Pneumonia Clinical Trial
Official title:
VALIDATION OF A SEVERITY SCORE TO IDENTIFY PATIENTS ADMITTED FOR COVID-19 PNEUMONIA AT HIGH RISK FOR AN INTENSIVE APPROACH
The outbreak of the coronavirus disease 2019 (COVID-19), first merged in China in December
2019, is now becoming a Public Health Emergency, recently confirmed as a pandemic disease by
the World Health Organization.
In particular, since February 2020, a rapidly growing number of cases has been identified in
Italy.
The clinical picture of ranges from asymptomatic cases, mild upper respiratory tract
infections to severe pneumonia with respiratory failure and death. In most severe cases,
COVID-19 disease may be complicated by acute respiratory distress syndrome (ARDS), septic
shock and multiorgan failure.
It results fundamental to early identify those subjects who rapidly may worsen their clinical
status, often requiring an intensive care unit (ICU) admission.
It has been showed that, mainly in more severe forms of SARS-Cov-2 disease, there is the
development of an hyperinflammatory status resembling a cytokine storm syndrome, as already
reported in SARS patients.
A recent study by Haung et al. reported that patients with COVID-19 infection showed high
amounts of IL1B, IFN-gamma, IP10 and MCP1, probably linked to activated T-helper1 (Th1) cell
responses. Those requiring ICU admission had higher levels of cytokines than those subjects
not requiring ICU admission, thus suggesting that cytokine storm was associated with disease
severity.
A similarity between cytokine profile of COVID-19 disease and secondary haemophagocytic
syndrome (sHLH) has been reported. Therefore, it was suggested to screen all patients with
severe COVID-19 infection both for hyperinflammatory markers (like ferritin), and the HScore
commonly used to generate a probability for diagnosis of sHLH (8), which includes some
laboratory parameters like triglycerides, fibrinogen, ferritin, serum aspartate
aminostransferase.
Based on our experience on patients affected by pneumonia from Covid19, we have observed that
those subjects with a more severe prognosis might have some predictive markers. We intend to
verify if these markers can identify those subjects with Covid19 infection who need a more
intensive therapy and to find a prognosis score.
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