LNSLNS

The suggestion from Dr. Weber and Prof. Gerber, that not only the mentioned laboratory parameters but also the serum levels of liver function markers should be closely monitored, is indeed important on the basis of initial indications. Transaminase levels as well as other liver-specific laboratory parameters were of course recorded in our collective, with the median showing no or only slightly increased values in the total collective at the time of admission: aspartate aminotransferase (AST), 48 (31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77) U/L; alanine aminotransferase (ALT), 30 (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55) U/L; and total bilirubin, 0.6 (0.4–0.8) mg/dL. The median gamma-GT and alkaline phosphatase (AP) remained in the normal range, at 35 (23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74) U/L, and 56 (44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78) U/L, respectively.

Additionally, Prof. Möckel asked about the implied meaning of our statement “serum, urine, and stool was tested for SARS-CoV-2”. This explicitly does not refer to antibody detection, but indeed to virus detection in the blood in 53% of patients using polymerase chain reaction (PCR). It is true that a large number of our patients in the intensive care unit were transferred in from other hospitals. As an ECMO center (ECMO, extracorporeal membrane oxygenation), we also accept many patients with acute respiratory distress from other hospitals independent of the SARS-CoV-2 pandemic. Of course, this situation made it difficult to compare patients with ARDS in the intensive care unit to those who could be treated in a normal ward. For this reason, and in view of the small number of cases, we deliberately decided against a statistical evaluation of the significance.

Patients who were hospitalized due to COVID-19 but who were not transferred to the intensive care unit indeed required long periods of inpatient treatment. In addition to a strong inflammatory reaction and long-lasting fever, another reason for this was that almost all of them required supplemental oxygen. A newer analysis of our data showed that oxygen-dependent patients were hospitalized for a median of 12 (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29) days. Oxygen administration was required for 8 (5, 6, 7, 8, 9, 10, 11, 12, 13) days, and the patients had an elevated body temperature for 7 (2, 3, 4, 5, 6, 7, 8, 9, 10, 11) days. Needless to say, many patients who are SARS-CoV-2 positive and present to the emergency room do not need to be hospitalized. However, these patients are not described in our collective.

DOI: 10.3238/arztebl.2020.0717c

On behalf of the authors:

Prof. Dr. med. Michael Dreher

Uniklinik RWTH Aachen

Department of Pneumology and Intensive Care Medicine

Medical Clinic V, Aachen, Germany

mdreher@ukaachen.de

Paul Balfanz

Dr. med. Dirk Müller-Wieland

Prof. Dr. med. Nikolaus Marx

Uniklinik RWTH Aachen

Department of Cardiology, Angiology and Internal Intensive Medicine, Medical Clinic I, Aachen, Germany

Conflict of interest statement

Prof. Dreher has served as a paid consultant for GSK and has received speaking honoraria from AstraZeneca and Novartis.

The remaining authors declare that no conflict of interest exists.

1.
Dreher M, Kersten A, Bickenbach J, et al.: The characteristics of 50 hospitalized COVID-19 patients with and without ARDS. Dtsch Arztebl Int 2020; 117: 271–8 VOLLTEXT
1.Dreher M, Kersten A, Bickenbach J, et al.: The characteristics of 50 hospitalized COVID-19 patients with and without ARDS. Dtsch Arztebl Int 2020; 117: 271–8 VOLLTEXT

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