Prognostic Significance of Soluble CD163 in Hospitalized Patients with COVID-19

Objective: Soluble CD163 (sCD163) is a biomarker involved in inflammation. There is little data on the prognostic utility of sCD163 in coronavirus disease-2019 (COVID-19). This study investigated the relationship between serum sCD163 and the prognosis of COVID-19. Methods: A total of 79 hospitalized patients diagnosed with COVID-19 were included in this retrospective study. Patients were divided into two groups as survivors and non-survivors. The clinical characteristics, serum sCD163 level, and other laboratory data of patients were compared between the groups. Results: Forty-two (53.2%) of the 79 cases were male. The mean age was 70.4±12 years in the non-survivor group and 64.2±14 years in the survivor group (p=0.079). Serum sCD163, prothrombin time, and lactate were significantly higher in non-survivors than in survivors (p=0.023, p=0.015, p=0.018, respectively). The optimum cutoff value of serum sCD163 by receiver operating curve analysis was 2.92 ng/mL, resulting in 74% sensitivity and 52% specificity for predicting mortality (area under the curve: 0.620, 95% confidence interval: 0.481-0.759, p=0.048). Serum sCD163>2.92 ng/mL was associated with 4.3 times higher mortality risk as assessed by logistic regression analysis (p=0.014). Conclusion: sCD163 is an independent predictor of mortality in COVID-19 positive patients who have a fatal course of the disease. (English) [ FROM AUTHOR] Amaç: Suluble CD163 (sCD163) enflamasyonla ilgili biyobelirteçlerinden biridir. Koronavirüs hastalığı-2019'da (COVÍD-19) sCD163'ün prognostik faydası hakkında çok az veri var. Bu çalışma sCD163 seviyeleri ve hastalığın prognozu arasında ilişki olup olmadığının araştırılmasını amaçladı. Gereç ve Yöntem: Bu retrospektif çalışmaya COVÍD-19 tanısı konan toplam 79 hastanede yatan hasta dahil edildi. Hastalar sağ kalanlar ve sağ kalmayanlar olarak iki gruba ayrıldı. Hastaların klinik özellikleri, serum sCD163 düzeyi ve diğer laboratuvar verileri gruplar arasında karşılaştırıldı. Bulgular: Yetmiş dokuz olgunun 42'si (%53,2) erkek idi. Hayatta olmayan grupta yaş ortalaması 70,4±12 yıl ve hayatta olan grupta 64,2±14 yıl saptandı (p=0,079). Hayatta olmayanlarda sCD163, protrombin zamanı ve laktat düzeyleri hayatta olanlara göre istatistiksel olarak anlamlı yüksek bulundu sırasıyla (p=0,023, p=0,015, p=0,018). Hayatta olmayan grupta alıcı çalışma karakteristik analizi yapıldığında sCD163>2,92 olduğunda eğrinin altındaki alan (AUC) değeri (AUC: 0,620, %95 güven aralığı: 0,481-0,759, p=0,048), sensitivitesi %74, spesifitesi %52 bulundu. Lojistik regresyon analizinde sCD163>2,92 olduğunda mortalite riski 4,3 kat daha fazla olarak saptandı (p=0,014). Sonuç: sCD163 ölümcül seyri olan COVÍD-19 pozitif hastalarda mortalitenin bağımsız bir öngördürücüsüdür. (Turkish) [ FROM AUTHOR] Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Association of mortality and endothelial dysfunction with serum ADMA level in COVID-19 patients.

Objectives: To investigate the role of asymmetric dimethylarginine (ADMA) level in predicting intensive care and mortality in patients affected with coronavirus disease 2019 (COVID-19). Methods: This retrospective, cross-sectional study was conducted at Sakarya University Training and Research Hospital (Sakarya, Turkey) between April and August of 2020. We enrolled patients who were diagnosed with COVID-19 via real-time reverse-transcription polymerase chain reaction and admitted to the intensive care (Severe COVID-19; S-COVID) or non intensive care (Moderate COVID-19; M-COVID). We then analyzed the relationship of the ADMA level with various parameters between S-COVID and M-COVID groups. Results: This study included 87 patients, comprising 43 females and 44 males, with a mean age of 61 and 71.50 years, respectively. The male/female distribution was 22/25 (46.8%/53.2%) in the M-COVID group and 22/18 (55%/45%) in the S-COVID group. The hospitalization time, white blood cell count, neutrophil count, lymphocyte-to-albumin ratio, international normalization ratio, D-dimer, troponin, ferritin, lactate dehydrogenase, C-reactive protein, procalcitonin, erythrocyte sedimentation rate, fibrinogen, lactate, ADMA, and mortality rate were significantly higher (p < 0.05). In contrast, lymphocyte, total cholesterol, high-density lipoprotein, calcium, and albumin values were lower (p < 0.05) in the S-COVID group than in the M-COVID group. While the mortality rate was 55% in S-COVID patients, no mortality was detected in M-COVID patients (p < 0.05). Moreover, ADMA level was 6618 ± 3000 (6400) in S-COVID patients and 5365 ± 3571 (3130) in M-COVID patients, indicating a statistically significant difference (p = 0.012). Conclusion: The asymmetric dimethylarginine level increases in severe outcomes; hence, it can potentially predict severity in patients with COVID-19.

Comparative evaluation of memory T cells in COVID-19 patients and the predictive role of CD4+CD8+ double positive T lymphocytes as a new marker

SUMMARY BACKGROUND: The COVID-19 pandemic has affected the entire world, posing a serious threat to human health. T cells play a critical role in the cellular immune response against viral infections. We aimed to reveal the relationship between T cell subsets and disease severity. METHODS: 40 COVID-19 patients were randomly recruited in this cross-sectional study. All cases were confirmed by quantitative RT-PCR. Patients were divided into two equivalent groups, one severe and one nonsevere. Clinical, laboratory and flow cytometric data were obtained from both clinical groups and compared. RESULTS: Lymphocyte subsets, CD4+ and CD8+ T cells, memory CD4+ T cells, memory CD8+ T cells, naive CD4+ T cells, effector memory CD4+ T cells, central memory CD4+ T cells, and CD3+CD4+ CD25+ T cells were significantly lower in severe patients. The naive T cell/CD4 + EM T cell ratio, which is an indicator of the differentiation from naive T cells to memory cells, was relatively reduced in severe disease. Peripheral CD4+CD8+ double-positive T cells were notably lower in severe presentations of the disease (median DP T cells 11.12 µL vs 1.95 µL;p&lt;0.001). CONCLUSIONS: As disease severity increases in COVID-19 infection, the number of T cell subsets decreases significantly. Suppression of differentiation from naive T cells to effector memory T cells is the result of severe impairment in adaptive immune functions. Peripheral CD4+CD8+ double-positive T cells were significantly reduced in severe disease presentations and may be a useful marker to predict disease severity. RESUMO OBJETIVO: A pandemia de COVID-19 tem afetado o mundo todo, constituindo uma ameaça grave para a saúde humana. As células T desempenham um papel crítico na imunidade celular contra infecções virais. Procuramos desvendar a relação entre sub grupos de células T e a severidade da doença. MÉTODOS: Um total de 40 pacientes com COVID-19 foram aleatoriamente recrutados para o presente estudo transversal. Todos os casos foram confirmados por RT-PCR quantitativo. Os pacientes foram divididos em dois grupos equivalentes, um grave e um não-grave. Os dados da avaliação clínica, laboratorial e da citometria de fluxo foram obtidos para ambos os grupos e comparados. RESULTADOS: Os subconjuntos de linfócitos, células T CD4+ e CD8+, células T de memória CD4+, células T de memória CD8+, células T CD4+ virgens, células T efetoras CD4+, células T de memória central CD4+ e células T CD3+ CD4+ CD25+ estavam significativamente mais baixas nos pacientes graves. A razão células T virgens/células T efetoras TCD4+, que é um indicador da diferenciação entre células T virgens e células de memória, estava relativamente reduzida em casos graves da doença. As células T duplo-positivas CD4+CD8+ periféricas estavam notavelmente mais baixas em casos graves da doença (mediana das células T DP: 11,12 µL vs. 1,95 µL;p&lt;0,001). CONCLUSÃO: Conforme aumenta a gravidade da doença nos casos de COVID-19, o número de subconjuntos de células T diminui significativamente. A supressão da diferenciação de células T virgens para células T efetoras é o resultado do comprometimento grave das funções imunológicas adaptativas. As células T duplo-positivas CD4+CD8+ periféricas estavam notavelmente mais baixas em casos graves da doença e podem ser um marcador útil para predizer a severidade da doença.

Correlation of Lung Ultrasound and Computed Tomography Findings in COVID-19 Pneumonia.

OBJECTIVE: To evaluate the laboratory confirmed COVID-19 pneumonia and correlate the findings obtained by thorax ultrasound (USG) and thorax computed tomography (CT). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Departments of Infection Disease, Internal Medicine and Radiology, Sakarya Training and Research Hospital, Sakarya, Turkey, between March and May 2020. METHODOLOGY: This study was consisted of 100 adult patients having rRT-PCR positive COVID-19 pneumonia diagnossed by thorax CT. The clinical features, thorax USG and CT findings of these patients were recorded and expressed. USG and thorax CT findings were scored using a method described before. Continuous variables were expressed as mean (±SD) values. The Kolmogorov-Smirnov test was used for the normal distribution test, and continuous variables were compared using the Mann-Whitney U test.  USG and CT performed at time of admission to the hospital. Descriptive statistics were conducted based on the structures of variable. RESULTS: A total of 100 patients (54 men and 46 women; mean age, 59.88±13.03 years; range, 28-91years) with COVID-19 pneumonia were evaluated. Involvement areas on the lower posterior of the right side were detected as 70% by ultrasound and 74% by CT. Positively correlation was detected in lung scans assessed by USG and CT (p<0.001, r=0.705). CONCLUSION: Ultrasound has several advantages including no ionizing radiation exposure for health care workers, being a safe, fast and non-invasive diagnostic technique with bedside usage. Hence, ultrasound is an efficient alternative to diagnosis and monitor of patients with COVID-19 pneumonia. Key Words: COVID-19, Lung ultrasound, Pneumonia, RRT-PCR.

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 &#305;nfection

SUMMARY BACKGROUND Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p&gt;0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p &lt;0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p&lt;0.001) CONCLUSION The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19. RESUMO ANTECEDENTES A doença de coronavírus 2019 é uma doença respiratória inflamatória aguda. Causa muitas alterações nos parâmetros do hemograma. Baixos níveis de albumina estão associados ao risco de mortalidade em pacientes hospitalizados. O objetivo do presente estudo é revelar o local da razão entre contagem de neutrófilos e albumina na predição de mortalidade em pacientes com COVID-19. MÉTODOS Cento e quarenta e quatro pacientes do sexo feminino e 79 do sexo masculino foram incluídos no estudo. Os pacientes foram divididos em dois grupos: Grupo 1 não grave (n: 85), Grupo 2 grave (n: 59). Dados demográficos, contagem de neutrófilos, linfócitos e plaquetas, níveis de albumina e proteína C reativa (PCR) foram registrados. A razão de contagem de neutrófilos para albumina (NAR) foi calculada dividindo-se as contagens absolutas de neutrófilos pelos níveis de albumina. O NAR e os níveis dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas no sexo e na contagem de plaquetas (201 vs 211 K/mL) entre os grupos (p&gt;0,05). Idade (62,0±14,3 vs 68,6±12,2 anos), albumina (33,1 vs 29,9 gr/L), PCR (33 vs 113 mg/l), contagem de neutrófilos (4 vs 7,24 K/mL), contagem de leucócitos (6,70 vs 8,50 K/mL), valores de NAR (113,5 vs 267,2) e número de óbitos (5 vs 33) foram estatisticamente maiores (p&lt;0,001) no Grupo 2 que no Grupo 1. O valor NAR de 201,5 mostrou mortalidade em todos os pacientes com COVID-19 com sensibilidade de 71,1% e especificidade de 71,7% (AUC: 0,736, IC 95%: 0,641-0,832, p&lt;0,001). CONCLUSÃO O presente estudo mostrou que os níveis de NAR podem ser um marcador barato e simples para predizer mortalidade em pacientes com COVID-19.

Comparative evaluation of memory T cells in COVID-19 patients and the predictive role of CD4+CD8+ double positive T lymphocytes as a new marker.

BACKGROUND: The COVID-19 pandemic has affected the entire world, posing a serious threat to human health. T cells play a critical role in the cellular immune response against viral infections. We aimed to reveal the relationship between T cell subsets and disease severity. METHODS: 40 COVID-19 patients were randomly recruited in this cross-sectional study. All cases were confirmed by quantitative RT-PCR. Patients were divided into two equivalent groups, one severe and one nonsevere. Clinical, laboratory and flow cytometric data were obtained from both clinical groups and compared. RESULTS: Lymphocyte subsets, CD4+ and CD8+ T cells, memory CD4+ T cells, memory CD8+ T cells, naive CD4+ T cells, effector memory CD4+ T cells, central memory CD4+ T cells, and CD3+CD4+ CD25+ T cells were significantly lower in severe patients. The naive T cell/CD4 + EM T cell ratio, which is an indicator of the differentiation from naive T cells to memory cells, was relatively reduced in severe disease. Peripheral CD4+CD8+ double-positive T cells were notably lower in severe presentations of the disease (median DP T cells 11.12 µL vs 1.95 µL; p< 0.001). CONCLUSIONS: As disease severity increases in COVID-19 infection, the number of T cell subsets decreases significantly. Suppression of differentiation from naive T cells to effector memory T cells is the result of severe impairment in adaptive immune functions. Peripheral CD4+CD8+ double-positive T cells were significantly reduced in severe disease presentations and may be a useful marker to predict disease severity.

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection.

BACKGROUND: Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS: 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS: There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001). CONCLUSION: The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.