COVID-19 patients may manifest thrombocytopenia and some of these patients succumb to infection due to coagulopathy. The aim of our study was to examine platelet count values in patients infected with SARS-CoV-2, comparing them to a control group consisting of non-COVID-19 patients. Moreover, we evaluated the correlation between the platelet value and the respiratory alteration parameters and the outcome (hospitalization and mortality) in COVID-19 patients. The mean platelet values (×10⁹/L) differed between patients with positive or negative SARS-CoV-2 swabs (242.1 ± 92.1 in SARS-CoV-2 negative vs. 215.2 ± 82.8 in COVID-19 patients, p < 0.001). In COVID-19 patients, the platelet count correlated with the A-aO₂ gradient (p = 0.001, rho = −0.149), with its increase over the expected (p = 0.013; rho = −0.115), with the PaO₂ values (p = 0.036; rho = 0.093), with the PCO₂ values (p = 0.003; rho = 0.134) and with the pH values (p = 0.016; rho = −0.108). In COVID-19 negative patients, the platelet values correlated only with the A-aO₂ gradient: (p = 0.028; rho = −0.101). Patients discharged from emergency department had a mean platelet value of 234.3 ± 68.7, those hospitalized in ordinary wards had a mean value of 204.3 ± 82.5 and in patients admitted to sub-intensive/intensive care, the mean value was 201.7 ± 75.1. In COVID-19 patients, the survivors had an average platelet value at entry to the emergency department of 220.1 ± 81.4, while that of those who died was 206.4 ± 87.7. Our data confirm that SARS-CoV-2 infection may induce thrombocytopenia, and that the reduction in platelet counts could be correlated with the main blood gas parameters and with clinical outcome; as a consequence, platelet count could be an important prognostic factor to evaluate and stratify COVID-19 patients.

Background: The lung ultrasound (LUS) score has been proposed as an optimal scheme for the ultrasound study of patients with suspected/confirmed COVID-19 pneumonia. The aims of our study were to evaluate the use of lung ultrasound as a diagnostic tool for diagnosing SARS-CoV-2 pneumonia, to examine the validity of the LUS score for the diagnosis of COVID-19 pneumonia, and to correlate this score with hospitalization rate and 30-day mortality. Materials and Methods: A retrospective analysis was performed on 1460 patients who were referred to the General Emergency Department of the S. Orsola-Malpighi Hospital from April 2020 to May 2020 for symptoms suspected to indicate SARS-CoV-2 infection. The ultrasound examination was based on a common execution scheme called the LUS score, as previously described. Results and Conclusions: The LUS score was found to correlate with the degree of clinical severity and respiratory failure (paO₂/FiO₂ ratio and the alveolar–arterial gradient increase than expected for age). It was shown that COVID-19 patients with an LUS score of >7 require the use of oxygen support, and a value of >10 is associated with an increased risk of oro-tracheal intubation. The LUS score was found to present higher values in hospitalized patients, increasing according to the degree of care intensity. Patients who died from COVID-19 were characterized by a mean LUS score of 11 at presentation to the emergency department. An LUS score of >7.5 was found to indicate a sensitivity of 83% and a specificity of 89% for 30-day mortality in COVID-19 patients. The use of LUS seems to be an optimal first level method for pneumonia detection and risk stratification in patients with suspected SARS-CoV-2 infection.

Introduction: Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively. Aims: The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort. Methods: Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017. Demographic and clinical characteristics, risk profile, primary (stroke and composite outcome) and secondary (TIA recurrence, cerebral hemorrhage, new onset atrial fibrillation) outcomes were compared between CWS, lacunar (L), and nonlacunar (NL) TIAs. Results: 1,035 patients (33 CWS, 189 L-TIAs, 813 NL-TIAs) were enrolled. Newly diagnosed (ND) hypertension, hypercholesterolemia, cigarette smoking, and leukoaraiosis were independent risk factors of CWS (p < 0.05). CWS showed the highest stroke (30.3% vs. 0.5% and 1.5% for L-TIAs and NL-TIAs, respectively) and composite outcome risk at follow-up (p < 0.001), but better 3-month post-stroke prognosis (mRS 0–2 90.0% vs. 36.8%; p = 0.002). CWS-related stroke mostly occurred <48 h (80.0%) and had a small vessel occlusion etiology (100%), affecting more often the internal capsule (60.0%). Dual antiplatelet therapy (DAPT) versus single antiplatelet therapy was associated with lower 3-month cumulative stroke incidence (12.5% vs. 57.1%; p = 0.010). Intravenous thrombolysis (IVT) showed similar 3-month efficacy and safety in strokes after TIAs groups (median mRS 0, IQR 0–1; p = 0.323). Conclusions: CWS is associated with higher stroke risk and better functional prognosis than L- and NL-TIAs. CWS risk profile is consistent with severe small vessel disease, and ND hypertension could represent a major risk factor. DAPT and IVT seem effective and safe in preventing and treating stroke following CWS.

One of the challenges that emerged during the coronavirus disease 2019 (COVID-19) pandemic and is still relevant today is the need to identify patients with acute respiratory failure (ARF) who could benefit from conventional oxygen therapy (COT) - oxygen supplementation with nasal cannulas, Venturi masks, and non-rebreather masks - without recurring to advanced respiratory therapy, such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), or invasive mechanical ventilation. The aim of the study was to develop a clinical tool able to predict the failure of COT in COVID-19 patients presenting to the emergency department (ED) with ARF. This was a retrospective monocentric cohort study carried out in the ED of the University Hospital of Bologna Sant’Orsola-Malpighi Polyclinic, Italy. The cohort comprised 101 COVID-19 patients with ARF from the first pandemic wave who received COT. This cohort was used to develop a scale that considers serum lactate concentration, partial arterial oxygen pressure/inspired oxygen fraction (PaO₂/FiO₂) ratio, and body temperature to predict COT failure, referred to as the Lactate, Oxygenation, and Temperature (LOT) score. The highest possible score was 17 points. The LOT score was associated with COT failure (area under the receiver operating curve or AUROC = 0.79, 95% CI 0.69 - 0.89, p < 0.001); the cut-off value of > 5 points had optimal predictive power and showed significantly higher 30-day mortality (log-rank χ² = 28,828, p < 0.0001). The LOT score was able to effectively predict COT failure in COVID-19 patients with ARF. Patients with LOT score > 5 had a very high risk of therapy failure, and more advanced respiratory therapies must be considered in these patients.

Aim Lung ultrasound (LUS) is a reliable, radiation-free, and bedside imaging technique used to assess several pulmonary diseases. Although COVID-19 is diagnosed with a nasopharyngeal swab, detection of pulmonary involvement is crucial for safe patient discharge. Computed tomography (CT) is currently the gold standard. To treat paucisymptomatic patients, we have implemented a “fast track” pathway in our emergency department, using LUS as a valid alternative. Minimal data is available in the literature about interobserver reliability and the level of expertise needed to perform a reliable examination. Our aim was to assess these. Materials and Methods This was a single-center prospective study. We enrolled 96 patients. 12 lung areas were explored in each patient with a semiquantitative assessment of pulmonary aeration loss in order to obtain the LUS score. Scans were performed by two different operators, an expert and a novice, who were blinded to their colleague’s results. Results 96 patients were enrolled. The intraclass correlation coefficient (ICC) showed excellent agreement between the expert and the novice operator (ICC 0.975; 0.962–0.983); demographic features (age, sex, and chronic pulmonary disease) did not influence the reproducibility of the method. The ICC was 0.973 (0.950–0.986) in males, 0.976 (0.959–0.986) in females; 0.965 (0.940–0.980) in younger patients (≤ 46 yrs), and 0.973 (0.952–0.985) in older (> 46 yrs) patients. The ICC was 0.967 (0.882–0.991) in patients with pulmonary disease and 0.975 (0.962–0.984) in the other patients. The learning curve showed an increase in interobserver agreement. Conclusion Our results confirm the feasibility and reproducibility of the method among operators with different levels of expertise, with a rapid learning curve.