10 articles
Chronic kidney disease and COVID-19 are both associated with significant morbidity. Patients with chronic kidney disease are at risk for severe COVID-19, and SARS-CoV-2 infection may accelerate CKD progression. This study aimed to compare renal outcomes in CKD patients with and without prior COVID-19 and to identify predictors of progression.
We conducted a prospective cohort study of 280 pre-dialysis CKD patients (stages G2–G5), followed for 12 months. Of these, 140 had a history of COVID-19 (post-COVID group), and 140 had no such history (control group). Baseline assessments included renal function (eGFR, creatinine, urea), inflammatory markers (CRP, ferritin, LDH), hematologic indices (hemoglobin, leukocytes, platelets), and SF-36 quality of life scores. CKD progression was defined as a ≥30% eGFR decline or the initiation of dialysis. Analyses included group comparisons, correlations, logistic regression, and ROC curves.
Baseline characteristics and mean eGFR (~60 mL/min/1.73 m²) were similar across groups. CRP and ferritin levels were elevated in both groups without significant differences. Post-COVID patients reported lower vitality and higher social functioning on SF-36 (both p < 0.001). After 12 months, the post-COVID group showed greater eGFR decline (–3.1 vs –1.2 mL/min) and a higher progression rate (28% vs 15%, p < 0.01). Multivariable analysis identified prior COVID-19 (adjusted OR ≈2.3, 95% CI: 1.3–4.0) and low baseline hemoglobin as independent predictors of progression; CRP and ferritin were not predictive. LDH showed a modest association. Hemoglobin alone predicted progression with an AUC of 0.78; the combined model (COVID status + hemoglobin) yielded an AUC of 0.85.
CKD patients with prior COVID-19 experienced a faster renal function decline over one year than those without COVID-19. Persistent anemia and elevated LDH were also associated with increased progression risk. These findings emphasize the importance of post-COVID renal monitoring and early intervention in CKD patients to prevent deterioration.
The COVID-19 pandemic has posed the biggest challenge to the global health system. Kidney damage is common in COVID-19 and ranges from mild proteinuria to severe acute kidney injury.
Objective. The aim of the study was to establish the dynamics of COVID-19 in patients who develop acute kidney injury and to identify risk factors for developing acute kidney injury associated with COVID-19.
A retrospective descriptive study was conducted, including 40 patients of both sexes, aged between 37 and 88 years, who were admitted to the intensive care unit of the Timofei Moșneaga Republican Clinical Hospital during the period 2020-2022. Statistical analysis was performed using the Student’s t-test.
The most common factors identified as determinants were advanced age, comorbidities, mechanical ventilation, and nephrotoxic drugs. The presence of proteinuria, hematuria, and leukocyturia was identified. Urea and creatinine levels were elevated on admission and continued to rise; 10% of patients required renal replacement therapy. It was observed that the greater the degree of lung damage, the earlier mechanical ventilation was instituted, which could lead to the development of early acute kidney injury. All patients were mechanically ventilated and developed acute kidney injury, contributing to a severe course of COVID-19.
Acute kidney injury is one of the most frequent and severe complications encountered among mechanically ventilated patients with severe forms COVID-19 and is often associated with a fulminant course and a high mortality rate.
Scleroderma Renal Crisis (SRC) is a life-threatening complication of systemic sclerosis (SSc), traditionally associated with anti-RNA polymerase III antibodies, corticosteroid use, and diffuse skin involvement. However, the role of COVID-19 as a potential trigger for SRC remains poorly understood. This study explores the occurrence of COVID-19-associated SRC, focusing on its clinical presentation, underlying risk factors, and outcomes.
We present a case series of two unvaccinated patients with systemic sclerosis who developed SRC following COVID-19 infection, despite the absence of traditional risk factors. Clinical features, laboratory findings, renal histopathology, and disease progression were analyzed to assess potential mechanisms linking SARS-CoV-2 infection to SRC onset. Both patients developed abrupt-onset malignant hypertension and acute kidney injury after supporting the COVID-19. Neither patient had a history of corticosteroid use or known anti-RNA polymerase III positivity, suggesting an alternative mechanism of SRC activation. Notably, both cases had pre-existing renal anomalies (renal developmental abnormality and prior nephrectomy), which may have contributed to increased susceptibility. Despite aggressive management, both patients developed dialysis-dependent renal failure and succumbed to SRC-related complications.
Our findings highlight COVID-19 as a potential trigger for SRC, possibly through endothelial dysfunction, inflammatory cytokine storms, and renal microangiopathy. The presence of pre-existing kidney conditions may further predispose SSc patients to SRC following SARS-CoV-2 infection. Additionally, the lack of vaccination in these cases raises the question of whether COVID-19 immunization could reduce SRC risk. Further research is needed to elucidate the pathophysiology, risk stratification, and long-term outcomes of COVID-19-associated SRC, as well as the role of vaccination in prevention.
Currently, extensive research has shown that almost all published prediction models are poorly studied and have significant limitations, leading to their predictive performance often being overestimated. Additionally, there is still no universally accepted scoring system, primarily due to the need for adaptation to heterogeneous patient samples (including patient numbers, clinical profiles, and risk factors) and/or ongoing differences in the organization of healthcare systems across various countries.
This is a narrative literature review. A bibliographic search was conducted in the PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published between 2000 and 2024 were selected based on keyword combinations such as "artificial intelligence", "prediction model", "algorithm", "machine learning", and "COVID-19". Information on machine learning predictive models was selected and processed to identify characteristics that can be used to predict diagnosis, severity, length of hospital stay, ICU admission, treatment, vaccination, and mortality in COVID-19 patients. After processing the data according to the search criteria, 125 full-text articles were identified. The final bibliography includes 52 relevant sources, which were considered representative of the literature on this synthesis article topic.
Artificial intelligence techniques are increasingly being used to predict outcomes in COVID-19 patients, particularly in estimating mortality among individuals infected with SARS-CoV-2, which can rapidly and effectively support clinical decision-making. According to the analysis of multiple studies, strong predictors of mortality in COVID-19 patients include advanced age, male gender, comorbidities, reduced levels of calcium, albumin, red blood cells, and oxygen saturation, as well as lymphopenia, elevated blood urea nitrogen, creatinine, lactate dehydrogenase, D-dimers, neutrophils, interleukin-6, procalcitonin, bilirubin, ferritin, aspartate aminotransferase, and troponin.
Artificial intelligence techniques provide potential advantages over conventional assessment methods. The information obtained from machine learning and deep learning algorithms, including easily accessible and interpretable data, can assist healthcare workers in making accurate decisions for the appropriate and timely care of COVID- 19 patients. This can improve patient outcomes, reduce the burden on healthcare systems, and ultimately decrease mortality rates.
Ozone therapy can be used as a monotherapy or as an adjunctive treatment to standard COVID-19 treatment protocols. Current evidence indicates that this approach may improve clinical outcomes, paraclinical markers, and reduce radiological signs of inflammation, with no side effects.
he study included 100 consecutive patients aged 18 and older with COVID-19, admitted to the Intensive Care Unit at the Institute of Emergency Medicine. Patients were randomly divided into two groups: 50 patients underwent treatment according to the National Clinical Protocol along with major ozonated autohemotherapy (the study group), while the other 50 patients were treated only according to the National Clinical Protocol (the control group).
Although the initial oxygenation index (PaO2/FiO2) values were similar in both study groups, a dynamic analysis revealed a clear efficacy of ozone therapy. By the end of the first-week treatment, the mean oxygenation index in the ozone-treated group was significantly higher than in the standard treatment group: 296.8±105.1 mm Hg versus 232.8±110.6 mm Hg (p<0.01). The use of oxygen therapy (70.0% vs. 78.0%), non-invasive ventilation (70.0% vs. 76.0%), and invasive mechanical ventilation (22.0% vs. 38.0%) tended to be lower in the ozone group, though this difference was not statistically significant (p>0.05). Both treatment groups showed a significant clinical improvement, with 54.0% of COVID-19 patients in the ozone group and 50.0% in the conventional treatment group achieving a two-point reduction in clinical severity score (p>0.05).
The mean oxygenation index significantly increased in the study patient group (246.86±30.3 mm Hg on day 1 and 296.75±105.1 mm Hg on day 7 of treatment; p<0.01) and remained unchanged in the control group (235.86±33.4 mm Hg on day 1 and 232.82±110.6 mm Hg on day 7 of treatment; p>0.05). Although the mortality rate was lower among COVID-19 patients treated with ozone therapy (24.0%) compared to those receiving standard treatment (34.0%), this difference did not achieve any statistical significance.
COVID-19 was initially considered a predominantly respiratory infection, with mortality associated with progression of respiratory failure, but currently is recognized as a multisystem disease with a wide range of manifestations. One of the most common complications of COVID-19 is acute kidney injury (AKI), which predominantly evolved to chronic kidney disease (CKD). The objective of the study was to investigate the types of acute kidney injury and their prognostic value in hospitalized patients with COVID-19 with evolution to chronic kidney disease.
The study utilized a comprehensive database of patients admitted to general department of COVID-19 at Timofei Moșneaga Republican Clinical Hospital from 2020 to 2022 years (in total 1000 patients). The first part of the study was a retrospective study, focusing on patients with confirmed COVID-19 and lung injury was diagnosed by computer tomography. The second part was a prospective study assessing the prognostic value of inflammatory markers, renal functional status and kidney injury.
AKI occurs in 29.6% of patients with COVID-19. The risk of AKI and CKD is higher in patients with more comorbidities, a more severe course of disease, elevated levels of ASAT/ALAT > 1.6 and hematuria at admission, which significantly increases the risk of progression to CKD. Patients with a history of CKD, and who had ASAT > 40 U/L, ASAT/ALAT > 1.6 and hematuria, experience the onset of AKI before hospitalization. Independent negative predictors of hospital-developed AKI include hypertension, Charlson Comorbidity Index > 4 points, respiratory failure, ASAT/ALAT > 1.6, D-dimers > 250 ng/ml, and hematuria. Hospital mortality in patients with COVID-19 was 20.8%, compared to 8.5% in patients without AKI, and this rate increased to 50% when AKI developed (p < 0.001).
Patients who developed AKI during admission had a higher incidence of negative outcomes compared to those with AKI prior to admission. Independent predictors of in-hospital mortality in COVID-19 patients were increased serum CRP. Death in hospitalized patients with COVID-19 and AKI was independently associated with factors such as age > 75 years, history of CKD, admission to Intensive Care Unit, leukocytosis, and ASAT/ALAT > 1.6.
During COVID-19 pandemic, non-invasive ventilation (NIV) was widely used during COVID-19 Pandemic. The factors predicting NIV failure in COVID-19 patients remain debatable. The goal of this research is to identify the parameters that may correlate NIV failure.
A retrospective analysis of COVID-19 patients’ data, who were admitted to ICU of the Institute of Emergency Medicine, Chisinau, during July-October 2020 and connected to NIV. The study analyzed the demographics, laboratory and respiratory parameters (at admission, at NIV initiation, 24-48h and 72-96h of NIV) and their relation with NIV failure. For continuous variables, the established confidence interval was 95%. The Kruskal-Wallis H test was used for continuous variables and the Fisher’s exact test or chi-squared test was used for category data.
In study were included 154 patients. NIV failed in 52 patients. In NIV failure group were registered a higher rate of hypertension (88% vs 74%, p = 0.033), delirium (60% vs 20%, p=0.001) and need for sedation (83% vs 48, p=0.001). The urea levels were lower in NIV success group at admission, at NIV initiation and at 24-48h of NIV. The neutrophil/ lymphocyte ratio was higher in NIV failure group at NIV initiation; at 24-48h and 72-96h of NIV. NIV failure group had a higher level of WBC count and C-reactive protein at 24-48h and 72-96h as well as D-dimer at 72-96h of NIV. The ROX index was higher in NIV success group from NIV initiation and through 72h of NIV.
The presence of abnormal values of neutrophil/lymphocyte ratio, urea, lymphocytes, WBC count, C-reactive protein, D-dimer and ROX index during non-invasive ventilation, as well as association of delirium and need for sedation, can be suggestive and informative for high risk of NIV failure in COVID-19 patients. Continuous measurement of these parameters may help the clinicians to decide the optimal timing of conversion to invasive ventilation.
COVID-19 infection affects people of any age or gender. It was found that children up to 6 months of age have a major risk of developing a severe form of the infection. Contemporary diagnostic imaging methods of high sensitivity, such as lung CT, allow to establish the degree of lung damage, the volume and the sequelae arising from enduring the COVID-19 infection. The long-term consequences of the COVID-19 infection are still being researched. Pneumonia in the infection of COVID-19 can lead to the long-term development pulmonary fibrosis, atelectasis, bronchiectasis.
The 5-month-old boy is admitted to the Pneumology Clinic with dyspnea, tachypnea, acrocyanosis, agitation, food refusal. It is known from the anamnesis that at the age of 4 months the child suffered a severe form of the COVID-19 infection. Non-contrast lung CT was performed which suggests fibro-atelectatic changes in both lungs, predominantly in the apical and basal segments.
Infants show an increased vulnerability to develop bronchopulmonary changes after COVID-19. The case is suggestive from a clinical point of view, emphasizing the connection between the form, the evolution of the disease, and the consequences arising from the COVID-19 infection. Fibrotic pulmonary evolutionary changes are suggestive of SARS-CoV-2 virus infection.
COVID-19 is currently considered a systemic disease affecting the immune system, primarily, lungs, heart, central nervous system, kidneys, intestines, liver and spleen. Impaired liver function and the presence of biochemical changes in liver can be found in approximately 14-53% of adults infected with SARS-CoV-2. Impaired liver function in patients infected with COVID-19 may occur due to a direct effect of the virus on hepatocytes, as well as being secondary to factors such as a systemic inflammatory response of the infected host, the onset of hypoxia (associated with lung damage), multiple organ failure, or due to abusive treatment using overlapping and hepatotoxic drugs.
The purpose of this article is to describe a clinical case study regarding the clinical and paraclinical manifestations of liver damage in a 12-year-old child infected with SARS-CoV-2, hospitalized at the Municipal Children’s Clinical Hospital „Valentin Ignatenco”, Republic of Moldova.
The epidemiological, clinical and paraclinical data were used to highlight this study, followed by the conclusions of multidisciplinary specialists, retrieved from the inpatient medical records of the 12-year-old child with moderate COVID-19 infection, who was admitted for emergency treatment.
A 12-year-old patient F. was admitted to the „Covid-19” subunit, complaining of severe general malaise, fever up to 39°C, cough, rhinorrhea. The objective clinical examination revealed hepatomegaly and lack of splenomegaly. Laboratory findings determined leukocytosis 15.88 x109/l, neutrophilia 72.2%, lymphopenia 26.1%, increased ESR (Erythrocyte Sedimentation rate) – 20 mm/h, increased CRP (C-reactive protein) >12.0 mg/l, increased ALT (alanine aminotransferase) by 16 (50.9-487-764 U/l) values compared to the normal reference and a 3-fold increase in AST (aspartate aminotransferase) that is higher than the normal range (55.8 - 113 - 181 U/l), an increased fibrinogen - 5.3 g/l, increased ferritin - 2834 pmol/l and D-dimer levels - 762 ng/ml. Hepatomegaly was detected on abdominal ultrasound. Covid-19 infection was confirmed by a rapid test of nasopharyngeal exudate for SARS-CoV-2 antigens.
Patients with the novel coronavirus (COVID-19) show varying degrees of liver dysfunction, especially those with increased levels of AST and ALT. A question arises within the clinical practice, as whether the liver damage occurred due to direct viral hepatotoxicity or due to the drugs used in COVID-19 treatment.
The COVID-19 pandemic has a major negative impact on health and socio-economic well-being. Understanding the characteristics of COVID-19 disease and identifying the wide range of factors affecting health and quality of life can be the key to providing viable solutions to improve the management of patients and their physical and psycho-emotional rehabilitation. The purpose of the present study was to evaluate the influence of SARS CoV-2 infection on the health status of adults hospitalized with the diagnosis of COVID-19 in the Republic of Moldova.
The presented study is a retrospective, cohort, consisting of a sample of 7441 patients randomly selected, aged 18 y/o and older, hospitalized in 10 public medical institutions in Chisinau, Moldova. Diagnosis of COVID-19 was confirmed by detection of CoV-2 SARS RNA. The data in the patients' medical records were processed and stored according to the unified, pre-established form, prepared in accordance with the requirements of the software „Electronic Patient Record COVID-19”. The severity of COVID-19 disease was assessed using two principles: (1) according to the criteria of the National Clinical Protocol PCN-371; (2) according to the 7-point graduated scale developed by the WHO Special Committee (V.3.0, 3 March 2020) in randomized multicenter clinical trials.
Only 30.07% patients mentioned the presence of a close contact with a COVID-19 positive person. The average age of the patients in the study was 52.83 years. Mild form was diagnosed in 5.00% of patients, medium - 66.15%, severe –20.67%, critical-8.18%. The main complaints of patients were fever, fatigue or physical asthenia, cough, and headache. More than 1/4 of those hospitalized have severe or critical forms of COVID-19; more than 1/3 - require oxygen therapy, and every 6-th patient needs non-invasive high-flow oxygen ventilation or mechanical ventilation. Old age, male sex, chronic comorbidities increase statistically significantly the probability of patients having an unfavorable prognosis in COVID-19. 7.93% of patients died, according to the age group: every 2-nd patient over 90 years, every 3-rd over 80 years, every 5-th over 70 years, and every 9-th over 60 years died.
(1) The uncertainty of the source of infection lead to delay specific prophylactic public health measures; (2) In COVID-19, in a hospital-type medical management, the emphasis should be placed mainly on patients over the age of 50; (3) There is no specific clinical manifestation in COVID-19, that would allow to distinguish the disease from other pathologies; (4) Age over 60 y.o, male sex, and chronic cardiovascular diseases, diabetes mellitus, chronic kidneys diseases and malignant tumors unfavorable influence the evolution of COVID-19; (5) Antibiotic administration remains at a high level in hospitalized patients and is often unjustified and unnecessary.