSIONS: The illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Proteína C-Reativa/análise , Infecções por Coronavirus/terapia , Feminino , Humanos , Japão/epidemiologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Neutrófilos , Pandemias , Pneumonia Viral/terapia , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Kardiologiia ; 60(7): 64-71, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155942

RESUMO

Aim      To analyze the relationship between serum concentrations of high-sensitivity C-reactive protein (hsCRP) in dynamics and development of restenosis at 12 months following elective coronary stent placement (CSP).Material and methods  The key role in atherogenesis, neointimal proliferation and restenosis belongs to inflammation. This study included 91 patients (median age, 60 [56; 66] years) with stable exertional angina after an elective CSP using second-generation stents. Follow-up coronarography was performed for 60 patients at 12 months. Concentration of hsCRP was measured immediately prior to CSP and at 1, 3, 6, and 12 months after CSP. Restenosis of the stented segment (50% or more narrowing of the stented segment or a 5-mm vessel segment proximally or distally adjacent to the stented segment) was observed in 8 patients.Results According to results of the ROC analysis, the increase in hsCRP concentration >0.9 mg/l (>25%) at one month after CSP had the highest predictive significance with respect of restenosis (area under the ROC curve, 0.89 at 95 % confidence interval (CI) from 0.79 to 0.99; sensitivity, 87.5 %; specificity, 82.8 %; р=0.0005), which was superior to the absolute value of hsCRP concentration >3.0 mg/l (area under the ROC curve, 0.82 at 95 % CI from 0.68 to 0.96; р=0.0007).Conclusion      Increased concentration of hsCRP ≥0.9 mg /l (≥25 %) at a month after CSP was associated with restenosis of the coronary artery stented segment.


Assuntos
Proteína C-Reativa , Reestenose Coronária , Idoso , Angiografia Coronária , Reestenose Coronária/diagnóstico , Reestenose Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Prognóstico , Curva ROC , Stents
3.
Kardiologiia ; 60(9): 68-75, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131477

RESUMO

Aim To evaluate the relationship between high-sensitivity C-reactive protein (hsCRP) and echocardiographic (EchoCG) indicators of heart failure (HF) among adult population of the North region of Russia.Material and methods The Know Your Heart transversal study was performed in 2015-2017 on a random sample of adult population of Arkhangelsk aged 35-69 years (n=2381). The exclusion criterion for this study was a concentration of hsCRP >10 mg/l. The group of subclinical inflammation included 686 participants with hsCRP ≥2.0 mg/l; the comparison group consisted of 1158 participants with hsCRP <2.0 mg/l. Analysis included cardiometabolic risk factors, EchoCG indexes of left ventricular (LV) systolic and diastolic function and biomarkers (NT-proBNP, hsTroponin Т, cystatin С). Linear and logistic regressions were used.Results The group with hsCRP ≥2.0 mg/l had higher rates of arterial hypertension, diabetes mellitus, HF, and myocardial infarction in history than the comparison group. The hsCRP level was independently associated with waist circumference (ß=0.379, p <0.001), male gender (ß=-0.135, p<0.001), smoking (ß=0.109, p<0.001), triglycerides (ß=0.083, p<0.001), diastolic blood pressure (ß=0.082, p<0.001), cystatin C (ß=0.082, p<0.001), glycated hemoglobin (ß=0.064, p=0.003), and low-density lipoproteins (LDL) (ß=0.049, p=0.025). Independent predictors of subclinical inflammation included older age, smoking, abdominal obesity, elevated values of LDL (>3.0 mmol/l), triglycerides (>1.7 mmol/l), and cystatin C (>1.2 mg/l). hsCRP was independently negatively associated with LV ejection fraction, left atrial volume index, ratio of early to late LV diastolic filling velocity (p=0.003, p=0.002, p=0.005, respectively), which reflected the relationship of the increased content of hsCRP with impairment of LV systolic and diastolic function. A relationship between heart remodeling indexes and hsCRP concentration was shown.Conclusion In a sample of adult population from the North region of Russia, the hsCRP concentration was independently associated with cardiometabolic risk factors and structural and functional changes in the heart detected by EchoCG, which reflects a potential contribution of inflammation to heart remodeling and development of HF.


Assuntos
Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Adulto , Idoso , Proteína C-Reativa/análise , Ecocardiografia , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Federação Russa/epidemiologia , Volume Sistólico , Função Ventricular Esquerda
4.
Virulence ; 11(1): 1569-1581, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33172355

RESUMO

A pandemic designated as Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide. Up to date, there is no efficient biomarker for the timely prediction of the disease progression in patients. To analyze the inflammatory profiles of COVID-19 patients and demonstrate their implications for the illness progression of COVID-19. Retrospective analysis of 3,265 confirmed COVID-19 cases hospitalized between 10 January 2020, and 26 March 2020 in three medical centers in Wuhan, China. Patients were diagnosed as COVID-19 and hospitalized in Leishenshan Hospital, Zhongnan Hospital of Wuhan University and The Seventh Hospital of Wuhan, China. Univariable and multivariable logistic regression models were used to determine the possible risk factors for disease progression. Moreover, cutoff values, the sensitivity and specificity of inflammatory parameters for disease progression were determined by MedCalc Version 19.2.0. Age (95%CI, 1.017 to 1.048; P < 0.001), serum amyloid A protein (SAA) (95%CI, 1.216 to 1.396; P < 0.001) and erythrocyte sedimentation rate (ESR) (95%CI, 1.006 to 1.045; P < 0.001) were likely the risk factors for the disease progression. The Area under the curve (AUC) of SAA for the progression of COVID-19 was 0.923, with the best predictive cutoff value of SAA of 12.4 mg/L, with a sensitivity of 83.9% and a specificity of 97.67%. SAA-containing parameters are novel promising ones for predicting disease progression in COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Idoso , Área Sob a Curva , Betacoronavirus/genética , Biomarcadores , Sedimentação Sanguínea , Proteína C-Reativa/análise , China , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Laringe/virologia , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Valor Preditivo dos Testes , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Proteína Amiloide A Sérica/análise
5.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(5): 637-643, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33210493

RESUMO

Polycystic ovary syndrome (PCOS) is a common endocrine disease of child-bearing period women and one of the main causes of infertility in women. Pentraxin 3 (PTX3) is a multifunctional protein with a series of biological activities. PTX3 participates in the regulation of insulin secretion and glucose metabolism, ovarian cumulus cell function, inflammatory factor activity, androgen metabolism, lipid absorption and transport, and endothelial cell function, thereby improving insulin resistance, promoting follicular development and ovulation, reducing chronic inflammation, inhibiting androgen levels, improving lipid metabolism abnormalities and preventing atherosclerosis and cardiovascular diseases, thus participating in the occurrence of PCOS and its complications. This article reviews the mechanism of PTX3 in PCOS and its complications, trying to provide new ideas and directions for the study of PCOS pathogenesis and its clinical diagnosis and treatment.


Assuntos
Proteína C-Reativa , Síndrome do Ovário Policístico , Componente Amiloide P Sérico , Proteína C-Reativa/metabolismo , Criança , Feminino , Humanos , Resistência à Insulina , Síndrome do Ovário Policístico/fisiopatologia , Componente Amiloide P Sérico/metabolismo
6.
PLoS One ; 15(11): e0241663, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147270

RESUMO

BACKGROUND/AIM: The coronavirus disease 2019 (COVID-19) had become a big threat worldwide. Liver injury is not uncommon in patients with COVID-19, and clarifying its characteristics is needed. This study aimed to identify factors associated with liver injury and to develop a new classification of predictive severity in patients with COVID-19. METHODS: Confirmed patients with COVID-19 (n = 60) were recruited retrospectively from Musashino Red Cross Hospital. The factors of liver injury especially on the elevation of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) were analyzed. Grading was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS: During a median hospitalization follow-up of 15 (4-41) days, 51 (85.0%) patients had COVID-19 pneumonia. In clinical courses, oxygenation was needed for 25 (41.6%) patients and intubation was needed for 9 (15.0%) patients. A total of 27 (45.0%) patients had gastrointestinal symptoms (GS), such as appetite loss, diarrhea, and nausea. A logistic regression analysis revealed that C-reactive protein (CRP) at baseline, oxygenation, intubation, and GS were significant factors of liver injury. Based on these results, patients were classified into three groups: group 1, no oxygenation pneumonia; group 2, pneumonia with oxygenation or GS; and group 3, intubation. We classified 25 (41.7%), 26 (43.3%), and 9 (15.0%) patients into mild, moderate, and severe groups, respectively. The peak of AST and ALT levels was significantly stratified with this criteria (mild [median AST, 28 IU/L; median ALT, 33 IU/L], moderate [median AST, 48 IU/L; median ALT, 47.5 IU/L], and severe [median AST, 109 IU/L; median ALT, 106 IU/L]; P<0.001 and P = 0.0114, respectively). CONCLUSION: COVID-19-related liver injury was significantly stratified based on GS and severity of pneumonia.


Assuntos
Infecções por Coronavirus/patologia , Doenças do Sistema Digestório/patologia , Doenças do Sistema Digestório/virologia , Hepatopatias/patologia , Hepatopatias/virologia , Pneumonia Viral/patologia , Pneumonia/patologia , Pneumonia/virologia , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Proteína C-Reativa/metabolismo , Doenças do Sistema Digestório/metabolismo , Feminino , Seguimentos , Humanos , Fígado/metabolismo , Fígado/patologia , Fígado/virologia , Hepatopatias/metabolismo , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/metabolismo , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
Medicine (Baltimore) ; 99(45): e22971, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157938

RESUMO

Coronavirus disease 2019 (COVID-19) has rapidly spread on a global scale. Therefore, it is urgent to identify risk factors that could be associated with severe type of COVID-19 from common type.For this retrospective study, we recruited patients with COVID-19 in Wuhan and Zhoukou. Patients were classified into a severe group and common group based on guidelines after admission. Clinical manifestations and laboratory tests were compared, and univariate binary logistic regression and multivariate regression analyses were applied to assess potential risk factors.A total of 126 patients were recruited from January 23 to March 23, 2020. Ninety cases were identified as the common type and 36 as the severe type. The average age in the severe group was significantly older than that in the common group (P = .008). Patients with severe COVID-19 exhibited higher proportions of dyspnea (P = .001), weakness (P = .023), and diarrhea (P = .046). Moreover, there were more patients with hypertension (P = .01) or coinfection (P = .001) in the severe group than in the common group. Additionally, severe COVID-19 was associated with increased neutrophil counts (P < .001), C-reactive protein (P < .001), procalcitonin (P = .024) and decreased lymphocyte counts (P = .001), hemoglobin (P < .001), total protein (TP) (P < .001), and albumin (ALB) (P < .001). Based on logistic regression analysis, dyspnea (P < .001), TP (P = .042), and ALB (P = .003) were independent risk factors for severe disease.Patients with lower TP, ALB, and dyspnea should be carefully monitored, and early intervention should be implemented to prevent the development of severe disease.


Assuntos
Infecções por Coronavirus/diagnóstico , Progressão da Doença , Hospitalização , Pneumonia Viral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Proteínas Sanguíneas/análise , Proteína C-Reativa/análise , China , Dispneia/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica Humana/análise , Adulto Jovem
8.
PLoS One ; 15(11): e0242045, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166991

RESUMO

Coronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. However, the information on the risk factors associated with the mortality of COVID-19 and of their prognostic potential is limited. In this retrospective study, the clinical characteristics, treatment and outcome data were collected and analyzed from 676 COVID-19 patients stratified into 140 non-survivors and 536 survivors. We found that the levels of Dimerized plasmin fragment D (D-dimer), C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in non-survivals on admission (non-survivors vs. survivors: D-Dimer ≥ 0.5 mg/L, 83.2% vs. 44.9%, P<0.01; CRP ≥10 mg/L, 50.4% vs. 6.0%, P<0.01; LDH ≥ 250 U/L, 73.8% vs. 20.1%, P<0.01; PCT ≥ 0.5 ng/ml, 27.7% vs. 1.8%, P<0.01). Moreover, dynamic tracking showed D-dimer kept increasing in non-survivors, while CRP, LDH and PCT remained relatively stable after admission. D-dimer has the highest C-index to predict in-hospital mortality, and patients with D-dimer levels ≥0.5 mg/L had a higher incidence of mortality (Hazard Ratio: 4.39, P<0.01). Our study suggested D-dimer could be a potent marker to predict the mortality of COVID-19, which may be helpful for the management of patients.


Assuntos
Infecções por Coronavirus/mortalidade , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Pneumonia Viral/mortalidade , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Proteína C-Reativa/análise , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Estimativa de Kaplan-Meier , L-Lactato Desidrogenase/análise , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Pró-Calcitonina/análise , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
9.
PLoS One ; 15(11): e0240347, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33175876

RESUMO

BACKGROUND: As a pandemic, a most-common pattern resembled organizing pneumonia (OP) has been identified by CT findings in novel coronavirus disease (COVID-19). We aimed to delineate the evolution of CT findings and outcome in OP of COVID-19. MATERIALS AND METHODS: 106 COVID-19 patients with OP based on CT findings were retrospectively included and categorized into non-severe (mild/common) and severe (severe/critical) groups. CT features including lobar distribution, presence of ground glass opacities (GGO), consolidation, linear opacities and total severity CT score were evaluated at three time intervals from symptom-onset to CT scan (day 0-7, day 8-14, day > 14). Discharge or adverse outcome (admission to ICU or death), and pulmonary sequelae (complete absorption or lesion residuals) on CT after discharge were analyzed based on the CT features at different time interval. RESULTS: 79 (74.5%) patients were non-severe and 103 (97.2%) were discharged at median day 25 (range, day 8-50) after symptom-onset. Of 67 patients with revisit CT at 2-4 weeks after discharge, 20 (29.9%) had complete absorption of lesions at median day 38 (range, day 30-53) after symptom-onset. Significant differences between complete absorption and residuals groups were found in percentages of consolidation (1.5% vs. 13.8%, P = 0.010), number of involved lobe > 3 (40.0% vs. 72.5%, P = 0.030), CT score > 4 (20.0% vs. 65.0%, P = 0.010) at day 8-14. CONCLUSION: Most OP cases had good prognosis. Approximately one-third of cases had complete absorption of lesions during 1-2 months after symptom-onset while those with increased frequency of consolidation, number of involved lobe > 3, and CT score > 4 at week 2 after symptom-onset may indicate lesion residuals on CT.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Betacoronavirus/isolamento & purificação , Proteína C-Reativa/análise , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Tempo de Internação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Pandemias , Alta do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1199-1202, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198863

RESUMO

OBJECTIVE: To analyze the expression and clinical significance of serum retinol binding protein 4 (RBP4), superoxide dismutase (SOD) and hypersensitive C-reactive protein (hs-CRP) in patients with acute ST-segment elevated myocardial infarction (STEMI). METHODS: Seventy-eight patients with STEMI who underwent percutaneous coronary intervention (PCI) admitted to Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2017 to March 2019 were enrolled. On the basis of the routine treatment, atorvastatin calcium or rosuvastatin calcium treatment was given. According to the results of coronary angiography, the patients were divided into three groups: single-vessel, double-vessel and three-vessel lesions, and the severity of coronary artery disease score (SYNTAX score) was performed. The serum RBP4, SOD and hs-CRP were measured and compared among different groups before and after treatment. The correlation between the three serum parameters of STEMI patients and the SYNTAX score, risk prediction (STEMI high-risk score) and prognosis were recorded and compared among different groups. RESULTS: There was no significant difference in serum RBP4, SOD and hs-CRP among different groups before treatment. In multivessel (double-vessel and three-vessel) vascular disease group, SYNTAX score was significantly correlated with RBP4 and hs-CRP (double-vessel lesions: r values were 0.616 and 0.489 respectively, three-vessel lesions: r values were 0.423 and 0.357 respectively, all P < 0.05), but had no correlation with SOD (r values were 0.108 and 0.055 respectively, both P > 0.05), and high-risk score was closely correlated with RBP4 and hs-CRP levels (r values were 0.581 and 0.623 respectively, both P < 0.01). There was no significant difference in the prognosis of patients treated with different statins. There were 8 and 7 high-risk patients in the atorvastatin calcium group and rosuvastatin calcium group, respectively, and 2 and 3 dead patients respectively (both P > 0.05). CONCLUSIONS: Combined detection of serum RBP4, SOD and hs-CRP levels can be used as better indicators to predict the risk of STEMI, which is worthy of clinical application.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Proteína C-Reativa/análise , China , Humanos , Infarto do Miocárdio/tratamento farmacológico , Proteínas Plasmáticas de Ligação ao Retinol , Superóxido Dismutase
12.
Zhonghua Yi Xue Za Zhi ; 100(42): 3303-3308, 2020 Nov 17.
Artigo em Chinês | MEDLINE | ID: mdl-33202491

RESUMO

Objective: To explore the associations of regulatory B cells (Breg cells) and regulatory T cells (Treg cells) with the clinical effect of Infliximab in the treatment of Chinese patients with Crohn's disease (CD). Methods: From January 2017 to June 2019, a total of 32 CD patients at active stage and 33 age and gender-matched healthy controls were collected from the Second Affiliated Hospital of Wenzhou Medical University in this study. Approximate 5 ml of peripheral fasting venous blood was obtained from every subject. Peripheral blood mononuclear cells (PBMCs) were isolated from whole blood. Then multi-color flow cytometry was applied to determine the proportion of Breg (CD3-CD19+IL-10+B cells) in B cells and the proportion of Treg (CD4+CD25+Foxp3+T cells) in CD4+T cells. Infliximab (5 mg/kg) was given intravenously at week 0, 2 and 6 to induce CD remission, and then maintained with the same dose of Infliximab every 8 weeks. And the proportions of Breg and Treg were examined at week 14 of Infliximab treatment, then compared with those of week 0. Simultaneously, C-reactive protein (CRP), leucocyte count, platelet count, erythrocyte sedimentation rate were detected in CD patients to assess the clinical effect at week 0 and 14 of Infliximab treatment. Results: Before infliximab treatment, compared with healthy controls, the proportion of Breg in B cells was significantly increased [(3.15±1.17)% vs (2.64±0.38)%, P=0.024)], and the proportion of Treg in CD4+T cells was significantly decreased [(2.15±0.49)% vs (4.25±0.41)%, P<0.001] in CD patients. And the proportion of Breg was positively related with the proportion of Treg in CD patients either at week 0 or week 14 of Infliximab treatment (r=0.628, P<0.001; r=0.749, P<0.001). At week 14 of Infliximab treatment, according to symptoms, Crohn's disease activity index (CDAI) and endoscopic mucosal healing, CD patients were classified as remission group (CDAI<150 and endoscopic mucosal healing, R group) and non-remission group (CDAI≥150 or mucosal non-healing group, N group). Compared with CD patients at week 0 of Infliximab treatment, both the proportion of Breg and Treg were significantly enhanced [(5.89±2.60)% vs (3.19±1.27)%, P<0.001; (4.59±0.72)% vs (2.08±0.47)%, P<0.001], whereas CDAI and CRP was significantly reduced [CDAI: (63.19±14.69) vs (195.62±58.13), P<0.001; CRP: (3.65±2.23) mg/L vs (29.80±30.06) mg/L, P<0.001] in R group at week 14 of Infliximab treatment. The proportions of Breg and Treg were negatively related with the CRP (r=-0.279, P=0.026; r=-0.406, P=0.001) and CDAI (r=-0.409, P=0.001; r=-0.708, P<0.001) in CD patients at week 0 and 14 of Infliximab treatment. At week 14 of Infliximab treatment, ROC curve analysis showed that the predictive value of "Breg+Treg" for the effect of Infliximab was higher than the other parameters (area under ROC: 0.782, cutoff value: 0.895 5, P=0.034). Conclusions: Breg cells and Treg cells are not only significantly correlated with CD disease activity, but the combined detection of the two types of immune cells has higher clinical value for predicting the effect of Infliximab in CD patients at active stage.


Assuntos
Linfócitos B Reguladores , Doença de Crohn , Proteína C-Reativa , Doença de Crohn/tratamento farmacológico , Humanos , Infliximab/uso terapêutico , Linfócitos T Reguladores
13.
Epidemiol Infect ; 148: e255, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33050972

RESUMO

To determine what exacerbate severity of the COVID-19 among patients without comorbidities and advanced age and investigate potential clinical indicators for early surveillance, we adopted a nested case-control study, design in which severe cases (case group, n = 67) and moderate cases (control group, n = 67) of patients diagnosed with COVID-19 without comorbidities, with ages ranging from 18 to 50 years who admitted to Wuhan Tongji Hospital were matched based on age, sex and BMI. Demographic and clinical characteristics, and risk factors associated with severe symptoms were analysed. Percutaneous oxygen saturation (SpO2), lymphocyte counts, C-reactive protein (CRP) and IL-10 were found closely associated with severe COVID-19. The adjusted multivariable logistic regression analyses revealed that the independent risk factors associated with severe COVID-19 were CRP (OR 2.037, 95% CI 1.078-3.847, P = 0.028), SpO2 (OR 1.639, 95% CI 0.943-2.850, P = 0.080) and lymphocyte (OR 1.530, 95% CI 0.850-2.723, P = 0.148), whereas the changes exhibited by indicators influenced incidence of disease severity. Males exhibited higher levels of indicators associated with inflammation, myocardial injury and kidney injury than the females. This study reveals that increased CRP levels and decreased SpO2 and lymphocyte counts could serve as potential indicators of severe COVID-19, independent of comorbidities, advanced age and sex. Males could at higher risk of developing severe symptoms of COVID-19 than females.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Adolescente , Adulto , Fatores Etários , Área Sob a Curva , Proteína C-Reativa/análise , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/complicações , Feminino , Humanos , Incidência , Inflamação/etiologia , Tempo de Internação , Modelos Logísticos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Pandemias , Pneumonia Viral/complicações , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
14.
J Med Case Rep ; 14(1): 187, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33054818

RESUMO

BACKGROUND: The understanding of coronavirus disease 2019 (COVID-19) is rapidly evolving. Although it is primarily a respiratory illness, other manifestations, such as Guillain-Barré syndrome, immune thrombocytopenia, and immune-mediated thrombotic thrombocytopenic purpura, have been described. We present a case of a patient with hemophagocytic lymphohistiocytosis secondary to COVID-19 treated with tocilizumab with a marked biochemical improvement. CASE PRESENTATION: In this case report we present a Caucasian patient with COVID-19 who developed a marked elevation of inflammatory parameters with ferritin 36,023 µg/L, but also elevated C-reactive protein 334 mg/L and lactate dehydrogenase 1074 U/L, 1 week after admission to the intensive care unit. He met five of eight criteria for hemophagocytic lymphohistiocytosis, but he lacked the high fever and cytopenia seen in the majority of cases. He was treated with tocilizumab, a monoclonal antibody targeting the interleukin-6 receptor, and over the next days, a rapid decrease in ferritin and C-reactive protein levels was observed. However, his respiratory failure only improved gradually, and he was weaned off the respirator 11 days later. CONCLUSION: COVID-19 may induce a hyperinflammatory clinical picture and in some cases develop into hemophagocytic lymphohistiocytosis. In our patient's case, therapeutic interleukin-6 blockade abrogated signs of hyperinflammation but did not seem to improve pulmonary function. Measurement of ferritin and C-reactive protein, as well as quantification of interleukin-6 on indication, should be performed in patients with severe COVID-19. Specific treatment in such patients must also be contemplated, preferably in randomized controlled trials.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Inflamação/sangue , Interleucina-6 , Pandemias , Pneumonia Viral , Idoso , Anticorpos Monoclonais/administração & dosagem , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Ferritinas/sangue , Humanos , Interleucina-6/análise , Interleucina-6/antagonistas & inibidores , Linfo-Histiocitose Hemofagocítica/etiologia , Masculino , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Respiração Artificial/métodos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(42): e22748, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080738

RESUMO

To compare clinical features and outcomes between early and late onset of neonatal bacterial meningitis (NBM).Patients were allocated in 2 groups: early onset neonatal bacterial meningitis (ENBM) and late onset neonatal bacterial meningitis (LNBM). Data analysis includes asphyxia at birth, premature rupture of membranes (PROM), amnionitis, amniotic fluid contamination, maternal age, clinical manifestations of the patients, laboratory findings, radiological results, complications related to meningitis, duration of hospitalization and therapeutic effect.There was no difference in gender, birth weight, gestational age, and incidence of asphyxia between 2 groups. The incidence of PROM, chorioamnionitis and amniotic fluid contamination, proportion of small-for-gestational-age infants, convulsions, intracranial hemorrhage, hyperbilirubinemia, and the protein level of cerebrospinal fluid in ENBM group were higher than that in LNBM group (P < .05); the proportion of fever, elevated C-reaction protein and the abnormal of platelet counts in LNBM group was higher than that in ENBM group (P < .05). There was no difference in the incidence of complications and hospitalization time between 2 groups. The rate of effective treatment in LNBM group was significantly higher than that in ENBM group (P < .05).Patients with conditions of amniotic fluid contamination, chorioamnionitis, small-for-gestational-age and PROM might be more prone to develop ENBM and ENBM had worse outcomes than LNBM.


Assuntos
Meningites Bacterianas/epidemiologia , Adulto , Líquido Amniótico , Proteína C-Reativa/análise , Proteínas do Líquido Cefalorraquidiano/análise , China/epidemiologia , Corioamnionite/epidemiologia , Diarreia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Hemorragias Intracranianas/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Contagem de Plaquetas , Gravidez , Complicações na Gravidez/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Nascimento a Termo
16.
PLoS One ; 15(10): e0239571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057443

RESUMO

IMPORTANCE: The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. OBJECTIVE: The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. DESIGN, PARTICIPANTS AND LOCATIONS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. RESULTS: Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. CONCLUSIONS: This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease.


Assuntos
Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Eosinofilia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Prognóstico , Fatores Sexuais , Espanha
17.
Medicine (Baltimore) ; 99(42): e22551, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080689

RESUMO

A first C-reactive protein (CRP) test, as often performed by clinicians during the presentation of patients with an acute bacterial infection, might be misleading. The aim of our study was to explore the dynamic between a second CRP test taken within 12 hours from admission CRP test in a cohort of patients diagnosed with acute bacterial infection in comparison to CRP in a control group of apparently healthy individuals.This was a historical cohort study comprised of all patients admitted to the Sourasky Tel-Aviv Medical Center, Israel, between July 2007 and March 2016. The study cohort included adult patients who were diagnosed as having an infection, assumed to be of bacterial etiology (cellulitis and erysipelas, pneumonia, cholecystitis, pyelonephritis, or septicemia), who had a CRP test during the first 6 hours of hospital admission (baseline CRP), and a successive CRP test up to 12 hours from the first one (recurrent CRP). The control group was of healthy subjects who attended our medical center for a routine annual check-up.The study included 950 patients. Baseline CRP ranged from 0.04 to 454 mg/L. The median CRP velocity was 0.53 mg/L/h. Patients were grouped by baseline CRP into 4 groups (CRP < 10, 10-74.9, 75-199.9, ≥200). There was an increase in median CRP velocity between the first (0.48 mg/L/h) and the second (0.93 mg/L/h) groups, which then was decreased in the next 2 groups (0.46 and -2.58 mg/L/h, respectively). In 45 of 103 (44%) patients of the group of baseline CRP concentration less than 10 mg/dL with bacterial diagnosis, there was a complete overlap with CRP values of apparently healthy individuals during their routine annual checkup.A first single low CRP result cannot exclude the presence of a significant bacterial infection. Patients with acute bacterial infection might present with a relatively low CRP value that at times correspond to normal limit CRP concentrations. A second test, obtained within 12 hours of admission, might serve as an important tool to identify patient with an evolving inflammatory burst commonly seen during acute bacterial infection.


Assuntos
Infecções Bacterianas/sangue , Proteína C-Reativa/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
18.
Isr Med Assoc J ; 22(10): 605-611, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33070482

RESUMO

BACKGROUND: There is limited clinical information on coronavirus disease-19 (COVID-19) patients in Israel. OBJECTIVES: To describe the characteristics, outcomes, and potential associations of hospitalized COVID-19 patients in Israel. METHODS: We conducted a single-center, retrospective study of 58 consecutive laboratory-confirmed COVID-19 patients admitted to Laniado Hospital, Israel, between 14 March 2020 and 14 May 2020. Demographic, clinical, and laboratory data on admission were collected and analyzed, and the association to subsequent respiratory failure was assessed. RESULTS: Mean age of patients was 70.7 ± 16.9 years (53% males, 47% females.); 74% had at least one co-morbidity. Most patients were of Jewish Ashkenazi descent. During hospitalization 15 patients (mean age 78.18 ± 10.35 years); 80% male, 73% Sephardi descent developed respiratory failure rates of 60% occurring on average 10.6 days following intubation. Laboratory tests at admission displayed a significant increase in C-reactive protein (CRP) and creatine kinase (CK) and a decrease in absolute lymphocyte count (ALC) in patients who eventually developed respiratory failure (163.97 mg/L, 340.87 IU/L, 0.886 K/µl vs. 50.01 mg/L and 123.56 IU/L, 1.28 K/µl, respectively). Multivariate logistic analysis revealed an integrated parameter of CRP, CK, and ALC highly correlated with respiratory failure. Receiver operating characteristic curve revealed the area under the curve of CRP, CK, and ALC and the integrated parameter to be 0.910, 0.784, and 0.754, respectively. CRP was the strongest predictor to correlate with respiratory failure. CONCLUSIONS: CRP, CK, and ALC levels on admission could possibly be used to detect high-risk patients prone to develop respiratory failure.


Assuntos
Infecções por Coronavirus/epidemiologia , Progressão da Doença , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Insuficiência Respiratória/mortalidade , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Estudos de Coortes , Infecções por Coronavirus/prevenção & controle , Creatina Quinase/análise , Testes Diagnósticos de Rotina/métodos , Feminino , Humanos , Israel , Laboratórios Hospitalares/organização & administração , Modelos Logísticos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Curva ROC , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Taxa de Sobrevida
20.
Sci Rep ; 10(1): 16726, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028914

RESUMO

COVID-19 is commonly mild and self-limiting, but in a considerable portion of patients the disease is severe and fatal. Determining which patients are at high risk of severe illness or mortality is essential for appropriate clinical decision making. We propose a novel severity score specifically for COVID-19 to help predict disease severity and mortality. 4711 patients with confirmed SARS-CoV-2 infection were included. We derived a risk model using the first half of the cohort (n = 2355 patients) by logistic regression and bootstrapping methods. The discriminative power of the risk model was assessed by calculating the area under the receiver operating characteristic curves (AUC). The severity score was validated in a second half of 2356 patients. Mortality incidence was 26.4% in the derivation cohort and 22.4% in the validation cohort. A COVID-19 severity score ranging from 0 to 10, consisting of age, oxygen saturation, mean arterial pressure, blood urea nitrogen, C-Reactive protein, and the international normalized ratio was developed. A ROC curve analysis was performed in the derivation cohort achieved an AUC of 0.824 (95% CI 0.814-0.851) and an AUC of 0.798 (95% CI 0.789-0.818) in the validation cohort. Furthermore, based on the risk categorization the probability of mortality was 11.8%, 39% and 78% for patient with low (0-3), moderate (4-6) and high (7-10) COVID-19 severity score. This developed and validated novel COVID-19 severity score will aid physicians in predicting mortality during surge periods.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Projetos de Pesquisa , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/análise , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
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