Fever Patterns, Cytokine Profiles, and Outcomes in COVID-19

Ng, Deborah Hee Ling; Choy, Chiaw Yee; Chan, Yi‐Hao; Young, Barnaby Edward; Fong, Siew‐Wai; Ng, Lisa F. P.; Rénia, Laurent; Lye, David Chien; Chia, Po Ying; Ping, Angela Chow Li; Ang, Brenda; Wong, Chen Seong; Lee, Cheng Chuan; Ding, Ying; Tay, Jun-Yang; Marimuthu, Kalisvar; Lee, Lawrence S.; Leo, Yee‐Sin; L, Li; Li, Ang; Cui, Lin; Chen, Mark; Chan, Mónica; Sadasiv, Mucheli Sharavan; Ng, Oon-Tek; Lee, Pei Hua; Lim, Poh Lian; Sadarangani, Sapna; Vasoo, Shawn; Sutjipto, Stephanie; Yeo, Tsin Wen; Mak, Tze Minn

doi:10.1093/ofid/ofaa375

Cited by 36 publications

(26 citation statements)

References 28 publications

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“…The fourth loop is the hypercoagulatory loop, which is represented by platelet count in this model. A meta-analysis of 7,613 Covid-19 patients revealed that patients with severe disease had a lower platelet count than those with non-severe disease (Jiang et al, 2020), which is in line with our data. However, not all studies have found platelet counts to be a predictor of Covid-19 mortality (Amgalan and Othman, 2020).…”

Section: Discussionsupporting

confidence: 91%

Development and external validation of a logistic regression derived formula based on repeated routine hematological measurements predicting survival of hospitalized Covid-19 patients

Heber

Pereyra

Schrottmaier

et al. 2020

Preprint

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BackgroundThe Covid-19 pandemic has become a global public health crisis and providing optimal patient care while preventing a collapse of the health care system is a principal objective worldwide.ObjectiveTo develop and validate a prognostic model based on routine hematological parameters to predict uncomplicated disease progression to support the decision for an earlier discharge.DesignDevelopment and refinement of a multivariable logistic regression model with subsequent external validation. The time course of several hematological variables until four days after admission were used as predictors. Variables were first selected based on subject matter knowledge; their number was further reduced using likelihood ratio-based backward elimination in random bootstrap samples.SettingModel development based on three Austrian hospitals, validation cohorts from two Austrian and one Swedish hospital.ParticipantsModel development based on 363 survivors and 78 non-survivors of Covid-19 hospitalized in Austria. External validation based on 492 survivors and 61 non-survivors hospitalized in Austria and Sweden.OutcomeIn-hospital death.Main ResultsThe final model includes age, fever upon admission, parameters derived from C-reactive protein (CRP) concentration, platelet count and creatinine concentration, approximating their baseline values (CRP, creatinine) and change over time (CRP, platelet count). In Austrian validation cohorts both discrimination and calibration of this model were good, with c indices of 0.93 (95% CI 0.90 - 0.96) in a cohort from Vienna and 0.93 (0.88 - 0.98) in one from Linz. The model performance seems independent of how long symptoms persisted before admission. In a small Swedish validation cohort, the model performance was poorer (p = 0.008) compared with Austrian cohorts with a c index of 0.77 (0.67 - 0.88), potentially due to substantial differences in patient demographics and clinical routine.ConclusionsHere we describe a formula, requiring only variables routinely acquired in hospitals, which allows to estimate death probabilities of hospitalized patients with Covid-19. The model could be used as a decision support for earlier discharge of low-risk patients to reduce the burden on the health care system. The model could further be used to monitor whether patients should be admitted to hospital in countries with health care systems with emphasis on outpatient care (e.g. Sweden).

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Section: Discussionsupporting

confidence: 91%

Development and external validation of a logistic regression derived formula based on repeated routine hematological measurements predicting survival of hospitalized Covid-19 patients

Heber

Pereyra

Schrottmaier

et al. 2020

Preprint

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“…COVID-19 patients had higher mRS scores (i.e., a higher level of disability) than individuals without COVID-19 at discharge, even though both groups shared similar baseline mRS scores ( Pilotto et al, 2020 ). Fever has been recognized as the most common symptom of hospitalized COVID-19 patients ( Benussi et al, 2020 ; Ng et al, 2020 ; Qiu et al, 2020 ; Wang et al, 2020 ). Oxygen therapy has been widely taken for COVID-19 patients ( Barrett et al, 2020 ; Hassan et al, 2020 ; Kayem et al, 2020 ; Liu et al, 2020 ; Paganini et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Alterations of frontal-temporal gray matter volume associate with clinical measures of older adults with COVID-19

Duan

Premi

Padovani

et al. 2021

Neurobiology of Stress

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COVID-19, the infectious disease caused by the most recently discovered severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global pandemic. It dramatically affects people's health and daily life. Neurological complications are increasingly documented for patients with COVID-19. However, the effect of COVID-19 on the brain is less studied, and existing quantitative neuroimaging analyses of COVID-19 were mainly based on the univariate voxel-based morphometry analysis (VBM) that requires corrections for a large number of tests for statistical significance, multivariate approaches that can reduce the number of tests to be corrected have not been applied to study COVID-19 effect on the brain yet. In this study, we leveraged source-based morphometry (SBM) analysis, a multivariate extension of VBM, to identify changes derived from computed tomography scans in covarying gray matter volume patterns underlying COVID-19 in 120 neurological patients (including 58 cases with COVID-19 and 62 patients without COVID-19 matched for age, gender and diseases). SBM identified that lower gray matter volume (GMV) in superior/medial/middle frontal gyri was significantly associated with a higher level of disability (modified Rankin Scale) at both discharge and six months follow-up phases even when controlling for cerebrovascular diseases. GMV in superior/medial/middle frontal gyri was also significantly reduced in patients receiving oxygen therapy compared to patients not receiving oxygen therapy. Patients with fever presented significant GMV reduction in inferior/middle temporal gyri and fusiform gyrus compared to patients without fever. Patients with agitation showed GMV reduction in superior/medial/middle frontal gyri compared to patients without agitation. Patients with COVID-19 showed no significant GMV differences from patients without COVID-19 in any brain region. Results suggest that COVID-19 may affect the frontal-temporal network in a secondary manner through fever or lack of oxygen.

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“…Cases with prolonged fever were also more likely to require ICU admission (11.1% vs 0.9%; p = .05) (13).…”

Section: Discussionmentioning

confidence: 97%

Remdesivir for the treatment of COVID-19 disease: A retrospective comparative study of patients treated with and without Remdesivir

Madan

Patel

Sharan

et al. 2021

Preprint

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Background: Remdesivir (RDV) in coronavirus disease 2019 (COVID-19) has been found to be beneficial in patients with severe disease; however, its role in mild-moderate disease and its optimal timing need to be identified. Objective: To assess the course of illness and final outcome in patients who received RDV at various stages of illness, and compare it to the non-RDV group. Methods: This is a retrospective data analysis of 1262 COVID-19 patients hospitalized from May5, 2020 to August 31, 2020. The primary outcomes were progression to mechanical ventilation (MV) or death. Kaplan Meier survival analysis and log rank test were used for evaluating primary outcomes. Results: 398 patients comprised the RDV group and 260 patients comprised the non-RDV group. 2/3rd of patients were above 50 years of age in both the groups and 3/4th patients were male. Mortality rate was 5.8% in RDV group (10.4% in non-RDV group). Mortality rate was 3.6%, 4% and 16.7% when RDV was started within 5 days, 5 to 10 days and after 10 days of symptom onset respectively. Fewer patients in RDV group progressed to MV (4.0% v/s 8.2%). Earlier discharge occurred in RDV group. Use of supplemental oxygen was observed in 44.7% patients in RDV group (54.2% in non-RDV group). No significant adverse events were observed with RDV. Survival analysis showed that probability of event (death) was significant for patients with hypertension (HT) and/or diabetes mellitus (DM) in RDV group. Conclusion: Early initiation of RDV is associated with shorter hospital stay, lower mortality as well as reduced need for supplemental oxygen and mechanical ventilation.

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Fever Patterns, Cytokine Profiles, and Outcomes in COVID-19

Cited by 36 publications

References 28 publications

Development and external validation of a logistic regression derived formula based on repeated routine hematological measurements predicting survival of hospitalized Covid-19 patients

Development and external validation of a logistic regression derived formula based on repeated routine hematological measurements predicting survival of hospitalized Covid-19 patients

Alterations of frontal-temporal gray matter volume associate with clinical measures of older adults with COVID-19

Remdesivir for the treatment of COVID-19 disease: A retrospective comparative study of patients treated with and without Remdesivir

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