Barbieri, Greta

ABSTRACT Background Several hematological and biochemical parameters have been related to the COVID‐19 infection severity and outcomes. However, less is known about clinical indicators reflecting lung involvement of COVID‐19 patients at hospital admission. Computed tomography (CT) represents an established imaging tool for the detection of lung injury, and the quantitative analysis software CALIPER has been used to assess lung involvement in COVID‐19 patients. Herein, the relationship between the lung involvement expressed by CALIPER interstitial lung disease (ILD) percentage and a set of blood parameters related to tissue oxygenation and damage in COVID‐19 patients at hospital admission was evaluated. Methods We performed a retrospective and a prospective study involving 321 and 75, respectively, COVID‐19‐positive patients recruited from Pisa University Hospital. The association between CALIPER ILD percentages and selected blood parameters was investigated by a regression tree approach, after multiple imputations of the dataset missing values. Results High serum lactate dehydrogenase (LDH) values appeared to be predictive of high CALIPER ILD percentages at hospital admission in both retrospective and prospective datasets, even if the predictive performance of the algorithm was not optimal. Conclusions LDH levels could be evaluated as a tool for early identification of COVID‐19 patients at risk of extensive lung injury, as well as in fast screening procedures before hospitalization.

The COVID-19, due to SARS-CoV-2, has uncovered many real-world issues when it comes to healthcare management and has led to a widespread mortality. Observations thus far from the reports of COVID-19 have indicated that certain risk groups for example, those with pre-existing cardiovascular (CV) disease, hypertension, diabetes, chronic kidney disease and tobacco use are prone to disease development and specifically development of severe disease and possible fatality. It is increasingly evident that many CV conditions occur frequently. These include myopericarditis, acute coronary syndromes, thrombosis, arrhythmias, hypertension and heart failure. Many professional organisations and societies related to cardiology have produced guidelines or recommendations on most of the above-mentioned aspects. Given these rapid developments, the aims of this review manuscript were to summarise and integrate recent publications with newly developed guidelines and with the first-hand experience of frontline physicians and to yield a pragmatic insight and approach to CV complications of COVID-19. We emphasise on a strategic tier-based approach for initial assessment and management of COVID-19, and then delve into focused areas within CV domains, and additionally highlighting the role of point-of-care ultrasound especially lung ultrasound, echocardiography and electrocardiography, in the management of these patients. We hope this paper will serve as a useful tool in the CV management of COVID-19 for clinicians practicing in both developing and developed countries.