Increased Incidence of Acute Pulmonary Embolism in Emergency Department Patients During the COVID‐19 Pandemic (original) (raw)
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Advances in Clinical and Experimental Medicine, 2023
Background. On March 11, 2020, coronavirus disease (COVID-19) was declared a global threat by the World Health Organization (WHO). It quickly became apparent that reducing inpatient mortality rates and early phase prediction of possible deterioration or severe disease course relied on finding more specific biomarkers. Objectives. This retrospective study assessed initial clinical, laboratory and radiological features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients and explored their impact on mortality and the course of the disease. Such efforts aimed to facilitate the identification of high-risk patients and to improve the formulation of treatment plans for these individuals. Materials and methods. The cohort comprised 111 consecutive adult inpatients diagnosed with COVID-19 and hospitalized in the Internal Medicine Ward of the University Clinical Center of prof. K. Gibiński of the Medical University of Silesia in Katowice, Poland, a COVID-19 Treatment Unit, between November 16, 2020 and February 15, 2021. All available clinical, laboratory and radiological findings were extracted from electronic records and assessed as possible risk factors for poor prognosis. Results. Clinicasl and radiological features with higher frequency in COVID-19 non-survivors included older age, history of smoking, concomitant cardiovascular diseases, low oxygen saturation (SpO 2), and high infection risk assessed on admission as well as high opacity score, percentage of opacity and percentage of high opacity in computed tomography. Non-survivors had decreased serum lymphocytes, monocytes, calcium, magnesium, and hemoglobin oxygen saturation. They also had increased red cell distribution width (RDW), C-reactive protein (CRP), procalcitonin, alkaline phosphatase (ALP), creatinine, blood urea nitrogen (BUN), D-dimer, troponin, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, as well as a base deficit. Conclusions. This retrospective study identified several markers associated with a fatal course of COVID-19. The early assessment of SARS-CoV-2-infected inpatients should consider these markers.
Comparative evaluation of four SARS-CoV-2 antigen tests in hospitalized patients
International Journal of Infectious Diseases, 2021
Objectives: Rapid identification of infected subjects is a cornerstone for controlling a pandemic like the current one with the SARS-CoV-2. Easy to handle antigen tests can provide timely results, which is of particular importance in a primary care setting. However, concerns exist regarding their sensitivity, which led us to evaluate four commercially available tests in patients hospitalized for COVID-19. Methods: We analyzed in parallel nasopharyngeal/oropharyngeal swabs from 154 consecutive patients admitted to our department with moderate to severe COVID-19, using quantitative RT-PCR (Cobas, Roche) and up to four antigen tests from different distributors. Antigen test results were linked to Ct (cycle threshold) values as markers for patients' infectivity. Results: We found that two out of four antigen tests correctly identified subjects with high viral loads (Ct 25), and three out of four tests detected more than 80% of subjects with a Ct 30, which is considered the threshold for infectivity. However, one test investigated had a poor clinical performance. When investigating subjects with Ct values >30, we found that the antigen test was still positive in up to 45% of those cases. Conclusion: Most antigen tests had a sufficient sensitivity to identify symptomatic subjects infected with SARS-CoV-2 and with transmissible infection. On the other hand, antigen testing may not be suitable to identify loss of infectivity in COVID-19 subjects during follow-up. Newly introduced antigen tests need to be validated in a clinical or primary care setting to define their clinical usefulness.
Clinical Infectious Diseases, 2020
This is the first known community transmission case of the novel coronavirus disease (COVID-19) in the United States, with significant public health implications. Diagnosis of COVID-19 is currently confirmed with PCR based testing of appropriate respiratory samples. Given the absence of travel or known exposure history, this patient did not meet the criteria for testing according to CDC guidelines at the time of her presentation. Since this case, any patient with severe disease (eg, ARDS or pneumonia) requiring hospitalization without an explanatory diagnosis can be tested even if no clear source of exposure is identified. While influencing national health policies for revising screening criteria, this case also highlighted significant knowledge gaps in diagnosis and treatment and a desperate need for early, widespread, fast and cheap testing for COVID-19.
Confirmatory and supportive laboratory investigations in SARS-CoV-2 infection; a systematic review
Journal of Preventive Epidemiology
The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread over 210 countries. In order to mitigate the epidemic and to flatten the curve, apart from multiple containment measures, an accurate identification of those infected is imperative. The objective of this review was to review, systematically, the performance of diagnostic and screening technologies and the yield of different clinical samples for the detection of SARS-CoV-2. Here we have critically evaluated the results obtained from different clinical samples and laboratory investigations and the performance of rRT-PCR (real-time reverse transcriptase polymerase chain reaction) technique in the diagnosis of SARS-CoV-2.
2023
Introduction and objectives. After the COVID-19 pandemic, SARS-CoV-2 has established itself as one of the main respiratory pathogens, affecting vulnerable populations, this including hospitalized patients who suffer from some type of immunocompromise, immunosuppression or immunodeficiency. Among the various ways to detect the virus, the most widely used in the clinical setting are rapid tests and the polymerase chain reaction (PCR). There are also panels for the detection of multiple pathogens (multiplex PCR). The additional cost of these syndromic panels is offset by the fast turnaround time that dramatically increases their clinical utility. The objective of the present study was to evaluate the concordance between rapid SARS-CoV-2 immunochromatographic tests (IC) and respiratory multiplex PCR. Methods and materials. We retrospectively studied samples from hospitalized immunosuppressed patients in whom rapid SARS-CoV-2 testing by IC and multiplex PCR was requested simultaneously. A Cohen's kappa coefficient was performed between the qualitative result for SARS-CoV-2 between both methods. In addition, the diagnostic utility of IC against multiplex PCR was obtained, as well as the percentage of positivity for microorganisms other than SARS-CoV-2. Results. When using Cohen's kappa coefficient, the observed concordance was 0.708, the IC obtained a total of 79 false negatives (14.90%). A sensitivity of 74.35%, a specificity of 100%, a prevalence in the study population of 58%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 73.75% were obtained. The multiplex PCR panel was able to detect 9.63% of microorganisms in patients in whom IC and PCR for SARS-CoV-2 were negative.
Clinical Characteristics and Outcomes for 7,995 Patients with SARS-CoV-2 Infection
ObjectiveSevere acute respiratory syndrome virus (SARS-CoV-2) has infected millions of people worldwide. Our goal was to identify risk factors associated with admission and disease severity in patients with SARS-CoV-2.DesignThis was an observational, retrospective study based on real-world data for 7,995 patients with SARS-CoV-2 from a clinical data repository.SettingYale New Haven Health (YNHH) is a five-hospital academic health system serving a diverse patient population with community and teaching facilities in both urban and suburban areas.PopulationsThe study included adult patients who had SARS-CoV-2 testing at YNHH between March 1 and April 30, 2020.Main outcome and performance measuresPrimary outcomes were admission and in-hospital mortality for patients with SARS-CoV-2 infection as determined by RT-PCR testing. We also assessed features associated with the need for respiratory support.ResultsOf the 28605 patients tested for SARS-CoV-2, 7995 patients (27.9%) had an infection...
A comparison of a SARS-CoV-2 rapid-test and serological-test in a Public Health Hospital
The Journal of Infection in Developing Countries, 2022
Introduction: Nowadays, with the start of the vaccination campaign is very important to assess the extent of exposure of the population and identifying rapid, sensitive and accurate test to quickly identify new cases of SARS-CoV-2. The rapid test, cheap and easy to perform, is therefore very useful in developing countries, where the vaccination campaign has not yet reached adequate coverage. Methodology: We compared the VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with the Roche Elecsys Anti-SARS-CoV-2 (Roche Diagnostics, Rotkreuz, Switzerland) to recognize past infections and to compare VivaDiag COVID-19 IgM/IgG Rapid Test (VivaCheck Biotech Co., Ltd) with Abbott Real Time PCR SARS-CoV-2 assay to recognize infection during its acute phase so that it’s possible to evaluate the use of commercially available assays in clinical practice. Results: Of the 1,100 patients tested with serological and rapid test, 1,085 were negative both to serological and rapid test, 4 ...