December 3, 2020 - a podcast by COVID19LST

In today's episode we discuss:

—Management: A systematic review analyzed a set of 45 studies (n= 4,203 patients) published between November 1, 2019 and March 15, 2020 and found that elevated leukocyte count, alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), and procalcitonin levels predicted ICU admission in patients with COVID-19. Acute respiratory distress syndrome (ARDS) was predicted by elevated LDH, while mortality was predicted by increased leukocyte count and elevated LDH. Treatment with lopinavir-ritonavir showed no significant benefit across mortality and ARDS rates, while corticosteroids were associated with a higher rate of ARDS. These findings suggest that elevated levels of LDH, leukocytosis, procalcitonin, AST, and ALT may be important early signs of disease severity, though early antiviral and steroid treatments do not appear to offer much clinical benefit.

· Members of the Department of Geriatrics at Peking University First Hospital in China conducted a systematic review and meta-analysis of 25 articles assessing coagulation parameters in 3952 SARS-CoV-2 positive patients published between December 1, 2019 and May 1, 2020 and  found significantly higher D-dimer (standardized mean difference [SMD] 0.83, I^2=56.9%), prothrombin time (SMD 0.39, I^2=79.4%), and fibrinogen (SMD 0.35, I^2=42.4%) in patients with more severe COVID-19 compared to those with less severe disease, suggesting that hypercoagulability is associated with severity of COVID-19 and coagulation parameters should be assessed in these patients to monitor progression.

—Silver Linings: A literature review by investigators at McGill University of vaccine trials for 23 different viral infectious diseases from January 2005 through March 2020 showed that these trials historically have a 10% chance of moving from phase 2 through Food and Drug Administration (FDA) licensure within 10 years, and the average timeline from phase 2 to approval was 4.4 years, suggesting an unparalleled achievement if COVID-19 vaccine is approved within 18 months of the start of the pandemic.

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