Extrapulmonary manifestations of COVID-19

Nature Medicine, Journal Year: 2020, Volume and Issue: 26(7), P. 1017 - 1032

Published: July 1, 2020

Language: Английский

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Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

Thrombosis Research, Journal Year: 2020, Volume and Issue: 191, P. 148 - 150

Published: April 30, 2020

Language: Английский

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Neurological associations of COVID-19

The Lancet Neurology, Journal Year: 2020, Volume and Issue: 19(9), P. 767 - 783

Published: July 2, 2020

SummaryBackgroundThe COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is of a scale not seen since the 1918 influenza pandemic. Although predominant clinical presentation with disease, neurological manifestations are being recognised increasingly. On basis knowledge other coronaviruses, especially those that and Middle East epidemics, cases CNS peripheral nervous system disease SARS-CoV-2 might be expected to rare.Recent developmentsA growing number case reports series describe wide array in 901 patients, but many have insufficient detail, reflecting challenge studying such patients. Encephalopathy has been reported for 93 patients total, including 16 (7%) 214 hospitalised Wuhan, China, 40 (69%) 58 intensive care France. Encephalitis described eight date, Guillain-Barré 19 detected CSF some Anosmia ageusia common, can occur absence features. Unexpectedly, cerebrovascular also emerging as an important complication, cohort studies reporting stroke 2–6% COVID-19. So far, 96 described, who frequently had vascular events context pro-inflammatory hypercoagulable state elevated C-reactive protein, D-dimer, ferritin.Where next?Careful clinical, diagnostic, epidemiological needed help define burden SARS-CoV-2. Precise definitions must used distinguish non-specific complications (eg, hypoxic encephalopathy critical neuropathy) from directly or indirectly virus, infectious, para-infectious, post-infectious encephalitis, states leading stroke, neuropathies syndrome. Recognition associated whose infection mild asymptomatic prove challenging, if primary illness occurred weeks earlier. The proportion infections will probably remain small. However, these left sequelae. With so people infected, overall their health social economic costs large. Health-care planners policy makers prepare this eventuality, while ongoing investigating associations increase our base.

Language: Английский

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Incidence of venous thromboembolism in hospitalized patients with COVID‐19

Journal of Thrombosis and Haemostasis, Journal Year: 2020, Volume and Issue: 18(8), P. 1995 - 2002

Published: May 5, 2020

Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications.To investigate the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized patients with COVID-19.Single-center cohort study 198 COVID-19.Seventy-five (38%) were admitted intensive care unit (ICU). At time data collection, 16 (8%) still 19% had died. During a median follow-up 7 days (IQR, 3-13), 39 (20%) diagnosed VTE whom 25 (13%) symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences at 7, 14 21 16% (95% CI, 10-22), 33% 23-43) 42% CI 30-54) respectively. For these 10% 5.8-16), 21% 14-30) 25% 16-36). appeared be associated death (adjusted HR, 2.4; 95% 1.02-5.5). was higher ICU (26% 17-37), 47% 34-58), 59% 42-72) days) than on wards (any 5.8% 1.4-15), 9.2% 2.6-21), (2.6-21) 14, days).The observed risk for COVID-19 is high, particularly patients, which should high level clinical suspicion low threshold diagnostic imaging DVT or PE. Future research focus optimal prophylactic strategies prevent potentially improve survival.

Language: Английский

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Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

JAMA Internal Medicine, Journal Year: 2020, Volume and Issue: 180(11), P. 1436 - 1436

Published: July 15, 2020

Importance

The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes critical illness from COVID-19.

Objectives

To assess factors associated with death to examine interhospital variation in treatment for patients

Design, Setting, Participants

This multicenter cohort study assessed 2215 adults laboratory-confirmed COVID-19 who were admitted intensive care units (ICUs) at 65 hospitals across March 4 April 4, 2020.

Exposures

Patient-level data, including demographics, comorbidities, organ dysfunction, hospital number ICU beds.

Main Outcomes Measures

primary outcome was 28-day in-hospital mortality. Multilevel logistic regression used evaluate outcomes.

Results

A total (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] least 1 chronic comorbidity) included study. At 28 days after admission, 784 (35.4%) had died, 824 (37.2%) discharged, 607 (27.4%) remained hospitalized. end follow-up (median, 16 days; interquartile range, 8-28 days), 875 (39.5%) 1203 (54.3%) 137 (6.2%) Factors independently older age (≥80 vs <40 years age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 1.19-1.90), higher body mass index (≥40 <25: OR, 1.51; 1.01-2.25), coronary artery 1.47; 1.07-2.02), active cancer 2.15; 1.35-3.43), presence hypoxemia (Pao₂:Fio₂<100 ≥300 mm Hg: 2.94; 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score 2-4 0: 2.61; 1.30–5.25), kidney (renal 2.43; 1.46–4.05) admission. Patients fewer beds a risk (<50 ≥100 beds: 3.28; 2.16-4.99). Hospitals varied considerably risk-adjusted proportion died (range, 6.6%-80.8%) percentage received hydroxychloroquine, tocilizumab, other treatments supportive therapies.

Conclusions Relevance

identified demographic, clinical, hospital-level that may be critically ill can facilitate identification medications therapies improve

Language: Английский

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Platelet gene expression and function in patients with COVID-19

Blood, Journal Year: 2020, Volume and Issue: 136(11), P. 1317 - 1329

Published: June 23, 2020

Language: Английский

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Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

Nature reviews. Immunology, Journal Year: 2021, Volume and Issue: 21(5), P. 319 - 329

Published: April 6, 2021

Language: Английский

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The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management

Thrombosis Research, Journal Year: 2020, Volume and Issue: 194, P. 101 - 115

Published: June 20, 2020

The 2019 coronavirus disease (COVID-19) presents with a large variety of clinical manifestations ranging from asymptomatic carrier state to severe respiratory distress, multiple organ dysfunction and death. While it was initially considered primarily illness, rapidly accumulating data suggests that COVID-19 results in unique, profoundly prothrombotic milieu leading both arterial venous thrombosis. Consistently, elevated D-dimer level has emerged as an independent risk factor for poor outcomes, including Several other laboratory markers blood counts have also been associated prognosis, possibly due their connection At present, the pathophysiology underlying hypercoagulable is poorly understood. However, growing body initial events occur lung. A inflammatory response, originating alveoli, triggers dysfunctional cascade thrombosis pulmonary vasculature, local coagulopathy. This followed, patients more disease, by generalized macro- microvascular Of concern, observation anticoagulation may be inadequate many circumstances, highlighting need alternative or additional therapies. Numerous ongoing studies investigating coagulopathy provide mechanistic insights can direct appropriate interventional strategies.

Language: Английский

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Effects of COVID-19 on the Nervous System

Cell, Journal Year: 2020, Volume and Issue: 183(1), P. 16 - 27.e1

Published: Aug. 19, 2020

Language: Английский

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Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis

EClinicalMedicine, Journal Year: 2020, Volume and Issue: 29-30, P. 100639 - 100639

Published: Nov. 20, 2020

BackgroundStudies have suggested that there is increased risk of thromboembolism (TE) associated with coronavirus disease 2019 (COVID-19). However, overall arterial and venous TE rates COVID-19 effect on mortality unknown.MethodsWe did a systematic review meta-analysis studies evaluating in COVID-19. We searched PubMed, Cochrane, Embase for published up to June 12, 2020. Random effects models were used produce summary odds ratios (OR) patients compared those without TE. Heterogeneity was quantified I2.FindingsOf 425 identified, 42 enrolling 8271 included the meta-analysis. Overall rate 21% (95% CI:17–26%): ICU, 31% CI: 23–39%). deep vein thrombosis 20% 13–28%): 28% 16–41%); postmortem, 35% CI:15–57%). pulmonary embolism 13% 11–16%): 19% CI:14–25%); 22% CI:16–28%). 2% 1–4%): 5% (95%CI: 3–7%). Pooled among 23% (95%CI:14–32%) CI:6–22%) The pooled 74% higher who developed not (OR, 1.74; 95%CI, 1.01–2.98; P = 0.04).InterpretationTE are high death. Robust evidence from ongoing clinical trials needed determine impact thromboprophylaxis COVID-19.FundingNone.

Language: Английский

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