Background: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the C-reactive protein (CRP) and D-Dimer levels for predicting in-hospital outcomes in COVID-19. Methods: A retrospective cohort study was performed to determine the association of CRP and D-Dimer with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. On presentation, the unadjusted odds for the need of IMV (OR 2.5, 95% CI 1.3-4.8, p = 0.012) and upgrade to ICU (OR 3.2, 95% CI 1.6-6.5, p = 0.002) were significantly higher for patients with CRP (>101 mg/dl). Similarly, the unadjusted odds of in-hospital mortality were significantly higher in patients with high CRP (>101 mg/dl) and high D-Dimer (>501 ng/ml), compared to corresponding low CRP (<100 mg/dl) and low D-Dimer (<500 ng/ml) groups on day-7 (OR 3.5, 95% CI 1.2-10.5, p = 0.03 and OR 10.0, 95% CI 1.2-77.9, p = 0.02), respectively. Both high D-Dimer (>501 ng/ml) and high CRP (>101 mg/dl) were associated with increased need for upgrade to the ICU and higher requirement for IMV on day-7 of hospitalization. A multivariate regression model mirrored the overall unadjusted trends except that adjusted odds for IMV were high in the high CRP group on day 7 (aOR 2.5, 95% CI 1.05-6.0, p = 0.04). Conclusion: CRP value greater than 100 mg/dL and D-dimer levels higher than 500 ng/ml during hospitalization might predict higher odds of in-hospital mortality. Higher levels at presentation might indicate impending clinical deterioration and the need for IMV.

Introduction The comparative efficacy and safety of valve‐in‐valve transcatheter aortic valve replacement (ViV‐TAVR) and redo‐surgical AVR (redo‐SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown. Method Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV‐TAVR = 4083 and redo‐SAVR = 4243) were included. Results The mean age of patients undergoing ViV‐TAVR was older, 76 years compared to 73 years for those undergoing SAVR. The baseline characteristics for patients in ViV‐TAVR vs. redo‐SAVR groups were comparable. At 30‐days, the odds of all‐cause mortality (OR 0.45, 95% CI 0.30–0.68, p = .0002), cardiovascular mortality (OR 0.44, 95% CI 0.26–0.73, p = .001) and major bleeding (OR 0.29, 95% CI 0.15–0.54, p = .0001) were significantly lower in patients undergoing ViV‐TAVR compared to redo‐SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52–1.58, p = .74), myocardial infarction (OR 0.92, 95% CI 0.44–1.92, p = .83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27–1.07, p = .08) between the two groups. During mid to long‐term follow up (6‐months to 5‐years), there were no significant differences between ViV‐TAVR and redo‐SAVR for all‐cause mortality, cardiovascular mortality and stroke. ViV‐TAVR was, however, associated with higher risk of prosthesis‐patient mismatch and greater transvalvular pressure gradient post‐implantation. Conclusion ViV‐TAVR compared to redo‐SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long‐term follow up, the outcomes were similar for both groups.

No abstract