ABSTRACT
Introduction: Some parameters evaluated in the complete count blood examination may have prognostic value in many hematological and infectious diseases Erythroblasts (NRBC) are physiologically present in peripheral blood only in the neonatal period at low concentrations, however they may be present in numerous adult pathologies such as thalassemia syndromes, myeloproliferative diseases and extramedullary hematopoiesis. In these cases their presence has been correlated to the severity of the prognosis.Immature granulocytes (IG) are present from 1% to 5%, they can be related to the development of an infection, to an inflammatory or pathological process or to a severe state of hypoxia. The aim of this study is to investigate the prognostic significance of blood erythroblasts and immature granulocytes in of Sars- CoV-2 infection. Method(s): A total of 314 Covid-19 patients (median age 61 years) including 224 males and 90 females were included in this study. NRBC were identified and counted by Sysmex XN-3000 that measures the nucleic acid content using fluorescence angle in the same channel in which white blood cells are counted. Evaluation of IG was performed with the fluorescence optical method Results: Receiver operating characteristic (ROC) curves where used to determine the optimal cut-off values for IG and NRBC that distinguished between critical (IP) and noncritical patients (NIP). Approximately 14.6% of all Covid-19 patients were NRBC-positive while 28.7% were IGpositive The majority of NRBC-positive and IG-positive patients had relevant values already in the first week of hospitalization. The values were more than tripled in IP then in NIP. Finally, in-hospital mortality of NRBCpositive and IG-positive patients were 7.6% and 10.2% respectively Conclusion(s): NRBCs and GIs can help in the early identification of high-risk Covid-19 patients The screening for NRBCs and GIs and can be useful to distinguish between IP and NIP.
ABSTRACT
Background and aim. The SAVE-MORE study showed that the early start of treatment with the IL-1alpha/beta inhibitor anakinra, guided by suPAR (Soluble Urokinase-Type Plasminogen Activator Receptor) >=6ng/mL, in patients with moderate or severe COVID-19, significantly reduced the risk of worse clinical outcome at day 28. With press release 665 of 28/09/2021, AIFA has approved the inclusion of anakinra in the 648/96 list for the treatment of hospitalized adults with COVID-19 and suPAR >=6ng/mL. However, suPAR methods are not widely available, which hinders the prescription and clinical use of anakinra. Aim of this study was to identify a panel of biochemical tests as a surrogate marker of suPAR positivity (>=6ng/mL). Methods. The study included 456 (median (IQR) age: 75 ys (60-83);M: F 54:46%) hospitalized patients in the Infectious Disease Unit (n=124) and Medical ICU (n=332) of the Maggiore Policlinico Hospital of Milan with molecular diagnosis of COVID-19. suPAR was measured at admission by suPARnostic TurbiLatex kit (Vendor: ViroGates A/S, Denmark;Italian distributor: B.S.N. Srl) on Roche Cobas c702. Results. Median suPAR was 7.6ng/mL (4.8-10.8), with 63% of patients displaying suPAR >=6ng/mL. At the univariate logistic regression analysis, suPAR was found to be associated with age (p<0.001), WBC (p=0.002), #NE (p<0.001), Hb (p<0.001), CREA (p<0.001), LDH (p=0.005), FERR (p=0.006), CRP (p<0.001), Fib (p=0.005), DD (p<0.001), but not with sex (p=0.943), #LY (p=0.444), #MO (p=0.233), PLT (p=0.064), ALT (p=0.238), TBIL (p=0.534), TnT (p=0.153) and TSH (p=0.970). However, at the multivariate analysis, only age (p<0.001), Hb (p=0.043), CREA (p<0.001), LDH (p=0.021), CRP (p=0.005) and DD (p=0.004) were found as independent predictors of suPAR positivity. Percentage of correct classification (< vs >= 6ng/mL) and AUC of the multivariate model were 75.1% and 0.83 (95%CI 0.80-0.87). Conclusions. suPAR is independently associated with age, Hb, CREA, LDH, CRP and DD. Due to the moderate % of correct classification of the multivariate model (75%), we conclude that this combination of blood markers cannot be used as a surrogate of suPAR for anakinra prescription. Further clinical validation is needed to assess a possible role of the model in predicting COVID-19 severity and mortality.
ABSTRACT
Background: Recent studies have shown that patients diagnosed with coronarivus disease 2019 (COVID-19) and also with previous cardiovascular diseases have a higher mortality due to worsening heart disease. At the same time, patients without previous cardiovascular disease may also have cardiac complications. The aim of this multicenter study was to assess high sensitivity cardiac troponin T (hs-cTnT) in patients with COVID-19 and to evaluate the incidence of myocardial injury. Methods: In this multicenter study we enrolled 543 patients, 57.8% males, median age 63 years (range 18-99) from three selected hospitals: University Hospital Tor Vergata in Rome, Fondazione IRCCS Ca 'Granda Ospedale Maggiore Policlinico, in Milan, S Chiara Hospital in Trento. We measured hs-cTnT in all patients to assess myocardial injury and correlations with patient's age, symptoms and disease course. Results: The data showed that, among the 543 patients studied, 257 patients (47.3%) had hs-cTnT values higher than the upper reference limit (URL) of 14 ng/L. Patients with high hscTnT had more frequently fever (p < 0.01) and respiratory symptoms (p < 0.01), compared to the group with hscTnT values below URL. The results showed also that patients with hs-cTnT above URL had a higher frequency of previous cardiovascular disease (p < 0.01) as well as of hypertension (p < 0.01). Instead, among 231 patients with no previous cardiovascular disease, 81 (31.5%) had hs-cTnT values above the URL. Finally. the majority of the patients with high hs-cTnT were admitted to the intensive care unit (p < 0.01). Conclusion: Our data suggest the assessment of high sensitivity cardiac troponin in patients with COVID-19 for early diagnosis of cardiac involvement.