Search Results (668)

Background: Severe COVID-19 reflects a multi-layered host response with systemic inflammation, thrombo-inflammation, tissue damage, oxidative stress and altered antiviral interferon biology. We performed an integrated exploratory analysis of first-wave hospitalized patients to identify biomarker patterns associated with adverse clinical evolution during established admission. Methods: We analyzed 60 hospitalized COVID-19 patients and 18 healthy controls for soluble IFNAR2 (sIFNAR2) comparison. Biomarker samples were obtained during hospitalization, approximately seven days after symptom onset. Outcomes were final clinical status, severe respiratory involvement, post-sampling clinical worsening and death. Analyses included non-parametric testing, false-discovery-rate adjustment, effect-size estimation, exploratory ROC curves, parsimonious regression, penalized internal validation, composite scores and molecular-structure analyses. Results: Final status was favorable outcome in 31 patients, severe non-fatal disease in 22 and death in 7. sIFNAR2 was higher in patients than in healthy controls and highest among non-survivors, but did not distinguish favorably from severe non-fatal disease. The most consistent severity-associated signals were IL-6, D-dimer, total thiols, IL-10, LDH, ferritin, leukocytes and IL-1RA. D-dimer, IL-6 and ferritin yielded the largest exploratory univariable AUCs for severe respiratory involvement, whereas ferritin, IL-10, IL-1RA and sIFNAR2 predominated in event-limited mortality analyses, which were based on only seven deaths. Composite multi-axis scores and PLS-DA were tools requiring external validation. Conclusions: Biomarker patterns during admission were associated with adverse evolution. Conventional markers remained the most practical signals, while cytokines, redox markers and sIFNAR2 provided complementary biological information. sIFNAR2 should be interpreted as an exploratory complementary marker of the interferon receptor axis, mainly linked to mortality, not as a stand-alone clinical test or functional measure of IFNAR signaling. Full article

Background and Objectives: Convalescent plasma (CP) was widely used during the early phase of the COVID-19 pandemic; however, evidence regarding its clinical benefit has remained inconsistent. This study evaluated the associations of CP administration timing and the ELISA antibody level of the transfused unit with clinical outcomes among patients with COVID-19. Materials and Methods: This retrospective real-world cohort study included 272 adults with RT-PCR-confirmed COVID-19 who received a single CP unit at the University of Health Sciences Trabzon Kanuni Training and Research Hospital, Türkiye, between 1 April 2020 and 1 April 2021. At CP administration, 180 patients were hospitalized, and 92 were treated as outpatients; initial cohort assignment was retained throughout follow-up. Anti-SARS-CoV-2 IgG was assessed using the semi-quantitative Euroimmun ELISA, and exploratory low (0.00–0.99), medium (1.00–4.99), and high (≥5.00) categories were used. The primary outcome was 30-day all-cause mortality. Results: During follow-up, 18 of 92 outpatients (19.6%) required hospitalization. Thirty-day mortality was higher among hospitalized patients than among outpatients (39.4% vs. 1.1%; p < 0.001), reflecting major baseline clinical differences between the groups. Median ELISA indices did not differ significantly between hospitalized patients and outpatients [4.23 (IQR, 2.65–6.43) vs. 3.64 (IQR, 2.16–6.13); p = 0.308]. Among hospitalized patients, ELISA-index distributions were similar between survivors and non-survivors (p = 0.427), and the index was not associated with mortality when analyzed continuously after log2 transformation (OR per doubling, 0.89; 95% CI, 0.67–1.19; p = 0.425). The high-versus-medium category comparison was also non-significant (OR, 0.88; 95% CI, 0.48–1.62; p = 0.757), as was the timing-by-ELISA interaction (p = 0.074). Conclusions: In this CP-treated cohort, the ELISA index of the transfused unit was not independently associated with 30-day mortality. The exploratory subgroup findings do not establish CP effectiveness or superiority of a particular timing or antibody-level category. Full article

Cancer survivors face an elevated risk of severe COVID-19 outcomes and were prioritized for vaccination, yet reported rates of vaccination refusal in this population vary widely. The objective of this scoping review was to map the available evidence on COVID-19 vaccination refusal among adult cancer survivors in the United States, to characterize the reported barriers and enablers, and to examine how differences in measurement account for variation in the reported estimates. PubMed, EBSCOhost, CINAHL, medRxiv, and Google Scholar were searched for studies published between 1 December 2020 and 30 April 2026 reporting primary data on COVID-19 vaccination refusal among U.S. adults with a current or previous cancer diagnosis. Findings were charted and summarized descriptively. Six sources comprising 3344 participants met the eligibility criteria. Reported refusal ranged from 7.3% to 39.0%, a more than fivefold difference, with a median of 14.7%. This variation corresponded closely to what each source measured: declination of an offered vaccine, likelihood of acceptance on a Likert scale, hesitancy assessed before vaccines were widely available, or observed non-receipt of any dose. Barriers included concerns about vaccine safety, efficacy, and interaction with cancer treatment, mistrust of science and government, and low perceived need; clinician recommendation was the most consistent enabler. Estimates of vaccination refusal in this population are not directly comparable and should be interpreted alongside the construct measured. Full article

COVID-19, caused by the SARS-CoV-2 coronavirus, emerged as a global pandemic in 2020, with profound impacts on public health and a substantial burden on intensive care units (ICUs). Because critically ill patients are at increased risk of rapid clinical deterioration and death, there is a need for reliable early prognostic biomarkers to support risk stratification and optimize clinical management. Therefore, this study investigated whether clinical and laboratory parameters obtained at hospital admission could serve as prognostic biomarkers for endotracheal intubation and mortality in critically ill patients with COVID-19 admitted to ICUs. A retrospective analytical study was conducted using the medical records of 107 critically ill patients with confirmed COVID-19 admitted to ICUs. Patients were classified according to clinical outcome as survivors (n = 22) or non-survivors (n = 85). Clinical characteristics and laboratory biomarkers obtained at hospital admission were analyzed. D-dimer, lactate dehydrogenase (LDH), red cell distribution width (RDW), the AST/ALT ratio, and age were independently associated with mortality. In addition, D-dimer and LDH demonstrated moderate discriminatory performance for predicting the need for endotracheal intubation. These findings suggest that routinely available clinical and laboratory parameters obtained at hospital admission may serve as complementary prognostic biomarkers to support early risk stratification and clinical decision-making in critically ill patients with COVID-19. Nevertheless, prospective multicenter studies are warranted to externally validate these findings and further establish their clinical applicability. Full article

Background/Objectives: Long COVID is frequently characterized by neurological, cognitive, neuropsychiatric, and autonomic symptoms (NeuroCOVID). However, their impact on daily functioning remains insufficiently investigated. This study evaluated the association between NeuroCOVID burden and functional impairment among Italian Long COVID survivors. Methods: A secondary cross-sectional analysis was conducted on 250 adults using a validated Italian Long COVID questionnaire. A NeuroCOVID Burden Score (10 symptom domains) and a Functional Impairment Score (daily activities) were constructed and analyzed using correlation and multivariable linear regression. Results: The sample (mean age 33.2 years; 63.6% female) demonstrated high internal consistency for both scores. A strong positive correlation was found between NeuroCOVID burden and functional impairment (r = 0.703; p < 0.001). Conclusions: Persistent NeuroCOVID burden was strongly associated with greater limitations in daily activities. In multivariable regression, NeuroCOVID Burden Score remained independently associated with functional impairment (B = 0.671; 95% CI 0.566–0.776; p < 0.001), together with acute COVID-19 severity (B = 0.156; 95% CI 0.055–0.257; p = 0.003). The final model explained 52.5% of the variance in functional impairment (R² = 0.525). Full article

Background and objectives: Cancer survivors continue to face significant psychological and quality-of-life challenges following the COVID-19 pandemic. This study aimed to investigate levels of depression, anxiety, stress, quality of life, and perceived social support among patients with cancer during the post-COVID-19 period and to examine their interrelationships. Materials and Methods: A cross-sectional study was conducted among 162 Greek adults with cancer. Participants completed questionnaires assessing psychological distress (Depression Anxiety Stress Scale-21), health-related quality of life (EORTC QLQ-C30), and perceived social support. Descriptive statistics, factor analysis, group comparisons, and correlation analyses were performed. Results: High levels of psychological distress were observed, with 32.1% of participants reporting severe or extremely severe depression, 40.1% severe or extremely severe anxiety, and 29.0% severe or extremely severe stress. Quality of life was moderate, with emotional and social functioning being the most impaired domains, while fatigue, insomnia, and financial difficulties were the most prominent symptoms. Depression, anxiety, and stress were strongly associated with poorer quality of life and greater symptom burden. Higher perceived social support, particularly from family and friends, was associated with better quality of life and lower psychological distress. Conclusions: These findings highlight the need for comprehensive oncology care that incorporates routine psychological assessment and psychosocial support to improve cancer survivorship outcomes. Full article

Background: The post-acute consequences of prolonged Coronavirus Disease 2019 (COVID-19) infection are a major public health problem characterized by long-lasting, multisystem manifestations. There is limited evidence from Saudi Arabia, particularly from nationally representative studies using standard case definitions. Objective: This study aimed to estimate the prevalence of Long COVID, characterize its symptoms, identify risk factors, and assess disease burden and healthcare utilization among Saudi adults. Methods: Between June 2023 and December 2024, we conducted a national cross-sectional mixed-methods study among 1790 adults with PCR-confirmed COVID-19 infection in all 13 regions of Saudi Arabia. Long COVID was defined using the WHO consensus case definition (symptoms persisting ≥ 3 months post-infection not attributable to alternative diagnoses). Results: The prevalence of Long COVID was 32.0% (95% CI 29.8–34.3). The most common symptoms were fatigue (68%), dyspnea (45%), and cognitive impairment (39%). Independent predictors included female sex (adjusted odds ratio [aOR] 1.8, 95% CI 1.4–2.3), moderate-to-severe acute infection (aOR 2.5, 95% CI 2.0–3.1), incomplete vaccination (aOR 1.6, 95% CI 1.2–2.1), metabolic disorders (aOR 1.6, 95% CI 1.2–2.1), and obesity (aOR 1.5, 95% CI 1.2–1.9). Among Long COVID patients, 41% required specialty care and 12% reported work disability. Conclusions: Long COVID affects approximately one-third of COVID-19 survivors in Saudi Arabia, imposing a significant healthcare and socioeconomic burden. These findings highlight the need for swift action and policy implementation within the health care system to mitigate long-term consequences. Full article

Background: Post-COVID-19 condition (PCC) remains a public health concern due to persistent metabolic and inflammatory alterations, especially among ICU survivors. Oxidative stress is involved in PCC pathophysiology, and the Mediterranean diet may be associated with redox balance. Objective: To evaluate the association between Mediterranean diet adherence (main exposure variable) and oxidative stress/redox stress biomarkers (primary outcomes) in ICU survivors with persistent symptoms after severe COVID-19. Additionally, body composition and inflammatory markers were explored as secondary outcomes related to redox status. Methods: This cross-sectional study included 123 adult ICU survivors with PCC (51 ± 13.2 years; 53% men; 75% with obesity). Protein carbonyls, TBARS, sulfhydryl groups, glutathione, CRP, albumin, and IL-6 were measured. Diet adherence during post-COVID-19 outpatient follow-up was assessed using MEDAS, and body composition by DXA. Participants were categorized by the median score, and Poisson regression models were applied. Results: The median MEDAS total score was 4 (IQR 2–5), indicating overall low adherence to the Mediterranean diet. Lower adherence was associated with higher glutathione levels (p = 0.04), with no differences in pro-oxidant markers. Higher sulfhydryl levels were associated with lower body fat, higher appendicular skeletal muscle mass, and lower CRP and IL-6. Conclusions: Low adherence was frequent and associated with antioxidant differences. Redox status was also associated with body composition and inflammatory markers. Full article

Background: Post-acute sequelae of COVID-19 (PASC), commonly known as long COVID, affects an estimated 10–30% of SARS-CoV-2 non-hospitalised and 50–70% of hospitalised survivors. This condition remains clinically heterogeneous, and the specific mechanisms driving the transition from acute infection to chronic sequelae remain poorly understood. We assessed independent risk factors, tracked the evolution of clinical features, defined distinct symptom-based phenotypes, and assessed the impact of different pandemic waves on the likelihood of developing long COVID in hospitalised survivors. Methods: We conducted a single-centre, retrospective cohort study at a university hospital in London. The population comprised 627 adults hospitalised with acute COVID-19 between February 2020 and December 2022. Baseline characteristics and outcomes were compared between long COVID and resolved cases using appropriate statistical tests for continuous and categorical variables. Multivariable logistic regression identified risk factors. McNemar’s test quantified the phenotypic shift from admission to follow-up. Latent Class Analysis (LCA) identified clinical subtypes based on symptom clusters. Results: Of 627 patients, 252 (40.2%) met long COVID criteria. Comorbidity burden was the strongest predictor; patients with a single condition had a 4-fold increase in odds (aOR 4.62, 95% CI 2.36–9.04). The ORs were also significantly elevated among patients with 2 (aOR 3.26), 3 (aOR 2.68), or 4 or more (aOR 3.24) comorbidities. Older age (aOR 1.04), acute disease severity (measured by length of hospital stay) (aOR 1.27 per log-day) and elevated admission fibrinogen (aOR 1.21 per g/L) were significant predictors. Temporal analysis revealed a precipitous decline in risk from Wild-type/Alpha (>50%) to Delta/Omicron (<21%). We observed a distinct phenotypic shift: while acute respiratory inflammation resolved, systemic fatigue increased fourfold (7.0% to 32.4%), and memory difficulties emerged in the post-acute phase. LCA identified two phenotypes: fatigue-dominant and multisystem phenotypes. Conclusions: Long COVID is a multifactorial syndrome driven by host susceptibility, acute severity, and persistent coagulopathy. Clinical management should move beyond a monolithic approach and favour phenotype-specific strategies. Full article

Background/Objectives: Congenital gastrointestinal malformations (CGIMs) remain a significant cause of pediatric mortality, particularly during the neonatal period in resource-limited settings. Mortality varies widely, across conditions and healthcare systems, yet data from Eastern European centers remain limited. We aimed to determine mortality during index admission and identify baseline factors associated with death among children with CGIMs treated at our tertiary surgical center, including the COVID-19 pandemic years. Methods: We conducted a single-center retrospective study (January 2020–December 2024) of all consecutive children admitted with congenital gastrointestinal malformations. The primary outcome was death during index admission. Secondary mortality outcomes included death within 30 days of admission and 30-day postoperative mortality. Comparisons were performed between survivors and non-survivors. Data were extracted from medical records and potential risk factors of mortality were evaluated using univariable analyses and multivariable logistic regression. Statistical analysis was performed using SPSS version 31 (IBM) and a p-value of <0.05 was considered statistically significant. Results: Overall, index-admission mortality was 11.7% (27/231), with 55.6% of deaths occurring within 30 days from admission and 85.2% occurring postoperatively. Mortality was highest among patients with cloacal malformations, duodenal atresia/stenosis, and esophageal atresia ± tracheoesophageal fistula. Deaths occurring during the neonatal period accounted for 85% of all deaths. Compared with survivors, non-survivors had significantly lower birth weight, gestational age, and Apgar scores, increased ASA score, and higher rates of prematurity, syndromic conditions, associated anomalies, and sepsis. In multivariable analysis, prematurity remained independently associated with index-admission mortality (adjusted OR 3.20, 95% CI 1.23–8.31; p = 0.017). In an exploratory multivariable analysis including in-hospital complications, sepsis was strongly associated with mortality (adjusted OR 8.63, 95% CI 3.16–23.55, p < 0.001). Conclusions: Mortality during index admission remained substantial among children with congenital gastrointestinal malformations. Prematurity was the only baseline characteristic independently associated with mortality. In an exploratory analysis, sepsis identified from retrospective clinical documentation was associated with mortality. Improved care for preterm infants and prevention of severe infection may improve outcomes. Larger multicenter studies are needed to validate these findings and refine risk stratification strategies for high-risk patients. Full article

Background/Objectives: Hexosylceramides (HexCers) are bioactive lipids whose circulating levels have been associated with severe illness. Blood lipid profiles differ between COVID-19 and non-COVID-19 sepsis and are also affected by liver cirrhosis. To evaluate the impact of SARS-CoV-2 infection and investigate associations with disease severity and underlying liver cirrhosis among circulating HexCer species, we analyzed plasma samples from patients with systemic inflammatory response syndrome (SIRS), sepsis, or septic shock. Methods: Plasma levels of five HexCer species were quantified by flow injection analysis tandem mass spectrometry (FIA-MS/MS) in 159 patients with SIRS, sepsis, or septic shock. Among these patients, 24 had COVID-19, and 31 liver cirrhosis. In addition, serum HexCer levels were analyzed in 41 patients with moderate and 61 patients with severe COVID-19. Results: Patients with SIRS, sepsis or septic shock exhibited largely comparable plasma HexCer18:1;O2/22:0, 23:0, and 24:0 concentrations, all of which were significantly lower than those observed in healthy controls. These species and in addition HexCer18:1;O2/16:0 and 24:1 levels were modestly lower in patients with septic shock compared to those with SIRS. No significant differences in any of the five HexCer species were observed between patients with COVID-19 and non-COVID-19 septic shock or between ventilated patients with and without COVID-19, indicating that circulating HexCer levels are associated with disease severity rather than SARS-CoV-2 infection. HexCer18:1;O2/24:1 levels were increased in patients with cirrhosis. No significant differences in HexCer levels were observed between survivors and non-survivors. Conclusions: In COVID-19 and non-COVID-19 patients circulating levels of HexCer18:1;O2/22:0, HexCer18:1;O2/23:0, and HexCer18:1;O2/24:0 decline early during systemic inflammation, whereas reductions in HexCer18:1;O2/16:0 and 24:1 levels become apparent in septic shock. These findings indicate that alterations in circulating HexCer species reflect sepsis severity rather than being specific to COVID-19. Full article

Long COVID affects an estimated 10–20% of SARS-CoV-2 survivors with heterogeneous, multi-system symptoms persisting for months to years, contributing to significant workforce disruption and reduced functional capacity. This exploratory study identified symptom clusters following SARS-CoV-2 infection, examined associated personal and clinical characteristics, and assessed work status across clusters. Among 273 individuals from a single clinical site, we used baseline surveys to capture long COVID symptoms and 2-week follow-up surveys to assess work status, and applied K-means clustering to identify symptom groupings. Three preliminary clusters emerged: Cluster 1 (“brain fog”), characterized by fatigue (96%), difficulty remembering (97%), and difficulty concentrating (94%); Cluster 2 (“undifferentiated”), with low prevalence across all symptoms; and Cluster 3 (“persistent acute”), marked by cough (92%), congestion (80%), headaches (78%), and body aches (78%). Notably, among Cluster 1 (“brain fog”) respondents, 44% reported not working, and approximately half attributed their work absence to COVID-related symptoms. These hypothesis-generating findings suggest that neurocognitive symptom clusters may be associated with greater work absence in some individuals, though the small number of respondents limits firm conclusions. The findings suggest that targeted occupational rehabilitation strategies may warrant further investigation as potential strategies for individuals experiencing post-infectious cognitive impairment following SARS-CoV-2 infection. Full article

Background/Objectives: Intensive care unit (ICU) mortality reflects interactions between baseline vulnerability, acute physiological derangement, ICU-acquired infection, and the intensity of organ-support therapy. Methods: This single-center retrospective cohort study included 3323 adult first ICU hospitalizations at the University Clinical Hospital in Bialystok, Poland, between 1 January 2017 and 1 June 2023. Secondary ICU admissions/readmissions, patients aged <18 years, and one pregnancy admission were excluded. Patients were classified as ICU survivors (n = 1778) or ICU non-survivors (n = 1545). Variables were compared using t-tests, chi-square tests, or Fisher exact tests, and an adjusted logistic regression model was fitted as an exploratory prognostic model. Results: ICU mortality was 46.5%, and 28-day ICU mortality was 40.2%. Non-survivors were older than survivors (66.7 ± 15.1 vs. 60.9 ± 17.2 years; p < 0.001) and more frequently had arterial hypertension, diabetes mellitus, COVID-19, ischemic heart disease, atrial fibrillation, renal failure, and acute myocardial infarction or ischemic stroke. In the adjusted model, ICU mortality was associated with age per 10 years (OR 1.32, 95% CI 1.18–1.47), COVID-19 (OR 3.15, 95% CI 2.07–4.79), ventilator-associated pneumonia (OR 1.68, 95% CI 1.22–2.30), lactate per 1 mmol/L (OR 1.29, 95% CI 1.16–1.43), pH per 0.1-unit decrease (OR 1.79, 95% CI 1.41–2.29), mechanical ventilation (OR 14.74, 95% CI 3.40–63.87), cardiopulmonary resuscitation (OR 9.45, 95% CI 4.67–19.13), renal replacement therapy (OR 2.01, 95% CI 1.39–2.91), and treatment of acidosis or alkalosis (OR 1.95, 95% CI 1.29–2.94). Conclusions: ICU non-survival was associated with older age, COVID-19, cardiovascular and renal vulnerability, ICU-acquired infection, inflammatory and metabolic dysfunction, and early requirement for rescue organ-support interventions. These findings should be interpreted as adjusted associations, not causal effects. Full article

Background: Coronavirus disease 2019 (COVID-19) is frequently complicated by acute respiratory distress syndrome (ARDS), which is associated with high mortality. The lactate-to-albumin ratio (LAR) and C-reactive protein-to-albumin ratio (CAR) have been proposed as prognostic markers in critical illness, but their comparative performance in COVID-19–associated ARDS is not well established. Methods: We conducted a retrospective cohort study using the MIMIC-IV database, which contains data from Beth Israel Deaconess Medical Center, United States, including COVID-19 ICU admissions from 2020 to 2022. Adult COVID-19 patients with available PaO₂/FiO₂, lactate, albumin, and C-reactive protein measurements within the first 48 h of ICU admission were included. Receiver operating characteristic analysis, Kaplan–Meier survival analysis, and Cox proportional hazards regression were performed. Results: Of the 3620 patients screened, 66 met the inclusion criteria; 36 survived and 30 died. Non-survivors had significantly higher LAR and CAR values at ICU admission. In ROC analyses, LAR demonstrated moderate discrimination for 30-day mortality (AUC 0.706) and showed higher discriminatory performance than CAR in most subgroup analyses. Among ARDS patients, LAR showed moderate predictive ability (AUC 0.693), compared with CAR (AUC 0.655). In severe ARDS, both markers demonstrated improved discrimination (0.722 AUC for LAR and 0.797 for CAR). High LAR was associated with significantly higher 30-day mortality in all ARDS patients (60.5% vs. 24.0%; p = 0.0056) and severe ARDS patients (72.0% vs. 20.0%; p = 0.0022). Elevated CAR was also associated with increased mortality, particularly in severe ARDS (73.1% vs. 14.3%; p < 0.001). In multivariable Cox regression, LAR remained independently associated with 30-day mortality. Conclusions: LAR demonstrated independent prognostic value for 30-day mortality in critically ill COVID-19 patients with ARDS. CAR showed variable performance. These readily available biomarkers, particularly LAR, may aid early risk stratification although larger studies are needed to confirm these findings. Full article

Six years into the COVID-19 pandemic, evidence is increasingly clear that long COVID affects women disproportionately, with higher rates of persistent cognitive and neurological symptoms. Yet, the biological mechanisms underlying this sex-dimorphic impact remain elusive. We investigated whether the immune storm of acute COVID-19 leaves a silent yet sex-specific scar on white matter integrity that shapes long-term cognitive health. In 60 previously hospitalized COVID-19 survivors, we combined an inflammatory snapshot at admission proxied by the systemic immune-inflammation index (SII) with 3T diffusion MRI and a comprehensive cognitive battery (BACS) acquired three months after recovery. Sex reshaped the inflammation–brain relationship: a higher SII predicted a diffuse alteration pattern within core associative and inter-hemispheric fibres in females only, sparing the male architecture despite a comparable inflammatory burden. In women, white matter damage coupled with poorer psychomotor coordination, and mean diffusivity fully mediated the link, unveiling a female-specific pathway from systemic inflammation to cognitive slowdown. COVID-19 inflammation imprints a durable, sex-sensitive footprint on white matter that selectively undermines psychomotor coordination in female survivors, despite a clinical recovery. This work positions women’s white matter as a critical target of post-COVID neuroinflammation and argues for sex-informed monitoring and interventions that explicitly tackle immune–brain crosstalk in long COVID. Full article