We read with interest the recent article by Terpos et al. 1 They reviewed different hematologic findings and complications of COVID-19. Especially, we are interested in lymphopenia in severe COVID-19 patients, which is a predictor factor of severity and mortality. We aimed to report the occurrence of lymphopenia, lymphocyte subsets, and its impact on ICU mortality in critically ill patients with COVID-19. In this single-center cohort, we included adult patients with confirmed COVID-19 infection by a positive reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of a nasopharyngeal swab, admitted in the intensive care unit (ICU) of the Mohammed VIth university hospital of the Marrakech region (Morocco), from March 19, 2020 to May 15, 2020. We collected demographic data, comorbidities, clinical signs at the ICU admission, laboratory findings, chest CT scan if available, outcomes, time from onset of the first symptom to ICU admission, and sequential organ failure assessment (SOFA) scores. We expressed continuous variables as medians and interquartile (IQR) ranges or means (standard deviations (SD)), as appropriate, and compared using independent group Student's t test or the Mann-Whitney U test. Categorical variables were described using percentages and compared using the χ 2-test, although Fisher's exact test was used when the data were sparse. We performed univariable to evaluate the risk factors of mortality. The analysis was processed by spss 10.0 for Windows (SPSS, Chicago, IL, USA). A Pvalue of <.05 was considered statistically significant. Patients CD3+ CD4+ CD8+ CD4+/ CD8+ B cells NK cells Outcome

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

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