Today during grand rounds, we had two more of our wonderful residents who were selected during our annual research symposium to present their work at Grand Rounds.
R2 Revathy Sampath-Kumar presented her research on IVC diameter and how it predicts acute decompensated heart failure during hospitalization. She discussed the high prevalence and incidence of heart failure and the resulting high cost burden of heart failure and hospitalizations. She discussed the current challenges of existing volume status measurements, and reviewed the pathophysiology of congestion to justify why IVC diameters correlate to volume status in ADHF patients. Dr. Sampath-Kumar’s study involved retrospective review for 200 patients admitted to UCSD with ADHF and TTE at some point during admission. She demonstrated that those patient who were rehospitalized within 1 year had significantly larger IVC diameters, regardless of their clinical volume status at that time, showing that higher IVC diameter is a poor prognosticator for future hospitalizations and that IVC diameter is a good proxy for PA pressure. Overall, IVC diameter, corrected IVC diameter, NYHA functional class, pro-BNP, and TR/MR all were the strongest predictors for ADHF rehospitalization. A cut-off point of 2.07 cm is clinically useful for prediction of rehospitalization in 1 year, with a favorable receiver operating curve, which can be used to assess the need for ongoing diuresis or need for close follow-up.
R2 Ana Lucia Fuentes then presented her research regarding neutrophil extracellular trap (NET) formation increases with COVID-19. She started by introducing NET’s and their role in the innate immune system, including the role of NET’s (DNA complex formation) that is used to fight microorganism invaders. The formation of NETs can also result in adverse effects and have been implicated in several autoimmune diseases, including ANCA-associated vasculitidies, SLE, and RA. NET’s have also been implicated in the pathogenesis of ARDS. Dr. Lucia Fuentes’ research centered on linking the increase in NET formation with COVID-19-related ARDS. She first isolated neutrophils from peripheral blood of 21 COVID-19 patients, treated them with PMA and Nigericin to stimulate NET formation, and compare them with non-treated neutrophils to determine differences in NETosis. APACHE-II scores were calculated for the source patients as a proxy for severity of illness and then the degree of NETosis was correlated to the APACHE II scores. COVID-19 patients were found to produce more NETs (higher NETosis) than the healthy controls and the increased NETosis was found to be associated with an elevated ANC. Patients with higher APACHE II socres had higher rates of NETosis. Overall, these data support the hypothesis that COVID-19 patients have more hyperactivated neutrophils and that increased NETosis correlated with COVID-19 disease severity and can potentially act as a biomarker. Finally, ANC also correlates with NETosis and ANC may in itself be potentially used as a biomarker for COVID-19 disease severity.
Congratulations to both Revathy and Ana Lucia for presenting their amazing research at Grand Rounds!