Ground-glass opacity on emergency department chest X-ray: a risk factor for in-hospital mortality and organ failure in elderly admitted for COVID-19

Roig-Marín, Noel; Roig-Rico, Pablo

doi:10.1080/00325481.2021.2021741

Cited by 11 publications

(10 citation statements)

References 27 publications

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“…'Ground-glass' opacities in COVID and long COVID One of the early hallmarks of acute COVID-19 was the observation of extensive, diffuse opacities in highresolution computed tomography (HRCT) scans of the lungs of patients, consistent with the breathing difficulties widely observed. These opacities resembled ground glass [126], and indeed are commonly referred to as 'ground-glass opacities' (GGO) [127][128][129][130][131][132]. They are largely formed of fibrin, though we are not aware that anyone has yet stained them for amyloid structures (which is what we believe they must be, and there is ample precedent for this in other diseases (e.g.…”

Section: Amyloid Fibrin Microclots (Fibrinaloids) In Covid-19 and Lon...mentioning

confidence: 93%

A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications

Kell

Laubscher

Pretorius

2022

Biochemical Journal

183

212

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Post-acute sequelae of COVID (PASC), usually referred to as ‘Long COVID’ (a phenotype of COVID-19), is a relatively frequent consequence of SARS-CoV-2 infection, in which symptoms such as breathlessness, fatigue, ‘brain fog’, tissue damage, inflammation, and coagulopathies (dysfunctions of the blood coagulation system) persist long after the initial infection. It bears similarities to other post-viral syndromes, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Many regulatory health bodies still do not recognize this syndrome as a separate disease entity, and refer to it under the broad terminology of ‘COVID’, although its demographics are quite different from those of acute COVID-19. A few years ago, we discovered that fibrinogen in blood can clot into an anomalous ‘amyloid’ form of fibrin that (like other β-rich amyloids and prions) is relatively resistant to proteolysis (fibrinolysis). The result, as is strongly manifested in platelet-poor plasma (PPP) of individuals with Long COVID, is extensive fibrin amyloid microclots that can persist, can entrap other proteins, and that may lead to the production of various autoantibodies. These microclots are more-or-less easily measured in PPP with the stain thioflavin T and a simple fluorescence microscope. Although the symptoms of Long COVID are multifarious, we here argue that the ability of these fibrin amyloid microclots (fibrinaloids) to block up capillaries, and thus to limit the passage of red blood cells and hence O2 exchange, can actually underpin the majority of these symptoms. Consistent with this, in a preliminary report, it has been shown that suitable and closely monitored ‘triple’ anticoagulant therapy that leads to the removal of the microclots also removes the other symptoms. Fibrin amyloid microclots represent a novel and potentially important target for both the understanding and treatment of Long COVID and related disorders.

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Section: Amyloid Fibrin Microclots (Fibrinaloids) In Covid-19 and Lon...mentioning

confidence: 93%

A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications

Kell

Laubscher

Pretorius

2022

Biochemical Journal

183

212

View full text Add to dashboard Cite

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“…Generally, radiographic findings associated with COVID-19 from both chest x-ray 5 , 6 and CT reflect a typical lung injury of viral pneumonia 7 , 8 . The primary radiographic findings are ground-glass opacity and pulmonary consolidation—suggesting the possible presence of organizing pneumonia 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Both chest x-rays 5 , 6 and chest computed tomography (CT) have helped guide diagnosis and treatment of COVID-19 7 , 8 , but there is a paucity of studies describing the association between COVID-19 and physical characteristics of the conducting airways. Previous studies provide evidence of an increase in diameter of the trachea proportional to severity of COVID-19 pneumonia 9 , suggesting that severe inflammation is associated with edema in the trachea and an increase in diameter of the trachea among patients with COVID-19 10 .…”

Section: Introductionmentioning

confidence: 99%

Greater central airway luminal area in people with COVID-19: a case–control series

Jeltema

Gorman

Ovrom

et al. 2022

Sci Rep

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Respiratory epithelium in the conducting airways of the human body is one of the primary targets of SARS-CoV-2 infection, however, there is a paucity of studies describing the association between COVID-19 and physical characteristics of the conducting airways. To better understand the pathophysiology of COVID-19 on the size of larger conducting airways, we determined the luminal area of the central airways in patients with a history of COVID-19 compared to a height-matched cohort of controls using a case–control study design. Using three-dimensional reconstruction from low-dose high-resolution computed tomography, we retrospectively assessed airway luminal cross-sectional area in 114 patients with COVID-19 (66 females, 48 males) and 114 healthy, sex- and height-matched controls (66 females, 48 males). People with a history of smoking, cardiopulmonary disease, or a body mass index greater than 40 kg·m−2 were excluded. Luminal areas of seven conducting airways were analyzed, including trachea, left and right main bronchus, intermediate bronchus, left and right upper lobe, and left lower lobe. For the central conducting airways, luminal area was ~ 15% greater patients with COVID-19 compared to matched controls (p < 0.05). Among patients with COVID-19, there were generally no differences in the luminal areas of the conducting airways between hospitalized patients compared to patients who did not require COVID-19-related hospitalization. Our findings suggest that males and females with COVID-19 have pathologically larger conducting airway luminal areas than healthy, sex- and height-matched controls.

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“…Current literature provides evidence of using characteristic imaging features, such as hazy opacifications, GGO, and consolidations at time of first hospital presentation as predictors of inferior outcomes 9 , 35 , 36 . However, the small sample size of this study unfortunately provided insufficient statistical power to assess the MBrixia score’s capability to predict clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Chest x-ray imaging score is associated with severity of COVID-19 pneumonia: the MBrixia score

Jensen

Costa

Nørgaard

et al. 2022

Sci Rep

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Spatial resolution in existing chest x-ray (CXR)-based scoring systems for coronavirus disease 2019 (COVID-19) pneumonia is low, and should be increased for better representation of anatomy, and severity of lung involvement. An existing CXR-based system, the Brixia score, was modified to increase the spatial resolution, creating the MBrixia score. The MBrixia score is the sum, of a rule-based quantification of CXR severity on a scale of 0 to 3 in 12 anatomical zones in the lungs. The MBrixia score was applied to CXR images from COVID-19 patients at a single tertiary hospital in the period May 4th–June 5th, 2020. The relationship between MBrixia score, and level of respiratory support at the time of performed CXR imaging was investigated. 37 hospitalized COVID-19 patients with 290 CXRs were identified, 22 (59.5%) were admitted to the intensive care unit and 10 (27%) died during follow-up. In a Poisson regression using all 290 MBrixia scored CXRs, a higher MBrixia score was associated with a higher level of respiratory support at the time of performed CXR. The MBrixia score could potentially be valuable as a quantitative surrogate measurement of COVID-19 pneumonia severity, and future studies should investigate the score’s validity and capabilities of predicting clinical outcomes.

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Ground-glass opacity on emergency department chest X-ray: a risk factor for in-hospital mortality and organ failure in elderly admitted for COVID-19

Cited by 11 publications

References 27 publications

A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications

A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications

Greater central airway luminal area in people with COVID-19: a case–control series

Chest x-ray imaging score is associated with severity of COVID-19 pneumonia: the MBrixia score

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