4 research outputs found
Serum lipid mediator profiles in COVID-19 patients and lung disease severity: a pilot study
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is highly heterogeneous, ranging from asymptomatic to severe and fatal cases. COVID-19 has been characterized by an increase of serum pro-inflammatory cytokine levels which seems to be associated with fatal cases. By contrast, the role of pro-resolving lipid mediators (SPMs), involved in the attenuation of inflammatory responses, has been scarcely investigated, so further studies are needed to understand SPMs metabolism in COVID-19 and other infectious diseases. Our aim was to analyse the lipid mediator metabolome, quantifying pro- and anti-inflammatory serum bioactive lipids by LC–MS/MS in 7 non-infected subjects and 24 COVID-19 patients divided into mild, moderate, and severe groups according to the pulmonary involvement, to better understand the disease outcome and the severity of the pulmonary manifestations. Statistical analysis was performed with the R programming language (R Foundation for Statistical Computing, Vienna, Austria). All COVID-19 patients had increased levels of Prostaglandin E2. Severe patients showed a significant increase versus controls, mild- and moderate-affected patients, expressed as median (interquartile range), in resolvin E1 [112.6 (502.7) vs 0.0 (0.0) pg/ml in the other groups], as well as in maresin 2 [14.5 (7.0) vs 8.1 (4.2), 5.5 (4.3), and 3.0 (4.0) pg/ml, respectively]. Moreover, 14-hydroxy docosahexaenoic acid (14-HDHA) levels were also increased in severe vs control and mild-affected patients [24.7 (38.2) vs 2.4 (2.2) and 3.7 (6.4) ng/mL, respectively]. Resolvin D5 was also significantly elevated in both moderate [15.0 (22.4) pg/ml] and severe patients [24.0 (24.1) pg/ml] versus controls [0.0 (0.0) pg/ml]. These results were confirmed by sparse partial least squares discriminant analysis which highlighted the contribution of these mediators to the separation between each of the groups. In conclusion, the potent inflammatory response to SARS-CoV-2 infection involves not only pro- but also anti-inflammatory lipid mediators that can be quantified in easily accessible serum samples, suggesting the need to perform future research on their generation pathways that will help us to discover new therapeutic targets
ESCMID COVID-19 living guidelines: drug treatment and clinical management: author’s reply.
Scope: In January 2021, the ESCMID Executive Committee decided to launch
a new initiative to develop ESCMID guidelines on several
COVID-19-related issues, including treatment of COVID-19.
Methods: An ESCMID COVID-19 guidelines task force was established by the
ESCMID Executive Committee. A small group was established, half
appointed by the chair, and the remaining selected with an open call.
Each panel met virtually once a week. For all decisions, a simple
majority vote was used. A long list of clinical questions using the PICO
(population, intervention, comparison, outcome) format was developed at
the beginning of the process. For each PICO, two panel members performed
a literature search with a third panellist involved in case of
inconsistent results. Voting was based on the GRADE approach.
Questions addressed by the guideline and recommendations: A synthesis of
the available evidence and recommendations is provided for each of the
15 PICOs, which cover use of hydroxychloroquine, bamlanivimab alone or
in combination with etesevimab, casirivimab combined with imdevimab,
ivermectin, azithromycin and empirical antibiotics, colchicine,
corticosteroids, convalescent plasma, favipiravir, remdesivir,
tocilizumab and interferon beta-1a, as well as the utility of antifungal
prophylaxis and enoxaparin. In general, the panel recommended against
the use of hydroxychloroquine, ivermectin, azithromycin, colchicine and
interferon beta-1a. Conditional recommendations were given for the use
of monoclonal antibodies in high-risk outpatients with mild-moderate
COVID-19, and remdesivir. There was insufficient evidence to make a
recommendation for use of favipiravir and antifungal prophylaxis, and it
was recommended that antibiotics should not be routinely prescribed in
patients with COVID-19 unless bacterial coinfection or secondary
infection is suspected or confirmed. Tocilizumab and corticosteroids
were recommended for treatment of severe COVID-19 but not in outpatients
with non-severe COVID-19.
Scope: The aim of the present guidance is to provide evidence-based
recommendations for management of adults with coronavirus disease 2019
(COVID-19). More specifically, the goal is to aid clinicians managing
patients with COVID-19 at various levels of severity including
outpatients, hospitalized patients, and those admitted to intensive care
unit. Considering the composition of the panel, mostly clinical
microbiologists or infectious disease specialists with no pulmonology or
intensive care background, we focus only on pharmacological treatment
and do not give recommendations on oxygen supplement/support. Similarly,
as no paediatricians were included in the panel; the recommendations are
only for adult patients with COVID-19. Considering the current
literature, no guidance was given for special populations such as the
immunocompromised. (C) 2021 European Society of Clinical Microbiology
and Infectious Diseases. Published by Elsevier Ltd. All rights reserved