Serum cortisol as a predictor of major adverse outcomes in patients with COVID-19

BackgroundSeveral biomarkers were found to predict the severity and outcome of COVID-19 infection.AimsTo determine the serum cortisol response in patients with Coronavirus Disease 2019 (COVID-19) and its correlation with disease outcomes.Methods A prospective study among confirmed COVID-19 patients aged 18 years old and above. Morning cortisol levels were measured within 24 hours of admission. Relationship between cortisol levels and outcomes (intensive care unit (ICU) admission, intubation, and death) were analysed.Results A total of 206 patients positive for COVID-19 (mean age of 53.6±15.2 years) were included in the study. Mortality was recorded in 21 (30.4 per cent) patients with cortisol levels of ≥570nmol/L, 6 (8.8 per cent) among patients with 181–569nmol/L cortisol level, and 8 (11.6 per cent) among patients with ≤180nmol/L cortisol. Patients with cortisol levels of ≥570nmol/L were more likely to be admitted to the ICU, be intubated and longer hospital stay. Serum cortisol and ferritin levels were the most significant predictors of mortality. ConclusionOn admission, the morning cortisol level was predictive of mortality, ICU admission, intubation, and length of hospital stay in patients with COVID-19 and may be listed as an independent predictor for worse outcomes of COVID-19 infection

Clinical and biochemical characteristics of people experiencing post-coronavirus disease 2019-related symptoms: A prospective follow-up investigation

BackgroundPost-acute coronavirus disease 2019 (COVID-19) syndrome, also known as long COVID, is a prolonged illness after the acute phase of COVID-19. Hospitalized patients were known to have persisting symptoms of fatigue, headache, dyspnea, and anosmia. There is a need to describe the characteristics of individuals with post-COVID-19 symptoms in comparison to the baseline characteristics.PurposeTo investigate the clinical and biochemical characteristics of people who recovered from COVID-19 after 6 months of discharge from the hospital.MethodsThis was a prospective follow-up investigation of hospitalized and discharged COVID-19 patients. Adult patients admitted to King Saud University Medical City, Riyadh, Saudi Arabia, with laboratory-confirmed COVID-19 and discharged were recruited. The baseline demographic information, comorbidities, vital signs and symptoms, laboratory parameters, COVID-19 therapy, and outcomes were collected from the medical records. Blood samples were collected for cytokines estimation. A detailed interview about signs and symptoms was undertaken during the follow-up.ResultsHalf of the followed-up people reported experiencing at least one of the COVID-19-related symptoms. The mean blood pressure was found higher in follow-up. People with the symptoms were characterized by low lymphocyte count, lower serum calcium levels, and hyperglycemia compared to people without any post-COVID-19 symptoms. Cytokines IL-8, VEGF, and MCP-1 were higher in people with the most frequent symptoms.ConclusionPeople with post-COVID-19 symptoms were characterized by lower lymphocyte count, lower serum calcium levels, and hyperglycemia compared to people without symptoms. Individuals with the most frequent post-COVID-19 symptoms had higher baseline pro-inflammatory, chemotactic, and angiogenic cytokines

Concomitant macro and microvascular complications in diabetic nephropathy

To determine the prevalence of concomitant microvascular and macrovascular complica-tions of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Dete-rioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing com-plications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggre-ssive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

<b>Background and Objectives:</b> One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients. <b>Design and Setting:</b> Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia. <b>Patients and Methods:</b> DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine &gt;130 &#956;mol/L; and/or GFR &lt;60 mL/min/1.73m ² ]. <b>Results:</b> Of 1952 files reviewed, 621 (31.8&#x0025;) met the criteria for DN, and 294 (47&#x0025;) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m ² to 45.1 (24.1) mL/min/1.73m ² at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3&#x0025;) patients, with 250 (40.3&#x0025;) patients doubling their first-hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5&#x0025; of the cohort developed ESRD and were dialyzed. GFR &gt;90 mL/min/1.73m ² at the first hospital visit; duration of diabetes &gt;10 years; persistent proteinuria; systolic blood pressure &gt;130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy. <b>Conclusion:</b> Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3&#x0025; of patients in 9.9 years

Normal Reference Levels of Serum Cystatin C in Saudi Adults

This is the first report from Saudi Arabia studying the normal reference intervals in adult Saudi subjects and evaluating serum cystatin C as a prospective marker for the assessment of the glomerular filtration rate (GFR). Three hundred healthy adult Saudi subjects including 156 males (52&#x0025;) and 144 females (48&#x0025;), with a mean age of 31.21 &#x00B1; 9.82 years were prospectively studied to establish normal reference ranges for cystatin C. A total of 68.34&#x0025; of the study patients were in the age-group of 21-40 years. The mean serum cystatin C in the 300 healthy subjects was 0.751 &#x00B1; 0.11 mg/L (0.50 - 1.09), increasing gradually with age: it was 0.738 &#x00B1; 0.11 mg/L (0.51 - 1.09) in the age-group 21 - 30 years and 0.807 &#x00B1; 0.12 (0.51 - 1.09) among subjects who were &gt; 50 years of age. The mean serum cystatin C in females (0.778 &#x00B1; 0.118 mg/L) was significantly hig-her than in males (0.726 &#x00B1; 0.095 mg/L) (p &lt; 0.0001). The serum cystatin C level was within the defined reference range of 0.53 - 0.95 mg/L in 95&#x0025; of the subjects with a mean value of 0.74 &#x00B1; 0.097 mg/L, and was falling within the 95&#x0025; confidence interval of 0.73865 - 0.7637 mg/L, and with 98.84&#x0025; area under the curve (AUC). All the other renal function markers (urea, serum crea-tinine, calculated GFR, BMI) among the studied subjects were within the normal reference ranges for adult Saudi population. The serum cystatin C level had a significant correlation with the body mass index (BMI) (r = 0.155; p = 0.007) and a correlation with serum creatinine as well (r = 0.009; p = 0.873). It showed a negative correlation with calculated GFR as per Cockroft-Gault equation (r = - 0.101; p = 0.083)

Clinical characteristics and computed tomography findings in Arab patients diagnosed with pulmonary sarcoidosis

<b>Background and Objective</b> : Sarcoidosis is prevalent worldwide with significant heterogeneity across different ethnic groups. We aimed To describe the clinical characteristics and computed tomography findings among Arab patients with pulmonary sarcoidosis. <b> Methods</b> : A retrospective study of patient demographics, symptoms, co-morbid illness, sarcoidosis stage, treatment, pulmonary function and CT results. <b> Results</b> : Of 104 patients, most (77&#x0025;) were 40 years of age or older at diagnosis, and females in this category (&#899;40 years ) significantly outnumbered male patients (69/104 (66.3&#x0025;) vs. 35/104 (33.7&#x0025;), <i>P</i>=.003). The most common complaints were dyspnea (76&#x0025;), cough (72.1&#x0025;) and weight loss (32.7&#x0025;). The majority of patients displayed impairment in lung function parameters at presentation. However, significant impairment in forced vital capacity, percentage predicted (FVC&#x0025;) (&lt; 50&#x0025;) was present in only 17&#x0025; of patients. The most frequent CT finding was mediastinal lymph node enlargement in 49 patients (73.1&#x0025;). Parenchymal abnormalities indicating lung fibrosis were noted in 31 patients (46.3&#x0025;), and traction bronchiectasis was the most common (35.8&#x0025;) fibrotic pattern detected on CT scans. <b>Conclusion</b> : At presentation, clinical manifestations of sarcoidosis among this sample of Arab patients were similar to reports from other nations. Further studies are needed to explore the effects of race and ethnicity on disease severity in the Middle East

Long-Term Weight Outcomes after Bariatric Surgery: A Single Center Saudi Arabian Cohort Experience

Background: Obesity is considered a global chronic disease requiring weight management through lifestyle modification, pharmacotherapy, or weight loss surgery. The dramatic increase in patients with severe obesity in Saudi Arabia is paralleled with those undergoing bariatric surgery. Although known to be beneficial in the short term, the long-term impacts of surgery within this group and the sustainability of weight loss after surgery remains unclear. Objectives: We aimed to assess the long-term weight outcomes after bariatric surgery. Setting: The study was conducted at King Khalid University Hospital (KKUH), King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Methods: An observational prospective cohort study on adult patients with severe obesity undergoing bariatric surgery (sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB)) during the period between 2009 and 2015 was conducted. Weight loss patterns were evaluated pre- and post-surgery through clinical and anthropometric assessments. Absolute weight loss was determined, and outcome variables: percent excess weight loss (%EWL), percent total weight loss (%TWL), and percent weight regain (%WR), were calculated. Statistical analysis using univariate and multivariate general linear modelling was carried out. Results: A total of 91 (46 males and 45 females) patients were included in the study, with the majority belonging to the SG group. Significant weight reductions were observed at 1 and 3 years of follow-up (p &lt; 0.001) from baseline. The %EWL and %TWL were at their maximum at 3 years (72.4% and 75.8%) and were comparable between the SG and RYGB. Decrements in %EWL and %TWL and increases in %WR were seen from 3 years onwards from bariatric surgery until the study period ended. The yearly follow-up attrition rate was 20.8% at 1 year post-surgery, 26.4% at year 2, 31.8% at year 3, 47.3% at year 4, 62.6% at year 5, and 79.1% at end of study period (at year 6). Conclusion: The major challenge to the successful outcome of bariatric surgery is in maintaining weight loss in the long-term and minimizing weight regain. Factors such as the type of surgery and gender need to be considered before and after surgery, with an emphasis on the need for long-term follow-up to enssure the optimal benefits from this intervention

Validation of predictive equations for glomerular filtration rate in the Saudi population

Predictive equations provide a rapid method of assessing glomerular filtration rate (GFR). To compare the various predictive equations for the measurement of this parameter in the Saudi population, we measured GFR by the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formulas, cystatin C, reciprocal of cystatin C, creatinine clearance, reciprocal of creatinine, and inulin clearance in 32 Saudi subjects with different stages of renal disease. We com-pared GFR measured by inulin clearance and the estimated GFR by the equations. The study included 19 males (59.4&#x0025;) and 13 (40.6&#x0025;) females with a mean age of 42.3 &#177; 15.2 years and weight of 68.6 &#177; 17.7 kg. The mean serum creatinine was 199 &#177; 161 &#956;mol/L. The GFR measured by inulin clearance was 50.9 &#177; 33.5 mL/min, and the estimated by Cockcroft-Gault and by MDRD equations was 56.3 &#177; 33.3 and 52.8 &#177; 32.0 mL/min, respectively. The GFR estimated by MDRD revealed the strongest correlation with the measured inulin clearance (r= 0.976, P= 0.0000) followed by the GFR estimated by Cockcroft-Gault, serum cystatin C, and serum creatinine (r= 0.953, P= 0.0000) (r= 0.787, P= 0.0001) (r= -0.678, P= 0.001), respectively. The reciprocal of cystatin C and serum creatinine revealed a correlation coefficient of 0.826 and 0.93, respectively. Cockroft-Gault for-mula overestimated the GFR by 5.40 &#177; 10.3 mL/min in comparison to the MDRD formula, which exhibited the best correlation with inulin clearance in different genders, age groups, body mass index, renal transplant recipients, chronic kidney disease stages when compared to other GFR predictive equations