INFECTIOUS DISEASES
Recent Covid-19 research
Including a blood test that can accurately predict the severity of disease, the efficacy of intravenous hydrocortisone in recovery and a study investigating the link between delirium and Covid-19 in older patients
November 3, 2020
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IV hydrocortisone reduces mortality in Covid-19 patients receiving intensive care
IV Hydrocortisone has been found to improve the recovery of Covid-19 patients following seven days of treatment in 93% of cases compared to those who were not treated with the steroid.
This is according to a worldwide study, which was overseen in Ireland by Prof Alistair Nichol, intensive care consultant at St Vincent’s University Hospital and chair of critical care medicine at UCD.
In a paper published in the Journal of the American Medical Association (JAMA), researchers demonstrated that delivering iv hydrocortisone improved recovery and survival for critically ill Covid-19 patients.
The findings were made through the ‘randomised embedded multifactorial adaptive platform-community acquired pneumonia’ (REMAP-CAP) trial.
“This is really good news for patients who are unfortunate enough to get really unwell with Covid-19 and end up in intensive care units in Ireland,” said Prof Nichol.
“The trial that we conducted showed that if we gave this drug to patients when they enter the ICU and are very unwell, it can actually reduce the mortality rate from 40% to 32%.That’s a 20% reduction in mortality. And it can also reduce the need for the complex and expensive machines that people sometimes need to support organs when they’re unwell”.
He added: “Steroids are a powerful drug that suppress the immune system, so we wouldn’t recommend people to make this decision themselves. This study was very much confined to people who are critically unwell in the ICU.”
The World Health Organization is now updating its Covid-19 treatment guidance as a result.
Between March and June, the REMAP-CAP corticosteroid trial randomised 403 adult Covid-19 patients admitted to an intensive care unit to receive the steroid hydrocortisone or no steroids at all.
The Health Research Board helped fund the Irish arm of this trial.
Blood test to predict Covid severity
Researchers have developed a score that can accurately predict which patients will develop a severe form of Covid-19. The study, led by researchers at RCSI, is published in The Lancet’s translational research journal EBioMedicine.
The measurement, called the Dublin-Boston score, is designed to enable clinicians to make more informed decisions when identifying patients who may benefit from therapies, such as steroids, and admission to an intensive care unit.
Until this study, no Covid-19-specific prognostic scores were available to guide clinical decision-making. The Dublin-Boston score can now accurately predict how severe the infection will be on day seven after measuring the patient’s blood for the first four days.
The blood test works by measuring the levels of two molecules that send messages to the body’s immune system and control inflammation. One of these molecules, interleukin (IL)-6, is pro-inflammatory, and a different one, called IL-10, is anti-inflammatory. The levels of both are altered in severe Covid-19 patients.
Based on the changes in the ratio of these two molecules over time, the researchers developed a point system where each one-point increase was associated with a 5.6 times increased odds for a more severe outcome.
“The Dublin-Boston score is easily calculated and can be applied to all hospitalised Covid-19 patients,” said RCSI Professor of Medicine Gerry McElvaney, the study’s senior author and a consultant in Beaumont Hospital.
“More informed prognosis could help determine when to escalate or de-escalate care, a key component of the efficient allocation of resources during the current pandemic. The score may also have a role in evaluating whether new therapies designed to decrease inflammation in Covid-19 actually provide benefit.”
Delirium as a symptom of Covid-19
TCD graduate Dr Mary Ní Lochlainn is at the centre of a new study focused on older adults and Covid-19. As a specialist registrar in geriatric medicine and a doctoral fellow, undertaking a PhD at King’s College London, her research interests focus on healthy ageing, preventing frailty and maintaining resilience.
During recent months she joined a research team at King’s College London looking into the effects of Covid-19 on older adults. The key finding was that new-onset confusion or ‘delirium’ was an important symptom of Covid in those who were frail. Of the hospital patients studied, one in five patients had confusion as the only presenting feature of the disease, highlighting the importance of public awareness of this symptom.
“This finding will be of particular importance in nursing homes where the staff can look out for confusion or changes in behaviour amongst residents,” Dr Ní Lochlainn said.
“Current guidance in Ireland does not include confusion as a symptom to prompt testing. Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of Covid-19.”
“Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age.”
It is not yet clear why this extreme confusion or delirium happens. Data from more than 800 people over the age of 65 was analysed. They included 322 patients in hospital with Covid-19, and 535 people using an app to record symptoms or log health reports on behalf of friends and family. All had received a positive test result.