Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey

Abstract

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared just over 7 months ago in Wuhan, China. Early reports from China indicated that although some cases are asymptomatic, 20% of COVID-19 cases follow a severe course, necessitating hospitalization, with a quarter of hospitalized patients requiring intensive care unit (ICU) facilities [1]. Later reports from China and other countries substantiated these data, although ICU admission rates, proportion of patients receiving invasive mechanical ventilation (IMV), and mortality rates differ considerably between studies [2]. The life-threatening form of respiratory failure, acute respiratory distress syndrome (ARDS) is a frequent complication in COVID-19 [3]. The severity of ARDS is classified into categories of mild, moderate, and severe, depending on the degree of hypoxemia [4]. Patients with moderate-tosevere ARDS require invasive mechanical ventilation (IMV) and have a poor prognosis [4]. The incidence of ARDS and specifically, moderate-to-severe ARDS, among COVID-19 patients is currently unknown [5]. We describe here the results of a survey of clinical studies reporting COVID-19-associated ARDS in hospitalized patients since the beginning of the COVID-19 pandemic in January until the end of July 2020. Our aim was to obtain a clearer picture of the incidence of COVID-19-associated ARDS in hospitalized patients on a global level, to better define the burden to healthcare

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

“…Further evidence of attenuated cytokine reaction in HD patients could be manifest in the low proportion of ARDS reported in various studies. Our meta-analysis indicated an overall incidence of ARDS of 18.5%, which is significantly lower than the reported incidence from hospitalized patients (33%) [49]. On the other hand, the reduction of activity of angiotensin-converting enzyme 2 (ACE2) was observed in HD patients compared to CKD or renal transplant recipients [50].…”

Challenges and opportunities for antiviral monoclonal antibodies as COVID-19 therapy

“…In severe cases of deep lung infections, a hyperinflammatory milieu associated with dramatically increased expression of IL-6, CRP, and other inflammatory markers, is associated with worse prognoses [ 172 ]. The hyperinflammatory responses frequently trigger acute respiratory distress syndrome (ARDS); a recent survey showed that ~33% of hospitalized COVID-19 patients develop ARDS, ~26% are transferred to the ICU, and ~ 16% die [ 184 ]. By this stage of the infection, the positive feedback loop of inflammatory signaling can proceed in the absence of innate sensing of viral pathogen-associated molecular patterns [ 36 , 172 , 185 ], as evidenced by the fact that at least some patients with critical disease who receive convalescent plasma treatment can fully clear virus within 3 days (per RT-PCR), but still experience worsening decompensation and eventually death [ 186 ].…”

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

“…Further evidence of attenuated cytokine reaction in HD patients could be manifest in the low proportion of ARDS reported in various studies. Our meta-analysis indicated an overall incidence of ARDS of 18.5%, signi cantly lower than the reported incidence from hospitalized patients (33%) [35]. It is unknown whether the immuno-compromised status per se, or the hemodia ltration/hemoperfusion may have facilitated cytokine clearance.…”