Simple prognostic factors and change of inflammatory markers in patients with severe coronavirus disease 2019: a single‐center observational study

Abstract

Aim The aim of this study was to investigate the prognostic factors and evaluate the change in inflammatory markers of patients with coronavirus disease 2019 (COVID‐19) requiring mechanical ventilation. Methods This retrospective observational study conducted from April 1, 2020, to February 18, 2021, included 97 adult patients who required mechanical ventilation for severe COVID‐19 pneumonia and excluded nonintubated patients with a positive COVID‐19 polymerase chain reaction test and those who had any obvious bacterial infection on admission. All patients were followed up to discharge or death. We obtained clinical information and laboratory data including levels of presepsin, interleukin‐6, procalcitonin, and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibody every day. Poor outcome was defined as death or receiving a tracheostomy during hospitalization, and favorable outcome was defined as discharge after extubation. Results Differences (median [interquartile range]) were detected in age (76 [70–82] versus 66 [55–74] years), day from the onset of first symptoms to admission for mechanical ventilation (5 [3–7] versus 10 [8–12] days), and P/F ratio (i.e., ratio of arterial oxygen concentration to the fraction of inspired oxygen) after intubation (186 [149–251] versus 236 [180–296]) in patients with poor outcome versus those with favorable outcome on admission. Serum SARS‐CoV‐2 antibody levels had already increased on admission in patients with favorable outcome. We determined the day from the onset of first symptoms to admission for mechanical ventilation to be one of the independent prognostic factors of patients with COVID‐19 (adjusted odds ratio 0.69, confidence interval 0.56–0.85). Conclusion These results may contribute to understanding the mechanism of progression in severe COVID‐19 and may be helpful in devising an effective therapeutic strategy.

Presepsin levels and COVID-19 severity: a systematic review and meta-analysis

“…All studies highlighted a possible relationship between PSP levels and COVID-19 severity, but this correlation was statistically significant in 10 works (1005 patients over 1373) [18,19,[22][23][24][27][28][29][30][31]. Among studies involving adult patients [17][18][19][20][21][22][23][24][25][27][28][29][30][31], the mean age of the pooled sample was 62.7 ± 5.7 years. Mortality in the included studies ranged between 8 and 45%.…”

“…Considering that sepsis and SARS-CoV-2 infection share immunopathogenetic and pathophysiological similarities, we believe that PSP may help in risk stratification [16]. In the last two years of pandemic, the interest in the possible correlation between COVID-19 severity and levels of PSP has increased and several studies have been published [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. In 2021, Amhed et al proposed a review on this correlation [39] highlighting that PSP levels predicted the aggravation of COVID-19 infection.…”

“…Therefore, it was recently postulated that elevated levels of PSP could predict the outcome of patients with SARS-CoV-2 infection [17,18]. The relationship between PSP and COVID-19 severity is known, although not well detailed and comprehensively evaluated [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Thus, we conducted a systematic review and meta-analysis aimed at establishing the role of PSP in assessing SARS-CoV-2 infection severity.…”

Methylprednisolone pulse therapy for critically ill patients with coronavirus disease 2019: A single‐center retrospective observational study

“…Although the effectiveness of other steroids has been previously tested, 2,3 the optimal dose and duration of steroid therapy remains unclear 4–6 . In Japan, high‐dose steroids (e.g., methylprednisolone [mPSL] 1000 mg/day) are routinely used for treating interstitial pneumonia, whereas steroid pulse therapy (SPT) has been prescribed for critically‐ill COVID‐19 pneumonia patients 7–9 . Three randomized controlled trials (RCTs) showed that high‐dose steroid therapy improved outcomes in moderate to critically ill COVID‐19 pneumonia patients 4,5,10 .…”

“…[4][5][6] In Japan, high-dose steroids (e.g., methylprednisolone [mPSL] 1000 mg/day) are routinely used for treating interstitial pneumonia, whereas steroid pulse therapy (SPT) has been prescribed for critically-ill COVID-19 pneumonia patients. [7][8][9] Three randomized controlled trials (RCTs) showed that high-dose steroid therapy improved outcomes in moderate to critically ill COVID-19 pneumonia patients. 4,5,10 However, Japanese COVID-19 guidelines include "no recommendation" for SPT, 11 based on only one low-quality RCT 5 using a nonstandard corticosteroid dose in Japan.…”