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Introduction In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. Methods Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO 2 /FiO 2 < 300 and PaCO 2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. Results We enrolled 128 patients, mean age 61,7 years. Mean HACOR at one hour after starting CPAP was 3,27 ± 3,84 and mean PaO 2 /FiO 2 was 203,30 ± 92,21 mmHg; 35 patients (27,3%) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03%, while PaO 2 /FiO2 accuracy was 81,25%. Conclusion Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO 2 /FiO 2 has also shown to be a good predictor of failure.

Background: Altered metabolism of skin glycosaminoglycan has rarely been investigated in localized scleroderma in contrast to systemic sclerosis. Objective: The aim of this investigation is to elucidate the change in skin glycosaminoglycan of localized scleroderma. Methods: We analyzed 5 skin samples of localized scleroderma and 10 site-matched control skin samples using high performance liquid chromatography after 1-phenyl-3-methyl-5-pyrasolone labeling. Results: The involved skin constantly showed an increased amount of ΔDi-4S(DS), the main disaccharide unit of dermatan sulfate, a decreased amount of ΔDi-HA, the main disaccharide unit of hyaluronic acid, and an elevated ratio of ΔDi-4S(DS)/ΔDi-HA as compared with the uninvolved skin or the site-matched control skin. Conclusion: These results correlate well with those findings in systemic sclerosis, indicating that the alteration in skin GAG may be closely related to the fibrotic process.

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