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Due to current advances and growing experience in the management of coronavirus Disease 2019 , the outcome of COVID-19 patients with severe/critical illness would be expected to be better in the second wave compared with the first wave. As our hospitalization criteria changed in the second wave, we aimed to investigate whether a favorable outcome occurred in hospitalized COVID-19 patients with only severe/critical illness. Among 642 laboratory-confirmed hospitalized COVID-19 patients in the first wave and 1121 in the second wave, those who met World Health Organization (WHO) definitions for severe or critical illness on admission or during follow-up were surveyed. Data on demographics, comorbidities, C-reactive protein (CRP) levels on admission, and outcomes were obtained from an electronic hospital database. Univariate analysis was performed to compare the characteristics of patients in the first and second waves. There were 228 (35.5%) patients with severe/critical illness in the first wave and 681 (60.7%) in the second wave. Both groups were similar in terms of age, gender, and comorbidities, other than chronic kidney disease. Median serum CRP levels were significantly higher in patients in the second wave compared with those in the first wave [109 mg/L (interquartile range [IQR]: 65-157) vs. 87 mg/L (IQR: 39-140); p < 0.001]. However, intensive care unit admission and mortality rates were similar among the waves.Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID-19 patients, we found similar demographics and outcomes among hospitalized COVID-19 patients with severe/ critical illness in the first and second wave.

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BackgroundElevated fecal calprotectin (FC) levels indicate activity in Crohn's disease (CD) and ulcerative colitis and are used as non-invasive biomarkers in these diseases. Gastrointestinal involvement of Behçet's syndrome (GIBS) shows clinical and endoscopic similarities to CD. A previous study suggested that FC may help to diagnose GIBS patients (1), but we are not aware of any studies addressing its role in identifying disease activity in such patients.ObjectivesTo determine whether FC helps to distinguish active GIBS patients from those in remission.MethodsWe collected fecal and serum specimens before colonoscopy from 39 GIBS patients who agreed to participate (Table). Twenty-six patients were asymptomatic whereas 13 had abdominal pain and/or diarrhea. We also filled disease activity index for intestinal Behçet's disease (DAIBD) and Crohn's disease activity index (CDAI) in each patient. Active gastrointestinal (GI) involvement was defined as having ulcers on colonoscopy. We included 22 active and 25 inactive CD patients as controls. We used 150 μg/g as the cut-off for a positive FC level. None of the patients were receiving NSAIDs that could increase FC levels.ResultsAmong the 39 GIBS patients, 14 had active ulcers on colonoscopy (8/13 symptomatic and 6/26 of asymptomatic). FC level was >150 μg/g in 12/14 active GIBS patients and in 6/25 patients in GI remission (OR: 19, 95% CI: 3 to 110). The median FC and CRP levels were higher among active GIBS patients whereas serum calprotectin levels were not different (Table). Among CD patients, 16/25 active patients and 3/22 patients in remission had a FC level >150 μg/g (OR: 11, 95% CI: 11 to 49). There was a high correlation between FC and CDAI scores (r=0.64, p<0.001) and a very high correlation between FC and DAIBD scores (r=0.71, p<0.001), while FC was not correlated with serum calprotectin and CRP levels. Among the 6 GIBS patients who had high FC levels despite being in remission for GI involvement, 2 had active mucocutaneous lesions, 1 had concomitant macrophage activation syndrome (MAS), 1 had polycythemia vera with trisomy 8 and 2 were started high dose corticosteroids. Repeat FC levels could be obtained in 3 of these patients, after the resolution of MAS and mucocutaneous lesions, and were <150 in all 3.Table 1.Demographic, clinical and laboratory features of active GIBS patients and in GIBS patients who are in remissionActive GIBSGIBS in remission P value (n=14)(n=25) Gender, M/F5/910/150.15Mean±SD age, years47.5±7.240±110.03Median (IQR) FC, μg/g301 (176–957)30 (30–134)<0.001 FC ≥150 μg/g, n (%)12 (86)6 (24)<0.001 Median (IQR) serum calprotectin, ng/mL98 (39–128)69 (54–101)0.5Median (IQR) serum CRP, mg/dL2 (1–5)3 (2–15)0.07Median (IQR) CDAI scores52 (4–189)30 (0–92)0.2Median (IQR) DAIBD scores40 (4–81)20 (0–37)0.1ConclusionsFC seems to be a useful non-invasive tool for identifying active GI involvement in GIBS patients. Whether the presence of other BS manifestations can cause false positive results in GIBS patients in remission remains to be studied. On ...