ABSTRACT
Background: Homocysteine (Hcy) has been reported as a potential predictive biomarker for CoViD-19 infection severity in many studies. Hyper-homocysteinemia is related to many virus infection outcomes, including HEV, HPV and HIV. Recent data confirmed the value of Hcy in predicting the risk of severe pneumonia. Materials and Methods: Our retrospective cohort study, including 313 CoViD-19 hospitalized patients (female 34.8%;mean age 62 years), also included a broad panel of clinical laboratory data collected. Of the enrolled patients, 10.9% died during hospitalization (3% were transferred to other hospitals and were lost to follow-up). Results: Hcy was found to be the strongest predictor of CoViD- 19 critical-progression leading to death. Univariate analysis demonstrated that age (OR 1.04), Hcy (OR 1.06), and neutrophil/lymphocyte count ratio (OR 1.03) were significant predictors of critical progression leading to death and RBC (OR 0.68) and lymphocytes count (OR 0.23) with benign outcome. ROC analysis indicated Hcy cut off of 16 μmol/L for predicting CoViD- 19 infection outcome (sensitivity 40% and specificity 84%);patients with Hcy levels >16 μmol/L had significantly increased risk of in-hospital mortality (p=0.002) both as a continuous and dichotomic value. Conclusions: Our results demonstrate that Hcy is an effective predictive biomarker for hospitalized CoViD-19 patients' outcome. Hcy may be a valuable biomarker to help clinicians to identify patients who are at higher risk for severe CoViD-19 infection.
ABSTRACT
OBJECTIVE: We aimed to assess the correlation between LUS Soldati proposed score and clinical presentation, course of disease and the possible need of ventilation support/intensive care. PATIENTS AND METHODS: All consecutive patients with laboratory confirmed SARS-CoV-2 infection and hospitalized in two COVID Centers were enrolled. All patients performed blood gas analysis and lung ultrasound (LUS) at admission. The LUS acquisition was based on standard sequence of 14 peculiar anatomic landmarks with a score between 0-3 based on impairment of LUS picture. Total score was computed with their sum with a total score ranging 0 to 42, according to Soldati LUS score. We evaluated the course of hospitalization until either discharge or death, the ventilatory support and the transition in intensive care if needed. RESULTS: One hundred and fifty-six patients were included in the final analysis. Most of patients presented moderate-to-severe respiratory failure (FiO2 <20%, PaO2 <60 mmHg) and consequent recommendation to invasive mechanic ventilation (CPAP/NIV/OTI). The median ultrasound thoracic score was 28 (IQR 18-36) and most of patients could be ascertained either in a score 2 (40%) or score 3 pictures (24.4%). The bivariate correlation analysis displayed statistically significant and high positive correlations between the LUS score and the following parameters: ventilation (rho=0.481, p<0.001), lactates (rho=0.464, p<0.001), dyspnea (rho=0.398, p=0.001) mortality (rho=0.410, p=0.001). Conversely, P/F (rho= -0.663, p<0.001), pH (rho = -0.363, p=0.003) and pO2 (rho = -0.400 p=0.001) displayed significant negative correlations. CONCLUSIONS: LUS score improve the workflow and provide an optimal management both in early diagnosis and prognosis of COVID-19 related lung pathology.