CO measured by COstatus was found to be equivalent and hence interchangeable with PiCCO in this study population. COstatus blood volumes were found to be within the expected physiological range whilst PiCCO blood volumes were significantly higher, which was also observed in other studies. Future studies using 3D echo/MRI are required to validate these blood volumes.

Background Vitamin D deficiency has been associated with an increased risk of respiratory infections. Objectives The study aimed to evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in patients admitted to the intensive care unit (ICU) as a predictor of coronavirus disease 2019 (COVID-19) mortality. Methods A single-center retrospective observational study was conducted. Forty adult patients (50% men) with confirmed COVID-19 who were admitted to the ICU were enrolled. The primary endpoint was mortality at day 60. Serum 25(OH)D concentration was measured on the day of admission to the ICU. We used the Mann–Whitney test, Fisher's exact test, Kaplan–Meier analysis, and receiver operator characteristic (ROC) analysis to assess serum 25(OH)D concentration as a predictor of COVID-19 mortality. Results All 40 patients had a low median (IQR) serum 25(OH)D concentration at admission [12 (9–15) ng/mL]. The median (IQR) serum 25(OH)D concentration was greater in survivors [13.3 (10.0–17.1) ng/mL, n = 22] than in nonsurvivors [9.6 (7.9–14.2) ng/mL; n = 18], P = 0.044. The area under the ROC curve was 0.69 (95% CI: 0.52, 0.86; P = 0.044). The 60-d mortality rate of those with serum 25(OH)D concentrations ≤9.9 ng/mL (n = 14, 71%) tended to be greater than that of those with concentrations >9.9 ng/mL (n = 26, 31%) (P = 0.065), and they had a 5.6-fold higher risk of death (OR: 5.63; 95% CI: 1.35, 23.45; P = 0.018). Conclusions The ICU patients had a low serum 25(OH)D concentration. Serum 25(OH)D concentrations ≤9.9 ng/mL on admission can be used to predict in-hospital mortality in patients with COVID-19. This trial was registered at clinicaltrials.gov as NCT04450017.

Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, is accompanied by a dysregulated immune response. In particular, NK cells, involved in the antiviral response, are affected by the infection. This study aimed to investigate circulating NK cells with a focus on their activation, depletion, changes in the surface expression of key receptors, and functional activity during COVID-19, among intensive care unit (ICU) patients, moderately ill patients, and convalescents (CCP). Our data confirmed that NK cell activation in patients with COVID-19 is accompanied by changes in circulating cytokines. The progression of COVID-19 was associated with a coordinated decrease in the proportion of NKG2D+ and CD16+ NK cells, and an increase in PD-1, which indicated their exhaustion. A higher content of NKG2D+ NK cells distinguished surviving patients from non-survivors in the ICU group. NK cell exhaustion in ICU patients was additionally confirmed by a strong negative correlation of PD-1 and natural cytotoxicity levels. In moderately ill patients and convalescents, correlations were found between the levels of CD57, NKG2C, and NKp30, which may indicate the formation of adaptive NK cells. A reduced NKp30 level was observed in patients with a lethal outcome. Altogether, the phenotypic changes in circulating NK cells of COVID-19 patients suggest that the intense activation of NK cells during SARS-CoV-2 infection, most likely induced by cytokines, is accompanied by NK cell exhaustion, the extent of which may be critical for the disease outcome.

Vitamin D as an immunomodulator has not been studied in patients with severe COVID-19. This study aimed to estimate the efficacy of vitamin D3 supplementation on cellular immunity and inflammatory markers in patients with COVID-19 admitted to the intensive care unit (ICU). A single-center, double-blind, randomized, placebo-controlled pilot trial was conducted (N = 110). Patients were randomly assigned to receive a weekly oral dose of 60,000 IU of vitamin D3 followed by daily maintenance doses of 5000 IU (n = 55) or placebo (n = 55). Primary outcomes were lymphocyte counts, natural killer (NK) and natural killer T (NKT) cell counts, neutrophil-to-lymphocyte ratio (NLR), and serum levels of inflammatory markers on 7th day of treatment. On day 7, patients in the vitamin D3 group displayed significantly higher NK and NKT cell counts and NLR than those in the placebo group did. The mortality rate (37% vs 50%, P = 0.16), need for mechanical ventilation (63% vs 69%, P = 0.58), incidence of nosocomial infection (60% vs 41%, P = 0.05) did not significantly differ between groups. Vitamin D3 supplementation, compared with placebo, significantly increased lymphocyte counts, but did not translate into reduced mortality in ICU.Trial Registration: ClinicalTrials.gov Identifier: NCT05092698.

The article presents a comparative retrospective analysis of clinical, laboratory data and outcomes in 39 patients with severe COVID-19 complicated by acute respiratory distress syndrome, who received high-flow oxygen therapy. Of which, 19 patients additionally received 75 mg of inhaled surfactant BL twice daily for 5 days using a nebulizer. As a result, mortality rate in the group of patients receiving surfactant was 10.5%, while in the standard therapy group — 50%; the number of patients transferred to the mechanical ventilation was 21% and 70%, respectively. As the patients receiving the surfactant were injected with COVID-19 hyperimmune convalescent plasma and monoclonal antibodies to interleukin-6 receptors more often than those from the control group, we recalculated the results regardless of these patients. However, a significant difference between the mechanical ventilation rate (2.5 times less often in the surfactant group) and mortality rate (3.5 times less in the surfactant group) was observed. The duration of hospitalization and stay at the intensive care unit was not significantly different between patients with and without surfactant treatment. Inhalation therapy with surfactant BL was well tolerated even by patients with chronic obstructive pulmonary disease. In no case did therapy have to be stopped due to side effects, the most common of which was coughing during inhalation. This retrospective analysis shows that the prescription of an inhaled surfactant prior to transferring patients to mechanical ventilation can prevent the progression of respiratory failure, put down mechanical ventilation, and improve survival.

Background. Providing an efficient care to the patients of the most severely affected category ICU patients has become one of the serious problems appearing in the COVID-19 pandemics. A typical patients clinical portrait in ICUs of COVID centers is very similar in different countries, however, the key to improve the treatment results for critically ill patients has not yet been found. Currently, 160 patients have been treated in the ICU of the FRCC of the FMBA of Russia. To May 16, 2020, the lethality in the ICU was 48.9% by the closed cases, the lethality among the patients on ventilation was 57.9%. The aim of the study is to identify predictors of the severe pneumonia caused by the SARS-CoV-2 virus, and to describe the clinical characteristics of patients admitted to an intensive care unit of the COVID-center of the Federal Research Clinical Center of FMBA of Russia. Methods. In this report, we describe the clinical, laboratory and instrumental data of 70 patients admitted to the ICU, and discuss the found predictors of the severe COVID-19 pneumonia course. Results. The following factors have been determined which contribute to the development of the severe course of the disease and to the risk of the unfavorable outcome: male gender, age older than 70.5 years, initial lymphocytopenia of lower than 0.98109/l, neutrophil to lymphocyte ratio of higher than 7.75, D-dimer level of higher than 0.85 g/ml, IL-6 of higher than 184.7 pg/ml, procalcitonin of higher than 0.22 ng/ml, hyperglycemia of higher than 9 mmol/l, signs of myocardial damage (high-sensitive troponin Т of higher than 22 pg/ml, echocardiography data), signs of the presence of a secondary bacterial infection and a severe vitamin D deficiency (lower than 9.9 ng/ml). The pathophysiological basics for the contribution of each factor to the severe course of the disease are provided. Conclusions. Clinical features of the patients change in course of pandemia. These influenced by changes in treatment approaches and new discoveries in disease pathophysiology. Above mentioned predictors of severe course of disease is partly modifiable and we are able to influence them and perhaps achieve better results in treatment of severe patients with COVID-19

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