ABSTRACT
Aim - to study the clinical and laboratory manifestations of a severe course of COVID-19 in a lethal outcome with an assessment of the pathomorphological picture based on autopsy material. Material and methods. A retrospective analysis of demographic, clinical and laboratory parameters, as well as the results of a pathoanatomical study of 54 patients with severe COVID-19 who died in the intensive care unit, was carried out. Results. Among the patients included in the study, women and men were equally divided. The mean age was 73.1+/-1.86 years (median 73 years). An increase in body temperature above 38 degreeS was observed in 81.5% of cases, weakness - in 70.4%, dry cough - in 46.3%, a feeling of lack of air - in 46.3%, muscle pain - in 40.7%. The volume of lung damage by the type of bilateral polysegmental pneumonia with areas of compaction of the type of "frosted glasses" and consolidation was more than 75.0% and was determined in 68.5% of patients. Concomitant diseases were detected in 94.4% of patients. It was found that all patients had a pronounced systemic inflammatory response, as evidenced by an increase in the level of C-reactive protein and procalcitonin in all patients. A decrease in albumin levels was observed in 88.9% of cases. A hypercoagulable shift with intravascular coagulation was noted. Morphological studies revealed damage to the lungs, liver, kidneys and pancreas with the development of thrombovascular changes. Conclusion. A severe course of COVID-19 with a fatal outcome was observed in older patients with clinical, radiological and laboratory manifestations of a systemic inflammatory response, which was accompanied by damage to various organs and systems.Copyright © Authors, 2022.
ABSTRACT
Objectives: Identifying COVID-19 patients with risk of adverse outcomes at first admission to the intensive care unit has several diagnostic challenges. The concentration of acute phase proteins synthesized by the liver increases or decreases markedly in the serum following inflammation and infection. This study aimed to investigate the predictive value of acute phase proteins in critically ill COVID-19 patients and to evaluate the efficacy of inflammatory markers in predicting mortality risk in the intensive care unit. Material-Methods: A retrospective study was conducted in critically ill COVID-19 patients treated in the intensive care unit. Overall, 123 patients with ARDS and/or multi-organ dysfunction were included in the first 24 hours of admission to intensive care unit. After 28 days, groups of survived (n=54) and dead patient (n=69) or groups of patients with (n=83) and without (n=40) invasive mechanical ventilation were formed. Serum amyloid A, C-reactive protein, albumin, and prealbumin values considered as acute phase proteins within the first 24 hours of admission to the intensive care unit were compared between groups. Result(s): Albumin and prealbumin levels significantly decreased in dead patients (p=0.011, p<0.001, respectively) and were mechanically ventilated patients (p=0.010, p=0.006, respectively). The Serum amyloid A levels in mechanically ventilated patients significantly increased (p=0.022). Conclusion(s): Low prealbumin and albumin levels and high serum amyloid A levels during admission to ICU can be used as a prognostic marker of disease severity and mortality.
ABSTRACT
OBJECTIVE: To identify the different variables that can cause liver injury in a patient hospitalized for COVID-19. MATERIALS AND METHODS: A prospective cohort study that included patients with COVID-19 who were admitted to the Central University Hospital of the State of Chihuahua from April 2020 to November 2020. A univariate analysis was performed to find the frequencies of demographic characteristics and of the drugs prescribed, as well as a comparison of means of the biochemical parameters using Student's t test. RESULT(S): One hundred thirty-four patients with a confirmed diagnosis of COVID-19 were included, who underwent liver function parameters and averages were obtained on the day of admission, on the fifth day and the last values recorded for improvement or death. Of the parameters, albumin levels showed a significant decrease on the 5th and last day of hospitalization compared to the first day of admission. On the other hand, the levels of alkaline phosphatase, gamma-glutamyl transferase and erythrocyte sedimentation rate increased significantly on the 5th and last day of stay. CONCLUSION(S): There are different mechanisms that can generate liver injury associated with COVID-19. Of these, the uncontrolled inflammatory response that occurs can alter liver function tests. Our results found a relationship between the alteration of different laboratory parameters and the days of hospital stay of patients with the disease.Copyright © 2023 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
ABSTRACT
Objective: To evaluate the effect of the modified systemic inflammation score (mSIS) on prognosis in patients diagnosed with COVID-19. Method(s): In this retrospective cross-sectional study, 181 patients were selected and divided into two groups: patients with and without admission to the intensive care unit (ICU). An albumin level of >=4.0 g/dL and lymphocyte-to-monocyte ratio (LMR) of >=3.4 was scored 0, an albumin level of <4.0 g/dL or LMR of <3.4 was scored 1, and an albumin level of <4.0 g/dL and LMR of <3.4 was scored 2. Result(s): A total of 242 COVID-19 positive patients were initially included in this study. Of these patients, 61 were excluded and 181 patients remained. Among the 181 participants, 94 (51.9%) were female, and the median age was 61 (51, 75) years. The mSIS scale ranged from 0 to 2. After analysis, the median score was 0 (0, 0) in the non-ICU group and 2 (0, 2) in the ICU group (P<0.001). The median white blood cell, lymphocyte counts, and albumin levels were lower in the ICU group (P<0.001, P<0.001, and P<0.001, respectively). In logistic regression analysis lymphocytopenia (OR=5.158, 95% CI=1.249-21.304, P=0.023), hypoalbuminemia (OR=49.921, 95% CI=1.843-1 352.114, P=0.020), AST elevation (OR=3.939, 95% CI=1.017-15.261, P=0.047), and mSIS=2 (OR=5.853, 95% CI=1.338-25.604, P=0.019) were identified as independent predictors of ICU admission. Conclusion(s): The mSIS can be used as an independent parameter for establishing the intensive care needs of patients with COVID-19.Copyright © 2023 Authors. All rights reserved.
ABSTRACT
The wide range of symptoms of the coronavirus disease 2019 (COVID-19) makes it challenging to predict the disease evolution using a single parameter. Therefore, to describe the pathophysiological response to SARS-CoV-2 infection in hospitalized patients with severe COVID-19, we compared according to survival or death, the sociodemographic and clinical characteristics, the biochemical and immunological attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectra from saliva samples and their correlation with chemometric findings. Herein, we demonstrate that ATR-FTIR spectroscopy allows the description of the events related to cell damage, such as lipids biogenesis and the secondary structure of proteins associated with lactate dehydrogenase and albumin levels. Moreover, humoral (IgM) and cellular (IFN-gamma, TNF-alpha, IL-10, and IL-6) responses were also increased in patients who died from COVID-19. Copyright © 2023 Adriana Martinez-Cuazitl et al.
ABSTRACT
Aim: The majority of the patients with COVID-19 are followed ambulatory. Determination of prognostic factors of mortality in risky groups is essential to improve patient management. The aim of this study is to describe the clinical presentation in patients over 65 years of age with COVID-19 who are followed up at home by a physician and provide insights into the initial prognostic factors in this distinctive population. Material(s) and Method(s): This is a retrospective and observational study. Clinical records of the patients aged over 65 years who were visited by the filiation team, including a physician at home, due to the diagnosis of COVID-19 disease within 2 months were reviewed. Factors affecting mortality were examined. Result(s): Our study included 51 deceased (mean age: 75,1+/-9,0 years, 40,2% males), and 102 patients with COVID-19 who survived (mean age: 73,0+/-6,9 years, 68,6% male). Platelet count ( < 150.000, OR 7,26, p=0,001), CRP level ( < 4, OR 4,55, p=0,02), albumin level ( OR 3,24, p=0,02), and Troponin I level (OR 0,03, p=0,02) were the strongest predictors for death. When propensity score matching was applied, gender (male, OR 7,14, p=0,02) and platelet count (< 150.000, OR 5,34, p=0,02) were the strongest predictors. Discussion(s): Elderly COVID-19 patients have a high mortality rate. An easily measurable and accessible platelet count may be a predictor of a bad outcome. Close follow-up and timely treatment may significantly reduce mortality in high-risk elderly patients under.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
Background: To determine the association between various demographic indicators and biochemical markers in COVID-19 patients in Western-Punjab. Material(s) and Method(s): An observational cross-sectional study was done on one hundred and fifty cases of all ages admitted in Isolation ward, reporting to Adesh Institute of Medical Sciences and Research, Bathinda, India with COVID-19(RT-PCR/ or RAT) from January 2022 to March 2022 were included. Clinical features like fever, cough and shortness of breath were recorded. Blood sample was collected in plain tube for biochemical markers like serum albumin, creatinine, ferritin, LDH, CRP and urea, SGOT, SGPT, procalcitonin, D-dimer, ESR, IL-6, ALP, bilirubin were analysed. Association of the clinical features and these biochemical markers were determined. Result(s): Patients were divided into 3 groups according to different ages (<40 years, 40-60 years, >60 years). Out of 150 patients 26 (17.3%) belonged to age group < 40, 60 (40.0%) belonged to age group 40-60 years and 64 (42.7%) belonged to age group >60 years. Mean age was 55.93 + / - 14.91. Out of 150, 39 (26.0%) were females and 111(74.0%) were males. 44 (29.3%) cases had hypertension and 59(39.3%) cases had diabetes mellitus. Urea levels in 118 (78.7%) patients were above normal reference values e and was statistically significant (p<0.015). 73 (48.7%) had SGOT levels above normal range [statistically significant (p<0.025)] while as 63 (42%) had SGOT above normal range [statistically significant (p<0.001)]. 98 (65.3 %) had IL-6 above normal range [statistically significant (p<0.003)]. While as albumin levels in 38 (25.3%) patients were within normal range and 112 (74.7%) patients had albumin below normal range [statistically significant (p<0.014)]. ESR (100%), D-dimer (100%), procalcitonin (100%), LDH (94%) were uniformly raised in almost all patients. Rest of the markers like ferritin (74%), bilirubin (6%), CRP (90%), creatinine (15.3%), ALP (14.7%) was also raised but was not statistically significant. Conclusion(s): Indian patients with COVID-19 disease showed variable pattern of clinical features.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Background and Aim: We investigated the possible relationships between RAAS inhibitor use (for hypertension) and COVID-19-related characteristics such as lung involvement on CT, admission to intensive care unit, and mortality. Method(s): This case-control study was conducted in a single-center with a retrospective and observational design. We included 220 patients from a total of 654 patients admitted with a confirmed diagnosis of COVID-19 infection (by RT-PCR) and who underwent simultaneous Thoracic CT scan. We divided the patients into three groups: patients without a history of hypertension or drug use as the non-HT group (n=74), patients with HT using RAAS inhibitors (ACEIs and ARBs) in the RAAS group (n=72), and patients with HT using CCBs in the CCB group. Result(s): Of the 220 patients, 117 (53.2%) were males and no difference was observed between the groups in term of sex. The overall median age of patients was 63 (21-93) years and the RAAS group was found to have significantly higher mean age, while the non-HT and RAAS groups were similar (66 [24-93] vs. 61 [32-89], 62 [21-88], p= 0.040). No significant difference was observed between the groups in terms of in-hospital mortality, 1-month mortality, mechanical ventilation need, lung involvement and other radiological findings. Albumin (OR=0.250, 95%CI: 0.091-0.690, p = 0.007), WBC (OR=1.000, 95%CI: 1.000-1.000, p = 0.004), platelet count (OR=0.987, 95%CI: 0.979-0.995, p = 0.002), CRP (OR=1.007, 95%CI: 1.001-1.014, p = 0.025) and male gender (OR=3.893, 95%CI: 1.598-9.480, p = 0.003) were determined as factors that were independently associated with ICU admission among hospitalized patients. Also, age (OR=1.095, 95%CI: 1.005-1.194, p = 0.038) and length of stay in ward (OR=0.809, 95%CI: 0.694-0.943, p = 0.007) were found to be independently associated with mortality in patients admitted to the ICU. Conclusion(s): In our study, we showed that patients using RAAS inhibitors for HT, those using CCB, and individuals without a history of HT or other chronic diseases did not differ in terms of lung involvement on CT. We also found that HT presence was not associated with ICU admission and death. Albumin level, CRP level, platelet count, WBC count and male gender are independent predictors of ICU admission;also found that age and length of ward stay days were independent predictors of death in patients hospitalized in the ICU.
ABSTRACT
Background: To determine the association between various demographic indicators and biochemical markers in COVID-19 patients in Western-Punjab. Material(s) and Method(s): An observational cross-sectional study was done on one hundred and fifty cases of all ages admitted in Isolation ward, reporting to Adesh Institute of Medical Sciences and Research, Bathinda, India with COVID-19(RT-PCR/ or RAT) from January 2022 to March 2022 were included. Clinical features like fever, cough and shortness of breath were recorded. Blood sample was collected in plain tube for biochemical markers like serum albumin, creatinine, ferritin, LDH, CRP and urea, SGOT, SGPT, procalcitonin, D-dimer, ESR, IL-6, ALP, bilirubin were analysed. Association of the clinical features and these biochemical markers were determined. Result(s): Patients were divided into 3 groups according to different ages (<40 years, 40-60 years, >60 years). Out of 150 patients 26 (17.3%) belonged to age group < 40, 60 (40.0%) belonged to age group 40-60 years and 64 (42.7%) belonged to age group >60 years. Mean age was 55.93 + / - 14.91. Out of 150, 39 (26.0%) were females and 111(74.0%) were males. 44 (29.3%) cases had hypertension and 59(39.3%) cases had diabetes mellitus. Urea levels in 118 (78.7%) patients were above normal reference values e and was statistically significant (p<0.015). 73 (48.7%) had SGOT levels above normal range [statistically significant (p<0.025)] while as 63 (42%) had SGOT above normal range [statistically significant (p<0.001)]. 98 (65.3 %) had IL-6 above normal range [statistically significant (p<0.003)]. While as albumin levels in 38 (25.3%) patients were within normal range and 112 (74.7%) patients had albumin below normal range [statistically significant (p<0.014)]. ESR (100%), D-dimer (100%), procalcitonin (100%), LDH (94%) were uniformly raised in almost all patients. Rest of the markers like ferritin (74%), bilirubin (6%), CRP (90%), creatinine (15.3%), ALP (14.7%) was also raised but was not statistically significant. Conclusion(s): Indian patients with COVID-19 disease showed variable pattern of clinical features. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Background: Coronavirus Disease-2019 (Covid-19) is the cause of a pandemic that has high mortality and global effects. The liver damage in Covid-19 cases in mechanical ventilation was investigated in this study. A total of 60 patients (the Study Group) who were diagnosed with Covid-19 pneumonia, and 65 individuals (the Control Group) were included prospectively in the study. The cases were divided into 3 groups as those who were intubated (severe), those who were not intubated (mild), and the healthy Control Group. The lung tomography results of those who were diagnosed with Covid-19 were examined in the study. The cases with positive RT-PCR (Real Time Polymerized Chain Reaction) test results were recorded from the system. The liver tests of the patients were compared with those of the Control Group. The two groups with and without intubation were also compared. The results were evaluated and analyzed statistically. When all the data were evaluated, it was found that LDH, GGT, AST, and aPTT levels were significantly higher in the mild and severe patient group compared to the Control Group, and the T. Protein and albumin levels were low (p<0.01). The N/L Ratio, and the CRP levels, which are the other acute phase reactants, were significantly higher (p<0.05). No statistically significant differences were detected when all parameters of the groups with and without intubation were compared (p>0.05). Increased D-dimer, GGT, D. Bil, LDH, NLR, and AST levels in Covid-19 patients in invasive mechanical ventilation are associated with mortality. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
ABSTRACT
SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are commonly reactivated in critically ill patients with severe infections. This study aimed to evaluate the proportion of reactivation of EBV and CMV and its impact on length of stay, need for ventilation, and Ichikado CT scores in patients with coronavirus disease 2019 (COVID-19). METHODS: A retrospective study was conducted comprising adult patients admitted to our hospital with COVID-19 infection from June 2021 to September 2021. Patients were divided into groups: virus-free, EBV-only, CMV-only, and EBV and CMV detected. Primary outcomes were length of stay, need for ventilation, and Ichikado CT score. Descriptive statistics, one-way ANOVA, Games-Howell, and Kruskal-Wallis tests were used. RESULTS: 189 patients were included with a median age of 51 years [41 – 66], 80 (42.3%) were female and 109 (57.7%) were male. CD4(+) counts were lower in all viral reactivation groups. EBV-only (157 cell/µl [93 – 279.2] ), CMV-only (82.5 cell/µl [65.5 – 323.7] ), both viruses (62.5 cell/µl [47.5 – 135.5]) and virus-free (221 cell/µl [117 – 318]), (H(3) = 12.029, p = < 0.01). A significant increase in the Ichikado CT score was seen in the viral reactivation groups. EBV 186.5 [43.6], CMV 177.5 [41.6], both-viruses group 204 [50.3] vs. virus-free 161 [45.8],( H(3) = 15.770, p = < 0.01). There was an increase in days of hospitalization when comparing the virus-free and the viral reactivation groups. EBV (9 days [5.5-15.5]), CMV (17 days [3-33]), both viruses (23 days [8-31]) vs. virus-free (5 days [3.5-9]), (H(3) = 15.487, p = < 0.01). Regarding the need for assisted ventilation, there was no difference between groups. 7 (9.1%) patients in the virus-free group, 29 (29.9%) patients in the EBV group, 2 (33.3%) patients in the CMV group, and 2 (22.2%) patients in the both-viruses group needed mechanical ventilation (X2 (3, N=189) = 11.699, p= 0.08). Additionally, a statistically significant decrease in albumin levels on admission was found in the EBV-only patients compared to the virus-free group, (3.4 g/dL [0.44] vs 3.75 g/dL [0.46], F(3,185) = 5.483, p = < 0.01). CONCLUSIONS: Viral reactivation is associated with lower CD4(+) count, an increase in length of stay, and higher Ichikado CT scores. CLINICAL IMPLICATIONS: EVB and CMV reactivation is associated with low CD4(+) counts and longer hospital stay. DISCLOSURES: No relevant relationships by David Akinwale No relevant relationships by Angelica Almaguer No relevant relationships by Sushen Bhalla No relevant relationships by Ailine Canete Cruz No relevant relationships by Ndiya Emeaba Speaker/Speaker's relationship with johnson and johnson Please note: approx year 2000 Added 03/31/2022 by Joseph Gathe, value=Honoraria clinical research relationship with gilead Please note: since 1990 Added 03/31/2022 by Joseph Gathe, value=Grant/Research clinical research relationship with ansun Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support clinical research relationship with regeneron Please note: 2020 Added 03/31/2022 by Joseph Gathe, value=Grant/Research Support No relevant relationships by Jesus Salvador Gonzalez Lopez No relevant relationships by Najia Hussaini No relevant relationships by Claudia Ramirez No relevant relationships by Salim Surani No relevant relationships by Daryelle Varon No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
ABSTRACT
Introduction: COVID -19 pandemic continues to affect millions worldwide, while the critical form of the disease requires ICU hospitalization to manage not only respiratory failure but multiple organ dysfunctions as well. Objectives: Our retrospective observational study aimed to test the hypothesis that there is a difference in mean values of indexes pointing to organ dysfunction on ICU admission day, like BUN over Creatinine ratio, BUN over Albumin ratio, and PaCO2 over HCO3 ratio among patients with confirmed critical COVID -19 infection who died and patients who survived ICU. Methods: During late 2020 to 2021, 69 patients indicated with the diagnosis of critical COVID -19 disease admitted to ICU. The patients were separated into two groups. Group A involved all patients who survived ICU and group B all patients who died in ICU. We looked for statistically significant differences between the medians values of two groups according to BUN/Cr, BUN/Alb, PaCO2/HCO3 ratios on the ICU admission day, performing unpaired t-test or Mann-Whitney Test according to equal S.D.s assumption. Results: (Table) Conclusions: According to our data, there was a strong statistically significant difference detected between the two groups according to BUN/Alb and PaCO2/HCO3, while the BUN/Cr ratio had no statistically significant difference. Our data suggest that prerenal disorder took place early and was already present on ICU admission day, although not statistically greater in group B. However, a renal disorder associated with albumin levels was greater in group B, and acute type II respiratory failure was by far greater in patients that died in the ICU, pointing that oxygenation disorder was not the only impact of COVID -19 infection on the ICU admission day.
ABSTRACT
A 26-year-old man complained of shortness of breath for 3 days before the hospital admission. The patient had a history of coughing up blood and had consumed alcohol and drugs. Decreased vesicular auscultation and dull percussion in the left lateral pulmo. Laboratory result showed increased neutrophil-lymphocyte ratio C-reactive protein, D-dimer, procalcitonin, ferritin, and decreased albumin level. Pleural fluid analysis indicated the presence of exudate, SARS-CoV-2 PCR positive, and increased ADA level to 43 U/L. Based on the examination results, we suspected that the etiology of the massive pleural effusion was tuberculous pleurisy, particularly due to increased ADA levels. The patient was diagnosed with COVID-19 pneumonia with massive pleural effusion and tuberculous pleurisy. Massive pleural effusion in SARS-CoV-2 infection is rare. Thus, laboratory modalities for massive pleural effusion diagnosis are needed to determine the etiology and effective treatment for the patient. ADA analysis could be considered as an initial examination in patients with pleural effusion during the wait for pleural fluid culture results.
ABSTRACT
Objective: Multisystem inflammatory syndrome (MIS-C) in children is a newly defined and serious health problem that develops after SARS-CoV-2 infection. Our aim is to report epidemiological, clinical, laboratory and radiological features of children with MIS-C. Material and Methods: Forty patients who applied to our hospital from October 2020 to February 2021 and met the MIS-C criteria were included in the study. Patients with gastrointestinal involvement (GIS), cardiac involvement and Kawasaki Disease (KD)-like MIS-C were examined clini-cally and laboratory. Results: The mean age of the patients was 8.2 ± 4.2 years and male patients were in the majority (70%). The most common symptoms were fe-ver (100%) and fatigue (90%). Gastrointestinal symptoms were present in 71%, cardiac involvement in %40, Kawasaki-like patients in %52.5, shock symptoms in 59%. Elevated levels of C-reactive protein, D-dimer, and ferritin were found in 100%, 97.5%, and 67.5% of the patients, respec-tively. Patients with cardiac involvement had higher mean age and lower lymphocyte levels. Shock findings were higher in patients with KD-like MIS-C. Also, INR and ferritin levels were higher in KD-like MIS-C patients (p= 0.028). The mean platelet count (p= 0.004) and albumin levels were lower (p= 0.048) in shock group. Conclusion: MIS-C is a hyperinflammatory syndrome with cardiac, GIS, and lung involvement. Cardiac findings were not common in patients presenting with KD-like MIS-C, but a poor prognosis was observed in KD-like MIS-C patients. Patients with cardiac involvement were older and their lymphocyte count was lower.
ABSTRACT
Background: The COVID-19-associated multisystem infammatory syndrome in children (MIS-C) is characterized by Kawasaki disease (KD)-like features and circulatory shock [1]. The genesis of SARS-CoV-2 variants triggered successive waves of mass infections followed by MIS-C outbreaks. Objectives: To compare MIS-C phenotypes across the waves of the COVID-19 pandemic. To identify predictors of pediatric intensive care unit (PICU) admission and treatment with biologic agents. Methods: Youth aged 0-18 years, fulflling the WHO case defnition of MIS-C, and admitted to the Alberta Children's Hospital during the COVID-19 pandemic (May 2020-December 2021) were included. Clinical, laboratory, imaging, and treatment data were captured (KD-like manifestations, signs of shock and/or hypotension, peak C-reactive protein (CRP) and ferritin, platelet count nadir, peak NT-proBNP and troponin, liver enzyme abnormalities, sodium and albumin nadir, echocardiogram fndings, biologic agents). Results: 57 consecutive MIS-C patients (median age 6 years, IQR 4-6;72% males) were included. 31 patients (54%) required PICU admission. All received immunoglobulins, 44 (77%) received corticosteroids, 8 patients (14%) were treated with biologic agents. Patients presenting during the third (mainly driven by Alpha variant) or fourth wave (mainly driven by Delta variant) presented with higher ferritin and NT-proBNP levels, and more liver enzyme abnormalities, hypoalbuminemia and thrombocytopenia compared to those presenting during the frst or second wave (Table 1, Figure 1). PICU admission was associated with the presence of shock/hypotension, higher CRP, ferritin, and NT-proBNP levels, lower albumin levels, and the presence of ventricular dysfunction on echocar-diogram (Table 1). A logistic regression model combining peak NT-proBNP, tro-ponin and ferritin levels explained 70% (Nagelkerke R2) of the variance in PICU admission and correctly classifed 91% of the cases. NT-proBNP was the sole signifcant contributor (p=0.017). Treatment with biologic agents was associated with higher CRP (mean 148.8 mg/l versus 251.7 mg/l;p=0.024) and ferritin (797 μg/l versus 1280 μg/l;p=0.049) levels. Conclusion: A shift in MIS-C phenotype was identifed across the successive COVID-19 waves, including the predominance of features associated with macrophage activation syndrome in later stages. These fndings may refect the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most important MIS-C feature predicting PICU admission, underscoring the importance of monitoring.
ABSTRACT
Aim: Fibrinogen and albumin are proteins that play a role in inflammation. In this study, it was aimed to investigate the role of fibrinogen, albumin, and fibrinogen/albumin ratio (FAR) levels as markers of disease severity and prognosis in coronavirus disease 2019 (COVID-19) patients. Material and Methods: Seventy-one patients aged between 19 and 84 years diagnosed with COVID-19 who were hospitalized in Sakarya University Training and Research Hospital, Neurology Department between March and May 2020 were analyzed retrospectively. Fibrinogen, albumin, FAR, D-dimer, platelet, and C-reactive protein (CRP) levels of the patients were compared according to the length of hospitalization duration, survival, and clinical severity of COVID-19. Results: Twenty-eight (%39.4) of the patients were male and 43 (%60.6) were female, and the mean age was 55.7±20.7 years. There was a significant difference between the groups of COVID-19 clinical severity in terms of age, fibrinogen, albumin, FAR, D-dimer, and CRP values (all p values were <0.001). Also, significantly higher fibrinogen, FAR, D-dimer, and CRP values were found in patients hospitalized longer, while the albumin level was lower in these patients (all p values were <0.001). FAR values were higher and albumin values were lower in non-surviving patients compared to surviving patients (p=0.025 and p<0.001, respectively). Conclusion: FAR levels may be useful in predicting mortality risk in COVID-19 patients. In addition, it may be helpful and useful in determining the prognosis since it has higher levels as the severity of the disease and the length of hospital stay increase.
ABSTRACT
Introduction: Many viruses through aerosols, droplets, and droplet nuclei utilize the respiratory passages to establish not only localized respiratory tract infections but also systemic disease. The coronaviruses (CoV) are no exception. The two most common illnesses that occurred in the recent past were severe acute respiratory syndrome (SARS, 2003) and the Middle East respiratory syndrome (MERS, 2012).1 The current pandemic, which broke out in late December 2019, has been a major threat to global public health due to significant morbidity and mortality, akin to snapping of Thanos' fingers. The novel coronavirus was initially named the 2019-novel CoV (2019-nCoV), but because of nearly 80% genetic homology to SARS-CoV, the Coronavirus Study Group of International Committee rechristened this virus as SARS-CoV-2.1 The disease was named coronavirus disease 2019 (COVID-19) on January 12, 2020, by the World Health Organization (WHO).2 According to the Advisory Committee on dangerous pathogens UK, COVID-19 is assigned as a hazardous group-3 organism, meaning that it can cause severe human disease.3 The novel coronavirus was named the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, 2019-nCoV) due to its high homology (∼80%) to SARS-CoV, which caused acute respiratory distress syndrome (ARDS) and high mortality during 2002-2003.4 The outbreak of SARS-CoV-2 was considered to have originally started via a zoonotic transmission associated with the seafood market in Wuhan, China. Later it was recognized that human-to-human transmission played a major role in the subsequent outbreak.5 The most common clinical manifestations of COVID-19 include fever, cough, dyspnea, fatigue, and myalgia. A few patients have developed severe pneumonia and they may present with acute respiratory distress syndrome (ARDS), extrapulmonary organ dysfunction, or even death. SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Lower respiratory tract infection-related symptoms including fever, dry cough, and dyspnea were reported in the initial case series.6 In addition, headache, dizziness, generalized weakness, vomiting, and diarrhea were observed.7 It is now widely recognized that respiratory symptoms of COVID-19 are extremely heterogeneous, ranging from minimal symptoms to significant hypoxia with ARDS. The heterogeneous disease course of COVID-19 is unpredictable with most patients experiencing mild self-limiting symptoms. However, up to 30% require hospitalisation, and up to 17% of these require intensive care support for acute respiratory distress syndrome (ARDS), hyperinflammation, and multiorgan failure. 8-10 A cytokine storm in patients with severe disease was identified in the early reports of Wuhan patients and is intrinsic to disease pathology. In this cohort, elevated plasma interleukin (IL)-2, IL-7, IL-10, granulocyte colony-stimulating factor (GCSF), interferon γ-induced protein 10 (IP10, monocyte chemoattractant protein-1 (MCP1), macrophage inflammatory protein 1-alpha (MIP1A), and tumor necrosis factor-alpha (TNF-α) levels in ICU patients were identified. 6 Studies have shown that severe or fatal cases of COVID-19 disease are associated with an elevated white cell count, blood urea nitrogen, creatinine, markers of liver and kidney function, C-reactive protein (CRP), interleukin-6 (IL-6), lower lymphocyte (<1000/μL) and platelet counts (<100 × 109/L) as well as albumin levels compared with milder cases in which survival is the outcome. Subsequent studies have implicated IL-6 as a valuable predictor of adverse clinical outcome and a potential therapeutic target.11,12 One or more clinical and wet biomarkers may enable early identification of high-risk cases, assisting disease stratification and effective use of limited specialist resources. Age is a strong risk factor for severe illness, complications, and death.13,14 Patients with no underlying medical comorbid conditions have an overall case fatality rate of <1%. Case fatality is higher for patients with comorbidit es. The severe cases are associated with elevated levels of inflammatory biomarkers such as serum lactate dehydrogenase, creatine kinase, C-reactive protein (CRP), d-dimer, procalcitonin, and ferritin.15 Since laboratory medicine has always supported clinical decision-making in various infectious diseases, it is important to assess the ability of laboratory-derived biomarkers to facilitate risk stratification of COVID-19 disease. This study will comprehensively explore clinical disease features and routine laboratory tests associated with COVID-19 disease and its complications, to address their association with disease severity and outcome. Hence, the present retrospective study will be done at our tertiary care centre to assess the association between different laboratory biomarkers and disease severity and outcomes in COVID-19 patients. Aims and objectives: Clinical correlation of biomarkers and disease severity in COVID-19 patients-a retrospective study. Review of Literature: Xia et al.16 in 2020 defined disease stages and identified stages' determining factors are instructive for the definition of standards for home quarantine. The authors demonstrated pulmonary involvement on a chest CT scan in 97.9% of cases. It took 16.81 ± 8.54 (3-49) days from the appearance of the first symptom until 274 patients tested virus-negative in naso- and oropharyngeal (NP) swabs, blood, urine, and stool, and 234 (83%) patients were asymptomatic for 9.09 ± 7.82 (1-44) days. Subsequently, 131 patients were discharged. One hundred and sixty-nine remained in the hospital;these patients tested virus-free and were clinically asymptomatic because of widespread persisting or increasing pulmonary infiltrates. Hospitalization took 16.24 ± 7.57 (2-47) days;the time interval from the first symptom to discharge was 21.37 ± 7.85 (3-52) days. The authors concluded that with an asymptomatic phase, disease courses are unexpectedly long until the stage of virus negativity. NP swabs are not reliable in the later stages of COVID-19. Pneumonia outlasts virus-positive tests if sputum is not acquired. Imminent pulmonary fibrosis in high-risk groups demands follow-up examinations. Investigation of promising antiviral agents should heed the specific needs of mild and moderate COVID-19 patients. Keddie et al.17 in 2020 investigated the routine laboratory tests and cytokines implicated in COVID-19 for their potential application as biomarkers of disease severity, respiratory failure, and need for higher-level care. The authors found CRP, IL-6, IL-10, and LDH were most strongly correlated with the WHO ordinal scale of illness severity, the fraction of inspired oxygen delivery, radiological evidence of ARDS, and level of respiratory support. IL-6 levels of ≥3.27 pg/mL provide a sensitivity of 0.87 and specificity of 0.64 for a requirement of ventilation, and a CRP of ≥37 mg/L of 0.91 and 0.66. The authors concluded that reliable stratification of highrisk cases has significant implications on patient triage, resource management, and potentially the initiation of novel therapies in severe patients. Malik et al.18 in 2020 in a systematic review and meta-analysis assessed the role of biomarkers in evaluating the severity of disease and appropriate allocation of resources. Studies having biomarkers, including lymphocyte, platelets, d-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin (PCT), and creatine kinase (CK), and describing outcomes were selected with the consensus of three independent reviewers. The authors found lymphopenia, thrombocytopenia, elevated d-dimer, elevated CRP, elevated PCT, elevated CK, elevated AST, elevated ALT, elevated creatinine, and LDH were independently associated with a higher risk of poor outcomes. The authors concluded a significant association between lymphopenia, thrombocytopenia, and elevated levels of CRP, PCT, LDH, d-dimer, and COVID-19 severity. The results have the potential to be used as an early biomarker to impro e the management of COVID-19 patients, by identification of high-risk patients and appropriate allocation of healthcare resources in the pandemic. Tjendra et al.19 in 2020 assessed specific laboratory parameters and summarized the currently available literature on the predictive role of various biomarkers in COVID-19 patients.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) and associated outcomes manifest differently depending on patients' background and pre-existing conditions. It remains unclear how African Americans with and without cancer have been affected. Aim: To determine epidemiological, clinical comorbidities, and laboratory test results to identify markers associated with mortality in COVID-19 cancer patients. Methods: We reviewed all COVID-19 hospitalized patient records from Dec. 2019 to Nov. 2021 at Howard University Hospital. Patients having a history of, or active cancer status were reviewed. All the clinical, treatment, lab values, and pathological data were extracted. Statistical analysis of the COVID-19 cancer patients and comparison with non-cancer COVID-19 patients were performed using univariate and multivariate analyses. Results: Out of 800 COVID-19 infected patients, a total of 49 patients were identified with different types of cancer, with both active and previous history. Females consisted of 26 cancer patients (53%). Cancer patients were older than non-cancer patients (mean age-70.6 vs. 56.3 years) and had an increased length of hospital stay (mean 13.9 vs 9.4 days). Among cancer patients, breast cancer was more prevalent in females and prostate cancer in males, (54% and 52% respectively). In both cases and controls, univariate and multivariate analyses did not show any correlation between individual symptoms or clinical comorbidities and death. Higher reduction in albumin level in cancer cases, from the time of admission to day five, was significantly associated with death during the same hospital stay compared to those who were discharged (p<0.001). In controls, lymphocytes count, AST, and Albumin have shown an association with increased mortality. Comparison of patients with active vs. previous cancer showed no significant difference in the clinical outcome, death vs discharge (P=0.34). Conclusion: Albumin level has shown to have an inverse relationship with clinical outcomes among all COVID infected African American patients. Reduction in Albumin level during the hospital stay, particularly in COVID-19 cancer patients should be considered as a predictor of mortality. No significant difference was noticed in the clinical outcome in patients with previous versus active cancer. Further research with a large cohort size is needed to verify and identify other predictors of outcome in COVID-19 cancer patients and develop appropriate treatment modalities.
ABSTRACT
Introduction: From the beginning of the Covid-19 outbreak, liver involvement has been reported in some adult studies and some possible mechanisms have been proposed for this. However, there are few studies in the paediatric age group. In this study, we aimed to determine the incidence rate of liver damage in paediatric patients with Covid-19 and their impact on the outcome. Methods: All Covid-19 RT-PCR positive children admitted to the Namazi Hospital in Shiraz, Iran, from March 2020 to April 2021 were enrolled. Clinical data, especially gastrointestinal signs and symptoms, and paraclinical data, including liver function tests, C-reactive protein (CRP) and lactate dehydrogenase (LDH) were gathered and all the patients were monitored during their hospital stay. Results: One hundred and ten patients were enrolled in this study and of them 67 patients (69%) were admitted to the PICU. Gastrointestinal symptoms were seen in 47 patients (42.7%) upon admission. Abnormally high AST and ALT were seen in 83 (75.4%) and 49 (44.5%) patients, respectively. In the patients admitted to the PICU (n = 67), 56 (83.6%) had abnormal AST and 34 (50.7%) had high ALT. Twenty-seven (62.8%) and 15 (34.9%) of the 43 patients who were not admitted to the PICU had high AST and ALT, respectively. The patients admitted to the PICU had significantly higher CRP and LDH and lower albumin levels. Logistic Regression analysis revealed that CRP, LDH and albumin are predictors of mortality. Conclusion: Abnormal liver function tests in children with Covid-19 are common and we can consider hypoalbuminaemia in addition to high LDH and CRP as poor prognostic factors.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) has quickly spread to become a pandemic. Most studies demonstrate that increased liver enzymes in COVID-19 have little clinical relevance. In severe COVID-19, lower albumin levels are seen. Aim: To see how hypoalbuminemia levels affect the COVID-19 patients. Study design: Retrospective cohort study. Place and duration of study: Services Institute of Medical Sciences Lahore and Bahria International Hospital, Lahore from 10th January 2021 to 17th September 2021. Methodology: Sixty-seven confirmed cases of COVID-19 on RT-PCR were recruited. They were further divided into two groups. Group N (normal albumin levels) had thirty-six participants whereas group HA (hypoalbuminemia) contained thirty-one participants. Both males and females of all age groups, having complete medical records were included. Biochemical variables were noted from the medical record within 48 to 72 hours after admission. Twenty eight days follow up was done to note the mortality. Patients having incomplete medical records who expired within 2 days after admission were excluded. Results: A significantly higher number of deaths, lymphopenia, hypertensive, diabetics, and asthmatic participants were found in Group HA as compared to Group N. Hypoalbuminemia is mostly seen in older age and biochemical variables such as total leukocyte count and, neutrophils were elevated, whereas lower levels of lymphocytes were found in group HA. Lower lymphocytes and higher creatinine levels are the most prevalent predictors of mortality. The Pearson’s correlation of albumin with lymphocytes showed a positive correlation and inverse correlation with TLC, Neutrophil counts, CRP levels Conclusion: The group HA is associated with higher mortality and increased levels of prognostic factors of mortality.