The most risk factor is
Case 270
【Discussion】
In 2018 before worldwide COVI-19 pandemic, Japanese ministry of Health, Labor and Welfare reported that death number per day of Japanese are 3733, followed by 3769 in 2020 and 3978 in 2021 (1). The number of Japanese deaths in 2021 was the highest in the Japanese data after world war II (1). But the main cause of the increasing was increasing of dying of old ages. The number of dying per day of COVID-19 is also increasing from 10 in 2020 to 40.8 in 2021 and 96.5 in 2022 (2022 01 01 to 2022 03 05) (1). In our hospital, five persons died during the previous two months from January 1st to February 28th. They died within 10 days after admission.
According to COVID-19 guideline (2), risk factors for advancing in severity are ages more than 65, COPD, chronic renal diseases, diabetes mellitus and immune deficiency. Ages of our five patients were more than 65, all patients had previous diseases of one case with COPD, one case with chronic renal disease, two cases with diabetes mellitus, three cases with heart diseases.
Laboratory markers for advancing in severity are related to values of white blood cells, lymphocytes, LDH, troponin, D dimer, ferritin, IL-6, and procalcitonin (2). Lymphocyte counts of five patients were less than 1000/mm³ and one less than 500. LDH values of four patients were higher than 222 of reference value. KL-6 was higher in only one case than reference value of 500. Procalcitonin values are higher in two cases tested than reference value of 0.05. Values of BNP and Troponin of all cases tested were far higher than reference values of 18.4 and 14, respectively. Needless to comment, lymphocyte functions to control immune system and antibody production, LDH increases in case of breakages of somatic cells, KL-6 increases in case of them of type II alveolar cells, BNP and Troponin increases cardiac dysfunction and coronary ischemia, respectively. In five cases, laboratory test revealed remarkably high values of BNP and Troponin. This indicates that five cases at admission have marked stress on heart, both cardiac function and coronary perfusion.
Clinical stages on COVID19 are categorized into Mild, Moderate I, Moderate II and Severe; Mild stage implies SpO2 ≥ 96%, no symptoms but slight cough, no pneumonia on radiological findings; Moderate I 93 < SpO2 < 96, dyspnea, positive pneumonia on radiological findings; Moderate II SpO2 ≤ 93 necessity of oxygen inhalation: Severe necessity under ICU control or under artificial respirator (2). Our five cases at admission were categorized; one case Moderate I; two cases Moderate II: two cases Severe. Three of the five cases with dying within 10 days after admission are categorized in Moderate I and Moderate II. It indicates that the symptoms worsened rapidly after admission. Three cases had underlying diseases of cardiac diseases.
Further, these three cases and one case with Severe (another one with Severe unknown to get vaccination) experienced no vaccination for COVID-19. It indicates that COVID-19 infection might trigger dysfunction of cardiac output and/or it might spread to lung rash, inducing speedy pulmonary dysfunction. In either way, our data implies the necessity of vaccination to avoid worsening of the underlying disease or to repress proliferation of virus. The advertisement for vaccine-naïve elders to get vaccination is more crucial than that for vaccine-experienced persons to get for third-time vaccination.
【Summary】
We listed five cases with COVID-19 who died from 2022 01 01 to 2022 02 28. They died within 10 days. All patients were more than 65 ages and owned underlying diseases such as COPD, chronic renal disease, diabetes mellitus and heart diseases. Laboratory test revealed lymphocyte counts less than 1000/mm³, LDH higher than 222 of reference value. KL-6 only one case than reference values of 500. Procalcitonin higher in two cases and BNP & Troponin far higher than reference values. Clinical stage at admission; one case Moderate I; two cases Moderate II: two cases Severe.
Four cases experienced no vaccination (the other one: unknown). It is borne in mind that Clinical stages on COVID-19; Mild stage implies SpO2 ≥ 96%, no symptoms but slight cough, no pneumonia on radiological findings; Moderate I 93< SpO2< 96, dyspnea, positive pneumonia on radiological findings; Moderate II SpO2 ≤ 93 necessity of oxygen inhalation: Severe necessity under ICU control or under artificial respirator.
No vaccination for COVID-19 induces that COVID-19 infection triggers more worsening of underlying disease and spread to lung parenchyma more speedily, leading pulmonary dysfunction.
【References】
1.Japanese Ministry of Health, Labor Welfare Homepage (in Japanese)
2.Medical guideline for new type corona virus infection version 7
2022.7.1