Early increase of soluble urokinase plasminogen activator receptor (suPAR) serum levels is indicative of increased risk of progression of coronavirus disease 2019 (COVID-19) to respiratory failure. The SAVE-MORE double-blind, randomized controlled trial evaluated the efficacy and safety of anakinra, an IL-1α/β inhibitor, in 594 patients with COVID-19 at risk of progressing to respiratory failure as identified by plasma suPAR ≥6 ng ml−1, 85.9% (n = 510) of whom were receiving dexamethasone. At day 28, the adjusted proportional odds of having a worse clinical status (assessed by the 11-point World Health Organization Clinical Progression Scale (WHO-CPS)) with anakinra, as compared to placebo, was 0.36 (95% confidence interval 0.26–0.50). The median WHO-CPS decrease on day 28 from baseline in the placebo and anakinra groups was 3 and 4 points, respectively (odds ratio (OR) = 0.40, P < 0.0001); the respective median decrease of Sequential Organ Failure Assessment (SOFA) score on day 7 from baseline was 0 and 1 points (OR = 0.63, P = 0.004). Twenty-eight-day mortality decreased (hazard ratio = 0.45, P = 0.045), and hospital stay was shorter.

IntroductionAlthough major changes of the immune system have been described in sepsis, it has never been studied whether these may differ in relation to the type of underlying infection or not. This was studied for the first time.MethodsThe statuses of the innate and adaptive immune systems were prospectively compared in 505 patients. Whole blood was sampled within less than 24 hours of advent of sepsis; white blood cells were stained with monoclonal antibodies and analyzed though a flow cytometer.ResultsExpression of HLA-DR was significantly decreased among patients with severe sepsis/shock due to acute pyelonephritis and intraabdominal infections compared with sepsis. The rate of apoptosis of natural killer (NK) cells differed significantly among patients with severe sepsis/shock due to ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) compared with sepsis. The rate of apoptosis of NKT cells differed significantly among patients with severe sepsis/shock due to acute pyelonephritis, primary bacteremia and VAP/HAP compared with sepsis. Regarding adaptive immunity, absolute counts of CD4-lymphocytes were significantly decreased among patients with severe sepsis/shock due to community-acquired pneumonia (CAP) and intraabdominal infections compared with sepsis. Absolute counts of B-lymphocytes were significantly decreased among patients with severe sepsis/shock due to CAP compared with sepsis.ConclusionsMajor differences of the early statuses of the innate and adaptive immune systems exist between sepsis and severe sepsis/shock in relation to the underlying type of infection. These results may have a major impact on therapeutics.

Supported by grants by the Hellenic Institute for the Study of Sepsis and by bioMérieux. Procalcitonin assays, material for detection of fecal colonization and laboratory training were provided by bioMérieux. Contribution of authors EJGB conceptualized the study design, participated in data analysis and drafting the manuscript, had full access to all of the study data and takes responsibility for their integrity and the accuracy of the analysis. EK participated in data analysis, drafted the manuscript, had full access to all of the study data and takes responsibility for their integrity and the accuracy of the analysis. MK performed data analysis and

It is accepted that the prevalence of known diabetes mellitus has increased in some countries, although the available data are incomplete and sometimes anecdotal. In 1974 a sample of the urban population (n = 21,410) in a suburb of Athens (Greece) was evaluated for the prevalence of known diabetes mellitus. The study was repeated 17 years later in the same area under the same conditions and methodology on 12,836 randomly selected inhabitants (both sexes, all ages). Visiting nurses contacted the inhabitants at home and filled in a questionnaire. The results show a clear increase in diabetes prevalence of the population as a whole (standardized rates: 1974: 2.4% (95% confidence intervals 2.2-2.6%) 1990: 3.1 (2.8-3.4%)). Standardization was done on the basis of data obtained from the same census. The changes were statistically significant in the 50-59, 60-69, and 70-79 age groups (1974: 5.87, 10.98, and 11.41%; 1990: 7.70, 13.68, and 19.52%, respectively). Thus, the prevalence of known diabetes mellitus has considerably increased during the last 17 years in a sample of urban Greek population.

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