Age, comorbidities, c-reactive protein and procalcitonin as predictors of severity in confirmed COVID-19 patients in the Philippines.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has been affecting people globally, and the Philippines is one of the countries greatly struck by the virus. The continued rise of new positive cases has drawn attention to the urgent need for healthcare management to cope with this challenge. Severity prediction could help improve medical decision-making and optimise the patient's treatment plan with a good clinical outcome. This study aimed to identify the determinants of COVID-19 disease severity. Methods: Demographic characteristics and laboratory findings were collected from electronic medical records and paper forms of all confirmed COVID-19 cases reported by the University of Perpetual Help DALTA Medical Center between the September 1, 2020 and the October 31, 2021. We performed statistical analyses and interpretation of data to compare severe and non-severe groups. Results: 5,396 confirmed cases were examined. Most of the severe cases were elderly, male, had blood type A, and with comorbidities. Cycle threshold (Ct) values were lower in the severe group. Most patients had higher-than-normal levels of all blood parameters except platelet, white blood cell (WBC), neutrophil, and lymphocyte counts. Age, sex, ABO blood groups, comorbidities, open reading frame 1 ab (ORF1ab) and nucleocapsid (N) gene Ct values, ferritin, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, white blood cell (WBC) count, neutrophil count, and lymphocyte count were significantly associated with disease severity. In multivariate analysis, age groups >60 and 30-59 years, presence of comorbidities, CRP level >5 ng/mL, and PCT >0.05 ng/mL were identified as disease severity predictors. Conclusions: Based on our results, age, comorbidities, CRP, and PCT level may be utilised as primary assessment factors for possible hospital admission and close monitoring upon testing. Early detection of these risk factors may provide strategic interventions that help reduce mortality, hospital admissions, and more expensive and extensive treatments.

Statistical analysis for COVID-19 infections including several association factors: Age, gender and blood parameters

Clinical manifestations of COVID-19 caused by the new coronavirus SARS-CoV-2 are associated with several blood parameters. In this report we investigate the relation between COVID-19 susceptibility to the gender, ABO blood, patient's age and blood parameters. Blood samples of 50 patients were analysed for five months to detect ferritin, D-dimer, CR Protein, W. BCs count, COVID-19 IgM and COVID-19 IgG. According to the gender of the cases. The results showed that number of male's incidence is higher than in females (31case-62% male) (19 case-38%) respectively. The incidence of COVID-19 in.age period 30-42 years showed the highest number for both genders. The ABO blood group investigations showed that cases with blood group A+ were the highest percentage and the lowest was in the AB+ blood group for both genders. The blood parameters were significant elevated;ferritin (95% Confidence Interval CI: 304.7-540.2, Median 198.3, Range (IQR) 1163.11), the reactive protein (CRP) titre significant elevated (95% CI, 62.11-93.73 mg/L, median of CRP titre 59) and D-Dimer (95% CI, 0.5647-1.039mg/L, median of D-Dimer titre 0.4 while Range (IQR) 3. Higher levels of white blood cell (95% CI, 10.55-12, median of WBC 10.94). Finally, elevated titre of IgG, CI 95% 2. 926-4.966, Median 2.405, Range (IQR) 17.03. Whereas, IgM CI 95% 6.905-12.04 Median 6.14, Range (IQR) 44.53). In summary, our results showed that COVID-19 impact significantly on ferritin, D-dimer, CR Protein, W. BCs count, IgM and IgG. Additionally, there was a significant association between COVID-19 predisposition and the ABO blood group. Persons with blood group A have a higher risk comparing with blood group AB individuals, how have a lower risk for COVID-19 infection. Based on the results of the study, it demonstrated a correlation between older age and change in blood parameters post Covid-19 infection. Current study suggest that aged people and blood group A might need particularly more awareness to protect and reduce the possibility of infection. © 2022 Author(s).

Potential of milkfish waste protein extract as an immune supplement for Covid-19 prevention

Indonesia is currently experiencing a Covid-19 pandemic, which reached 4.06 million cases on September 9, 2021. It infects humans when their immune systems is at a low level. Some references suggest consuming fish to boost immunity. Milkfish (Chanos chanos) contains 19.15% of the protein that is believed to elevate lymphocytes. In the current investigation, milkfish production reaches 170,852,179 tons in Java, Indonesia. As a result, the increase in those fish's production and consumption led to huge waste (byproduct). Therefore, the study aimed to investigate milkfish waste, including heads, tails, spines, and offal, as a protein supplement for Covid-19 prevention. They were collected from Langdungsari Market, Malang, East Java, Indonesia, and selected based on their quality and freshness. The waste was then cleaned and extracted employing 0.1 M of HCL. Afterwards, the extract was mixed with Na-CMC (sodium carboxymethyl cellulose). Furthermore, the test was carried out by inducing milkfish waste protein (MWP) extract to mice (Mus musculus) with three dosages (6.522 mg (T1), 9.730 mg (T2), and 15.332 mg (T3)) and one control. A complete hematology test, such as red blood cells (RBS), white blood cells (WBC), hemoglobin (Hb), hematocrit (PCV), differential leucocytes, absolute lymphocyte count (ALC), and blood cell indices was assessed to evaluate the immune responses of mice. Data was analyzed employing SPSS to determine the differences among treatments. The results showed that the administration of MPW extracts significantly affected the number of ALC, RBC, WBC, Hb, PCV, and differential leucocytes, particularly T1. Unfortunately, only eosinophils did not give response to the treatments. Regarding those results, it was found that the administration of milkfish MPW extract has the potential to be used as a supplement for boosting immunity. © 2022, BIOFLUX SRL. All rights reserved.

Predictive model of severity in SARS CoV-2 patients at hospital admission using blood-related parameters

Introduction Blood test alterations are crucial in SARS CoV-2 (COVID-19) patients. Blood parameters, such as lymphocytes, C reactive protein (CRP), creatinine, lactate dehydrogenase, or D-dimer, are associated with severity and prognosis of SARS CoV-2 patients. This study aims to identify blood-related predictors of severe hospitalization in patients diagnosed with SARS CoV-2. Methods Observational retrospective study of all rt-PCR and blood-test positive (at 48 hours of hospitalization) SARS CoV-2 diagnosed inpatients between March-May 2020. Deceased and/or ICU inpatients were considered as severe cases, whereas those patients after hospital discharge were considered as non-severe. Multivariate logistic regression was used to identify predictors of severity, based on bivariate contrast between severe and mild inpatients. Results The overall sample comprised 540 patients, with 374 mild cases (69.26%), and 166 severe cases (30.75%). The multivariate logistic regression model for predicting SARS CoV-2 severity included lymphocytes, C reactive protein (CRP), creatinine, total protein levels, glucose and aspartate aminotransferase as predictors, showing an area under the curve (AUC) of 0.895 at a threshold of 0.29, with 81.5% of sensitivity and 81% of specificity. Discussion Our results suggest that our predictive model allows identifying and stratifying SARS CoV-2 patients in risk of developing severe medical complications based on blood-test parameters easily measured at hospital admission, improving health-care resources management and distribution. © 2021 International Federation of Clinical Chemistry and Laboratory Medicine. All rights reserved.

Real-Time Monitoring of Blood Parameters in the Intensive Care Unit: State-of-the-Art and Perspectives.

The number of patients in intensive care units has increased over the past years. Critically ill patients are treated with a real time support of the instruments that offer monitoring of relevant blood parameters. These parameters include blood gases, lactate, and glucose, as well as pH and temperature. Considering the COVID-19 pandemic, continuous management of dynamic deteriorating parameters in patients is more relevant than ever before. This narrative review aims to summarize the currently available literature regarding real-time monitoring of blood parameters in intensive care. Both, invasive and non-invasive methods are described in detail and discussed in terms of general advantages and disadvantages particularly in context of their use in different medical fields but especially in critical care. The objective is to explicate both, well-known and frequently used as well as relatively unknown devices. Furtehrmore, potential future direction in research and development of realtime sensor systems are discussed. Therefore, the discussion section provides a brief description of current developments in biosensing with special emphasis on their technical implementation. In connection with these developments, the authors focus on different electrochemical approaches to invasive and non-invasive measurements in vivo.

Functional, Clinical, and Sociodemographic Variables Associated with Risk of In-Hospital Mortality by COVID-19 in People over 80 Years Old.

OBJECTIVES: The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19. DESIGN: Cohort study with a mean follow-up of 12.8 days. SETTING: Public university hospital (Madrid, Spain). PARTICIPANTS: 499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020. MEASUREMENTS: Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death. RESULTS: Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01-2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00-1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02-1.26)] and comorbidities [OR 1.28 (95%CI 1.06-1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04-3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01-3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06-1.12)] and creatine [OR 1.48 (95%CI 1.15-1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89-0.95)]. CONCLUSIONS: Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients.

SARS-CoV-2 Infection: Differences in Hematological Parameters Between Adults and Children.

Since December 2019, corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic, posing a huge threat to human health, and the current epidemic prevention situation is still severe. Hematological parameters directly reflect the damage of SARS-CoV-2 to human blood cells, which can better assess the severity and prognosis of patients infected with COVID-19, but hematological parameters have some differences between adults and children. This article comprehensively reviews the differences in hematological parameters between adults and children after SARS-CoV-2 infection, and provides a reference for the diagnosis and treatment of COVID-19.

Effects of the COVID-19 pandemic on the global health of women aged 50 to 70 years.

AIM/BACKGROUND: The most recent pandemic caused by the new coronavirus disease (COVID-19) urged dramatic changes in people's lives. Potentially, the COVID-19 pandemic affects physical and mental health as well as behavioral and social aspects. However, the direct impacts of the COVID-19 pandemic on health-related parameters are not yet known. The present study aimed to evaluate the effect of 16 weeks during the COVID-19 pandemic on health-related parameters of physically inactive women aged 50 to 70 years. METHODS: Thirty-four physically inactive women participated in the study. We performed tests to evaluate aerobic capacity and muscle strength, anthropometric measurements, blood pressure (BP), blood parameters, diet, and physical activity levels. All evaluations were carried out before and 16 weeks after the initial phase of the COVID-19 pandemic in Brazil (i.e., from March to July 2020). RESULTS: Systolic BP (p < .0001; effect size (ES) = 0.62), diastolic BP (p < .0001; ES = 0.71), grip strength of the right (p < .05; ES = 0.43) and left hand (p < .05; ES = 0.49), performance in six-minute walk test (p < .05; ES = 0.46), free time physical activity levels (p < .05; ES = 0.40), domestic physical activity levels (p < .05; ES = 0.39), platelet count (p < .0001; ES = 0.48), and mean corpuscular hemoglobin concentration (p < .0001; ES = 1.14) reduced in comparison to the period before the pandemic. In contrast, glycated hemoglobin levels (p < .0001; ES = 0.77), triglycerides (p < .05; ES = 0.40), and insulin levels (p < .05; ES = 0.60) increased in comparison to the period before the pandemic. CONCLUSION: The COVID-19 pandemic negatively impacted the general health status of physically inactive women aged 50 to 70, potentially increasing their susceptibility to comorbidities, such as type 2 diabetes and hypertriglyceridemia.

Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study.

BACKGROUND: The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinely collected at hospital admission to improve upon the use of NEWS2 alone for medium-term risk stratification. METHODS: Training cohorts comprised 1276 patients admitted to King's College Hospital National Health Service (NHS) Foundation Trust with COVID-19 disease from 1 March to 30 April 2020. External validation cohorts included 6237 patients from five UK NHS Trusts (Guy's and St Thomas' Hospitals, University Hospitals Southampton, University Hospitals Bristol and Weston NHS Foundation Trust, University College London Hospitals, University Hospitals Birmingham), one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). The outcome was severe COVID-19 disease (transfer to intensive care unit (ICU) or death) at 14 days after hospital admission. Age, physiological measures, blood biomarkers, sex, ethnicity, and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) measured at hospital admission were considered in the models. RESULTS: A baseline model of 'NEWS2 + age' had poor-to-moderate discrimination for severe COVID-19 infection at 14 days (area under receiver operating characteristic curve (AUC) in training cohort = 0.700, 95% confidence interval (CI) 0.680, 0.722; Brier score = 0.192, 95% CI 0.186, 0.197). A supplemented model adding eight routinely collected blood and physiological parameters (supplemental oxygen flow rate, urea, age, oxygen saturation, C-reactive protein, estimated glomerular filtration rate, neutrophil count, neutrophil/lymphocyte ratio) improved discrimination (AUC = 0.735; 95% CI 0.715, 0.757), and these improvements were replicated across seven UK and non-UK sites. However, there was evidence of miscalibration with the model tending to underestimate risks in most sites. CONCLUSIONS: NEWS2 score had poor-to-moderate discrimination for medium-term COVID-19 outcome which raises questions about its use as a screening tool at hospital admission. Risk stratification was improved by including readily available blood and physiological parameters measured at hospital admission, but there was evidence of miscalibration in external sites. This highlights the need for a better understanding of the use of early warning scores for COVID.

Dynamic changes in routine blood parameters of a severe COVID-19 case.

BACKGROUND: Novel coronavirus infectious disease (COVID-19) has been spreading worldwide, and tracking laboratory indexes during the diagnosis and treatment of patients with severe COVID-19 can provide a reference for patients in other countries and regions. METHODS: We closely tracked the epidemiological history, diagnosis and treatment process, as well as dynamic changes in routine blood indicators, of a severe COVID-19 patient who was hospitalized for 26 days. RESULTS: Our study found that the patient's condition worsened in the first week after admission, white blood cells (WBCs), neutrophils, lymphocytes, monocytes, eosinophils, red blood cells (RBCs), hemoglobin, neutrophil lymphocyte ratio (NLR), platelets (PLT) and platelet lymphocyte ratio (PLR) decreased. On the 7th day of admission, the levels of these cells decreased to their lowest values, though the red blood cell distribution width (RDW) and C-reactive protein (CRP) level remained at high values. From 8 to 14 days of admission, the patient's condition improved, hypoxemia was corrected, and mechanical ventilation was discontinued. The number of WBCs, neutrophils, monocytes, eosinophils and lymphocytes increased gradually, and the erythrocyte parameters stopped declining and stabilized in a certain range; CRP decreased rapidly. On the 20th day of admission, the nucleic acid test was negative, WBC, neutrophil, CRP, NLR and PLR decreased gradually, and monocyte, lymphocyte, and eosinophil counts increased. Although RBCs and hemoglobin (Hb) levels continued to decrease, RDW gradually increased, indicating the recovery of hematopoiesis. In addition, it should be noted that monocytes and eosinophils were at extremely low levels within 10 days after admission; the recovery time of eosinophils was approximately 12 days after admission, which was earlier than other parameters, which might be of great value in judging the progress of the disease. CONCLUSIONS: Dynamic changes in routine blood parameters might be helpful for the prognosis of COVID-19 patients and evaluation of the treatment effect.