ABSTRACT
Objective: The Covid-19 pandemic has revealed the importance of an evidence-based efficient triage system in the early identification of high risk patients and the rational use of limited medical resources for reducing mortality. The aim of this study was to evaluate the role of various inflammatory indices that can be easily calculated using readily accessible, inexpensive routine test parameters in risk stratification and prediction of prognosis in patients with Covid-19. Material and Methods: The study was carried out retrospectively with the data of 8036 patients with Covid-19, who were grouped according to their prognosis in outpatient and inpatient follow-ups, and inpatients as survivors and death. Using the complete blood count and C-reactive protein baseline results of the patients at admission, neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocytelymphocyte ratio (MLR), MVP-platelet ratio (MPR), platelet mass index (PMI), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), and multi-inflammatory indices (MII) were calculated. Results: Our results demonstrate that almost all of the inflammatory indices were significantly different in severe patients and in patients with high mortality risk, but not all of them had a predictive value. It has been seen that the most effective factors in determining the disease severity at the onset of Covid-19 are SIRI and age, and SII, MII-1 and MII-3 may also contribute to this prediction. Our results have also revealed that NLR is the most effective independent factor to predict mortality both at disease onset and for inpatients. Conclusion: Inflammatory indices, especially SIRI, NLR, SII, MII-1 and MII-3 can substantially contribute to clinical decisions in the early identification of high-risk patients and predicting mortality beginning from the onset of Covid-19.
ABSTRACT
Introduction: According to scientific studies, a high incidence of thrombotic events is known in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Background: To identify significant risk factors for thrombosis thrombosis (DVT) in intensive care patients with COVID-19. Materials and methods: We conducted a prospective cross-sectional study that included 465 adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. All patients underwent computer tomography of the chest organs, ultrasound angioscanning of lower extremities, body mass index was calculated, the presence of comorbotity diseases and indicators of volumetric blood saturation were considered. The level of D-dimer in blood plasma, coagulation parameters (fibrinogen, factor VIII) were taken from laboratory parameters in calculations. For subgroups with 5 or fewer people, the chi-square test and Fisher's exact test were used. For quantitative variables, analysis of variance (ANOVA) and the Pearson and Spearman correlation coefficient were used. For multiple variables, ordered logistic regression models were built, with likelihood ratio tests performed to compare the models. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%) had at least one comorbidity. The most common was arterial hypertension - 370 (79.57%), followed by chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases -25 (5.38%). The average body mass index was 29.7 kg/m2. In patients with DVT and venostasis, the body mass index (BMI) was more than 30 kg/m2 than without DVT (32.57+or-10.92 kg/m2, and 30.24+or-6.85 kg/m2, versus 29.22+or-6.46 kg/m2, respectively). Ultrasound angioscanning (USAS) confirmed deep vein thrombosis in 60 patients (13.8%) and was associated with older age (71.12+or-13.98 versus 67.20+or-11.16, p < 0.006), venous stasis was detected in 56 patients (12%) no DVT was detected in the rest of the studied patients. In the majority of cases, DVT was detected in the tibial segment -26 (43.33%), in 18 (30%) patients it was diagnosed in the popliteal veins and in 14 (23.33%) cases in the femoral segment. Diabetes mellitus (p=0.041), obesity (p=0.01) and CRF (p=0.028) were also significant risk factors for DVT. Conclusions: Significant risk factors for deep vein thrombosis in intensive care patients with COVID-19 are high levels of D-dimer (>=2.33 g/ml) and comorbidities such as obesity, chronic kidney failure, and diabetes mellitus.
ABSTRACT
Background and Objectives: Statins, which are primarily used for controlling blood cholesterol levels, have a well-known role in inhibiting the inflammatory process and reducing mortality rate of infectious diseases. This study aims to evaluate the effect of atorvastatin along with standard treatment protocol in hospitalized adults with COVID-19. Methods: This randomized controlled clinical trial was conducted on adults hospitalized due to COVID-19 infection at Shahid Beheshti Hospital in Qom, Iran from April to September 2020. They were randomly divided into groups of treatment (n=37, receiving atorvastatin 40 mg daily for 30 days plus standard treatment protocol) and control (n=37, receiving standard treatment protocol alone). The data were analyzed in SPSS v.22 software using chi-square, paired t-test, and ANOVA. P < 0.05 was statistically significant. Results: The CRP level in the atorvastatin-treated group decreased significantly such that there was a significant difference between the two groups after 30 days (P=0.01). There was no significant difference in Spo2 level on the discharge day. The length of hospitalization in the atorvastatin-treated group was significantly reduced compared to the control group (P < 0.05). Conclusion: The use of atorvastatin as an adjunctive treatment method, can significantly reduce the length of hospitalization and CRP level after 30 days in hospitalized patients.
ABSTRACT
Objectives: Aim of this study was to evaluate hepcidin levels and its correlation with inflammatory markers, vitamin D levels as well as its effects on intensive care unit (ICU) mortality in critically ill coronavirus disease-2019 (COVID-19) patients. Materials and Methods: Adult patients those were admitted to pandemic ICU between March 1st, 2021 and May 17th 2021 were prospectively included to the study. Hepcidin levels and inflammatory markers on day 1, 2, 3 and 7, admission vitamin D levels, length of ICU stay and ICU mortality were recorded and analysed. Results: Median age of patients was 60.5 (52.50-71.25) and 20 (66.7%) of them was male. It was observed that hepcidin levels and lymphocyte counts were increased significantly from day 1 to day 7 (p=0.01 and p<0.01, respectively). In contrast, C-reactive protein (CRP) and procalsitonin levels were decreased from day 1 to day 7 (p=0.01 and p<0.01, respectively). In the analysis admission hepcidin levels and inflammatory markers [IL-6 (p=0.61), CRP (p=0.82) and ferritin (p=0.27)], vitamin D (p=0.13) and iron level (p=0.90) was not correlated. There was no correlation between hepcidin levels and ICU mortality (p=0.95). Conclusion: In this study, hepcidin levels were above normal limits in critically ill COVID-19 patients. However, our findings do not support the use of hepcidin, IL6, serum ferritin, and vitamin D levels in predicting COVID-19 mortality.
ABSTRACT
Background: Patients with COVID commonly have mild symptoms or even be asymptomatic, a notable proportion of patients may develop severe pneumonia, acute respiratory distress syndrome, multiorgan failure and, death. NT-proBNP reflects haemodynamic stress and has proven useful for risk stratification in heart failure (HF) and other conditions such as pulmonary embolism and pneumonia. NT-proBNP is an important biomarker for the diagnosis and estimation of prognosis in cardiac insufficiency. Therefore, in the current study, we are aiming to investigate the association between the serum NT pro BNP levels in covid-19 patients and to correlate the same with the severity of COVID-19 infection. Methods: A cohort study involving 68 covid patients whose NT pro BNP levels was estimated at the time of admission and compared with other covid biomarkers. Patients classified as moderate and severe according to ICMR guidelines were included. Serum NTproBNP levels & other covid biomarkers like CRP, IL6, Ddimer, Ferritin, LDH were estimated. Results: Serum NT pro BNP levels were high in severely ill covid patients compared to moderately ill covid 19 patients and was found statistically significant. Serum NT pro BNP levels was positively correlating with other biomarkers. Mortality rate of 4.41% was reported. Conclusion: Serum NT-proBNP levels of COVID 19 patients can be used to predict the prognosis of covid which can help in early diagnosis and management of complications.
ABSTRACT
Numerous blood biomarkers are altered in COVID-19 patients;however, no early biochemical markers are currently being used in clinical practice to predict COVID-19 severity. COVID-19, the most recent pandemic, is caused by the SRS-CoV-2 coronavirus. The study was aimed to identify patient groups with a high and low risk of developing COVID-19 using a cluster analysis of several biomarkers. 137 women with confirmed SARS CoV-2 RNA testing were collected and analyzed for biochemical profiles. Two-dimensional automated hierarchy clustering of all biomarkers was applied, and patients were sorted into classes. Biochemistry marker variations (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) have split COVID-19 patients into two groups(severe cases and non-severe cases groups). Ferritin, lactate dehydrogenase LDH, D-dimer and CRP were markedly increased in COVID-19 patients in the first group (severe cases). Our findings imply that early measured levels of (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) are linked to a decreased probability of COVID-19 severity. Elevated levels of this biomarker may predict COVID severity development.
ABSTRACT
Objectives: Fetuin-A, a glycoprotein with several functions, is also a negative acute phase reactant. The purpose of this study was to investigate levels of serum fetuin-A in coronavirus disease 2019 (COVID-19) patients, its association with disease severity, and whether it has superiority over C-reactive protein (CRP). Methods: The research comprised 56 individuals with COVID-19(+) and 30 healthy controls. The COVID-19(+) patient population was split into three subgroups: mild, moderate, and severe. All participants' serum concentrations of fetuin- A, tumor necrosis factor-alpha (TNF-a), and interleukin-6 (IL-6) were measured using ELISA commercial test kits. In addition, CRP and other biochemical values from biochemistry laboratory data were gathered, and the CRP/fetuin-A ratio was calculated. Results: The fetuin-A concentration of the COVID-19(+) patient group was shown to be statistically lower than that of the healthy control group. TNF-a and IL-6 levels were found to be significantly different in both groups. While fetuin-A had a higher area under the curve (AUC) value than CRP (0.875 and 0.800, respectively), CRP/fetuin-A had the strongest AUC (0.933). Conclusion: Low serum fetuin-A concentrations in COVID-19 patients suggest that fetuin-A is a negative acute phase reactant for severe acute respiratory syndrome coronavirus 2. Furthermore, fetuin-A alone and CRP/fetuin-A value are both contenders for being more remarkable markers than CRP.
ABSTRACT
Background: In India, the first case of COVID-19 was reported on January 30, 2020. The case reporting is based on the testing of individuals by Real-time Reverse Transcription- Polymerase Chain Reaction (RT-qPCR). The present study was conducted to evaluatedifferent parameters, Haematological and Biomarker variations in patients with SARS-CoV2 Infection to assess the prognostic significance. Material & Methods: The present prospective study was conducted among 70 patients who were diagnosed with COVID-19 infection. Relavant physical examination and clinical data of the patient and routine blood investigations including, CBC, serum biochemistry, coagulation function and measurement of inflammatory markers were performed. The results were analyzed by using a SPSS Statistics software version 25.0. Results: In the present study total patients were 70 out of which 58.6% were males and 41.4% were females. Maximum subjects belong to age group 61-80 yrs (47.1%). Mean haemoglobin was 12.89g/l, mean platelet was 9.96x103/l. Mean neutrophil were 88.21%, mean lymphocyte were 8.84%, mean eosinophil were 1.47%, mean monocyte was 1.59%, mean TLC was 12007.14/l. Mean random blood sugar was 148.09 mg/dl. Mean D-dimer was 0.56. Mean CRP levels were 65.5 mg/l. Mean LDH was 516.03 IU/L, mean IL-6 was 282.6pg/ml, and mean procalcitonin was 0.8 ng/ml. Mean SGOT was 62.36u/l, mean ALP was 171.87IU/L, mean urea levels were 57.10 mg/dl and mean INR was 1.22. Outcome mortality was present in total 14 subjects (5 were male and 9 were female) out of all 70 subjects. Conclusion: The present study concluded that Mean values of neutrophil, eosinophil, TLC, random blood sugar, IL6, SGOT, ALP, urea levels and INR were increased in patients with SARS-CoV2 Infection.
ABSTRACT
OBJECTIVES: To compare the values of the hematological and inflammatory markers in 1st and 4th waves to predict the outcome of COVID-19 in a hospital-based study. METHODOLOGY: This comparative study was conducted in the Department of Hematology, Hayatabad Medical Complex Peshawar, from April 2020 to 20 August 2021. Tests of significance (Independent t-test/Mann Whitney U test) and Chi-square test were used. Relevant information was recorded on a pre-designed proforma prepared following the study's objectives. RESULTS: A total of 178 patients, 71 from (the 1st wave) and 107 from (the 4th wave) with known outcomes, were studied. A statistically significant difference exists between the groups (1st vs 4th wave) regarding hematological markers;neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001). Similarly, significantly higher inflammatory markers values were recorded in the 1st wave compared with the 4th wave regarding inflammatory markers;CRP (p=0.002) and D-dimer (p=0.001). During the 1st wave, Total Leukocyte Count (TLC), ANC and d-dimer were the leading prognostic indicators to predict mortality/worst outcome in COVID-19 with an Area Under Curve (AUC) of 0.74, 0.70 and 0.7 on receiver operating characteristics (ROC) respectively. In 4th, the Area under the curve (AUC) of d-dimer was 0.84 to predict mortality. CONCLUSION: TLC, ANC, NLR, and low platelet count were the worst hematological markers in COVID-19 in the first wave, while d-dimer and CRP were the primary prognostic inflammatory markers. Unlikely in the 4th wave, the prognostic values of hematological markers were merely significant. The d-dimer values in both the waves proved to be reliable for predicting the severity and mortality of COVID-19.
ABSTRACT
It has been two years since the global outbreak of the highly contagious and deadly corona virus disease (COVID-19) caused by SARS-CoV-2 first emerged in China. Since then, various diagnostic, prognostic and treatment strategies undertaken to address the pandemic have been dynamically evolving. Predictive and prognostic role of various biomarkers in COVID-19 has been a subject of intense exploration. We aimed to determine the association of Carcinoembryonic antigen (CEA) and various surrogate inflammatory biomarkers with the severity of COVID-19 disease. This retrospective cohort study was carried out on 98 patients admitted in Jaypee Hospital, Noida with COVID-19 disease. Information regarding demographics, laboratory parameters and clinical history was collected from Hospital Information System. Serum levels of CEA and other biomarkers such as Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), Ferritin, and Procalcitonin (PCT) were assessed. Correlation analyses were performed between the parameters and acute respiratory distress syndrome (ARDS) stages. Logistic regression and ROC curve analysis were performed to assess the various parameters for distinguishing COVID-19 patients requiring ICU admission. Mean hospital stay, NLR, CEA, IL-6, CRP, Ferritin (P < 0.0001) and PCT (P = 0.01) were significantly higher in ICU patients when compared to general ward patients. NLR, median serum CEA, IL-6, and CRP levels were significantly higher in non-survivor compared to the survivors (P < 0.0001, 0.0341 and 0.0092). CEA correlated well with disease severity based upon ARDS classification and was a better marker to differentiate patient according to ARDS stages (ARDS 0 vs 2 P = 0.0006;0 vs 3 P < 0.0001;ARDS 1 vs 2 P = 0.0183;1 vs 3 P = 0.0006). The area under the Receiver operating characteristic (ROC) curve for CEA was 0.7467 (95% CI- 0.64885- 0.84459) which revealed the potential of CEA as a biomarker to distinguish COVID-19 patients requiring ICU admission. CEA can be used to predict the severity of COVID-19 associated ARDS as well as patients requiring ICU admission. Along with routine inflammatory biomarkers (NLR, CRP, IL-6, PCT, and ferritin), CEA should be used for early identification of critical COVID-19 positive patients and for assessing prognosis.
ABSTRACT
INTRODUCTION: There are several clinical outcomes associated with coronavirus disease 2019 (COVID-19) infection, including pneumonia, acute respiratory distress syndrome, and death. The aim of this study is to evaluate whether serum cortisol levels affect COVID-19 prognosis. METHODS: A retrospective study was conducted with COVID-19 pneumonia patients hospitalized in an internal medicine clinic at the Haseki Training and Research Hospital in Istanbul from March 13 to May 31, 2020. Demographics, laboratory test results, and clinical outcomes of the patients were recorded. The patients were divided into two groups based on whether they were hospitalized for 1-9 days or 10 days. Both groups were classified according to their average age and duration of hospitalization/discharge, and laboratory parameters were analyzed. RESULTS: This study was conducted on 129 COVID-19 pneumonia patients, 13 of whom died during the study period. The mean age was 68.7+or-10.9 years for nonsurvivors and 55.7+or-15.9 years for survivors (p=0.001). Serum cortisol levels were significantly elevated in patients with a long hospital stay. While there was no significant difference in the hemogram or biochemical parameters of the two groups, correlation analysis showed a close relationship between serum cortisol levels and length of hospitalization. DISCUSSION AND CONCLUSION: Cortisol is a reliable predictor of the length of hospital stay and prognosis of COVID-19 patients.
ABSTRACT
No effective antiviral drugs and vaccines are available for the treatment of patients with severe coronavirus 2019 (COVID-19). Therefore, available, safe, and inexpensive drugs and supplements such as melatonin are among the proposed options for controlling inflammation. We did a randomized, single-blind study in Imam Khomeini Hospital between June 30, 2020, and August 5, 2020. Mild to moderate COVID-19 patients aged 25-65 years were eligible to enter the study based on chest CT scan, clinical symptoms, and physician diagnosis. The intervention group was prescribed 6 mg of oral melatonin for 2 weeks, which consumed half an hour before bedtime every night in low light conditions. Clinical symptoms and C-reactive protein (CRP) were measured before and after treatment in the melatonin received and control(regular medications)groups. Among screened patients with COVID-19, 14 patients were assigned to receive melatonin, and 17 patients were considered as controls. A significant difference (p=0.005) between CRP 1 and CRP 2 levels (before and after using melatonin) was found in the melatonin group while this difference (p=0.069) was not significant in the control group. Also, the percentage of recovery (based on symptoms) in patients who took melatonin was higher than that of patients in the control group (85.7%VS 47.1%). The result of this study confirmed the effectiveness of melatonin in mild to moderate outpatients with COVID-19. More clinical trials on elderly, diabetic, obese patients and severe cases are suggested in future studies.
ABSTRACT
Angiotensin II levels in COVID-19 are controversial. We studied 12 hospitalized patients, including their baseline levels of peripheral lymphocyte subsets (via flow cytometry) and plasma angiotensin II (via radioimmunoassay). Controls comprised radioimmunoassay's 124 healthy subjects. Angiotensin II levels (pg/ml) were elevated among patients versus controls (Mean +or- standard deviation: 98.8 +or- 146.9 versus 23.7 +or- 15.6, p < 0.0001;Median, interquartile range: 27, 20 to 116 versus 22, 14 to 28). Half the patients had lymphocytopenia (< 1000 cells/mm3), and the CD3+/CD4+ counts were negatively associated with body mass index, viral load, hospital stay and non-home discharge. Angiotensin II imbalance appears to be a biomarker for COVID-19 morbidity and merits further investigation.
ABSTRACT
Objective: To retrospectively analyze the clinical characteristics of 95 patients with severe coronavirus disease 2019 (COVID-19) admitted to Hankou Hospital of Wuhan, and provide evidence for clinical diagnosis and treatment of severe cases. Methods: From January to March 2020, 95 patients with severe COVID-19 were admitted to a designated Hankou Hospital of Wuhan. The clinical manifestations, laboratory examinations, chest CT, respiratory support, drug treatment, and outcomes were collected and analyzed. Results: Among the 95 patients, there were 76(80.0%) severe cases (severe group) and 19 (20.0%) critically ill cases (critically ill group);the average ages of the two groups were (56.9 .. 14.0) and (66.2 .. 14.1) years old, respectively. The main symptoms included fever [85 (89.5%)], cough [73 (76.8%)] dyspnea [57 (60.0%)], sputum expectoration [32 (33.7%)], diarrhea [20 (21.1%)], etc. The initial symptom was fever [64 (67.4%)], followed by cough [17 (17.9%)]. The main comorbidities were hypertension [29 (30.5%)], diabetes [18 (18.9%), coronary heart disease [12 (12.6%)], etc. Liver injury was the most frequently seen complication which occurred in 35 patients (36.8%), while myocardial damage in 20 patients (21.1%), heart failure in 10 patients (10.5%), and renal damage in 8 patients (8.4%). The level of urea nitrogen [7.5 (3.1-36.6) mmol/L], creatinine [88.0 (46.0-681.0) mol/L], aspartate aminotransferase (AST) [49.0 (8.0-2 290.0) U/L], total bilirubin [12.4 (6.8-112.4) mol/L], white blood cells [8.7 (2.7-16.3) .. 109], neutrophil count [7.9 (1.0-14.6) .. 109/L], high-sensitivity C-reactive protein (hsCRP) [35.6 (0.1-37.9) mg/L] and procalcitonin (PCT) [0.3 (0.1-9.6) ng/mL] in the critically ill group were higher than the severe group [4.5 (1.5-14.6) mmol/L, 70.0 (34.0-149.0) mol/L, 30.5 (10.0-184.0) U/L, 7.8 (1.4-24.5) mol/L, 4.5 (1.7- 10.7) .. 109/L 3.1 (0.6-9.1) .. 109/L, 31.8 (0.1- 40.4) mg/L, 0.1 (0.0- 1.2) ng/mL], and the difference were statistically significant (P all < 0.05);the albumin level reflecting nutritional status [30.2 (24.6-36.4) g/L] was lower than the severe group [35.2(23.5-44.5)g/L], and the difference was statistically significant (P < 0.001). Chest computed tomographic scans showed bilateral ground glass opacity or patchy shadows in the lungs of all patients. A total of 77 patients (82.1%) were discharged, and 13 patients (13.7%) died;of which, the mortality of the critically ill group was 68.4% (13 out of 19). Conclusions: The majority of patients with severe COVID- 19 were elderly. The main clinical manifestations were fever, cough, and dyspnea. Most patients had underlying diseases such as hypertension, diabetes and coronary heart disease. The occurrence of organ dysfunctions such as liver injury, cardiac damage, heart failure and kidney injury might be an important cause of death. The mortality of severe patients with COVID-19 was high, and treatment was even tough.
ABSTRACT
Objective:In this study, to evaluate the clinical course and prognosis in COVID-19 patients, to evaluate the hematological and biochemical parameters at the time of admission to the hospital.
ABSTRACT
Objective: This study aims to determine the prognostic values of biomarkers obtained from complete blood count in the diagnosis of the coronavirus disease of 2019 (COVID-19) patients who came to the pediatric emergency department of Diyarbakir Pediatric Hospital. Material and Methods: A total of 190 child patients with COVID-19 with definite diagnosis and 41 healthy children as a control group were included in this study. The lymphocyte count, platelet count, mean platelet volume (MPV), plateletcrit (PCT), C-reactive protein (CRP), neutrophil- lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) obtained from the patients' complete blood count were evaluated.
ABSTRACT
Covid-19 is a severe acute respiratory syndrome, the disease presents with a ranging from asymptomatic to severe symptomatic illness with multiple organ failure and death, and can cause a severe effect on the coagulation system. This study aimed to determine the effect of the covid 19 on the extrinsic and intrinsic pathway of coagulation [prothrombin time(PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT)] and to determine the association of age and gender with the severity of COVID-19 in Sudan in order to improve the outcome. A cross-sectional study carried out among 487 COVID-19 patients attending Khartoum State. COVID-19 patients were confirmed by RT-PCR. For all patients, the prothrombin times (PT), International normalized ratio (INR), and Activated partial thromboplastin (APTT) were estimated by using a semi-automated coagulometer analyzer. Patients were divided into three subclass groups according to the Severity of COVID-19 (mild, severe in the emergency room) (ER) and intensive care unit (ICU), and the clotting factors values were compared between the groups. The results were statically analyzed by spss version 21 for data analysis. These results showed statistically significant increased Levels of PT, INR, and APTT for all (P. value = 0.000), compared to the control group. Also, the levels of coagulation tests were higher in ICU COVID-19 patients (P. value = 0.000) compared to mild and severe subgroups. This study concluded that: coagulation clotting times were increased in COVID-19 patients, especially among patients in ICU which could be a marker for DIC and even death.
ABSTRACT
We report a case of a 19-year-old female with multisystemic inflammatory syndrome that was associated with the novel coronavirs disease 2019 (COVID-19), which manifested as serious illness that occurred four weeks after COVID-19 infection. Her clinical manifestations involved multiple organ systems including high-grade fever with shock syndrome, pulmonary edema, myopericarditis with pericardial effusion, hepatitis, generalized maculopapular rash, and several elevated inflammatory markers. She was treated with human immunoglobulin, methylprednisolone, acetylsalicylic acid, enoxaparin, and empirical antibiotics. She required a 2-week hospitalization and was discharged after improvement of clinical symptoms and normalization of inflammatory markers. A day prior to discharge, an echocardiography was done and it showed normal ventricular function and no coronary aneurysmal dilation.
ABSTRACT
Background Coronavirus disease 2019 (COVID-19) presents clinically a variety of pathological and clinical organ dysfunctions, ranging in severity from asymptomatic to fatal. The care and monitoring of COVID-19 patients may benefit from the use of biochemical and hematological markers. Objective To observe the alteration of serum biochemical and hematological parameters in COVID-19 positive patients, attending a Tertiary Care Hospital. Method A descriptive cross-sectional study was conducted on all COVID-19 positive patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal from 15th December 2021 to 15th February 2022. The test results of different serum biochemical and hematological parameters done for these patients were recorded in clinical laboratory services and obtained retrospectively for the analysis. The data were entered in MS excel and analyzed by SPSS version 20. Result Out of 1537 COVID-11699 declared positive patients, 712 (46.32%) were male and 825 (53.68%) female. Mean age of COVID positive patients was 40.03+/-20.08 years. The level of serum SGOT, SGPT, ALP and GGT was significantly elevated in 39.9%, 42.8%, 32.3% and 47.2% of COVID positive patients respectively. Blood Urea, creatinine, uric acid and sugar level were significantly elevated in 63%, 56.1%, 33.1% and 47.6% patients respectively. The serum level of LDH, D-dimer, CRP and procalcitonin (PCT) were significantly increased in 52.1%, 75.9%, 71.6% and 61.2% of patients respectively. The serum value of total cholesterol, triglyceride, HDL and LDL were significantly lowered in 52.2%, 43.8%, 70.1% and 60.3% of patients respectively. RBC concentration and level of hemoglobin was reduced in 56.6% and 53.6% of COVID positive patients respectively whereas total leukocyte count was elevated in 80.7% with increase in neutrophil in 87.9% and decrease in lymphocyte in 79.4%. Conclusion A portion of COVID-19 positive patients showed drastically altered test results for various serum biochemical and hematological markers, although many of them had normal findings. Copyright © 2022, Kathmandu University. All rights reserved.
ABSTRACT
We retrospectively investigated 68 parturients with or without COVID-19 undergone emergency cesarean section with combined spinal-epidural anesthesia(CSEA) from a single tertiary university hospital in Wuhan, China. The cases were divided into 2 groups: patients with COVID-19 pneumonia(Group 1) and cases without COVID-19 pneumonia(Group 2). The patients in Group 1 were later divided into 2 groups: patients with low-angiotensin converting enzyme(ACE)(Group 3) and patients with normal-ACE(Group 4). The ACE levels, blood pressure and anesthesia management between the patients of Group 1 and Group 2, Group 3 and Group 4 were recorded as the primary outcome. The secondary outcome included perioperative symptoms, laboratory parameters and vital signs. Compared with Group 2, the patients in Group 1 had different ACE level and lower blood pressure after CSEA. Compared with Group 4, the patients in Group 3 showed lower SBP after CSEA(127 vs. 130 mm Hg, p=0.028), accompanied with more partus matures and younger age(28 vs. 32 years, p=0.007). ACE may be a possible biomarker to predict the anesthesia effects on patients with COVID-19 infections undergoing emergency cesarean delivery.