Role of Initial and Follow-up LDH Titer in COVID-19 Pneumonia: A Single Center Experience of 2000 Cases in Tertiary Care Setting in India

Introduction: Robust data of LDH (Lactate dehydrogenase) is available in bacterial infection, and it can be utilized in this COVID-19 Pneumonia pandemic for initial assessment, planning of treatment in indoor setting in association with HRCT severity. Method(s): Prospective, observational, 12 weeks follow up study, included 2000 COVID-19cases confirmed with RT PCR. All cases were assessed with lung involvement documented and categorized on HRCT thorax, oxygen saturation, LDH at entry point and follow up.Age, gender, comorbidity and BIPAP/NIV use and outcome as with or without lung fibrosis as per CT severity. Statistical analysis is done by Chi square test. Result(s): HRCT severity score at entry point has significant correlation with LDH titer [p<0.00001] LDH titer has significant association with duration of illness (Doi) [p<0.00001] Comorbidities has significant association with LDH titer. [p<0.00001] LDH titer has significant association with oxygen saturation [p<0.00001] BIPAP/NIV requirement during hospitalization has significant association with LDH titer. [p<0.00001] Timing of BIPAP/NIV requirement has significant association with LDH titer. [p<0.00001] Follow-up LDH titer during hospitalization as compared to entry point (initial) normal and abnormal LDH has significant association in post-covid lung fibrosis [p<0.00001] Conclusion(s): LDH is easily available, and universally acceptable inflammatory marker in COVID-19 pandemic and documented very crucial role in covid-19 pneumonia in predicting severity of illness, assessing response to treatment and analyzing outcome during hospitalization.Copyright © 2023 Patil S.

The COVID-19 vaccine did not affect the basal immune response and menstruation in female athletes.

The COVID-19 pandemic restricted the regular training and competition program of athletes. Vaccines against COVID-19 are known to be beneficial for the disease; however, the unknown side effects of vaccines and postvaccination reactions have made some athletes hesitant to get vaccinated. We investigated the changes in inflammatory responses and menstrual cycles of female athletes before and after vaccination. Twenty female athletes were enrolled in this study. Blood was collected from each subject before the first COVID-19 vaccination and after the first and second vaccinations. Laboratory data, including white blood cell, neutrophil, lymphocyte, and platelet counts, and inflammatory markers, including NLR (neutrophil-to-lymphocyte ratio), PLR (platelet lymphocyte ratio), RPR (red cell distribution width to platelet ratio), SII (systemic immune-inflammation index), and NeuPla (neutrophil-platelet ratio), were analyzed statistically. The menstrual changes before and after vaccination and the side effects were collected by questionnaires. No significant changes in the laboratory data were found after the first and second shots when compared to those at prevaccination: white blood cell, neutrophil, lymphocyte, platelet, NLR, PLR, SII, RPR, and NeuPla (p > 0.05). In addition, there were no significant changes in the menstruation cycle or days of the menstrual period (p > 0.05). All side effects after vaccination were mild and subsided in 2 days. The blood cell counts, inflammatory markers, and menstruation of female athletes were not affected by COVID-19 vaccines.

Inflammatory and coagulation marker profiles in severe pediatric COVID-19 patients: a systematic review

Background Children are susceptible to SARS-CoV-2 infection and often present mild manifestations. However, severe and critical cases have also been reported. The inflammation and coagulation marker profile pattern in these patients along with the white blood cell differential count in critical PICU cases with non-COVID-19 etiology is not entirely clear.Objective To evaluate the inflammation and coagulation profiles in children presenting with severe/critical SARS-CoV-2 infection. Methods A systematic search and review of scientific literature was conducted following the PRISMA guidelines using ProQuest, SCOPUS, EBSCOHost, ScienceDirect, Cochrane, EMBASE, and Pubmed databases. All relevant original studies until March 11, 2021, were included. The risk of bias was appraised using the Modified Newcastle Ottawa Scale and JBI Critical Appraisal Checklist tools. Results We identified 14 studies across 6 countries, including a total sample of 159 severe and critically ill pediatric COVID-19 patients. Most of the subjects showed normal leukocytes, but in-creased CRP, procalcitonin, ferritin, and IL-6. Studies on coagula-tion profiles showed normal platelets, PT, aPTT, and inconsistent D-dimer results. Conclusion Inflammation and coagulation parameters in severe/ critically ill children with COVID-19 are atypical. Several inflammatory markers were elevated, including CRP, ferritin, procalcitonin, and IL-6. However, the elevated marker values are still lower compared to non-COVID infection patients. Further investigation of the parameters need to be done in serial examina-tion multicenter studies, which include control subjects. [Paediatr Indones. 2022;62:411-21;DOI: https://doi.org/10.14238/ pi62.6.2022.411-21 ].

Role of ferritin as "Core Marker" in the assessment of severity, response to therapy and predicting outcome in COVID-19 pneumonia: A large, two-center, prospective, observational study of 1000 cases in tertiary care setting in India

Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is heterogeneous disease with variable effect on lung parenchyma, airways, and vasculature, leading to long-term effects on lung functions. Robust data of ferritin in bacterial infection are available, and now its role as an inflammatory marker in COVID-19 pneumonia during initial assessment and planning of treatment is evolving. Materials and Methods: Prospective, two-center, observational study conducted from July 2020 to May 2021, in MIMSR Medical College and Venkatesh Hospital Latur, India, included 1000 COVID-19 cases confirmed with reverse transcription-polymerase chain reaction. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography (CT) of the thorax, oxygen saturation, inflammatory marker, Ferritin at the entry point, and follow-up during hospitalization. Age, gender, comorbidity, and use BIPAP (bi-level positive airway pressure)/NIV (noninvasive ventilation) (BIPAP/NIV) and outcome with or without lung fibrosis as per CT severity were key observations. CT severity scoring was done as per universally accepted standard scoring tool as score < 7 as mild, 7-14 as moderate, and score > 15 as severe affection of lung. Statistical analysis is performed using Chi-square test. Results: Age (50 years) and gender (male versus female) have significant association with ferritin in predicting severity of COVID 19 pneumonia (P < 0.00001) and (P < 0.010), respectively. CT severity score at the entry point with ferritin level has a significant association (P < 0.00001). Ferritin level has a significant association with the duration of illness (P < 0.00001). Comorbidities have a significant association with normal and abnormal ferritin levels, respectively (P < 0.00001). Ferritin level has a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement during treatment in critical care settings has a significant association with ferritin level (P < 0.00001). Timing of BIPAP/NIV requirement during the course of COVID-19 pneumonia in critical care settings has a significant association with ferritin level (P < 0.00001). Follow-up ferritin titer during hospitalization as compared to entry point normal and abnormal ferritin has a significant association in post-COVID lung fibrosis, respectively (P < 0.00001). Conclusions: Ferritin is easily available, sensitive, reliable, cost-effective, and universally acceptable inflammatory marker in COVID-19 pneumonia. Ferritin has a very crucial role in COVID-19 pneumonia in predicting the severity of illness and assessing response to treatment during hospitalization. Follow-up ferritin titer during hospitalization and at discharge can be used as early predictor of post-COVID lung fibrosis.

Apparent Association of Insulin With Interleukin-6 (IL-6) in Severe COVID-19 Patients Having Chronic Disease Comorbidities

BackgroundThe severe acute respiratory syndrome caused by the novel coronavirus (COVID-19), due to its fast spread, is a disease with global health, social and economic burden. This is complicated by its high morbidity and mortality among those with medical comorbidities and older adults. During the outbreak in Libya, intensive care facilities were overwhelmed by the number of patients requiring special care. Admission to such facilities was reserved for severe cases showing low blood oxygen levels. Due to the inflammatory process in COVID-19, we believed it was essential to evaluate the outcome of inflammation reflected in the changes in interleukin-6 (IL-6) and insulin.ObjectiveTo study the changes in IL-6 and insulin during the course of the disease, if an association between them exists, and whether this association changes following seven days of treatment.MethodWe analyzed the data of 60 patients diagnosed with COVID-19 and admitted to the hospitals' Intensive Care Units (ICU) in the eastern part of Libya. The study was initiated on January 18th and concluded on March 22, 2021. Samples for the analysis were collected on the first day of admission and after seven days of hospitalization for patients who survived till the selected day. The collected samples were used to analyze IL-6 as an indicator of change in inflammation and insulin as a potential anti-inflammatory modulator. In addition, the association of insulin with IL-6 was statistically tested.ResultsDiabetes and hypertension, the most commonly observed chronic diseases in Libya, were found to represent the highest comorbidities among the ICU patients included in this study. Nonetheless, other diseases affected a smaller proportion of them, ranging from two patients for malignancy to 10 patients for cardiovascular disease. In addition, both age and gender showed differences in the number of ICU hospitalized patients and the death tally among them.The study showed that the IL-6 level was on the rise during the course of COVID-19, whereas that of insulin was on the decrease. The two variables showed an association for admission day samples as well as for samples after seven days of ICU hospitalization.ConclusionAlthough, IL-6 appears to play a predictive role in the development and outcome of severe COVID-19, along with other biochemical and clinical findings it could serve as an indicator of the disease outcome. On the other hand, the role of insulin as a complementary factor for alleviating inflammation remains to be fully understood and requires further research. There is a pressing necessity for establishing the mechanism through which insulin is associated with inflammation modulatory pathways, in particular through the pathways involving IL-6.

Blood Purification Techniques, Inflammatory Mediators and Mortality in COVID-19 Patients.

BACKGROUND: Inflammatory mediators are an important component in the pathophysiology of the coronavirus disease 2019 (COVID-19). This study aimed to assess the effects of reducing inflammatory mediators using hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the mortality of patients with COVID-19. MATERIALS AND METHODS: Twelve patients with confirmed diagnosis of COVID-19 were included. All patients had acute respiratory distress syndrome (ARDS). Patients were divided into three groups, namely, HP, CRRT and HP+CRRT. The primary outcome was mortality and the secondary outcomes were oxygenation and reduction in inflammatory mediators at the end of the study. RESULTS: Patients were not different at baseline in demographics, inflammatory cytokine levels, and the level of acute phase reactants. Half of the patients (3 out of 6) in the HP+CRRT group survived along with the survival of one patient (1 out of 2) in the HP group. All four patients in the CRRT group died. Serum creatinine (SCr), Interleukin-1 (IL1), Interleukin-6 (IL6), Interleukin-8 (IL8), partial pressure of oxygen (PaO2), O2 saturation (O2 sat), and hemodynamic parameters improved over time in HP+CRRT and CRRT groups, but no significant difference was observed in the HP group (All Ps > 0.05). CONCLUSION: Combined HP and CRRT demonstrated the best result in terms of mortality, reduction of inflammatory mediators and oxygenation. Further investigations are needed to explore the role of HP+CRRT in COVID-19 patients.

Autoimmune Hemolytic Anemia Exacerbation Associated With COVID-19 Infection and Markedly Elevated Inflammatory Markers.

The association between previously diagnosed autoimmune hemolytic anemia and exacerbations due to coronavirus disease 2019 (COVID-19) infection is a rare phenomenon that is not well understood. In this case, we present a 68-year-old female with a past medical history significant for systemic lupus erythematosus (SLE), splenectomy, and autoimmune hemolytic anemia (AIHA) since childhood that had been very well controlled with only one previous exacerbation. This patient's chief complaint and clinical symptoms at admission were related to hemolytic anemia and not active COVID-19 infection. This case report reveals a possible association between the hyperinflammatory syndrome caused by COVID-19 and the exacerbation of previously well-controlled autoimmune diseases.

Incidence of Multisystem Inflammatory Syndrome in Children (MIS-C) with Covid-19 (SARS-CoV-2): Systematic Review and Meta-Analysis

Background: MIS-C associated with Covid-19 is characterized by way of persistent fever and is often associated with a stomach ache, vomiting, diarrhea, rash, and conjunctivitis, and other mucocutaneous manifestations. Aim: This work aims to determine the clinical course, safety profile, and inflammatory markers of Multisystem Inflammatory Syndrome in Children (MIS-C) which is associated with Covid-19 children. Methodology: A systematic search was performed over different medical databases to identify Pediatrics studies, which studied the outcome of the MIS-C of Covid-19 children. We conducted a meta-analysis process on the incidence of MIS-C as a primary outcome, and on the estimated level of serum C-Reactive Protein (CRP), ferritin, and D-dimer as secondary outcomes. Six studies were identified involving 1747 children with Covid-19. Our meta-analysis process showed a pooled incidence of MIS-C in Covid-19 children of 39.8%. Concerning the secondary outcome measures, the Fixed-effects model of the meta-analysis process revealed an average estimate CRP level of 223.1 mg/dl, an average estimate ferritin level of 566.5 mg/dl, and an average estimate D-dimer level of 595.6 mg/dl, respectively. Conclusion: To conclude, Covid-19 infection is typically very mild and often asymptomatic in children. Multisystem Inflammatory Syndrome in Children (MIS-C), which is a rare complication associated with Covid-19, presenting after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation.

Prognostic Significance of Urinary Biomarkers in Patients Hospitalized With COVID-19.

RATIONALE & OBJECTIVE: Acute kidney injury (AKI) is common in patients with coronavirus disease 2019 (COVID-19) and associated with poor outcomes. Urinary biomarkers have been associated with adverse kidney outcomes in other settings and may provide additional prognostic information in patients with COVID-19. We investigated the association between urinary biomarkers and adverse kidney outcomes among patients hospitalized with COVID-19. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: Patients hospitalized with COVID-19 (n=153) at 2 academic medical centers between April and June 2020. EXPOSURE: 19 urinary biomarkers of injury, inflammation, and repair. OUTCOME: Composite of KDIGO (Kidney Disease: Improving Global Outcomes) stage 3 AKI, requirement for dialysis, or death within 60 days of hospital admission. We also compared various kidney biomarker levels in the setting of COVID-19 versus other common AKI settings. ANALYTICAL APPROACH: Time-varying Cox proportional hazards regression to associate biomarker level with composite outcome. RESULTS: Out of 153 patients, 24 (15.7%) experienced the primary outcome. Twofold higher levels of neutrophil gelatinase-associated lipocalin (NGAL) (HR, 1.34 [95% CI, 1.14-1.57]), monocyte chemoattractant protein (MCP-1) (HR, 1.42 [95% CI, 1.09-1.84]), and kidney injury molecule 1 (KIM-1) (HR, 2.03 [95% CI, 1.38-2.99]) were associated with highest risk of sustaining primary composite outcome. Higher epidermal growth factor (EGF) levels were associated with a lower risk of the primary outcome (HR, 0.61 [95% CI, 0.47-0.79]). Individual biomarkers provided moderate discrimination and biomarker combinations improved discrimination for the primary outcome. The degree of kidney injury by biomarker level in COVID-19 was comparable to other settings of clinical AKI. There was evidence of subclinical AKI in COVID-19 patients based on elevated injury biomarker level in patients without clinical AKI defined by serum creatinine. LIMITATIONS: Small sample size with low number of composite outcome events. CONCLUSIONS: Urinary biomarkers are associated with adverse kidney outcomes in patients hospitalized with COVID-19 and may provide valuable information to monitor kidney disease progression and recovery.

Self-identified Race and COVID-19-Associated Acute Kidney Injury and Inflammation: a Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients.

BACKGROUND: Black individuals have been disproportionately affected by the coronavirus disease 2019 (COVID-19). However, it remains unclear whether there are any biological factors that predispose Black patients to COVID-19-related morbidity and mortality. OBJECTIVE: To compare in-hospital morbidity, mortality, and inflammatory marker levels between Black and White hospitalized COVID-19 patients. DESIGN AND PARTICIPANTS: This single-center retrospective cohort study analyzed data for Black and White patients aged ≥18 years hospitalized with a positive SARS-CoV-2 PCR test between March 1, 2020, and August 4, 2020. MAIN MEASURES: The exposure was self-identified race documented in the medical record. The primary outcome of was in-hospital death. Secondary outcomes included intensive care unit admission, hospital morbidities, and inflammatory marker levels. KEY RESULTS: A total of 1,424 Black and White patients were identified. The mean ± SD age was 56.1 ± 17.4 years, and 663 (44.5%) were female. There were 683 (48.0%) Black and 741 (52.0%) White patients. In the univariate analysis, Black patients had longer hospital stays (8.1 ± 10.2 vs. 6.7 ± 8.3 days, p = 0.011) and tended to have higher rates of in-hospital death (11.0% vs. 7.3%), myocardial infarction (6.9% vs. 4.5%), pulmonary embolism (PE; 5.0% vs. 2.3%), and acute kidney injury (AKI; 39.4% vs. 23.1%) than White patients (p <0.05). However, after adjusting for potential confounders, only PE (adjusted odds ratio [aOR] 2.07, 95% CI, 1.13-3.79) and AKI (aOR 2.16, 95% CI, 1.57-2.97) were statistically significantly associated with Black race. In comparison with White patients, Black patients had statistically significantly higher peak plasma D-dimer (standardized ß = 0.10), erythrocyte sedimentation rate (standardized ß = 0.13), ferritin (standardized ß = 0.09), and lactate dehydrogenase (standardized ß = 0.11), after adjusting for potential confounders (p<0.05). CONCLUSIONS: Black hospitalized COVID-19 patients had increased risks of developing PE and AKI and higher inflammatory marker levels compared with White patients. This observation may be explained by differences in the prevalence and severity of underlying comorbidities and other unmeasured biologic risk factors between Black and White patients. Future research is needed to investigate the mechanism of these observed differences in outcomes of severe COVID-19 infection in Black versus White patients.

Thyroid Dysfunction in COVID-19.

OBJECTIVE: The aim of this study was to evaluate thyroid dysfunction in COVID-19 and study its association with disease severity in COVID-19. METHODS: Patients with confirmed COVID-19 infection who were admitted to dedicated COVID hospital were recruited over 3 months period. Those with pre-existing thyroid disease were excluded. The thyroid function tests were performed and correlated with interleukin-6 levels. RESULTS: A total of 164 patients (14 children) with mean(SD) age 53.85 (19.54) years were recruited. The proportion of patients with mild, moderate and severe disease were 22 (13.4%), 78 (47.6%) and 64 (39.0%), respectively, among which 12 (54.5%), 56 (71.8%) and 43 (67.2%) patients had thyroid dysfunction, respectively; P = 0.309. Eighty eight (53.7%) had sick euthyroid (84 had low fT3 only), 14 had overt hypothyroidism and 9 had thyroiditis. Median (IQR) levels of serum fT3 showed significant decline from mild category [4.54 (3.81, 5.27)], to moderate [3.95 (3.67, 4.24)] and severe category [3.56 (3.22, 3.89)]; P = 0.011. Low fT3 had significant risk [odds ratio (95% CI)] of death [2.634 (1.01, 6.87); P = 0.031] and elevated IL-6 [2.575 (1.084, 6.118); P = 0.021]. CONCLUSION: Sick euthyroid was seen in the majority of patients hospitalized with COVID. Low fT3 was associated with death and increased inflammation, suggesting poor prognosis.

Clinical and Laboratory Predictors of Mortality in COVID-19 Infection: A Retrospective Observational Study in a Tertiary Care Hospital of Eastern India.

Introduction COVID-19 is associated with huge morbidity and mortality in India. Identification of factors associated with mortality would make a difference in the management of COVID-19 infection-related illness. Objective To assess clinical & laboratory parameters associated with adverse outcomes among 984 patients with COVID-19 infection admitted to a tertiary care hospital in eastern India. Materials and methods All patients with real-time polymerase chain reaction (RTPCR) or rapid antigen positive for COVID-19 admitted at our All India Institute of Medical Sciences (AIIMS) Patna between 1st July to 30th Aug 2020 were included for analysis. Statistical analysis was performed using Stata, version 10 (Stata Corp, College Station, USA). Four subgroup regression models have been analyzed to predict the odds of death. Results A total of 984 COVID-19 cases admitted to our hospital during the given period were analyzed. Out of 984 cases, 762 (77.44%) were males and 222 (22.56%) females. The overall case-fatality rate among admitted cases was 254 (25.81%) [males (26.64%) and females (22.96%)]. The final logistic regression model showed that patients presenting with severe COVID-19 disease (adjusted odds ratio [aOR]: 17.81), cough (aOR: 3.83), dyspnea (aOR:2.35), age 60-75 (aOR:1.47), age >75 years (aOR:3.97), presence of chronic kidney disease (CKD) (aOR:2.95), were found to be significantly associated with a high risk of mortality after controlling for the confounders (p<0.05). Among lab variable, total leukocyte count (TLC) (>10,000/mm3) (aOR: 1.74), neutrophil-lymphocyte ratio (NLR) (>3.3) (aOR:2.37), serum albumin (<3.4 g/dl) (aOR : 2.3), blood urea (>43 gm/dl) (aOR:3.72), ferritin (>322) (aOR:2.39), and D-dimer (>0.5) (aOR:5.58) were significantly associated with higher mortality (p<0.05) Conclusion Age 60 years plus, presence of CKD, and severe covid infection carried the highest risk of mortality. Lab markers such as raised TLC, ferritin, D-dimer, and low albumin were associated with worse outcomes in our subset of COVID-19-related illness.

The Value of Interleukin-6 among Several Inflammatory Markers as a Predictor of Respiratory Failure in COVID-19 Patients.

Patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure within a short period during the clinical course. It is essential to predict respiratory deterioration in the short term. We investigated the use of inflammatory markers to predict respiratory distress within three days from their analysis in COVID-19 patients. This retrospective observational study included 81 patients admitted with COVID-19. Patients were divided into two groups according to whether the maximum fraction of inspired oxygen (FiO2) for three days from the blood marker measurements was ≥0.4 (high FiO2 group; HFG) or <0.4 (low FiO2 group; LFG). Interleukin-6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase (LDH), white blood cell, D-dimer, and creatinine levels were compared between the two groups. The levels of all markers were significantly higher in HFG patients. Areas under the receiver operating characteristic curve of IL-6, CRP, and LDH had high values of 0.85, 0.82, and 0.81, respectively. The odds ratio of IL-6 which was crude and adjusted for dexamethasone administration initiated before laboratory measurement, showed the high value of 29.1 (5.6-295.6) and 53.9 (4.5-3242.8), respectively. IL-6 can be used as a reliable marker for predicting respiratory illness within three days after assessment.

Study to identify predictor of hypoxia in COVID-19 infection: A single-center, retrospective study.

BACKGROUND: Given the limited availability of critical care resources in our country, it is important to identify reliable predictors of hypoxia in patients with COVID-19 infection. We thus sought to compare differential predictive values of demographic, clinical, and laboratory measures and identify predictor for hypoxia in COVID-19 infection. MATERIALS AND METHODS: This is single-center retrospective analysis of patient admitted at AIIMS Patna between 15th June and 15th Aug. All the patients who had oxygen saturation less than 94% grouped under hypoxic group while ≥94% in non-hypoxic group at room air. Statistical analysis: Logistic regression model used to determine the predictor of hypoxia in COVID-19 infection. RESULTS: Total 73 were used for analysis. Study patients had a mean age of 55.05 ± 12.7 year, of whom 78.08% were male (57/73). 39 (53.42%) patients were found hypoxic at time of admission while 34 (46.56%) were non-hypoxic. Presence of dyspnoea significantly found more frequently in hypoxic patients (P = 0.0003). Patients with O2 saturation of less than 94% have more likely to have diabetes (P = 0.002) and hypertension (P = 0.02). Analysis of laboratory variables showed that leucocytosis (P = 0.007) and neutrophilia (P = 0.01) were significantly higher in hypoxic group compare to non-hypoxic group. Univariate regression model showed patient with any one comorbidities, diabetes, or hypertension was found as strong risk factor for hypoxia after COVID-19 infection (P < 0.05). CONCLUSION: This is the first study to identify predictor of hypoxia in COVID-19 infection. Patient with any one comorbidities, diabetes, or hypertension was found strong risk factor for hypoxia after COVID-19 infection. Among lab variable, leucocytosis, neutrophilia, lymphocytopenia, and CRP (>27.5 mg/L) were found as predictor of hypoxia in COVID infection.

Circulating calprotectin as a supporting inflammatory marker in discriminating SARS-CoV-2 infection: an observational study.

OBJECTIVE AND DESIGN: Fecal calprotectin (CLP) is widely known for its detection in stools of patients with inflammatory bowel diseases (IBDs), to investigate the intestinal inflammatory status. Current research is promoting the circulating protein role as a systemic inflammatory marker. However, most studies report serum calprotectin analysis although plasma assay prevents its massive release by granulocytes. In this perspective, the ongoing SARS-CoV-2 pandemic deserves deployment of convenient and easy-to-dose markers that could reliably address the state of infection. METHODS: We analyzed serum circulating calprotectin (cCLP) levels in hospitalized COVID-19 patients and plasma cCLP levels from patients with suspected SARS-CoV-2 infection, then assessed negative or positive on molecular tests. RESULTS: Our results confirm a significant circulating calprotectin increase in infected subjects respect to controls, in serum and plasma. Moreover, plasma calprotectin has higher levels in suspected patients with positive SARS-CoV-2-RT-PCR, compared to suspected patients with negative SARS-CoV-2-RT-PCR. Furthermore, ROC curves results showed the circulating plasma calprotectin discriminatory ability to differentiate infected SARS-CoV-2 patients at a cutoff value greater than 131.3 ng/ml. CONCLUSIONS: Our data propose circulating calprotectin as a new, quantitative and predictive marker, which in addition to being an interesting generic inflammatory marker may provide important indications in SARS-CoV-2 infection.

Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID-19 Patients.

BACKGROUND: The nutrition status of coronavirus disease 2019 patients is unknown. This study evaluates clinical and nutrition characteristics of severely and critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and investigates the relationship between nutrition risk and clinical outcomes. METHODS: A retrospective, observational study was conducted at West Campus of Union Hospital in Wuhan. Patients confirmed with SARS-CoV-2 infection by a nucleic acid-positive test and identified as severely or critically ill were enrolled in this study. Clinical data and outcomes information were collected and nutrition risk was assessed using Nutritional Risk Screening 2002 (NRS). RESULTS: In total, 413 patients were enrolled in this study, including 346 severely and 67 critically ill patients. Most patients, especially critically ill patients, had significant changes in nutrition-related parameters and inflammatory markers. As for nutrition risk, the critically ill patients had significantly higher proportion of high NRS scores (P < .001), which were correlated with inflammatory and nutrition-related markers. Among 342 patients with NRS score ≥3, only 84 (of 342, 25%) received nutrition support. Critically ill patients and those with higher NRS score had a higher risk of mortality and longer stay in hospital. In logistic regression models, 1-unit increase in NRS score was associated with the risk of mortality increasing by 1.23 times (adjusted odds ratio, 2.23; 95% CI, 1.10-4.51; P = .026). CONCLUSIONS: Most severely and critically ill patients infected with SARS-CoV-2 are at nutrition risk. The patients with higher nutrition risk have worse outcome and require nutrition therapy.

Clinical characteristics of asymptomatic carriers of novel coronavirus disease 2019: A multi-center study in Jiangsu Province.

Asymptomatic SARS-CoV-2-infected individuals are thought to play major roles in virus transmission. This study aimed to analyze the characteristics of asymptomatic carriers with COVID-19 to control the spread of the virus. We retrospectively investigated the clinical characteristics of 648 consecutive subjects who were enrolled in the study and were divided into asymptomatic carriers, mild cases, ordinary cases, severe or critical cases, and evaluated their impact on disease severity by means of Spearman correlation and multiple regression analyses. Receiver operating characteristic curve analysis was conducted to determine the optimum cutoff levels of laboratory findings for diagnostic predictors of asymptomatic carriers of COVID-19. In our study, a total of 648 subjects on admission with a mean age of 45.61 y including 345 males and 303 females were enrolled in our study. The leukocyte, lymphocyte, eosinophil, platelet, C-reactive protein, interleukin-6, CD3+, CD4+, and CD8 + T lymphocyte levels, and the erythrocyte sedimentation rate differed significantly among the groups (all p ≤ 0.05). Disease severity was negatively associated with the CD3+ (r = -0.340; p < 0.001), CD4+ (r = -0.290; p = 0.001) and CD8+ (r = -0.322; p < 0.001) T lymphocyte levels. The significant diagnostic predictors of asymptomatic carriers of COVID-19 included the blood cell, cytokine, and T lymphocyte subset levels. Inflammation and immune response may play important roles in disease progression. Hence, the laboratory parameters identified should be considered in clinical practice, which provide new insights into the identification of asymptomatic individuals and the prevention of virus transmission.