Morphological changes in leukocytes of acute SARS-CoV-2 infection patients, Amazon, Brazil / Alterações morfológicas em leucócitos de pacientes com infecção aguda por SARS-CoV-2, Amazônia, Brasil

RESUMO: Introdução: A pandemia pelo novo coronavírus (SARS-CoV-2) trouxe muitas incertezas sobre quais parâmetros laboratoriais seriam mais adequados durante a evolução da COVID 19. Objetivos: Correlacionar os resultados do hemograma (HGM), da relação neutrófilos/linfócitos (R N/L), da proteína C reativa (PCR) e dos achados morfológicos de indivíduos diagnosticados com infecção por SARS-CoV-2 através de Reação em Cadeia da Polimerase em Tempo Real (RT-PCR) em um laboratório particular de Belém, Pará, no período de março a setembro de 2020. Materiais e Métodos: Estudo retrospectivo com 30 indivíduos, de ambos os sexos, qualquer idade e queixa clínica, de origem domiciliar ou hospitalar que realizaram HGM, PCR e RT-PCR para COVID 19 até o 8o dia de infecção. As alterações morfológicas foram analisadas após a seleção das lâminas desses pacientes. Resultados:Amostra composta por 15 homens e 15 mulheres, com idades entre 7 e 92 anos. Desses, 12/30 indivíduos estavam em domicílio e 18/30 internados. As principais queixas foram febre, mal-estar geral, diarreia e desconforto respiratório. O estudo estatístico mostrou a existência de relação de dependência direta entre os aumentos da R N/L, PCR e necessidade de internação (p=0,0005). A análise morfológica mostrou neutrófilos hipossegmentados com granulações tóxicas, monócitos vacuolizados e linfócitos reativos com citoplasma basofílico. Conclusão: Nossos resultados associam os níveis intermediários e elevados da R N/L com o aumento de PCR e a gravidade da doença, porém, sem relação com os achados morfológicos em neutrófilos, linfócitos e monócitos que foram comuns a todos os pacientes diagnosticados até o 8o dia de infecção. (AU)

ABSTRACT: Morphological changes in leukocytes of acute SARS-CoV-2 infection patients, Amazon, BrazilORIGINAL ARTICLEIntroduction: The pandemic for the new coronavirus (SARS-CoV-2) brought many uncertainties about which laboratory parameters would be most suitable during the evolution of COVID 19. Objectives: Correlate the results of the blood count (BC), the neutrophil/lymphocyte ratio (N/LR), the C-reactive protein (CRP) and morphological findings of individuals diagnosed with SARS-CoV-2 infection through Polymerase Chain Reaction in Real Time (RT-PCR) in a private laboratory in Belém, Pará, from March to September 2020. Materials and Methods: Retrospective study with 30 individuals, of both sexes, any age and clinical complaint, of home or hospital origin who underwent BC, CRP and RT-PCR for COVID 19 until the 8th day of infection. Morphological changes were analyzed after selecting the slides for these patients. Results: Sample composed of 15 men and 15 women, aged between 7 and 92 years. Of these 12/30 individuals were at home and 18/30 were hospitalized. The main complaints were fever, malaise, diarrhea and respiratory distress. The statistical study showed a direct dependency relationship between increases in N/LR, CRP and the need for hospitalization (p = 0.0005). Morphological analysis showed hyposegmented neutrophils with toxic granulations, vacuolated monocytes, and reactive lymphocytes with basophilic cytoplasm. Conclusion: Our results associate intermediate and elevated levels of N/LR with increased CRP and disease severity, however, unrelated to the morphological findings in neutrophils, lymphocytes and monocytes that were common to all patients diagnosed up to the 8th day of infection. (AU)

Parámetros bioquímicos y biometría hemática de pacientes con COVID-19 moderado y grave en terapia intensiva de un hospital básico de Ecuador / Biochemical parameters and blood count of patients with moderate and severe COVID-19 in intensive care at a basic hospital in Ecuador

La infección por COVID-19 se presenta principalmente de forma leve y grave, ésta última hace necesaria la hospitalización y soporte respiratorio por complicaciones como el síndrome respiratorio agudo severo (SARS), cuyo curso clínico ha sido ampliamente descrito; sin embargo, la alteración de los perfiles de laboratorio no ha sido establecida de manera precisa. Se realizó un estudio retrospectivo para determinar parámetros bioquímicos y biometría hemática en 32 pacientes con COVID-19 moderado y grave, recluidos en el Hospital Básico "Raúl Maldonado Mejía" de Cayambe, Ecuador y evaluar su utilidad como indicadores de gravedad. Se revisaron las historias clínicas, obteniendo datos clínicos, bioquímicos y hematimétricos. Se observó mayor proporción de casos COVID moderado y grave en hombres, y de la forma grave en ambos géneros, con un promedio de edad entre 45-73 años. Las comorbilidades más frecuentes fueron: hipertensión arterial (HTA), diabetes mellitus tipo 2 (DM2), insuficiencia cardíaca congestiva (ICC) y obesidad. Los parámetros bioquímicos y hematimétricos con peor pronóstico para gravedad fueron: elevación de la actividad de lactato deshidrogenasa (LDH), alanina aminotranferasa (ALT), aspartato aminotranferasa (AST), niveles de proteina C reactiva (PCR), prolongación del tiempo de protrombina (TP), contaje total de leucocitos, índice neutrófilo/linfocito (INL) y disminución de linfocitos. Los parámetros bioquímicos (LDH, PCR, ALT, AST), de coagulación (TP) y hematimétricos (recuento de leucocitos, linfocitos e INL), pueden ser útiles indicadores de gravedad en pacientes con COVID-19, permitiendo identificar precozmente pacientes con enfermedad moderada y evitar el desarrollo de la forma más severa de la enfermedad y sus complicaciones(AU)

COVID-19 infection occurs mainly in mild and severe forms, the latter requiring hospitalization and respiratory support due to complications such as severe acute respiratory syndrome (SARS), the clinical course of which has been widely described; however, the alteration of laboratory profiles has not been precisely established. A retrospective study was carried out to determine biochemical parameters and blood counts in 32 patients with moderate and severe COVID-19, confined at the "Raúl Maldonado Mejía" Basic Hospital in Cayambe, Ecuador, and to evaluate their usefulness as indicators of severity. Medical records were reviewed. , obtaining clinical, biochemical and hematometric data. A higher proportion of moderate and severe COVID cases was observed in men, and the severe form in both genders, with an average age between 45-73 years. The most frequent comorbidities were: arterial hypertension (HTA), type 2 diabetes mellitus (DM2), congestive heart failure (CHF) and obesity. The biochemical and blood count parameters with the worst prognosis for severity were: elevation of lactate dehydrogenase (LDH) activity, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP) levels, prothrombin time (PT) prolonged, total leukocyte count, ne index utrophil/lymphocyte (INL) and decreased lymphocytes. Biochemical parameters (LDH, CRP, ALT, AST), coagulation (PT) and blood counts (leukocyte count, lymphocytes and INL) can be useful indicators of severity in patients with COVID-19, allowing early identification of patients with moderate disease and avoid the development of the most severe form of the disease and its complications(AU)

Association of inflammatory and coagulation biomarkers with mortality in patients aged 60 years or older and hospitalized with COVID-19 / Associação entre biomarcadores inflamatórios e da coagulação com mortalidade em pacientes com 60 anos de idade ou mais hospitalizados com COVID-19

Objectives: To analyze the association of inflammatory and coagulation biomarkers with mortality in geriatric patients with COVID-19. Methods: This is a retrospective cohort study of 206 patients aged 60 years or older who were hospitalized with COVID-19 at an intensive care unit. The analyzed variables were age, sex, length of hospital stay, and inflammatory biomarkers (C-reactive protein, neutrophil-to-lymphocyte ratio, procalcitonin, fibrinogen, ferritin, and d-dimer). We constructed a receiver operating characteristic curve and analyzed the area under the curve to evaluate the accuracy of biomarkers associated with mortality in patients with COVID-19. Results: Mean age was 72 (± 8) years. There were 101 deaths (49% of the total sample), which were significantly more frequent (p = 0.006) in the older age groups and were distributed as follows: 37.50% (60 ­ 69 years old); 50% (70 ­ 79 years old); 67.50% (80 ­ 89 years old); and 75% (over 90 years old). Mortality was associated with increased serum levels of procalcitonin, neutrophil-to-lymphocyte ratio, C-reactive protein, and d-dimer, and decreased fibrinogen levels. Neutrophil-to-lymphocyte ratio occupied the largest area under the receiver operating characteristic curve (area under the curve 0.859) in this group. Conclusions: In this study, inflammatory biomarkers neutrophil-to-lymphocyte ratio, procalcitonin, C-reactive protein, and d-dimer were associated with mortality in older patients with COVID-19 hospitalized at an intensive care unit, and neutrophil-to-lymphocyte ratio presented the best accuracy.

Objetivos: Analisar associação de biomarcadores inflamatórios e da coagulação com mortalidade em pacientes geriátricos com COVID-19. Metodologia: Estudo do tipo coorte retrospectiva de 206 pacientes com 60 anos de idade ou mais internados em unidade de terapia intensiva (UTI) com COVID-19. As variáveis analisadas foram idade, sexo, tempo de permanência hospitalar e biomarcadores inflamatórios, sendo esses proteína C reativa (PCR), relação neutrófilo-linfócitos (RNL), procalcitonina, fibrinogênio, ferritina e D-dímero. Empregou-se a curva ROC, com análise da área sob a curva (ACR), para avaliar a acurácia dos biomarcadores associados à mortalidade nos pacientes com COVID-19. Resultados: A média de idade foi de 72 (± 8) anos. Ocorreram 101 óbitos (49,02% da amostra total), significativamente mais frequente (p = 0,006) nas faixas etárias mais elevadas, distribuídos por faixa etária: 37,50% (60 ­ 69 anos); 50% (70 ­ 79 anos); 67,50% (80 ­ 89 anos); e 75% (nos maiores de 90 anos). A mortalidade foi associada a aumento dos níveis séricos dos biomarcadores procalcitonina, relação neutrófiloslinfócitos (RNL), proteína C reativa (PCR) e D-dímero, bem como diminuição dos níveis de fibrinogênio. A RNL ocupou a maior área sob a curva ROC (ACR 0,859) nesse grupo. Conclusões: Neste estudo, os biomarcadores inflamatórios RNL, procalcitonina, PCR e D-dímero foram associados com mortalidade em pacientes idosos portadores de COVID-19 internados em UTI, e a RNL foi a que apresentou a melhor acurácia.

Antígenos del sistema sanguíneo ABO como factor de riesgo para la gravedad de la infección por SARS-CoV-2 / Blood system ABO antigens as risk factor for severity of SARS-CoV-2 infection

Resumen Introducción: Se desconoce si existe una influencia del sistema sanguíneo ABO en susceptibilidad y gravedad de la enfermedad. Objetivo: Analizar si existe una asociación entre los antígenos del sistema ABO y la susceptibilidad y gravedad de la infección por SARS-CoV-2. Material y métodos: Se compararon las frecuencias de los antígenos del sistema ABO en 73 casos confirmados de infección por SARS-CoV-2 y 52 donadores clínicamente sanos. La gravedad de la infección se evaluó comparando la frecuencia de los antígenos por gravedad de la enfermedad y la mortalidad. Resultados: El riesgo de padecer infección por SARS-CoV-2 se incrementa en sujetos con antígeno A vs los no-A (OR=1.45; IC95 %:1.061-1.921). El fenotipo sanguíneo O disminuye el riesgo de padecer infección por SARS-CoV-2 (OR=0.686; IC95 %: 0.522-0.903). No se encontraron diferencias entre la gravedad de la enfermedad. En los pacientes graves, el riesgo de mortalidad se incrementó en sujetos con antígeno A vs los no-A (OR= 3.34; IC95 %: 1.417-8.159). Conclusión: El grupo sanguíneo A es un factor de riesgo para padecer infección por SARS-CoV-2, no así en la gravedad de la enfermedad, pero en los pacientes graves fue un factor de riesgo para la mortalidad.

Abstract Introduction: Whether there is an influence of the ABO blood system on susceptibility to the disease and its severity is unknown. Objective: To analyze if there is an association between the ABO blood system phenotypes and susceptibility to SARS-CoV-2 infection and its severity. Material and methods: The frequency of ABO antigens was compared in 73 confirmed cases of SARS-CoV-2 infection and 52 clinically healthy donors. The severity of the infection was evaluated by comparing the frequency of antigens by severity of the disease and mortality. Results: The risk of SARS-CoV-2 infection is increased in subjects with antigen A vs non-A subjects (OR=1.45; 95 %: 1.061-1.921). Blood phenotype O decreases the risk of SARS-CoV-2 infection (OR= 0.686; 95 % CI: 0.522-0.903). No differences were found regarding disease severity. The mortality risk is increased in subjects antigen A vs non-A (OR= 3.34; 95% IC: 1.417-8.159). Conclusion: Blood group A is a risk factor for SARS-CoV-2 infection, but not for disease severity, although in critically ill patients it is a risk factor for mortality.

Comparison of laboratory and radiological findings of pregnant and non-pregnant women with covid-19

Abstract Objective Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. Methods Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. Results Themean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when agewas compared between the groups, a statistically significant difference (p=0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p=0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p=0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 x 109/mcL and 232.00 ± 71.04 x 109/mcL respectively; p=0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p<0.05). Conclusion The laboratory findings and imaging studiesmay differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.

Caracterização do comprometimento pulmonar associado à COVID-19 em pacientes com necessidade de ventilação mecânica / Characterization of pulmonary impairment associated with COVID-19 in patients requiring mechanical ventilation

RESUMO Objetivo: Detectar precocemente a instabilidade respiratória e hemodinâmica para caracterizar o comprometimento pulmonar em pacientes com COVID-19 grave. Métodos: Analisamos retrospectivamente os dados colhidos de pacientes com COVID-19 que apresentaram insuficiência respiratória aguda com necessidade de intubação e ventilação mecânica. Utilizamos a avaliação da termodiluição transpulmonar por meio do dispositivo PiCCO™. Foram coletados os dados demográficos, respiratórios, hemodinâmicos e ecocardiográficos dentro das primeiras 48 horas após a admissão. Para resumir os dados, utilizamos estatística descritiva. Resultados: Entre 22 de março e 7 de abril de 2020, foram admitidos 23 pacientes com COVID-19 grave. Foram monitorados com o dispositivo PiCCO™ 12 (22,6%) deles. Quando da admissão, o volume diastólico final global indexado era normal (média de 738,8mL ± 209,2) e, na hora 48, encontrava-se moderadamente aumentado (879mL ± 179), enquanto o índice cardíaco se achava abaixo do normal (2,84 ± 0,65). Todos os pacientes revelaram a presença de água extravascular pulmonar acima de 8mL/kg na admissão (17,9 ± 8,9). Não identificamos qualquer evidência de origem cardiogênica. Conclusão: No caso de pneumonia grave por COVID-19, o quadro hemodinâmico e respiratório é compatível com edema pulmonar sem evidência de origem cardiogênica, o que favorece o diagnóstico de síndrome do desconforto respiratório agudo.

ABSTRACT Objective: To detect early respiratory and hemodynamic instability to characterize pulmonary impairment in patients with severe COVID-19. Methods: We retrospectively analyzed data collected from COVID-19 patients suffering from acute respiratory failure requiring intubation and mechanical ventilation. We used transpulmonary thermodilution assessment with a PiCCO™ device. We collected demographic, respiratory, hemodynamic and echocardiographic data within the first 48 hours after admission. Descriptive statistics were used to summarize the data. Results: Fifty-three patients with severe COVID-19 were admitted between March 22nd and April 7th. Twelve of them (22.6%) were monitored with a PiCCO™ device. Upon admission, the global-end diastolic volume indexed was normal (mean 738.8mL ± 209.2) and moderately increased at H48 (879mL ± 179), and the cardiac index was subnormal (2.84 ± 0.65). All patients showed extravascular lung water over 8mL/kg on admission (17.9 ± 8.9). We did not identify any argument for cardiogenic failure. Conclusion: In the case of severe COVID-19 pneumonia, hemodynamic and respiratory presentation is consistent with pulmonary edema without evidence of cardiogenic origin, favoring the diagnosis of acute respiratory distress syndrome.

Quais são os mecanismos celulares relacionados aos eventos tromboembólicos em pacientes com COVID-19? / What cellular mechanisms are related to thromboembolic events in patients with COVID-19?

Resumo O SARS-CoV-2 é o vírus responsável pela pandemia da COVID-19. Essa doença começou a ser melhor entendida devido a outras manifestações clínicas além das respiratórias. Ao longo dos meses de atendimento aos pacientes infectados pelo vírus, foram identificadas alterações clínicas e laboratoriais que incitaram os pesquisadores a discutir sobre o potencial do SARS-CoV-2 no desencadeamento de uma resposta imunológica exacerbada capaz de alterar a homeostase endotelial, através de mecanismos diretos e indiretos. Com esse intuito, foram revisados os possíveis mecanismos que desencadeiam este fenômeno em pacientes portadores de COVID-19. Dessa forma, torna-se importante o entendimento fisiopatológico dos mecanismos imunológicos relacionados à doença para a compreensão do potencial de dano endotelial que a COVID-19 pode promover.

Abstract SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. This disease is beginning to be better understood in terms of its other, non-respiratory, clinical manifestations. Over the course of months caring for patients infected by the virus, clinical and laboratory changes have been identified that have prompted researchers to debate the potential that SARS-CoV-2 has to trigger an exacerbated immune response that is capable of changing endothelial homeostasis through both direct and indirect mechanisms. With the intention of contributing to this debate, a review was conducted of the possible mechanisms that could trigger these phenomena in patients with COVID-19. It is important to understand the pathophysiology of the immunological mechanisms related to this disease in order to understand the potential endothelial damage that COVID-19 can provoke.

COVID-19 in Pregnancy: Implication on Platelets and Blood Indices / COVID-19 na gravidez: implicações nas plaquetas e índices sanguíneos

Abstract Objective To describe the hematological changes, the platelet indices in particular, in pregnant women with coronavirus disease 2019 (COVID-19) compared to healthy pregnant women. Methods A retrospective case-control study conducted at the Al Yarmouk Teaching Hospital, in Baghdad, Iraq, involving 100 pregnant women, 50 with positive viral DNA for COVID-19 (case group), and 50 with negative results (control group); both groups were subjected to a thorough hematological evaluation. Results Among the main hematological variables analyzed, the platelet indices, namely the mean platelet volume (MPV) and the platelet distribution width (PDW), showed statistically significant differences (MPV: 10.87±66.92 fL for the case group versus 9.84±1.2 fL for the control group; PDW: 14.82±3.18 fL for the case group versus 13.3±2.16 fL for the controls). The criterionvalue of the receiver operating characteristic (ROC) curve forPDWat a cutoffpoint of>11.8 fL showed a weak diagnostic marker, while the MPV at a cutoff value of>10.17 fL showed a good diagnostic marker. Conclusion The MPV and PDW are significantly affected by the this viral infection, even in asymptomatic confirmed cases, and we recommend that both parameters be included in the diagnostic panel of this infection.

Resumo Objetivo Descrever as alterações hematológicas, em particular os índices plaquetários em gestantes com doença coronavírus 2019 (COVID-19) em comparação com gestantes saudáveis. Métodos Estudo caso-controle retrospectivo realizado no Hospital Universitário Al Yarmouk, em Bagdá, Iraque envolvendo 100 gestantes, 50 com DNA viral positivo para COVID-19 (grupo caso) e 50 com resultados negativos (grupo controle); ambos os grupos foram submetidos a uma avaliação hematológica completa. Resultados Entre as principais variáveis hematológicas analisadas, os índices plaquetários, nomeadamente o volume plaquetário médio (VPM) e a largura de distribuição plaquetária (PDW), apresentaram diferenças estatisticamente significativas (VPM: 10,87±66,92 fL para o grupo caso versus 9,84±1.2 fL para o o grupo controle; PDW: 14,82±3,18 fL para o grupo caso versus 13,3±2,16 fL para os controles). O valor de critério da curva de característica de operação do receptor (ROC) para PDW em um ponto de corte de> 11,8 fL mostrou um marcador diagnóstico fraco, enquanto o do VPM emumvalor de corte de> 10,17 fL mostrou um bom marcador de diagnóstico. Conclusão OMPVe PDWsão significativamente afetados por esta infecção viral, mesmo em casos confirmados assintomáticos, e recomendamos que ambos os parâmetros sejam incluídos no painel de diagnóstico desta infecção.

Utilidad de los índices neutrófilo/linfocito, monocito/linfocito y linfocito/plaqueta para el pronóstico de complicaciones asociadas a COVID-19 / Usefulness of the neutrophil-to-lymphocyte, monocyte-to-lymphocyte and lymphocyte-to-platelet ratios for the prognosis of COVID-19-associated complications

Resumen Introducción: Diversos biomarcadores basados en conteos sanguíneos han sido de utilidad para el pronóstico de los pacientes en estado crítico por COVID-19. Objetivo: Describir la utilidad de los índices neutrófilo/linfocito (INL), monocito/linfocito (IML) y linfocito/plaqueta (IPL) para el pronóstico de la mortalidad y necesidad de soporte ventilatorio por COVID-19. Método: Cohorte retrospectiva de registros clínicos de pacientes con COVID-19 que requirieron atención hospitalaria. Resultados: Se analizaron 125 casos, la edad media fue de 51 años y 60 %, del sexo masculino; 21.6 % padecía diabetes mellitus tipo 2 y 18.4 %, hipertensión. La media de leucocitos fue 9.5 × 103/mL y la de neutrófilos, de 8.0 × 103/mL. La media del INL fue de 12.01; del IML, de 0.442 y del IPL, de 373.07. Respecto al área bajo la curva se registraron los siguientes valores en cuanto a mortalidad: INL, 0.594; IML, 0.628 e ILP, 0.505; en cuanto a ventilación mecánica: INL, 0.581; IML, 0.619 e ILP, 0.547. En el análisis univariado, INL > 13 (RM = 2.750, p = 0.001) e IML > 0.5 (RM = 2.069, p = 0.047) se asociaron a mortalidad; ILP no mostró impacto en la mortalidad ni en el soporte respiratorio. Conclusión: INL e IML son de utilidad para predecir la mortalidad en pacientes con COVID-19.

Abstract Introduction: Various biomarkers based on blood counts have been useful for the prognosis of patients critically ill with COVID-19. Objective: To describe the usefulness of the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and lymphocyte-to-platelet ([LPR) ratios for the prognosis of mortality and ventilatory support requirement for COVID-19. Method: Retrospective cohort of clinical records of patients with COVID-19 who required hospital care. Results: One-hundred and twenty-five cases were analyzed; mean age was 51 years, and 60 % were of the male gender; 21.6 % had type 2 diabetes mellitus, and 18.4 % had hypertension. Mean leukocyte count was 9.5 × 103/mL, with a neutrophil mean of 8.0 × 103/mL. Mean NLR was 12.01, while for MLR it was 0.442, and for LPR, 373.07. Regarding the area under the curve, the following values were recorded for mortality: 0.594 for NLR, 0.628 for MLR and 0.505 for LPR; as for mechanical ventilation, the values were 0.581 for NLR, 0.619 for MLR and 0.547 for LPR. In the univariate analysis, an NLR value > 13 (OR: 2.750, p = 0.001) and an MLR of > 0.5 (OR: 2.069, p = 0.047) were associated with mortality. LPR showed no impact on mortality or respiratory support. Conclusion: NLR and MLR are useful for predicting mortality in patients with COVID-19.

Anticoagulación en COVID-19 / Anticoagulation in COVID-19

La vida del mundo cambió como la conocíamos, desde diciembre de 2019, por una nueva pandemia viral, el "Coronavirus 2". Virus de alta contagiosidad y gravedad por el Síndrome Respiratorio Agudo Severo (SARS CoV-2) provocando alta morbimortalidad, desbordado las Unidades de Cuidados Intensivos del mundo, para atender a estos pacientes cuyo cuadro es primariamente respiratorio. Actualmente, además se enfrenta a una segunda amenaza, el aumento sustancial en comparación a otros pacientes hospitalizados (no COVID-19) de las complicaciones tromboembólicas.Esta publicación pretende realizar una revisión de la información actualizada disponible respecto a la epidemiología, fisiopatología y manejo de la enfermedad tromboembólica en pacientes con COVID-19 hospitalizados.

The life of the world changed as we knew it, since december 2019, due to a new viral pandemic, the "Coronavirus 2". Virus of high contagiousness and severity due to Severe Acute Respiratory Syndrome (SARS CoV-2) causing high morbidity and mortality, overwhelmed the Intensive Care Units of the world, to care for these patients whose primarily respiratory symptoms. Currently, it also faces a second threat, the substantial increase compared to other hospitalized patients (not COVID-19) of thromboembolic complications.This publication aims to review the updated information available regarding the epidemiology, pathophysiology, and management of thromboembolic disease in hospitalized COVID-19 patients.