Evaluating the effect of convalescent plasma (CP) on some cytokine storm indices in severe COVID-19 patients. Totally, 62 patients were randomly assigned into two groups for this clinical trial. Patients in the intervention group received one unit (500 mL) plasma on the admission day plus standard drugs while the controls merely received standard treatments. Eventually, primary and secondary outcomes were evaluated. In the CP group, compared with controls, the mean levels of lymphocytes and IL-10 significantly increased while the levels of IL-6, TNF-α, and IFN-γ decreased ( p < 0.05). The length of in-hospital stay, and mortality rate did not significantly reduce in the CP group compared with controls ( p > 0.05) while WHO severity scores remarkably improved ( p = 0.01), despite the higher frequency of underlying diseases among the CP group (66.7%) vs. controls (33.3%). Although CP has a remarkable immunomodulatory and antiviral potential to improve the cytokine storm and disease severity in COVID-19 patients, it did not considerably affect the mortality rate. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-021-02734-8.

Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

Aim: The aim of this study is the predictive validation of red cell distribution width (RDW) in COVID-19 patients. Method: In total, 331 COVID-19 patients were classified as ‘severe’ and ‘nonsevere’ groups based on the WHO standard criteria. The levels of RDW standard deviation (SD) were evaluated as both continuous and categorical variables. Multivariate statistical analyses were used. Results: RDW-SD ≤43 and ≤47 fl thresholds showed high specificity (90.1–91.4%) for diagnosing nonsevere illness and no risk of death. RDW-SD >47 indicated severe illness and a high mortality risk while 43<RDW-SD≤47 indicated severe illness with low risk of death. Conclusion: RDW-SD levels may be a potent independent predictor of the infection severity and mortality probability in COVID-19 patients.

Background: Patients with COVID-19 have shown a wide variety of symptoms and mortality rates in different communities. Objectives: This study aimed to compare the epidemiological, clinical, and paraclinical features of patients with COVID-19 who have overcome the disease with patients who died. Methods: All hospitalized patients admitted to Special Corona Hospital who had a positive real-time PCR test for SARS-CoV-2 from January to March 2020 were included in the study. Clinical characteristics, date of disease onset, hospital admission date, and the severity of COVID-19 were obtained from each patient's medical records. Independent sample t-test was used to compare continuous variables between the groups of the discharged and expired patients. The independence between categorical variables and the outcome was assessed by Chi-square or Fisher's exact tests. Results: The order of essential variables for admission as the starting time are pH, WBC count, loss of consciousness, neutrophil count, base excess (BE), HCO3, age, BUN, O2 saturation, and lymphocyte count. Conclusions: In the current study, the mortality rate of COVID-19 was 30% and was significantly associated with critical disease intensity, fever, chills, loss of consciousness, ischemic heart disease (IHD) history, Parkinson's disease, invasive O2 therapy, and troponin level.

Context: Since December 2019, the new coronavirus (COVID-19) has been identified as one of the significant challenges in the health systems of countries. Recently, the development and equipping of hospitals and medical centers have been considered as a priority, providing a variety of advanced services in the areas of diagnostic, therapeutic, and supportive services to patients. The present review aimed to shed light on the importance and crucial role of knowledge in the field of emergency medicine during the COVID-19 pandemic and to compare the local and international guidelines. Finally, in addition to the workplace and emergency practitioners’ acts, alongside the especial need to frequently disinfect with appropriate antiseptic materials, negative pressure ventilation should also be in the triage and emergency rooms. Besides, personal protection requirements should be sufficiently accessible, and emergency physicians should be trained to use them properly while adhering to safety principles. It is also recommended to use a cap, gown, appropriate mask, shield, and gloves during treatment, diagnostic and supportive measures, and practice frequent hand washing with antiseptic materials like alcohol solutions, as it reduces the risk of infection transmission. Moreover, it is imperative that nurses and physicians working in emergencies follow all safety principles at the end of the shift before entering their homes. Conclusions: Ultimately, the final goal is to reduce the virus transmission through early detection, supportive, diagnostic, and therapeutic actions, and appropriate follow-up.