As the coronavirus disease-2019 (COVID-19) pandemic continues, one major point of uncertainty is the impact this novel pathogen will have during the upcoming 2020 to 2021 flu season. While the influenza virus is a known contributor to human morbidity and mortality, the question of how a coinfection between COVID-19 and influenza might manifest is of utmost concern. The aim of this study was to review the limited cases of COVID-19/influenza coinfection currently available in the literature, along with cases in the community of El Paso, TX, to determine whether any patterns of clinical presentation and morbidity emerged. An international review of the literature was conducted. Six published articles describing COVID-19/influenza coinfection were identified, with a total of 13 patients described therein. Three additional patients were identified from the El Paso, TX data. The most common presenting symptoms were fever and cough. The most common laboratory findings were elevated C-reactive protein and lymphocytopenia. Thirteen patients presented with viral pneumonia findings on CT, and nine had findings of ground-glass opacity. Finally, complications were reported in six patients, with most common complication being acute respiratory distress syndrome. The results of the review indicate that, due to the similarity in presentation between COVID-19 and influenza, further analysis will be required to understand the effects of coinfection on morbidity and mortality. However, the limited number of coinfection cases in the literature indicates that the implementation of COVID-19 control measures may continue to play a role in limiting the spread of these human respiratory pathogens.
Background
Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection appears related to cytokine release syndrome (CRS) that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin‐6 (IL‐6) trends and MV in SARS‐CoV‐2 patients.
Methods
In this longitudinal observational study, 112 patients were evaluated from 2/1/2020 ‐ 5/31/2020. TCZ was administered followed by methylprednisolone to patients with > 3L oxygen (O2) requirement and pneumonia severity index (PSI) score ≤ 130 with CT scan changes. IL‐6, C‐reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D‐dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤ 0.05.
Results
80/112 SARS‐CoV‐2‐positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL‐6 levels pre‐administration of TCZ was 342.50 (78.25 ‐ 666.25) pg/mL compared to post‐administration on day 3 (563; 162 ‐ 783) pg/mL (
P
< 0.00001). On day 6, the median dropped to 545 (333.50 ‐ 678.50) pg/mL compared to day 3 (
P
= 0.709). CRP, ferritin, LDH, and D‐dimer levels were reduced following TCZ therapy.
Conclusions
Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D‐dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL‐6 levels may be helpful as a prognostic tool.
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Background
Recent literature suggests that approximately 5‐18% of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may progress rapidly to a severe form of the illness and subsequent death. We examined the relationship between sociodemographic, clinical, and laboratory findings with mortality among patients.
Methods
In this study, 112 patients were evaluated from February‐May 2020 and 80 patients met the inclusion criteria. Tocilizumab (TCZ) was administered, followed by methylprednisolone to patients with pneumonia severity index (PSI) score ≤ 130 and CT scan changes. Demographic data and clinical outcomes were collected. Laboratory biomarkers were monitored during hospitalization. Statistical analyses were performed with significance p≤ 0.05.
Results
Eighty (80) patients: 45 males (56.25%) and 35 females (43.75%) met the study inclusion criteria. Seven patients (8.75%) were deceased. An increase in mortality outcome was statistically significantly associated with higher average levels of IL‐6 with
P
value (0.050), and D‐dimer with
P
value (0.024). Bivariate logistics regression demonstrated a significant increased odds for mortality for patients with bacterial lung infections (OR: 10.83, 95% CI: 2.05 – 57.40,
P=0.005
) and multi‐organ damage (OR: 103.50, 95% CI: 9.92 – 1079.55,
P=0.001
). Multivariate logistics regression showed a statistically significant association for multi‐organ damage (AOR: 94.17, 95% CI: 7.39 ‐ 1200.78,
P=0.001
).
Conclusions
We identified three main predictors for high mortality. These include interleukin‐6 (IL‐6), D‐dimer, and multi‐organ damage. The latter was the highest potential risk for in‐hospital deaths. This warrants aggressive health measures for early recognition of the problem and initiation of treatment to reverse injuries.
This article is protected by copyright. All rights reserved.
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