MuLBSTA score in COVID-19 pneumonia and prediction of 14-day mortality risk: A study in an Indian cohort.

BACKGROUND: The infectious agent which has caused the COVID-19 pandemic is a coronavirus named SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). On one end of the spectrum, a patient suffering from COVID-19 may be asymptomatic or have mild symptoms, while on the other end of the spectrum, a patient may develop numerous life-threatening complications. The way a host responds to infection by SARS-CoV-2 depends on various host factors like hypertension, old age, etc., The MuLBSTA scoring system takes into account various clinical and laboratory parameters and tries to predict the mortality risk for a patient. Besides, the validation of MuLBSTA score for mortality because of COVID-19 has not been extensively studied in an Indian set-up. This study is aimed at finding the association between the MuLBSTA score and the 14-day mortality risk because of COVID-19 in Indian population. MATERIALS AND METHODS: This study included 122 patients who were receiving treatment for SARS-CoV-2 infection at a tertiary hospital in Ranchi, Jharkhand. The disease severity (as per the ICMR guidelines), the MuLBSTA score, and the disease outcome of all patients were noted and analyzed in this study. RESULTS: A strong association was seen between a MuLBSTA score of ≥12 and the 14-day mortality risk in COVID-19 patients. CONCLUSION: The MuLBSTA scoring system is an easy to calculate model, which predicts the 14-day mortality risk because of SARS-CoV-2 infection. This may help the primary care physicians in stratifying and referring the patients who have a higher chance of developing severe complications.

Pattern of liver function and clinical profile in COVID-19: A cross-sectional study of 91 patients.

BACKGROUND: - COVID-19 caused by SARS-CoV-2 leads to myriad range of organ involvement including liver dysfunction. AIM: To analyse the liver function in patients with COVID-19 and their association with respect to age, sex, severity of disease and clinical features. MATERIALS AND METHODS: This study was a cross-sectional study done at Rajendra Institute of Medical Sciences, Ranchi. 91 patients admitted with confirmed SARS-CoV-2 infection were included in this study and divided into asymptomatic, mild, moderate and severe groups. Liver function tests were compared among different severity groups. RESULTS: Of 91 patients with COVID-19, 70 (76.9%) had abnormal liver function. Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total bilirubin levels was 1-2 × ULN in 33(36.3%), 34(37.3%), 12(13.2%), 6(6.6%) cases and >2 × ULN in 20(22%), 18(19.8%), 7(7.7%) and 2 (2.2%) cases respectively. Mean AST and ALP levels among different severity groups of COVID-19 was statistically significant (p < 0.05) whereas mean ALT and total bilirubin levels was statistically non-significant (p > 0.05). There was no statistical difference between males and females with regard to abnormal liver function. Liver injury was seen in 64.3% cases of hypertension and 73.3% cases of diabetes. Fever, myalgia, headache and breathlessness were found to be correlated significantly with severity of disease. CONCLUSION: Liver injury is common in SARS-CoV-2 infection and is more prevalent in the severe disease group. Aspartate transaminase and alkaline phosphatase are better indicators of covid-19 induced liver injury than alanine transaminase and total bilirubin.

Validation of PSI/PORT, CURB-65 and SCAP scoring system in COVID-19 pneumonia for prediction of disease severity and 14-day mortality.

BACKGROUND: The unprecedented COVID-19 pandemic has put a serious burden on the healthcare system worldwide. Due to varied manifestations of SARS-CoV-2 infection, many scoring systems, which were earlier used for community acquired pneumonia (CAP) are in use to determine the disease severity and the need of ICU admissions for proper management. COVID-19 is a relatively new disease and the validity of these scoring systems in SARS-CoV-2 infection is not completely known. This study aimed to validate these scoring systems in cases of COVID-19 pneumonia in an Indian setup. The study has also tried to find the most accurate indicator of disease severity and 14-day mortality among these scoring systems. MATERIALS AND METHODS: This study included 122 SARS-CoV-2 infected patients at a tertiary hospital in Ranchi, Jharkhand. The severity of the disease according to ICMR protocol for COVID-19, the PSI/PORT score, the CURB-65 score and the SCAP score were calculated in all the patients and analysed with the disease outcome, that is, 14-day mortality. RESULTS: SCAP score, PSI/PORT score and CURB-65 criteria, all were good indicators of disease severity and 14-day mortality. However, when compared to other scoring systems, SCAP score was a more accurate marker of disease severity and 14-day mortality. CONCLUSION: The PSI/PORT scoring system, the CURB-65 criteria and the SCAP scoring system can be used to assess the COVID-19 severity and predict the 14-day mortality risk in cases of COVID-19 pneumonia.

Differential white blood cell count in the COVID-19: A cross-sectional study of 148 patients.

BACKGROUND: SARS-CoV-2 infection alters various blood parameters, which may indicate disease severity and thus help in better clinical management. AIM: To study the association between various hematological parameters and disease severity of COVID-19. To analyze the effects of hypertension and diabetes on neutrophil-lymphocyte ratio and neutrophil-monocyte ratio in patients suffering from COVID-19. MATERIALS AND METHODS: The study was a cross-sectional study involving 148 laboratory-confirmed cases of SARS-CoV-2 infection. The patients were divided into three groups on the basis of disease severity. Various hematological parameters were analyzed. The effects of hypertension and diabetes on NLR and NMR in COVID-19 patients were evaluated. RESULTS: Of the 148 patients, 78.4%, 8.1% and 13.5% cases were in the mild, moderate and severe groups, respectively. Mean age was 42.63 ± 16.04 years (IQR: 29, 54.75; Range: 7-74). 58.8% patients were male while the rest (42.2%) were female. Mean TLC (cells/mm3), neutrophil (%), lymphocyte (%), monocyte (%), eosinophil (%), neutrophil-lymphocyte ratio (NLR) and neutrophil-monocyte ratio (NMR) among mild, moderate and severe COVID-19 was statistically significant (p < 0.05). Basophil (%) and lymphocyte-monocyte ratio (LMR) was statistically insignificant among the three groups. Lymphocyte (%), monocyte (%) and eosinophil (%) were negatively correlated to disease severity. Among diabetics, both NLR and NMR were statistically significant (p < 0.05). However, among hypertensive cases, only the NLR was statistically significant. CONCLUSION: Older age, higher TLC, neutrophilia, lymphopenia, eosinopenia, high NLR and high NMR are associated with severe COVID-19. High NLR and high NMR are indicative of severe disease among diabetic patients. High NLR also indicates severe disease among hypertensive patients.