Viruses

Research

14 pages, 755 KiB

Open AccessArticle

Changes in Body Composition During Intensive Care Unit Stay and Outcomes in Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

by Hayato Nakabayashi, Junko Yamaguchi, Ken Takahashi, Yasuyoshi Kai and Kosaku Kinoshita

Viruses 2025, 17(5), 643; https://doi.org/10.3390/v17050643 (registering DOI) - 29 Apr 2025

Abstract

This single-center retrospective observational study investigated the association between changes in body composition during hospitalization and outcomes in patients with severe coronavirus disease (COVID-19) pneumonia. Body composition was assessed using chest computed tomography (CT) within 3 days of intensive care unit admission and [...] Read more.

This single-center retrospective observational study investigated the association between changes in body composition during hospitalization and outcomes in patients with severe coronavirus disease (COVID-19) pneumonia. Body composition was assessed using chest computed tomography (CT) within 3 days of intensive care unit admission and follow-up CT within 14 days. The study population comprised 89 adult patients, among whom 57 survived. The median APACHE II score on admission was 16. Initial CT scans showed that the iliopsoas muscle volume, sum of the pectoralis major and minor muscle areas, and erector spinae muscle (ESM) area were significantly larger in survivors than in non-survivors (p = 0.019, 0.011, and 0.001, respectively). Subcutaneous fat tissue (SAT) volume was higher in survivors (p = 0.003), and the rate of change in the SAT volume was lower in survivors (p = 0.043). Multivariate logistic regression analysis revealed that a high APACHE II score (OR: 0.834, 95% CI: 0.741–0.938, p = 0.002) and small ESM area (OR: 1.001, 95% CI: 1.000–1.002, p = 0.031) were independent predictors of mortality. In conclusion, the loss of supporting respiratory muscles, particularly ESM, may play a critical role beyond general acute sarcopenia, and the preserved SAT in non-survivors may reflect abnormal glucose metabolism due to severe inflammation. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

13 pages, 776 KiB

Open AccessArticle

Dynamics of Clinical, Radiological, and Biological Expression in Hospitalised COVID-19 Patients and Post-Infectious Mortality: Comparison Between 2024 and 2020

by Constantin-Marinel Vlase, Alina Plesea-Condratovici, Anca-Adriana Arbune, Roxana-Elena Goroftei-Bogdan, Cristian Gutu and Manuela Arbune

Viruses 2025, 17(5), 630; https://doi.org/10.3390/v17050630 (registering DOI) - 27 Apr 2025

Viewed by 76

Abstract

Clinical manifestations and mortality caused by SARS-CoV-2 change, consistent with circulating viral variants and population immunity. Our retrospective study analyses the hospitalised COVID-19 cases from Romania in 2024 comparative with 2020. The circulation of SARS-CoV-2 in the fourth year of the pandemic led [...] Read more.

Clinical manifestations and mortality caused by SARS-CoV-2 change, consistent with circulating viral variants and population immunity. Our retrospective study analyses the hospitalised COVID-19 cases from Romania in 2024 comparative with 2020. The circulation of SARS-CoV-2 in the fourth year of the pandemic led to changes in the characteristics of the hospitalised population, including clinical, biological, and radiological profiles, as well as an increase in 90-day mortality after hospitalisation. The hospitalised population became predominantly older with multiple comorbidities. Notable changes in symptomatology included an increase in the frequency of rhinorrhoea and syncope, while disturbances in taste and smell were less frequent. The mortality rate within the first 90 days increased in 2024 to 9%. Older age and a higher index of chronic comorbidities were associated with a higher frequency of severe forms and deaths within 90 days post-COVID-19. Hospitalisation for COVID-19 may be an unfavourable prognostic factor for the elderly population. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

14 pages, 226 KiB

Open AccessArticle

Risk Factors Affecting the Severity, Mortality, and Intensive Care Unit Admission of COVID-19 Patients: A Series of 1075 Cases

by Ecem Narin Çopur, Dilek Ergün, Recai Ergün, Serap Atik, Hatice Türk Dağı and Muslu Kazım Körez

Viruses 2025, 17(3), 429; https://doi.org/10.3390/v17030429 - 17 Mar 2025

Viewed by 442

Abstract

Background: The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is broad; it can range from asymptomatic cases to mild upper respiratory tract illness, respiratory failure, and severe multiorgan failure resulting in death. Therefore, it is important to identify the [...] Read more.

Background: The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is broad; it can range from asymptomatic cases to mild upper respiratory tract illness, respiratory failure, and severe multiorgan failure resulting in death. Therefore, it is important to identify the clinical course of the disease and the factors associated with mortality. Objective: The aim of this study is to identify the risk factors associated with the severity of the disease, intensive care unit admission, and mortality in COVID-19 patients. Methods: A total of 1075 patients with clinical and radiological findings compatible with COVID-19 pneumonia and positive SARS-CoV-2 PCR were selected and retrospectively screened. All included patients were classified according to the 7th edition of the 2019 Coronavirus Disease Guidelines published by the National Health Commission of China. Results: It was observed that elevated white blood count (WBC) increased the severity of COVID-19 by 3.26 times and the risk of intensive care unit (ICU) admission by 3.47 times. Patients with high D-dimer levels had a 91% increased risk, and those with high fibrinogen levels had a 2.08 times higher risk of severe disease. High C-reactive protein (CRP) values were found to increase disease severity by 6.89 times, mortality by 12.84 times, and ICU admission by 3.37 times. Conclusions: Identifying the factors associated with disease severity, ICU admission, and mortality in COVID-19 patients could help reduce disability and mortality rates in pandemics. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

17 pages, 523 KiB

Open AccessArticle

Systolic Pulmonary Artery Pressure as Long-Term Mortality Predictor in Elderly Critically Ill with Severe COVID-19 Pneumonia

by Marko Kurnik, Helena Božič and Matej Podbregar

Viruses 2025, 17(2), 244; https://doi.org/10.3390/v17020244 - 11 Feb 2025

Viewed by 641

Abstract

Background: COVID-19 can cause acute pulmonary hypertension (PH), worsening outcomes in critically ill elderly patients. Point-of-care ultrasound (POCUS), assessing right ventricular hemodynamics, predicts short-term outcomes. This study examines the long-term impact of acute PH on mortality in elderly COVID-19 patients. Methods: This retrospective [...] Read more.

Background: COVID-19 can cause acute pulmonary hypertension (PH), worsening outcomes in critically ill elderly patients. Point-of-care ultrasound (POCUS), assessing right ventricular hemodynamics, predicts short-term outcomes. This study examines the long-term impact of acute PH on mortality in elderly COVID-19 patients. Methods: This retrospective long-term study analyzed data from patients over 70 years old with severe COVID-19 pneumonia admitted to a mixed 25-bed, level 3 intensive care unit (ICU). POCUS focused on systolic pulmonary artery pressure (sPAP) at admission. Mortality was evaluated 1000 days post-admission. Results: The study included 130 patients, comprising 30 long-term survivors and 100 non-survivors, with a cumulative long-term mortality rate of 77%. Non-survivors had significantly higher sPAP values (39.1 ± 12.8 vs. 30.4 ± 9.2, p = 0.04), which were associated with long-term mortality in survival analysis. Conclusion: Acute pulmonary hypertension (PH), reflected by elevated systolic pulmonary artery pressure (sPAP), is strongly associated with long-term mortality in elderly critically ill COVID-19 patients. Early assessment of sPAP via POCUS may help identify high-risk patients and guide management strategies to improve outcomes. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

14 pages, 1210 KiB

Open AccessArticle

Significance of Initial Chest CT Severity Score (CTSS) and Patient Characteristics in Predicting Outcomes in Hospitalized COVID-19 Patients: A Single Center Study

by Aleksandra Milenkovic, Simon Nikolic, Zlatan Elek, Jelena Aritonovic Pribakovic, Aleksandra Ilic, Kristina Bulatovic, Milos Gasic, Bojan Jaksic, Milan Stojanovic, Dusica Miljkovic Jaksic, Arijeta Kostic, Roksanda Krivcevic Nikolcevic, Aleksandra Balovic and Filip Petrović

Viruses 2024, 16(11), 1683; https://doi.org/10.3390/v16111683 - 29 Oct 2024

Viewed by 1132

Abstract

The aim of this study is to examine the prognostic role of initial chest computed tomography severity score index (CTSS) and its association with demographic, socio-epidemiological, and clinical parameters in COVID-19 hospitalized patients. A retrospective study included patients who were hospitalized in the [...] Read more.

The aim of this study is to examine the prognostic role of initial chest computed tomography severity score index (CTSS) and its association with demographic, socio-epidemiological, and clinical parameters in COVID-19 hospitalized patients. A retrospective study included patients who were hospitalized in the COVID Hospital of the Clinical Hospital Center Kosovska Mitrovica from July 2020 to March 2022. We compared patient characteristics and outcome of their hospital stay with values of CT severity score (mild, moderate, and severe form of the disease). Patients with severe disease were statistically significantly older, they treated more days, and they presented statistically significant highest mortality rate compared to mild and moderate forms. Smokers and obese were significantly more frequent among patients with higher CT, while vaccinated patients were more common among those with a mild form. Biochemical parameters at admission also showed statistical significance between the examined groups. We can conclude that by employing the initial CT severity score as the strongest predictor of mortality, it is possible to predict the outcome in hospitalized patients. A comprehensive examination of the patient upon admission, including determining the extent of inflammatory changes in the lungs using computed tomography, the levels of oxygen saturation, and other laboratory parameters, can assist doctors in making an adequate clinical evaluation and apply appropriate therapeutic protocols in the treatment of COVID-19. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

12 pages, 2092 KiB

Open AccessArticle

Utility of ISARIC 4C Mortality Score, Vaccination History, and Anti-S Antibody Titre in Predicting Risk of Severe COVID-19

by Lin Pin Koh, Travis Ren Teen Chia, Samuel Sherng Young Wang, Jean-Marc Chavatte, Robert Hawkins, Yonghan Ting, Jordan Zheng Ting Sim, Wen Xiang Chen, Kelvin Bryan Tan, Cher Heng Tan, David Chien Lye and Barnaby E. Young

Viruses 2024, 16(10), 1604; https://doi.org/10.3390/v16101604 - 12 Oct 2024

Viewed by 1353

Abstract

The ISARIC 4C Mortality score was developed to predict mortality risk among patients with COVID-19. Its performance among vaccinated individuals is understudied. This is a retrospective study of all patients with SARS-CoV-2 infection admitted to the National Centre for Infectious Diseases, Singapore, from [...] Read more.

The ISARIC 4C Mortality score was developed to predict mortality risk among patients with COVID-19. Its performance among vaccinated individuals is understudied. This is a retrospective study of all patients with SARS-CoV-2 infection admitted to the National Centre for Infectious Diseases, Singapore, from January-2020 to December-2021. Demographic, clinical, and laboratory data were extracted, and multiple logistic regression (MLR) models were developed to predict the relationship between ISARIC score, vaccination status, anti-S antibody titre, and severe COVID-19. A total of 6377 patients were identified, of which 5329 met the study eligibility criteria. The median age of the patients was 47 years (IQR 35–71), 1264 (23.7%) were female, and 1239 (25.7%) were vaccinated. Severe disease occurred in 499 (9.4%) patients, including 133 (2.5%) deaths. After stratification, 3.0% of patients with low (0–4), 17.8% of patients with moderate (5–9), and 36.2% of patients with high (≥10) ISARIC scores developed severe COVID-19. Vaccination was associated with a reduced risk of progression to severe COVID-19 in the MLR model: aOR 0.88 (95% CI: 0.86–0.90), and the risk of severe COVID-19 decreased inversely to anti-S antibody titres. The anti-S antibody titre should be further investigated as an adjunct to the ISARIC score to triage COVID-19 patients for hospital admission and antiviral therapy. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

10 pages, 2058 KiB

Open AccessArticle

ct2vl: A Robust Public Resource for Converting SARS-CoV-2 Ct Values to Viral Loads

by Elliot D. Hill, Fazilet Yilmaz, Cody Callahan, Alex Morgan, Annie Cheng, Jasper Braun and Ramy Arnaout

Viruses 2024, 16(7), 1057; https://doi.org/10.3390/v16071057 - 30 Jun 2024

Viewed by 1428

Abstract

The amount of SARS-CoV-2 in a sample is often measured using Ct values. However, the same Ct value may correspond to different viral loads on different platforms and assays, making them difficult to compare from study to study. To address this problem, we [...] Read more.

The amount of SARS-CoV-2 in a sample is often measured using Ct values. However, the same Ct value may correspond to different viral loads on different platforms and assays, making them difficult to compare from study to study. To address this problem, we developed ct2vl, a Python package that converts Ct values to viral loads for any RT-qPCR assay/platform. The method is novel in that it is based on determining the maximum PCR replication efficiency, as opposed to fitting a sigmoid (S-shaped) curve relating signal to cycle number. We calibrated ct2vl on two FDA-approved platforms and validated its performance using reference-standard material, including sensitivity analysis. We found that ct2vl-predicted viral loads were highly accurate across five orders of magnitude, with 1.6-fold median error (for comparison, viral loads in clinical samples vary over 10 orders of magnitude). The package has 100% test coverage. We describe installation and usage both from the Unix command-line and from interactive Python environments. ct2vl is freely available via the Python Package Index (PyPI). It facilitates conversion of Ct values to viral loads for clinical investigators, basic researchers, and test developers for any RT-qPCR platform. It thus facilitates comparison among the many quantitative studies of SARS-CoV-2 by helping render observations in a natural, universal unit of measure. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

14 pages, 2040 KiB

Open AccessArticle

Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia—A Comparison with Chest Computed Tomography: A Prospective Study

by Katarzyna Zimna, Małgorzata Sobiecka, Jacek Wakuliński, Dorota Wyrostkiewicz, Ewa Jankowska, Monika Szturmowicz and Witold Z. Tomkowski

Viruses 2024, 16(6), 905; https://doi.org/10.3390/v16060905 - 3 Jun 2024

Cited by 1 | Viewed by 1061

Abstract

The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the [...] Read more.

The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, p < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively (p < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations. Full article

(This article belongs to the Special Issue COVID-19 and Pneumonia, 3rd Edition)

► Show Figures

Figure 1

Journal Menu

Journal Browser

COVID-19 and Pneumonia, 3rd Edition

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (8 papers)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI