Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia

Torres, Antoni; Ceccato, Adrián; Ferrer, Miquel; Gabarrús, Albert; Sibila, Oriol; Méndez, Raúl; Menéndez, Rosário; Bermejo-Martín, Jesús F.; Niederman, Michael S.

doi:10.3390/jcm8091461

Cited by 9 publications

(8 citation statements)

References 9 publications

(10 reference statements)

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“…The most plausible explanation for the different inflammatory marker trends is the use of evidence-based immunomodulatory therapies in the second wave. Corticosteroid use has been shown to result in a reduction in CRP levels in community-acquired pneumonia [ 21 ] and IL-6 and IL-1 receptor antagonists have been also shown to drastically alter the CRP response [ 22 ]. Our finding that CRP levels were significantly reduced after the day of ICU admission, when most patients had tocilizumab, sarilumab, or anakinra administered, confirms this previous observation [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in Inflammatory Marker Kinetics between the First and Second Wave of COVID-19 Patients Admitted to the ICU: A Retrospective, Single-Center Study

Szakmány

Tuckwell

Harte

et al. 2021

JCM

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Background: We sought to determine if there was a difference in the longitudinal inflammatory response measured by white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and ferritin levels between the first and the second COVID-19 wave of ICU patients. Methods: In a single-center retrospective observational study, ICU patients were enrolled during the first and second waves of the COVID-19 pandemic. Data were collected on patient demographics, comorbidities, laboratory results, management strategies, and complications during the ICU stay. The inflammatory response was evaluated using WBC count, CRP, PCT, and Ferritin levels on the day of admission until Day 28, respectively. Organ dysfunction was measured by the SOFA score. Results: 65 patients were admitted during the first and 113 patients during the second wave. WBC and ferritin levels were higher in the second wave. CRP and PCT showed markedly different longitudinal kinetics up until day 28 of ICU stay between the first and second wave, with significantly lower levels in the second wave. Steroid and immunomodulatory therapy use was significantly greater in the second wave. Mortality was similar in both waves. Conclusions: We found that there was a significantly reduced inflammatory response in the second wave, which is likely to be attributable to the more widespread use of immunomodulatory therapies.

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Section: Discussionmentioning

confidence: 99%

Differences in Inflammatory Marker Kinetics between the First and Second Wave of COVID-19 Patients Admitted to the ICU: A Retrospective, Single-Center Study

Szakmány

Tuckwell

Harte

et al. 2021

JCM

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“…Other reports showed that the degree of CD4 T lymphopenia is higher in patients with severe COVID-19 disease than in mild cases, and is associated with disease severity [7][8][9] . The CD4 T lymphocyte count was significantly lower in elderly patients than in middle-aged and young patients, which might be related to the virus attacking the target organ at the early stage, whereas in the later period, it starts to attack the body's immune system and causes to T lymphocyte apoptosis or bone marrow suppression, which is more obvious in middle-aged and elderly patients [10][11][12] .…”

Section: Discussionmentioning

confidence: 93%

Quantifying the clinical characteristics of coronavirus disease 2019 (COVID-19) of different age segments based on 60 patients

Gao

Xia

Zhiliang

et al. 2020

Preprint

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Background: To observe the clinical characteristics of the novel coronavirus pneumonia of different age segments infected with novel coronavirus disease 2019 (COVID-19), to increase awareness of the clinical features of COVID-19, and improve diagnosis and treatment. Methods: By 15 February 2020, 60 patients diagnosed with COVID-19 had been admitted our hospital. We prospectively analyzed the clinical features of different age segments infected with COVID-19, including epidemiological, clinical, laboratory, and radiological characteristics, and treatment, clinical outcomes, and prognosis of this part of patients. Results: We included 29 male and 31 female (median age = 46.18 years old (18–97). Fifty-five (91.7%) patients had a clear epidemiological contact history. The average incubation period is 7.92 days. The most common clinical manifestations are fever (85%) and cough (75). Peripheral white blood cell counts were mostly normal at admission, 7 days, and 14 days, with no difference in patients of different ages. The lymphocyte count was in the normal range on admission, but decreased after 7 days of disease treatment, especially in patients > 65 years old; the lymphocyte count increased again after 14 days. The lymphocyte count in >65-year-old patients was less than that in the <40 and 40–65 years old groups after 7 and 14 days, respectively. At admission, the CD4 T lymphocyte count was within the normal; however, after 14 days the CD4 T lymphocyte count was 723.46 ± 243.82/ml, 640.00 ± 242.30/ml, and 399.88 ± 256.16/ml in the three age segments, respectively. The > 65 years old group had higher levels of lactate dehydrogenase (269.83 ± 73.36 vs. 208.52 ± 35.67 and 243.83 ± 76.66) after 14 days. Imaging revealed more lesions in the 40–65 and > 65 years old groups. The days after the nucleic acid detection turned negative in the three age groups were : 9.19 ± 3.93 (<40), 10.04 ± 4.10 (40–65), and 13.57 ± 2.76 (>65). Conclusion: Patients with COVID-19 pneumonia generally had an epidemiological history. Older patients showed more extensive lesions upon admission, more severe illness, slower recovery of immune function, the longer viral nucleic acid persistence.

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“…As a result, this difference in average CRP during these two waves may not reflect any patterns and making any conclusion about it would be factually and statistically incorrect. The role of dexamethasone administration in reducing CRP response also needs to be explored 25–27…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study

Baslas

Condurache

Jayal

et al. 2022

Postgraduate Medical Journal

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BackgroundVarious complications have been reported in patients with COVID-19 including pneumomediastinum.MethodsThe primary objective of the study was to determine the incidence of pneumomediastinum in COVID-19 positive patients who underwent CT pulmonary angiography (CTPA). The secondary objectives were to analyse if the incidence of pneumomediastinum changed between March and May 2020 (peak of the first wave in the UK) and January 2021 (peak of the second wave in the UK) and to determine the mortality rate in patients with pneumomediastinum. We undertook an observational, retrospective, single-centre, cohort study of patients with COVID-19 admitted to Northwick Park Hospital.Results74 patients in the first wave and 220 patients in the second wave met the study criteria. Two patients during the first wave and eleven patients during the second wave developed pneumomediastinum.ConclusionsThe incidence of pneumomediastinum changed from 2.7% during the first wave to 5% during the second wave and this change was not statistically significant (p value 0.4057). The difference in mortality rates of patients with pneumomediastinum in both waves of COVID-19 (69.23%) versus patients without pneumomediastinum in both waves of COVID-19 (25.62%) was statistically significant (p value 0.0005). Many patients with pneumomediastinum were ventilated, which could be a confounding factor. When controlling for ventilation, there was no statistically significant difference in the mortality rates of ventilated patients with pneumomediastinum (81.81%) versus ventilated patients without pneumomediastinum (59.30%) (p value 0.14).

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Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia

Cited by 9 publications

References 9 publications

Differences in Inflammatory Marker Kinetics between the First and Second Wave of COVID-19 Patients Admitted to the ICU: A Retrospective, Single-Center Study

Differences in Inflammatory Marker Kinetics between the First and Second Wave of COVID-19 Patients Admitted to the ICU: A Retrospective, Single-Center Study

Quantifying the clinical characteristics of coronavirus disease 2019 (COVID-19) of different age segments based on 60 patients

Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study

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