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Prognostic value of elevated cardiac and inflammatory biomarkers in patients with severe COVID-19:a single-center,retrospective study

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Emergency and Critical Care Medicine 2022年第3期2卷 122-127页

作者： Neeraj kumar Sarfaraz Ahmad Mala Mahto abhyuday kumar Prabhat K.Singh Department of Trauma and Emergency All India Institute of Medical Sciences PatnaBiharIndia Department of Anaesthesiology All India Institute of Medical Sciences PatnaBiharIndia Department of Biochemistry All India Institute of Medical Sciences PatnaBiharIndia Director All India Institute of Medical Sciences PatnaBiharIndia

Background:The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health emergency.Many patients with COVID-19 experience cardiac injury.Patients with COVID-19 admitted to the intensive care unit(ICU)with acute myocardial injury showed increased high-sensitivity troponin levels.Abnormal troponin levels may indicate myocardial injury and are commonly associated with COVID-19.Methods:We conducted a retrospective observational study of 44 patients with severe COVID-19 in ICU during the second wave.The primary end point of our retrospective study was 28-day mortality,and the time of ICU admission was designated as day 0.We extracted and analyzed cardiac biomarkers,such as creatine kinase(CK),creatine kinase-MB(CK-MB),B-type natriuretic peptide(BNP),and high-sensitivity cardiac troponin I(hs-cTnI),and various inflammatory markers such as C-reactive protein(CRP)level,interleukin 6(IL-6),D-dimer,ferritin,lactate dehydrogenase,IL-6,and procalcitonin in patients with severe COVID-19 at ICU admission and 72 hours after ICU admission from our electronic medical record system.Results:The best cutoff of BNP were 326.8 and 398.5 pg/mL,CK were 195.95 and 180.12 U/L,CK-MB were 112.10 and 108.5 U/L,and hs-cTnI were 0.035 and 0.025 ng/mL,at ICU admission and 72 hours after ICU admission for predicting 28-day mortality among nonsurvivors.Conclusion:In patients with severe COVID-19,CK and hs-cTnI may be considered effective and valuable predictive cardiac biomarkers among nonsurvivors and predict poor prognosis.

关键词： Cardiac biomarkers COVID-19 Intensive care unit Mortality Prognosis Retrospective study

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COVID-19 presentation as acute pancreatitis:A case report

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Journal of Acute Disease 2022年第5期11卷 199-201页

作者： abhyuday kumar A.Valiyaparambath Neeraj kumar Amarjeet kumar Ajeet kumar Department of Anaesthesiology AIIMS PatnaBiharIndia801505 Departments of Trauma&Emergency AIIMS PatnaBiharIndia801505

Rationale:The gastrointestinal manifestations of COVID-19 include anorexia,nausea,vomiting,abdominal pain,and diarrhea.However,pancreatitis as the presentation of COVID-19 is rarely reported.Patient’s Concern:A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d.Diagnosis:Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction.Interventions:The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness.The patient was started on enteral feeding,analgesics,antibiotics,dexamethasone,low molecular weight heparin,and supportive therapy.Outcomes:The patient developed severe acute respiratory distress syndrome and died 6 days after admission.Lessons:Management of COVID-19 in the presence of pancreatitis is challenging.Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed.Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir.Dexamethasone,even though it has shown a beneficial effect in treating COVID-19,can have an additive effect in causing hyperglycemia in these cases.Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies,keeping in mind the considerations for both diseases.

关键词： Pancreatitis COVID-19 APACHE II Remdesivir Fluid

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Sudden cardiac death in a case of Crohn's disease with COVID-19: A case report

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Journal of Acute Disease 2022年第3期11卷 123-126页

作者： Neeraj kumar Subhajit Ghosh abhyuday kumar Sanjeev kumar Prem kumar Departments of Trauma&Emergency All India Institute of Medical SciencesPatnaIndia Departments of Anaesthesiology All India Institute of Medical SciencesPatnaIndia Departments of CTVS All India Institute of Medical SciencesPatnaIndia Departments of Radiology All India Institute of Medical SciencesPatnaIndia

Rationale:The mechanism of sudden cardiac death in COVID-19 can be multifactorial.Cardiac hypersensitivity to 5-ASA therapy leading to myocarditis has been reported in some cases.Cytokine storm syndrome and idiosyncratic reaction with mesalazine use may lead to sudden cardiac death in COVID-19.Use of immunosuppressants in hospitalized COVID-19 patients should be continued with caution,especially in patients with inflammatory bowel disease.Patient’s concern:A 75-year-old man who was tested positive for SARS-CoV-2 was admitted with a history of shortness of breath for the last two days.He was a known case of Crohn’s disease treated with mesalazine.Diagnosis:COVID-19 pneumonia with underlying Crohn’s disease leading to sudden cardiac death.Intervention:Remdesivir,antibiotics,steroids,low molecular weight heparin,tablet zinc,tab vitamin C,and other supportive treatment were started.Because of increased inflammatory markers,itolizumab was given to the patient on the 2nd day.Outcome:On the 5th day of the intensive care unit,the patient complained of sudden chest pain with respiratory distress leading to bradycardia and asystole and could not be resuscitated.Lessons:Causes for sudden cardiac death in COVID-19 pneumonia patients with Crohn’s disease is multifactorial.Although mesalazine may be a safe and effective drug in the management of inflammatory bowel disease,it can induce sytokine strom syndrome and idiosyncratic reactions that could be one of the reasons of sudden cardic death.Therefore,we should be aware of its serious and potentially life-threatening complications,especially in COVID-19 infected patients.

关键词： COVID-19 Sudden cardiac death Chron’s disease

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Severe progression of autoimmune hepatitis in a young COVID-19 adult patient: A case report

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Journal of Acute Disease 2022年第4期11卷 161-164页

作者： Neeraj kumar Sushant Satyapriya Shaik Mohammad Tahaseen Kunal Singh abhyuday kumar Department of Trauma&Emergency AIIMS PatnaBiharIndia801505 Department of Anaesthesiology AIIMS PatnaBiharIndia801505 Department of Medicine AIIMS PatnaBiharIndia801505

Rationale:The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far.This case report describes the clinical course of a patient with autoimmune hepatitis(AIH)who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit.Patient’s Concern:A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months.Diagnosis:AIH and Covid-19 with features of cytokine storm syndrome.Interventions:Intravenous furosemide,mannitol,syrup lactulose,steroids(prednisolone 40 mg),azathioprine 1 mg/kg body weight,rifaximin,vitamin K,and blood products.Outcomes:The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support,sustained low-efficiency hemodialysis,and resuscition.Lessons:The dramatic release of cytokines and the inflammatory‐immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.

关键词： COVID-19 Autoimmune hepatitis Cytokine storm syndrome Immunosuppressant drugs Liver dysfunction

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Cope's sign and complete heart block secondary to acute cholecystitis: A case report

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Journal of Acute Disease 2020年第4期9卷 176-178页

作者： Neeraj kumar Pankaj kumar Prakash K Dubey abhyuday kumar Amarjeet kumar Department of Trauma and Emergency AIIMS Patna Bihar India Department of Emergency Medicine Paras Global HospitalDarbhangaBiharIndia Department of Anaesthesiology&Critical Care IGIMS Patna Bihar India Department of Anesthesiology AIIMS Patna Bihar India

Rationale: Cope's sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient's concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope's sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.

关键词： Cope sign Complete heart block Temporary pacemaker insertion

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