Cluster Analysis of Biochemical Markers as Predictor of COVID-19 Severity

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. © 2022 University of Baghdad. All rights reserved.

Comparison of LDH-to-lymphocyte ratio in critical and non-critical COVID-19 patients and assessment of its utility in predicting the severity of infection

Background: It is a fact that the ongoing worst ever pandemic caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), have affected millions of people with large number of casualties worldwide. There has been now several published studies regarding the clinical, laboratory and radiological findings of COVID 19 infections. The aim of this study was to combine the two common hematological abnormalities viz. lymphopenia and elevated LDH to increase the sensitivity of diagnosis of COVID-19 infection. We compared the LDH-to-lymphocyte ratio in patients with COVID-19 infection admitted in the ICU and general ward to assess its relation with severity of disease. Our study may help in early identification and categorization of COVID-19 patients. Methodology: A total of 100 adult patients diagnosed by RT-PCR for COVID-19 were recruited for the study. One patient was excluded due to unclear history. We included 49 patients with severe disease from intensive care unit (ICU) and 50 patients from COVID ward with less severe disease. Serum lactate dehydrogenase (LDH) levels and absolute lymphocyte counts (ALC) of these patients were obtained during admission and the ratio of LDH to ALC was calculated for both groups. The collected data was statistically analyzed. Result(s): Serum LDH levels were higher in ICU patients group compared to the COVID ward patients. ALC on admission were lower in ICU patients than the ward patients. In both cases the difference was statistically significant with p value of 0.001 in all the cases. A p value of <0.05 was considered as statistically significant. LDH/ALC ratio median of all included patients was 0.390 with interquartile range (IQR) 0.450. In COVID ICU group the median of the LDH/ALC ratio was 0.580 with IQR 0.340 and in COVID ward group median was 0.220 with IQR 0.240. It suggests that the LDH/ALC ratio is significantly higher (p value of 0.001) in COVID ICU patients with severe disease in comparison to COVID ward patients having non-severe disease. Conclusion(s): LDH/ALC ratio on admission can be used as a sensitive prognostic marker in COVID-19 patients which can help in early identification of COVID patients who have potential risk to develop severe disease. Copyright © 2023 Ubiquity Press. All rights reserved.

C-reactive protein (CRP) and Lactate Dehydrogenase (LDH) as diagnostic and early prognostic marker of adverse disease outcomes in critical COVID-19 patients

Background: We used standard laboratory test to determine tissue injury and inflammatory state on the physiological condition of fever, cough, headache in 672 patients tested for CRP and 407 patients tested for LDH out of a total of 994 COVID-19 admissions during the period of April 2021-September 2021 at Parul Sevashram Hospital, Vadodara. The data was stratified based on the survivor/non-survivor status and severity of disease condition based on Ward or ICU admissions. The results were correlated with the vales of serum CRP and LDH levels for determining their prognostic significance. Patients and Methods: This is a retrospective, singlecentre, observational study using the data collected from MRD division through electronic records and standardized data collection template. It included patients who were tested for CRP and LDH at times of admission. Mean, Standard deviation, Median and Interquartile range (IQR) were used to present continuous variables. Student’s t-test was used for testing differences between the two groups applicable. For study of single variables, Z-score was performed. The SPSS version 16 software was used for performing linear regression in this study and statistical analysis was done. Result: Among 994 total enrolled patients with COVID-19, 672/994 (67.7%) patients were tested for CRP and 407/994 (40%) for LDH at the time of hospitalization. Our COVID-19 patients showed elevated concentration of LDH (median 699 U/L (IQR 485-1040);normal range 80-285), elevated CRP (median 48.35 mg/L (IQR 20.7-74.4);normal range <6.0), LDH values (median)(U/L) have been found to be significantly higher in non-survivors [791(588-1495)] as compared to the survivors [699 (492-1010)], (P value <0.0001). Moreover, the values of serum CRP (mg/L) were also higher in the non-survivor group as compared to the survivor group. [64.7(39.5-97.5) versus 39.8(16.9-67.15)]. This difference was highly significant (P value 2.92461E-11). Conclusion: LDH and CRP levels can assist to identify COVID-19 patients with the acute respiratory failure and at high risk of fatality. A high LDH may be related to tissue damage and high CRP related to inflammatory markers. Both the markers significantly correlate with increased incidences of death in COVID-19 patients. © 2022 by the Author(s).

Assessment of Methemoglobin, Hemoglobin, Ferritin and Lactate Dehydrogenase in COVID-19 Patients

Today world is trying to cope with the biggest pandemic caused by Coronavirus disease 2019 (COVID-19). The disease is graded as mild, moderate, serious and critical illness. Very few studies are done with methemoglobin along with other parameters for the assessment of the severity of COVID-19 disease. The objectives of the study were to estimate methemoglobin (Met-Hb), hemoglobin (Hb), ferritin and lactate dehydrogenase (LDH) levels in patients with COVID-19 disease and to investigate the interaction between these parameters and the severity of the disease. This observational study was conducted in three groups of COVID-19 patients-moderate, severe and critical, each group containing 30 patients, between June 2021 and September 2021 in the biochemistry department of a tertiary care hospital. For all patients, Met-Hb, Hb, ferritin, and LDH levels were estimated on the 2nd-3rd day of hospital admission. Patients in the critical group were older and had significantly high values of Met-Hb, ferritin and LDH and significantly low values of Hb (P<0.05). In multivariate ordinal regression analysis, older age (OR-3.08;95%CI:1.19-7.19;P-0.019), higher values of LDH (OR-8.66;95%CI:2.53-29.5;P-0.001) and ferritin (OR-3.08;95%CI:1.09-8.7;P-0.033) were independently associated with severity of the disease. A cut-off value of 410.50 U/L for LDH predicted the severity of the disease with 90% sensitivity and 88.3% specificity. In conclusion, higher levels of LDH and ferritin were related to the severity of the disease in COVID-19 cases. Although Met-Hb showed a minimal increase without any association with severity, it may be an underlying cause of hypoxia that may go unnoticed. So, monitoring of all these parameters should be done at intervals. [ FROM AUTHOR] Copyright of Journal of Pure & Applied Microbiology is the property of Dr. M. N. Khan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Predictors of Mortality in COVID-19 Patients in Southern California - Retrospective Multicenter Study.

Introduction The majority of patients infected with coronavirus disease 2019 (COVID-19) recover from the illness after suffering mild to moderate symptoms, while approximately 20% progress to severe or critical disease, which may result in death. Understanding the predictors of severe disease and mortality in COVID-19 patients will help to risk stratify patients and improve clinical decision making. US data to inform this understanding are, however, scarce. We studied predictors of COVID-19 mortality in a cohort of 1,116 hospitalized patients in Southern California in the United States. Methods We conducted a retrospective cohort study of COVID-19 patients admitted at two hospitals in Southern California United States between March 2020 and March 2021. Bivariate and multivariate analyses of the relationship between mortality and other variables such as demographics, comorbidities, and laboratory values were performed, with a p-value of 0.05 considered as significant. Results The analysis involved 1,116 COVID-19 patients, of which 51.5% were males and 48.5% were females. Of the 1,116 patients, 81.6% were whites, 7.2% were blacks, and 11.2% were other races. After adjusting for co-variables, age (p<0.001), admission to intensive care unit (p< 0.001), use of remdesivir (p=0.018), C-reactive protein (CRP) levels (p<0.001), and lactate dehydrogenase (LDH) levels (p=0.039) were independently associated with mortality in our study. Gender, race, body mass index, presence of co-morbidities such as diabetes and hypertension, and use of steroid, statin, calcium channel blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were not associated with mortality in the multivariate analysis. Conclusion In the cohort we studied, admission to intensive care unit was associated with decreased mortality while older age, use of remdesivir, and high levels of CRP and LDH were associated with increased mortality in COVID-19 patients.

Evaluation of a Few Biomarkers among COVID-19 Patients

Introduction: In the present study, the mean differences of Lactate Dehydrogenase (LDH), D-dimer, C-reactive protein, interleukin-6 and ferritin levels concentrations between study groups (patients with severe COVID-19 symptoms and patients with mild symptoms) compared tothe control group. The results showed that there were significant increased concentrations of biomarkers levels in group A as compared with group B and control. Objective: This present study aims to evaluate the COVID-19 biomarkers(Lactate Dehydrogenase (LDH), D-dimer, C-reactive protein, IL-6 and ferritin concentrations) among COVID-19 patients. Methodology: A total of 75 blood samples were collected from male patients with age groups ranging between 30 and 75 years who were suffering from coronavirus. Three groups were included in this study;each group includes 25 patients. Group A patients suffering from coronavirus with severe symptoms, group B patients suffering from coronavirus with mild symptoms and group C with healthy patients as control. All parameters were measured according to standard procedures. Data were analysed in SPSS version 20 by using mean ± SD.Significant association was established by chi-square test taking p-value<0.05. Results: Increased LDH values were linked to an increase in COVID-19 toxicity. On the basis of D-dimer, the probability of mortality can be determined. C-responsive protein and ferritin serum exercises were significantly increased in COVID-19 patients compared to those with mild side effects of COVID-19. IL-6 is a key immunomodulatory cytokine in both normal and infected tissues. Conclusion: LDH, D-dimer, C-reactive protein and serum ferritin are good predictors of COVID-19 severity and may be used for the assessment of clinical outcome. Copyright (c) 2022: Author(s).

Serum Lactate Dehydrogenase Level as a Prognostic Factor for COVID-19: A Retrospective Study Based on a Large Sample Size.

Background: In this study, we investigated the relationship between serum lactate dehydrogenase (LDH) level and disease progression and prognosis of patients with COVID-19. Methods: We retrospectively reviewed the information of 1,751 patients with COVID-19 from Leishenshan Hospital in Wuhan, China. Univariate and multivariate Cox regression analyses as well as Logistics regression analyses, and Kaplan-Meier curves were used to determine the association between LDH levels and the prognosis of COVID-19 patients. Results: LDH was an independent risk factor for in-hospital death no matter it was taken as classified variable and continuous variable (all P = 0.001) but not for severe or critical illness status. The Kaplan-Meier curves for LDH level showed that an elevated level of LDH was associated with in-hospital death. Conclusions: In patients with COVID-19, the increased LDH level is associated with a higher risk of negative clinical prognosis and higher mortality. This will provide a reference for clinicians and researchers to understand, diagnose, and treat patients with COVID-19. Further prospective studies with larger sample sizes are needed to verify these findings.

In-Line Monitoring of Downstream Purification Processes for VSV Based SARS-CoV-2 Vaccine Using a Novel Technique.

The COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) increases the need for a rapid development of efficient vaccines. Among other vaccines in clinical trials, a recombinant VSV-∆G-spike vaccine was developed by the Israel Institute for Biological Research (IIBR) and is being evaluated. The development of an efficient downstream purification process (DSP) enables the vaccine to be advanced to clinical trials. The DSP must eliminate impurities, either process- or product-related, to yield a sufficient product with high purity, potency and quality. To acquire critical information on process restrictions and qualities, the application of in-line monitoring is vital and should significantly impact the process yield, product quality and economy of the entire process. Here, we describe an in-line monitoring technique that was applied in the DSP of the VSV-∆G-spike vaccine. The technique is based on determining the concentrations of metabolites, nutrients and a host cell protein using the automatic chemistry analyzer, Cobas Integra 400 Plus. The analysis revealed critical information on process parameters and significantly impacted purification processes. The technique is rapid, easy and efficient. Adopting this technique during the purification process improves the process yield and the product quality and enhances the economy of the entire downstream process for biotechnology and bio pharmaceutical products.

Cardiac Troponin I association with critical illness and death risk in 726 seriously ill COVID-19 patients: A retrospective cohort study.

Background: For coronavirus disease 2019 (COVID-19), early identification of patients with serious symptoms at risk of critical illness and death is important for personalized treatment and balancing medical resources. Methods: Demographics, clinical characteristics, and laboratory tests data from 726 patients with serious COVID-19 at Tongji Hospital (Wuhan, China) were analyzed. Patients were classified into critical group (n = 174) and severe group (n= 552), the critical group was sub-divided into survivors (n = 47) and non-survivors (n = 127). Results: Multivariable analyses revealed the risk factors associated with critical illness in serious patients were: Advanced age, high respiratory rate (RR), high lactate dehydrogenase (LDH) level, high hypersensitive cardiac troponin I (hs-cTnI) level, and thrombocytopenia on admission. High hs-cTnI level was the independent risk factor of mortality among critically ill patients in the unadjusted and adjusted models. ROC curves demonstrated that hs-cTnI and LDH were predictive factors for critical illness in patients with serious COVID-19 whereas procalcitonin and D-Dimer with hs-cTnI and LDH were predictive parameters in mortality risk. Conclusions: Advanced age, high RR, LDH, hs-cTnI, and thrombocytopenia, constitute risk factors for critical illness among patients with serious COVID-19, and the hs-cTnI level helps predict fatal outcomes in critically ill patients.

Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study.

BACKGROUND: The World Health Organization has declared coronavirus disease 2019 (COVID-19) a public health emergency of global concern. Updated analysis of cases might help identify the risk factors of illness severity. RESULTS: The median age was 63 years, and 44.9% were severe cases. Severe patients had higher APACHE II (8.5 vs. 4.0) and SOFA (2 vs. 1) scores on admission. Among all univariable parameters, lymphocytes, CRP, and LDH were significantly independent risk factors of COVID-19 severity. LDH was positively related both with APACHE II and SOFA scores, as well as P/F ratio and CT scores. LDH (AUC = 0.878) also had a maximum specificity (96.9%), with the cutoff value of 344.5. In addition, LDH was positively correlated with CRP, AST, BNP and cTnI, while negatively correlated with lymphocytes and its subsets. CONCLUSIONS: This study showed that LDH could be identified as a powerful predictive factor for early recognition of lung injury and severe COVID-19 cases. METHODS: We extracted data regarding 107 patients with confirmed COVID-19 from Renmin Hospital of Wuhan University. The degree of severity of COVID-19 patients (severe vs. non-severe) was defined at the time of admission according to American Thoracic Society guidelines for community acquired pneumonia.

Increased Serum Aminotransferase Activity and Clinical Outcomes in Coronavirus Disease 2019.

AIM: Elevation of hepatic aminotransferases (aspartate aminotransferase [AST]/alanine aminotransferase [ALT]) is commonly noted among COVID-19 patients. It is unclear if they can predict the clinical outcomes among hospitalized COVID-19 patients. We aim to assess if elevations in AST/ALT were associated with poor outcomes in hospitalized COVID-19 patients. METHODS: We retrospectively evaluated hospitalized COVID-19 patients with clinically significant elevated aminotransferases (defined as >2 times upper limit of normal) and compared them with COVID-19 patients without an elevation in aminotransferases. RESULTS: The prevalence of elevation in AST/ALT was found to be 13.7% (20/145). The two groups were similar in baseline demographics, comorbidities, and the majority of laboratory tests. There was no difference in the mortality (50% vs. 36.8%, P = 0.32) and median hospital stay (7 days vs. 7 days, P = 0.78). However, there was a statistically significant increase in the rates of mechanical ventilation among elevated aminotransferases group compared with individuals without elevation (50% vs. 24%, P = 0.028). However, this difference was not observed after adjusting for inflammatory markers such as ferritin, lactate dehydrogenase, and lactic acid levels. CONCLUSION: Elevated aminotransferases among hospitalized COVID-19 patients is associated with higher rates of mechanical ventilation but did not achieve statistical significance after controlling for inflammatory markers. Also, patients with elevated aminotransferases did not have higher rates of mortality or prolonged length of stay.