Updates in Management of SARS-CoV-2 Infection

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 45806

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Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
Interests: infectious diseases; viral hepatitis; liver; COVID-19
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Dear Colleagues,

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has spread worldwide from the beginning of 2020. The infection is mostly asymptomatic but some patients may develop COVID‑19 (coronavirus disease 2019) with a severe or critical course leading to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Apart from the virus‑related damage of the lungs, pathomechanism of the disease seems to be linked to thromboembolism and inflammation accompanied by overproduction of proinflammatory cytokines, termed a cytokine storm, responsible for multiorgan damage and death. Since the development of a new therapeutic molecule, dedicated strictly to a particular virus is time‑consuming, physicians and scientists have started to test and repurpose old medications. Unfortunately, after one year of pandemics, there is still a lack of optimal therapy and no clear indicators of recovery. A major issue is also insufficient knowledge on predictors of the severe or deadly course of the disease, which could also help to switch from one therapeutic option to another. Due to many gaps still existing in the management of COVID-19, there is a need for the accumulation of new data particularly from real-world experience, which could be applicable to practice guidelines. The objective of this Topical Collection of the Journal of Clinical Medicine is to provide an update on the management for the diagnostic workup and pharmacotherapy of SARS‑CoV‑2 infection.

Prof. Dr. Robert Flisiak
Collection Editor

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Keywords

  • severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2)
  • COVID‑19 (coronavirus disease 2019)
  • management of COVID-19
  • management for the diagnostic workup
  • pharmacotherapy of SARS‑CoV‑2 infection

Published Papers (18 papers)

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Editorial

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4 pages, 204 KiB  
Editorial
Updates in Management of SARS-CoV-2 Infection
by Robert Flisiak, Dorota Zarębska-Michaluk, Marta Flisiak-Jackiewicz and Piotr Rzymski
J. Clin. Med. 2022, 11(15), 4472; https://doi.org/10.3390/jcm11154472 - 31 Jul 2022
Cited by 2 | Viewed by 1107
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the beginning of 2020 [...] Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)

Research

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11 pages, 515 KiB  
Article
Clinical Course and Severity of COVID-19 in 940 Infants with and without Comorbidities Hospitalized in 2020 and 2021: The Results of the National Multicenter Database SARSTer-PED
by Małgorzata Pawłowska, Maria Pokorska-Śpiewak, Ewa Talarek, Anna Mania, Barbara Hasiec, Elżbieta Żwirek-Pytka, Magdalena Stankiewicz, Martyna Stani, Paulina Frańczak-Chmura, Leszek Szenborn, Izabela Zaleska, Joanna Chruszcz, Ewa Majda-Stanisławska, Urszula Dryja, Kamila Gąsiorowska, Magdalena Figlerowicz, Katarzyna Mazur-Melewska, Kamil Faltin, Przemysław Ciechanowski, Michał Peregrym, Joanna Łasecka-Zadrożna, Józef Rudnicki, Barbara Szczepańska, Ilona Pałyga-Bysiecka, Ewelina Rogowska, Dagmara Hudobska-Nawrot, Katarzyna Domańska-Granek, Adam Sybilski, Izabela Kucharek, Justyna Franczak, Małgorzata Sobolewska-Pilarczyk, Ernest Kuchar, Michał Wronowski, Maria Paryż, Bolesław Kalicki, Kacper Toczyłowski, Artur Sulik, Sławomira Niedźwiecka, Robert Flisiak and Magdalena Marczyńskaadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(7), 2479; https://doi.org/10.3390/jcm12072479 - 24 Mar 2023
Cited by 3 | Viewed by 1321
Abstract
This study aimed to analyze the differences in severity and clinical characteristics of COVID-19 in infants hospitalized in Poland in 2021, when the dominance of variants of concern (VOCs) alpha and delta was reported, compared to 2020, when original (wild) SARS-CoV-2 was dominant [...] Read more.
This study aimed to analyze the differences in severity and clinical characteristics of COVID-19 in infants hospitalized in Poland in 2021, when the dominance of variants of concern (VOCs) alpha and delta was reported, compared to 2020, when original (wild) SARS-CoV-2 was dominant (III–IV vs. I–II waves of the pandemic, respectively). In addition, the influence of the presence of comorbidities on the clinical course of COVID-19 in infants was studied. This multicenter study, based on the pediatric part of the national SARSTer database (SARSTer-PED), included 940 infants with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 13 Polish inpatient centers. An electronic questionnaire, which addressed epidemiological and clinical data, was used. The number of hospitalized infants was significantly higher in 2021 than in 2020 (651 vs. 289, respectively). The analysis showed similar lengths of infant hospitalization in 2020 and 2021, but significantly more children were hospitalized for more than 7 days in 2020 (p < 0.009). In both analyzed periods, the most common route of infection for infants was household contact. There was an increase in the percentage of comorbidities, especially prematurity, in children hospitalized in 2021 compared to 2020. Among the clinical manifestations, fever was predominant among children hospitalized in 2021 and 2020. Cough, runny nose, and loss of appetite were significantly more frequently observed in 2021 (p < 0.0001). Severe and critical conditions were significantly more common among children with comorbidities. More infants were hospitalized during the period of VOCs dominance, especially the delta variant, compared to the period of wild strain dominance, even though indications for hospitalization did not include asymptomatic patients during that period. The course of COVID-19 was mostly mild, characterized mainly by fever and respiratory symptoms. Comorbidities, particularly from the cardiovascular system and prematurity, were associated with a more severe course of the disease in infants. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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12 pages, 657 KiB  
Article
Association between the Seroprevalence of Antibodies against Seasonal Alphacoronaviruses and SARS-CoV-2 Humoral Immune Response, COVID-19 Severity, and Influenza Vaccination
by Lidia Brydak, Dominika Sikora, Barbara Poniedziałek, Ewelina Hallmann, Karol Szymański, Katarzyna Kondratiuk and Piotr Rzymski
J. Clin. Med. 2023, 12(5), 1733; https://doi.org/10.3390/jcm12051733 - 21 Feb 2023
Viewed by 1340
Abstract
The present study assesses the seroprevalence of antibodies against seasonal human alphacoronaviruses 229E and NL63 among adult patients infected with SARS-CoV-2, and its association with the humoral response to SARS-CoV-2 infection and its severity, and influenza vaccination. A serosurvey was conducted to quantify [...] Read more.
The present study assesses the seroprevalence of antibodies against seasonal human alphacoronaviruses 229E and NL63 among adult patients infected with SARS-CoV-2, and its association with the humoral response to SARS-CoV-2 infection and its severity, and influenza vaccination. A serosurvey was conducted to quantify the presence of IgG antibodies against the nucleocapsid of 229E (anti-229E-N) and NL63 (anti-NL63-N), and anti-SARS-CoV-2 IgG antibodies (against nucleocapsid, receptor-binding domain, S2 domain, envelope, and papain-like protease) for 1313 Polish patients. The seroprevalence of anti-229E-N and anti-NL63 in the studied cohort was 3.3% and 2.4%. Seropositive individuals had a higher prevalence of anti-SARS-CoV-2 IgG antibodies, higher titers of the selected anti-SARS-CoV2 antibodies, and higher odds of an asymptomatic SARS-CoV-2 infection (OR = 2.5 for 229E and OR = 2.7 for NL63). Lastly, the individuals vaccinated against influenza in the 2019/2020 epidemic season had lower odds of seropositivity to 229E (OR = 0.38). The 229E and NL63 seroprevalence was below the expected pre-pandemic levels (up to 10%), likely due to social distancing, increased hygiene, and face masking. The study also suggests that exposure to seasonal alphacoronaviruses may improve humoral responses to SARS-CoV-2 while decreasing the clinical significance of its infection. It also adds to accumulating evidence of the favorable indirect effects of influenza vaccination. However, the findings of the present study are of a correlative nature and thereby do not necessarily imply causation. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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10 pages, 406 KiB  
Article
COVID-19 and Pulmonary Thrombosis—An Unresolved Clinical Puzzle: A Single-Center Cohort Study
by Loris Močibob, Frano Šušak, Maja Šitum, Klaudija Višković, Neven Papić and Adriana Vince
J. Clin. Med. 2022, 11(23), 7049; https://doi.org/10.3390/jcm11237049 - 29 Nov 2022
Cited by 3 | Viewed by 1358
Abstract
Pulmonary thrombosis (PT) is a frequent complication of COVID-19. However, the risk factors, predictive scores, and precise diagnostic guidelines on indications for CT pulmonary angiography (CTPA) are still lacking. This study aimed to analyze the clinical and laboratory characteristics associated with PT in [...] Read more.
Pulmonary thrombosis (PT) is a frequent complication of COVID-19. However, the risk factors, predictive scores, and precise diagnostic guidelines on indications for CT pulmonary angiography (CTPA) are still lacking. This study aimed to analyze the clinical and laboratory characteristics associated with PT in patients with COVID-19. We conducted a cohort study of consecutively hospitalized adult patients with COVID-19 who underwent CTPA at the University Hospital for Infectious Diseases in Zagreb, Croatia between 1 April and 31 December 2021. Of 2078 hospitalized patients, 575 (27.6%) underwent CTPA. PT was diagnosed in 178 (30.9%) patients (69.6% males, median age of 61, IQR 50–69 years). The PT group had a higher CRP, LDH, D-dimer, platelets, and CHOD score. PT was more frequent in patients requiring ≥15 L O2/min (25.0% vs. 39.7%). In multivariable analysis, only D-dimer ≥ 1.0 mg/L (OR 1.78, 95%CI 1.12–2.75) and O2 ≥ 15 L (OR 1.89, 95%CI 1.26–2.84) were associated with PT. PT was not associated with in-hospital mortality. In conclusion, our data confirmed a high incidence of PT in hospitalized patients with COVID-19, however, no correlation with traditional risk factors and mortality was found. CTPA should be performed in patients requiring high-flow supplemental oxygen or those with increased D-dimer levels. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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15 pages, 1259 KiB  
Article
Longwise Cluster Analysis for the Prediction of COVID-19 Severity within 72 h of Admission: COVID-DATA-SAVE-LIFES Cohort
by Rodrigo San-Cristobal, Roberto Martín-Hernández, Omar Ramos-Lopez, Diego Martinez-Urbistondo, Víctor Micó, Gonzalo Colmenarejo, Paula Villares Fernandez, Lidia Daimiel and Jose Alfredo Martínez
J. Clin. Med. 2022, 11(12), 3327; https://doi.org/10.3390/jcm11123327 - 10 Jun 2022
Cited by 6 | Viewed by 1806
Abstract
The use of routine laboratory biomarkers plays a key role in decision making in the clinical practice of COVID-19, allowing the development of clinical screening tools for personalized treatments. This study performed a short-term longitudinal cluster from patients with COVID-19 based on biochemical [...] Read more.
The use of routine laboratory biomarkers plays a key role in decision making in the clinical practice of COVID-19, allowing the development of clinical screening tools for personalized treatments. This study performed a short-term longitudinal cluster from patients with COVID-19 based on biochemical measurements for the first 72 h after hospitalization. Clinical and biochemical variables from 1039 confirmed COVID-19 patients framed on the “COVID Data Save Lives” were grouped in 24-h blocks to perform a longitudinal k-means clustering algorithm to the trajectories. The final solution of the three clusters showed a strong association with different clinical severity outcomes (OR for death: Cluster A reference, Cluster B 12.83 CI: 6.11–30.54, and Cluster C 14.29 CI: 6.66–34.43; OR for ventilation: Cluster-B 2.22 CI: 1.64–3.01, and Cluster-C 1.71 CI: 1.08–2.76), improving the AUC of the models in terms of age, sex, oxygen concentration, and the Charlson Comorbidities Index (0.810 vs. 0.871 with p < 0.001 and 0.749 vs. 0.807 with p < 0.001, respectively). Patient diagnoses and prognoses remarkably diverged between the three clusters obtained, evidencing that data-driven technologies devised for the screening, analysis, prediction, and tracking of patients play a key role in the application of individualized management of the COVID-19 pandemics. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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8 pages, 555 KiB  
Article
Comparison between Suspected and Confirmed COVID-19 Respiratory Patients: What Is beyond the PCR Test
by Stefania Principe, Amelia Grosso, Alida Benfante, Federica Albicini, Salvatore Battaglia, Erica Gini, Marta Amata, Ilaria Piccionello, Angelo Guido Corsico and Nicola Scichilone
J. Clin. Med. 2022, 11(11), 2993; https://doi.org/10.3390/jcm11112993 - 25 May 2022
Cited by 2 | Viewed by 1448
Abstract
COVID-19 modified the healthcare system. Nasal-pharyngeal swab (NPS), with real-time reverse transcriptase-polymerase (PCR), is the gold standard for the diagnosis; however, there are difficulties related to the procedure that may postpone it. The study aims to evaluate whether other elements than the PCR-NPS [...] Read more.
COVID-19 modified the healthcare system. Nasal-pharyngeal swab (NPS), with real-time reverse transcriptase-polymerase (PCR), is the gold standard for the diagnosis; however, there are difficulties related to the procedure that may postpone it. The study aims to evaluate whether other elements than the PCR-NPS are reliable and confirm the diagnosis of COVID-19. This is a cross-sectional study on data from the Lung Unit of Pavia (confirmed) and at the Emergency Unit of Palermo (suspected). COVID-19 was confirmed by positive NPS, suspected tested negative. We compared clinical, laboratory and radiological variables and performed Logistic regression to estimate which variables increased the risk of COVID-19. The derived ROC-AUCcurve, assessed the accuracy of the model to distinguish between COVID-19 suspected and confirmed. We selected 50 confirmed and 103 suspected cases. High Reactive C-Protein (OR: 1.02; CI95%: 0.11–1.02), suggestive CT-images (OR: 11.43; CI95%: 3.01–43.3), dyspnea (OR: 10.48; CI95%: 2.08–52.7) and respiratory failure (OR: 5.84; CI95%: 1.73–19.75) increased the risk of COVID-19, whereas pleural effusion decreased the risk (OR: 0.15; CI95%: 0.04–0.63). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19 (AUC 0.91). Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently from the NPS result. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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13 pages, 1110 KiB  
Article
Does the Serum Concentration of Angiotensin II Type 1 Receptor Have an Effect on the Severity of COVID-19? A Prospective Preliminary Observational Study among Healthcare Professionals
by Jarosław Janc, Michał Suchański, Magdalena Mierzchała-Pasierb, Ewa Woźnica-Niesobska, Lidia Łysenko and Patrycja Leśnik
J. Clin. Med. 2022, 11(7), 1769; https://doi.org/10.3390/jcm11071769 - 23 Mar 2022
Cited by 2 | Viewed by 2033
Abstract
SARS-CoV-2 is a virus that causes severe respiratory distress syndrome. The pathophysiology of COVID-19 is related to the renin–angiotensin system (RAS). SARS-CoV-2, a vector of COVID-19, uses angiotensin-converting enzyme 2 (ACE-2), which is highly expressed in human lung tissue, nasal cavity, and oral [...] Read more.
SARS-CoV-2 is a virus that causes severe respiratory distress syndrome. The pathophysiology of COVID-19 is related to the renin–angiotensin system (RAS). SARS-CoV-2, a vector of COVID-19, uses angiotensin-converting enzyme 2 (ACE-2), which is highly expressed in human lung tissue, nasal cavity, and oral mucosa, to gain access into human cells. After entering the cell, SARS-CoV-2 inhibits ACE-2, thus favouring the ACE/Ang II/angiotensin II type 1 receptor (AT1R) axis, which plays a role in the development of acute lung injury (ALI). This study aimed to analyse the influence of angiotensin 1 receptor (AT1R) levels in the serum on the course of the severity of symptoms in healthcare professionals who had a SARS-CoV-2 infection. This prospective observational study was conducted on a group of 82 participants. The study group included physicians and nurses who had a COVID-19 infection confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2. The control group consisted of healthy medical professionals who had not had a SARS-CoV-2 infection or who had no symptoms of COVID-19 and who tested negative for SARS-CoV-2 on the day of examination. We analysed the correlation between AT1R concentration and the severity of COVID-19, as well as with sex, age, blood group, and comorbidities. There were no statistically significant differences in the mean values of AT1R concentration in the recovered individuals and the non-COVID-19 subjects (3.29 vs. 3.76 ng/mL; p = 0.32). The ROC curve for the AT1R assay showed an optimal cut-off point of 1.33 (AUC = 0.44; 95% CI = 0.32–0.57; p = 0.37). There was also no correlation between AT1R concentration and the severity of symptoms associated with COVID-19. Blood type analysis showed statistically significantly lower levels of AT1R in COVID-19-recovered participants with blood group A than in those with blood group O. In conclusion, AT1R concentration does not affect the severity of symptoms associated with COVID-19 among healthcare professionals. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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12 pages, 1762 KiB  
Article
Demographic and Clinical Overview of Hospitalized COVID-19 Patients during the First 17 Months of the Pandemic in Poland
by Robert Flisiak, Piotr Rzymski, Dorota Zarębska-Michaluk, Magdalena Rogalska, Marta Rorat, Piotr Czupryna, Beata Lorenc, Przemysław Ciechanowski, Dorota Kozielewicz, Anna Piekarska, Maria Pokorska-Śpiewak, Katarzyna Sikorska, Magdalena Tudrujek, Beata Bolewska, Grzegorz Angielski, Justyna Kowalska, Regina Podlasin, Włodzimierz Mazur, Barbara Oczko-Grzesik, Izabela Zaleska, Aleksandra Szymczak, Paulina Frańczak-Chmura, Małgorzata Sobolewska-Pilarczyk, Krzysztof Kłos, Magdalena Figlerowicz, Piotr Leszczyński, Izabela Kucharek and Hubert Grabowskiadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(1), 117; https://doi.org/10.3390/jcm11010117 - 26 Dec 2021
Cited by 21 | Viewed by 3786
Abstract
Long-term analyses of demographical and clinical characteristics of COVID-19 patients can provide a better overview of the clinical course of the disease. They can also help understand whether changes in infection symptomatology, disease severity, and outcome occur over time. We aimed to analyze [...] Read more.
Long-term analyses of demographical and clinical characteristics of COVID-19 patients can provide a better overview of the clinical course of the disease. They can also help understand whether changes in infection symptomatology, disease severity, and outcome occur over time. We aimed to analyze the demographics, early symptoms of infection, laboratory parameters, and clinical manifestation of COVID-19 patients hospitalized during the first 17 months of the pandemic in Poland (March 2020–June 2021). The patients’ demographical and clinical data (n = 5199) were extracted from the national SARSTer database encompassing 30 medical centers in Poland and statistically assessed. Patients aged 50–64 were most commonly hospitalized due to COVID-19 regardless of the pandemic period. There was no shift in the age of admitted patients and patients who died throughout the studied period. Men had higher C-reactive protein and interleukin-6 levels and required oxygenation and mechanical ventilation more often. No gender difference in fatality rate was seen, although the age of males who died was significantly lower. A share of patients with baseline SpO2 < 91%, presenting respiratory, systemic and gastrointestinal symptoms was higher in the later phase of a pandemic than in the first three months. Cough, dyspnea and fever were more often presented in men, while women had a higher frequency of anosmia, diarrhea, nausea and vomiting. This study shows some shifts in SARS-CoV-2 pathogenicity between March 2020 and July 2021 in the Polish cohort of hospitalized patients and documents various gender-differences in this regard. The results represent a reference point for further analyses conducted under the dominance of different SARS-CoV-2 variants. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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12 pages, 688 KiB  
Article
Clinical and Epidemiological Characteristics of 1283 Pediatric Patients with Coronavirus Disease 2019 during the First and Second Waves of the Pandemic—Results of the Pediatric Part of a Multicenter Polish Register SARSTer
by Maria Pokorska-Śpiewak, Ewa Talarek, Anna Mania, Małgorzata Pawłowska, Jolanta Popielska, Konrad Zawadka, Magdalena Figlerowicz, Katarzyna Mazur-Melewska, Kamil Faltin, Przemysław Ciechanowski, Joanna Łasecka-Zadrożna, Józef Rudnicki, Barbara Hasiec, Martyna Stani, Paulina Frańczak-Chmura, Izabela Zaleska, Leszek Szenborn, Kacper Toczyłowski, Artur Sulik, Barbara Szczepańska, Ilona Pałyga-Bysiecka, Izabela Kucharek, Adam Sybilski, Małgorzata Sobolewska-Pilarczyk, Urszula Dryja, Ewa Majda-Stanisławska, Sławomira Niedźwiecka, Ernest Kuchar, Bolesław Kalicki, Anna Gorczyca and Magdalena Marczyńskaadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(21), 5098; https://doi.org/10.3390/jcm10215098 - 30 Oct 2021
Cited by 18 | Viewed by 2904
Abstract
This prospective multicenter cohort study aimed to analyze the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in children. The study, based on the pediatric part of the Polish SARSTer register, included 1283 children (0 to 18 years) who were diagnosed with [...] Read more.
This prospective multicenter cohort study aimed to analyze the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in children. The study, based on the pediatric part of the Polish SARSTer register, included 1283 children (0 to 18 years) who were diagnosed with COVID-19 between 1 March 2020 and 31 December 2020. Household contact was reported in 56% of cases, more frequently in younger children. Fever was the most common symptom (46%). The youngest children (0–5 years) more frequently presented with fever, rhinitis and diarrhea. Teenagers more often complained of headache, sore throat, anosmia/ageusia and weakness. One fifth of patients were reported to be asymptomatic. Pneumonia was diagnosed in 12% of patients, more frequently in younger children. During the second wave patients were younger than during the first wave (median age 53 vs. 102 months, p < 0.0001) and required longer hospitalization (p < 0.0001). Significantly fewer asymptomatic patients were noted and pneumonia as well as gastrointestinal symptoms were more common. The epidemiological characteristics of pediatric patients and the clinical presentation of COVID-19 are age-related. Younger children were more frequently infected by close relatives, more often suffered from pneumonia and gastrointestinal symptoms and required hospitalization. Clinical courses differed significantly during the first two waves of the pandemic. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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16 pages, 1597 KiB  
Article
Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients
by Frane Paštrovic, Marko Lucijanic, Armin Atic, Josip Stojic, Mislav Barisic Jaman, Ida Tjesic Drinkovic, Marko Zelenika, Marko Milosevic, Barbara Medic, Jelena Loncar, Maja Mijic, Tajana Filipec Kanizaj, Dominik Kralj, Ivan Lerotic, Lucija Virovic Jukic, Neven Ljubicic, Kresimir Luetic, Dora Grgic, Matea Majerovic, Rajko Ostojic, Zeljko Krznaric, Ivica Luksic, Nevenka Piskac Zivkovic, Tatjana Keres, Vlatko Grabovac, Jasminka Persec, Bruno Barsic and Ivica Grgurevicadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(18), 4222; https://doi.org/10.3390/jcm10184222 - 17 Sep 2021
Cited by 12 | Viewed by 2761
Abstract
Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the [...] Read more.
Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. Methods: Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. Results: Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1–3 × ULN and >3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. Conclusions: Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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12 pages, 1167 KiB  
Article
Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients
by Omar Ramos-Lopez, Rodrigo San-Cristobal, Diego Martinez-Urbistondo, Víctor Micó, Gonzalo Colmenarejo, Paula Villares-Fernandez, Lidia Daimiel and J. Alfredo Martinez
J. Clin. Med. 2021, 10(14), 3112; https://doi.org/10.3390/jcm10143112 - 15 Jul 2021
Cited by 12 | Viewed by 2013
Abstract
Objective: to screen putative associations between liver markers and proinflammatory-related features concerning infectious morbidity and fatal outcomes in COVID-19 patients. Methods: a total of 2094 COVID-19 positive patients from the COVID-DATA-SAFE-LIFES cohort (HM hospitals consortium) were classified according to median values of hepatic, [...] Read more.
Objective: to screen putative associations between liver markers and proinflammatory-related features concerning infectious morbidity and fatal outcomes in COVID-19 patients. Methods: a total of 2094 COVID-19 positive patients from the COVID-DATA-SAFE-LIFES cohort (HM hospitals consortium) were classified according to median values of hepatic, inflammatory, and clinical indicators. Logistic regression models were fitted and ROC cures were generated to explain disease severity and mortality. Results: intensive care unit (ICU) assistance plus death outcomes were associated with liver dysfunction, hyperinflammation, respiratory insufficiency, and higher associated comorbidities. Four models including age, sex, neutrophils, D-dimer, oxygen saturation lower than 92%, C-reactive protein (CRP), Charlson Comorbidity Index (CCI), FIB-4 and interactions with CRP, neutrophils, and CCI explained ICU plus death variance in more than 28%. The predictive values of ROC curves were: FIB-4 (0.7339), AST/ALT ratio (0.7107), CRP (0.7003), CCI index (0.6778), neutrophils (0.6772), and platelets (0.5618) concerning ICU plus death outcomes. Conclusions: the results of this research revealed that liver and proinflammatory features are important determinants of COVID-19 morbidity and fatal outcomes, which could improve the current understanding of the COVID-19 physiopathology as well as to facilitate the clinical management and therapy decision-making of this disease under a personalized medicine scope. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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5 pages, 197 KiB  
Article
SARS-CoV-2 and Cytomegalovirus Co-Infections—A Case Series of Critically Ill Patients
by Patrícia Moniz, Sérgio Brito and Pedro Póvoa
J. Clin. Med. 2021, 10(13), 2792; https://doi.org/10.3390/jcm10132792 - 25 Jun 2021
Cited by 24 | Viewed by 2401
Abstract
The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact [...] Read more.
The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
9 pages, 467 KiB  
Article
Evaluation of Two Rapid Antigenic Tests for the Detection of SARS-CoV-2 in Nasopharyngeal Swabs
by Ysaline Seynaeve, Justine Heylen, Corentin Fontaine, François Maclot, Cécile Meex, Anh Nguyet Diep, Anne-Françoise Donneau, Marie-Pierre Hayette and Julie Descy
J. Clin. Med. 2021, 10(13), 2774; https://doi.org/10.3390/jcm10132774 - 24 Jun 2021
Cited by 11 | Viewed by 4218
Abstract
(1) Background: In the current context of the COVID-19 crisis, there is a need for fast, easy-to-use, and sensitive diagnostic tools in addition to molecular methods. We have therefore decided to evaluate the performance of newly available antigen detection kits in “real-life” laboratory [...] Read more.
(1) Background: In the current context of the COVID-19 crisis, there is a need for fast, easy-to-use, and sensitive diagnostic tools in addition to molecular methods. We have therefore decided to evaluate the performance of newly available antigen detection kits in “real-life” laboratory conditions. (2) Methods: The sensitivity and specificity of two rapid diagnostic tests (RDT)—the COVID-19 Ag Respi-Strip from Coris Bioconcept, Belgium (CoRDT), and the coronavirus antigen rapid test cassette from Healgen Scientific, LLC, USA (HeRDT)—were evaluated on 193 nasopharyngeal samples using RT-PCR as the gold standard. (3) Results: The sensitivity obtained for HeRDT was 88% for all collected samples and 91.1% for samples with Ct ≤ 31. For the CoRDT test, the sensitivity obtained was 62% for all collected samples and 68.9% for samples with Ct ≤ 31. (4) Conclusions: Despite the excellent specificity obtained for both kits, the poor sensitivity of the CoRDT did not allow for its use in the rapid diagnosis of COVID-19. HeRDT satisfied the World Health Organization’s performance criteria for rapid antigen detection tests. Its high sensitivity, quick response, and ease of use allowed for the implementation of HeRDT at the laboratory of the University Hospital of Liège. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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14 pages, 495 KiB  
Article
Impact of Kidney Failure on the Severity of COVID-19
by Dorota Zarębska-Michaluk, Jerzy Jaroszewicz, Magdalena Rogalska, Beata Lorenc, Marta Rorat, Anna Szymanek-Pasternak, Anna Piekarska, Aleksandra Berkan-Kawińska, Katarzyna Sikorska, Magdalena Tudrujek-Zdunek, Barbara Oczko-Grzesik, Beata Bolewska, Piotr Czupryna, Dorota Kozielewicz, Justyna Kowalska, Regina Podlasin, Krzysztof Kłos, Włodzimierz Mazur, Piotr Leszczyński, Bartosz Szetela, Katarzyna Reczko and Robert Flisiakadd Show full author list remove Hide full author list
J. Clin. Med. 2021, 10(9), 2042; https://doi.org/10.3390/jcm10092042 - 10 May 2021
Cited by 12 | Viewed by 3874
Abstract
Background: Patients with kidney failure are at an increased risk of progression to a severe form of coronavirus disease 2019 (COVID-19) with high mortality. The current analysis was aimed to assess the impact of renal failure on the severity of COVID-19 and identify [...] Read more.
Background: Patients with kidney failure are at an increased risk of progression to a severe form of coronavirus disease 2019 (COVID-19) with high mortality. The current analysis was aimed to assess the impact of renal failure on the severity of COVID-19 and identify the risk factors of the fatal outcome in this population. Methods: The analysis included patients from the SARSTer database, a national real-world study evaluating treatment for COVID-19 in 30 Polish centers. Data were completed retrospectively and submitted online. Results: A total of 2322 patients were included in the analysis. Kidney failure was diagnosed in 455 individuals (19.65%), of whom 373 presented moderate stage and 82 patients, including 14 dialysis individuals, presented severe renal failure. Patients with kidney failure were significantly older and demonstrated a more severe course of COVID-19. The age, baseline SpO2, the ordinal scale of 4 and 5, neutrophil and platelet count, estimated glomerular filtration rate, and C-reactive protein concentration as well as malignancy and arterial hypertension were the independent predictors of 28-day mortality in logistic regression analysis. Conclusions: Underlying kidney disease in patients with COVID-19 is among the leading factors associated with a higher risk of severe clinical presentation and increased mortality rate. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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13 pages, 1834 KiB  
Article
HGF, IL-1α, and IL-27 Are Robust Biomarkers in Early Severity Stratification of COVID-19 Patients
by Álvaro Tamayo-Velasco, Pedro Martínez-Paz, María Jesús Peñarrubia-Ponce, Ignacio de la Fuente, Sonia Pérez-González, Itziar Fernández, Carlos Dueñas, Esther Gómez-Sánchez, Mario Lorenzo-López, Estefanía Gómez-Pesquera, María Heredia-Rodríguez, Irene Carnicero-Frutos, María Fe Muñoz-Moreno, David Bernardo, Francisco Javier Álvarez, Eduardo Tamayo and Hugo Gonzalo-Benito
J. Clin. Med. 2021, 10(9), 2017; https://doi.org/10.3390/jcm10092017 - 8 May 2021
Cited by 34 | Viewed by 2682
Abstract
Pneumonia is the leading cause of hospital admission and mortality in coronavirus disease 2019 (COVID-19). We aimed to identify the cytokines responsible for lung damage and mortality. We prospectively recruited 108 COVID-19 patients between March and April 2020 and divided them into four [...] Read more.
Pneumonia is the leading cause of hospital admission and mortality in coronavirus disease 2019 (COVID-19). We aimed to identify the cytokines responsible for lung damage and mortality. We prospectively recruited 108 COVID-19 patients between March and April 2020 and divided them into four groups according to the severity of respiratory symptoms. Twenty-eight healthy volunteers were used for normalization of the results. Multiple cytokines showed statistically significant differences between mild and critical patients. High HGF levels were associated with the critical group (OR = 3.51; p < 0.001; 95%CI = 1.95–6.33). Moreover, high IL-1α (OR = 1.36; p = 0.01; 95%CI = 1.07–1.73) and low IL-27 (OR = 0.58; p < 0.005; 95%CI = 0.39–0.85) greatly increased the risk of ending up in the severe group. This model was especially sensitive in order to predict critical status (AUC = 0.794; specificity = 69.74%; sensitivity = 81.25%). Furthermore, high levels of HGF and IL-1α showed significant results in the survival analysis (p = 0.033 and p = 0.011, respectively). HGF, IL-1α, and IL 27 at hospital admission were strongly associated with severe/critical COVID-19 patients and therefore are excellent predictors of bad prognosis. HGF and IL-1α were also mortality biomarkers. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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14 pages, 760 KiB  
Article
Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6
by Robert Flisiak, Jerzy Jaroszewicz, Magdalena Rogalska, Tadeusz Łapiński, Aleksandra Berkan-Kawińska, Beata Bolewska, Magdalena Tudrujek-Zdunek, Dorota Kozielewicz, Marta Rorat, Piotr Leszczyński, Krzysztof Kłos, Justyna Kowalska, Paweł Pabjan, Anna Piekarska, Iwona Mozer-Lisewska, Krzysztof Tomasiewicz, Małgorzata Pawłowska, Krzysztof Simon, Joanna Polanska and Dorota Zarębska-Michaluk
J. Clin. Med. 2021, 10(8), 1583; https://doi.org/10.3390/jcm10081583 - 9 Apr 2021
Cited by 23 | Viewed by 3780
Abstract
Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, [...] Read more.
Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08–0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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Review

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18 pages, 1206 KiB  
Review
The Use of Tocilizumab in Patients with COVID-19: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Studies
by Alberto Enrico Maraolo, Anna Crispo, Michela Piezzo, Piergiacomo Di Gennaro, Maria Grazia Vitale, Domenico Mallardo, Luigi Ametrano, Egidio Celentano, Arturo Cuomo, Paolo A. Ascierto and Marco Cascella
J. Clin. Med. 2021, 10(21), 4935; https://doi.org/10.3390/jcm10214935 - 25 Oct 2021
Cited by 17 | Viewed by 3106
Abstract
Background: Among the several therapeutic options assessed for the treatment of coronavirus disease 2019 (COVID-19), tocilizumab (TCZ), an antagonist of the interleukine-6 receptor, has emerged as a promising therapeutic choice, especially for the severe form of the disease. Proper synthesis of the available [...] Read more.
Background: Among the several therapeutic options assessed for the treatment of coronavirus disease 2019 (COVID-19), tocilizumab (TCZ), an antagonist of the interleukine-6 receptor, has emerged as a promising therapeutic choice, especially for the severe form of the disease. Proper synthesis of the available randomized clinical trials (RCTs) is needed to inform clinical practice. Methods: A systematic review with a meta-analysis of RCTs investigating the efficacy of TCZ in COVID-19 patients was conducted. PubMed, EMBASE, and the Cochrane COVID-19 Study Register were searched up until 30 April 2021. Results: The database search yielded 2885 records; 11 studies were considered eligible for full-text review, and nine met the inclusion criteria. Overall, 3358 patients composed the TCZ arm, and 3131 the comparator group. The main outcome was all-cause mortality at 28–30 days. Subgroup analyses according to trials’ and patients’ features were performed. A trial sequential analysis (TSA) was also carried out to minimize type I and type II errors. According to the fixed-effect model approach, TCZ was associated with a better survival odds ratio (OR) (0.84; 95% confidence interval (CI): 0.75–0.94; I2: 24% (low heterogeneity)). The result was consistent in the subgroup of severe disease (OR: 0.83; 95% CI: 0.74–0.93; I2: 53% (moderate heterogeneity)). However, the TSA illustrated that the required information size was not met unless the study that was the major source of heterogeneity was omitted. Conclusions: TCZ may represent an important weapon against severe COVID-19. Further studies are needed to consolidate this finding. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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Other

16 pages, 1996 KiB  
Systematic Review
Artificial Intelligence for COVID-19 Detection in Medical Imaging—Diagnostic Measures and Wasting—A Systematic Umbrella Review
by Paweł Jemioło, Dawid Storman and Patryk Orzechowski
J. Clin. Med. 2022, 11(7), 2054; https://doi.org/10.3390/jcm11072054 - 6 Apr 2022
Cited by 7 | Viewed by 2016
Abstract
The COVID-19 pandemic has sparked a barrage of primary research and reviews. We investigated the publishing process, time and resource wasting, and assessed the methodological quality of the reviews on artificial intelligence techniques to diagnose COVID-19 in medical images. We searched nine databases [...] Read more.
The COVID-19 pandemic has sparked a barrage of primary research and reviews. We investigated the publishing process, time and resource wasting, and assessed the methodological quality of the reviews on artificial intelligence techniques to diagnose COVID-19 in medical images. We searched nine databases from inception until 1 September 2020. Two independent reviewers did all steps of identification, extraction, and methodological credibility assessment of records. Out of 725 records, 22 reviews analysing 165 primary studies met the inclusion criteria. This review covers 174,277 participants in total, including 19,170 diagnosed with COVID-19. The methodological credibility of all eligible studies was rated as critically low: 95% of papers had significant flaws in reporting quality. On average, 7.24 (range: 0–45) new papers were included in each subsequent review, and 14% of studies did not include any new paper into consideration. Almost three-quarters of the studies included less than 10% of available studies. More than half of the reviews did not comment on the previously published reviews at all. Much wasting time and resources could be avoided if referring to previous reviews and following methodological guidelines. Such information chaos is alarming. It is high time to draw conclusions from what we experienced and prepare for future pandemics. Full article
(This article belongs to the Special Issue Updates in Management of SARS-CoV-2 Infection)
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