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Objective: Intensive care units (ICUs) collapsed under the global wave of coronavirus disease 2019 (COVID-19). Thus, we designed a clinical decision-making model that can help predict at hospital admission what patients with COVID-19 are at higher risk of requiring critical care. Method(s): This was a cross-sectional study in 119 patients that met hospitalization criteria for COVID-19 including less than 30 breaths per minute, peripheral oxygen saturation < 93%, and/or >= 50% lung involvement on imaging. Depending on the need for critical care, patients were retrospectively assigned to ICU and non-ICU groups. Demographic, clinical, and laboratory parameters were collected at admission and analyzed by classification and regression tree (CRT). Result(s): Forty-five patients were admitted to ICU and 80% of them were men older than 57.13 +/- 12.80 years on average. The leading comorbidity in ICU patients was hypertension. The CRT revealed that direct bilirubin (DB) > 0.315 mg/dl together with the neutrophil-to-monocyte ratio (NMR) > 15.90 predicted up to correctly in 92% of the patients the requirement of intensive care management, with sensitivity of 93.2%. Preexisting comorbidities did not influence on the tree growing. Conclusion(s): At hospital admission, DB and NMR can help identify nine in 10 patients with COVID-19 at higher risk of ICU admission.Copyright © 2022 Sociedad Medica del Hospital General de Mexico.
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Background: Cardiac arrhythias had a significant association with the increased mortality rate in COVID-19 patients in hospitals. The present study aimed to evaluate the frequency of supraventricular arrhythmias in COVID-19 patients and to assess the echocardiographic parameters and inflammatory biomarkers in COVID-19 patients who developed supraventricular arrhythmias. Method(s): This cross-sectional study enrolled 196 patients, 33 of them developed supraventricular arrhythmias during hospitalization in Zagazig University isolation hospital. Result(s): There was a statistically significant association between the occurrence of atrial fibrillation (AF) and both oxygen saturation and lymphocyte percentage, which was significantly lower in those with AF. There was a statistically significant association between the occurrence of AF and CORADS, C-reactive protein (CRP), and interleukin-6, which were significantly higher in those with AF. Younger age and higher oxygen saturation decreased the risk of supraventricular tachycardia among the studied patients. Increasing oxygen saturation decreased the risk of AF among the studied patients, while higher CRP significantly increased risk by 1.045 folds. Conclusion(s): Atrial arrhythmias, especially with AF considered prevalent in cases with COVID-19. The atrial arrhythmias were correlated with higher cardiac injury and inflammatory markers and elevated severe COVID-19 clinical manifestations. Regarding mortality in-hospital, the association between COVID-19 and atrial arrhythmias was independent. 2023 Journal of Indian College of Cardiology.Copyright © 2023 Intervention, Journal of Mental Health and Psychosocial Support in Conflict Affected Areas.
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Objective To analyze the clinical features of patients with coronavirus disease 2019COVID-19in Wuhan, and we provide reference for further prevention and control of the disease. Methods We collected the clinical data of patients with COVID-19 in Dongxihu Shelter Hospital of Wuhan from February 7 to March 6, 2020. The main symptoms, blood test results, lung CT results, and nucleic acid negative conversion were analyzed. Results A total of 654 patients were included, 17526.76%were mild, and 47973.24%were general. There were 344 males (52.60%), and 310 females (47.40%). The patients were with a mean age of49.36+/-10.30years, and 97 patients (14.83%) with a history of hypertension, 51 patients (7.80%) had a history of diabetes. The main clinical symptoms were fever with 547(83.64%) patients, 186 cases (28.44%) had chills, 15 cases (2.29%) had shiver, 342(52.29%) had fatigue symptoms, 413(63.15%) had cough, 137(20.95%) had chest tightness, and 109(16.67%) had diarrhea during the course of the disease. Blood routine tests of 395 patients, the white blood cell count (WBC) was (4.12+/-1.46)x109/L. The total white blood cell count was normal in 378 cases(95.70%), increased in 7(1.77%), and decreased in 10(2.53%). The lymphocyte percentage was (23.10+/-10.02)%, lymphocyte1.06+/-0.37x109/L. The percentage and count of lymphocyte were low. All the 654 cases were examined by CT, 175 cases (26.76%) showed normal lung CT, 422 cases (64.52%) showed patchy or segmental ground-glass opacity, and 57 cases (8.72%) showed multilobar consolidation, ground-glass shadow coexisted with consolidation or streak shadow. The interval between positive nucleic acid test before admission and negative test after admission was as short as 5 days and as long as 24 days, the average was (12.35+/-3.73) days. Conclusion Fever, coughing, and fatigue are the main symptoms in patients with COVID-19. The typical lung CT findings can be used as the basis for clinical diagnosis and disease evaluation. Patients with mild and common type had better prognosis.Copyright © 2021 Editorial Office of Chinese Journal of Schistosomiasis Control. All rights reserved.
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Introduction: Indicators that assess relationships among leukocytes may inform more and/or earlier than those measured in isolation. Method(s): Blood leukocyte differential counts collected from 101 Mayo Clinic COVID-19 patients were related to later outcomes following two approaches: (i) as unstructured data (e.g., lymphocyte percentages) and (ii) as data structures that assess intercellular interactions. Analyzing the same primary data, it was asked whether information contents differed among methods and/or when two sets of structured indicators are used. Result(s): While unstructured data did not distinguish survivors from non-survivors (Fig. 1, rectangle A), one data structure (here identified with letters expressed in italics) exhibited one perpendicular inflection that differentiated two patient groups (B). Two survivor-related observations were also distinguished from the remaining data points (B). A second data structure also revealed a single line of observations and a perpendicular data inflection (C), while more (four) patient groups were identified (D). Four validations were conducted: (i) increasing mortality levels among contiguous data subsets (0, 7.1, 16.2, or 44.4%) suggested construct validity (D);(ii) internal validity was indicated because 22 of the 45 survivors detected by the first data structure were also captured by the second one;(iii) the analysis of patients that differed in address, co-morbidities and other aspects supported external validity;and (iv) quasi non-overlapping data intervals predicted statistical validity (E, F). The structured approach also uncovered new and/ or dissimilar information: different leukocyte-related ratios explained the clusters identified in these analyses (E, F). Conclusion(s): Structured data may yield more information than methods that do not assess multicellular interactions. Possible applications include daily, longitudinal, and personalized analysis of hospital data.
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Background: Studies have shown that lymphopenia and a decreased CD4/ CD8 ratio are correlated with the severity of COVID-19 infections. As people with HIV (PWH) can have altered CD4/CD8 ratios at baseline, this study examined the relationship between lymphocyte and T-cell subsets with COVID-19 disease outcomes among PWH. Method(s): This retrospective study included adult PWH (identified by HIV ICD codes, HIV RNA or antibody results, or antiretroviral therapy use excluding preexposure prophylaxis) in the Optum COVID-19 EHR database with positive SARSCoV- 2 PCR or antigen tests from February 2020 to December 2021. Outcomes included 30-day hospitalization, ICU stay, mechanical ventilation, and death from COVID-19. Absolute lymphocyte counts and percent and CD4:CD8 ratios were collected prior to SARS-CoV-2 positivity (baseline) and then weekly for four weeks post-SARS-CoV-2 positivity. We examined lymphocyte trajectories in PWH who had available data at all time points, and we compared changes in counts and percentages at each week post-SARS-CoV-2 to baseline values, using Wilcoxon rank sum test. Result(s): Of a total of 4,525 PWH who tested positive for SARS-CoV-2, 102 PWH had available lymphocyte counts at all study time points. Compared to non-hospitalized PWH (n=38), hospitalized PWH (n=64) and PWH who were in the ICU (n=32) or ventilator dependent (n=27) experienced a larger drop in lymphocyte percentage in the first two weeks post-SARS-CoV-2 diagnosis with only a partial recovery in subsequent weeks. In patients who died (n=19), lymphocyte percentage recovered even more slowly. Hospitalized PWH, as compared to non-hospitalized PWH, had a significant decrease in lymphocyte percentage post-SARS-CoV-2 infection in the first week (-0.19 vs -0.05;< 0.001), second week (-0.23 vs -0.02;< 0.001), third week (-0.20 vs 0.00;< 0.001), and fourth week (-0.10 vs 0.00;0.001), a trend seen in the ICU, mechanically ventilated, and deceased groups as well (Table 1). By the first week, CD4/CD8 ratio in COVID-19 positive patients was lower in the deceased (-0.18 vs 0.00;p=0.4), ventilator dependent (-0.15 vs 0.00;p=0.2), and ICU (-0.15 vs 0.00;p=0.4) groups. Conclusion(s): Our study showed that not only is lymphopenia a marker of COVID-19 disease severity in PWH but also a failure of lymphocyte percentage recovery is associated with worse outcomes. There was also a trend towards worse outcomes associated with a lower CD4/CD8 ratio in the first week after COVID-19 infection. (Figure Presented).
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Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has been used as a mucolytic in pulmonary diseases. This drug apparently contributes to the retrieval of the intracellular antioxidant system. Objective(s): This study aimed to determine the efficacy of NAC in severe COVID-19 patients admitted to the intensive care unit (ICU). Method(s): This single-blinded randomized controlled phase III clinical trial included 40 patients with confirmed COVID-19 (based on polymerase chain reaction) admitted to the Shahid Mohammadi Hospital's ICU, Bandar Abbas, Iran, in 2020. All cases had severe COVID-19. They were allocated randomly to two equal groups. Patients in the control group received standard drug therapy based on the treatment protocol of the national COVID-19 committee, while those in the NAC group received a single dose of intravenous NAC (300 mg/kg) upon admission to the ICU in addition to standard drug treatment. Clinical status and laboratory tests were done on admission to the ICU and then 14 days later or at discharge without knowing the patient grouping. Result(s): The two groups were comparable regarding age, gender, and other baseline laboratory and clinical parameters. At the final evaluation, respiratory rate (21.25 +/- 4.67 vs. 27.37 +/- 6.99 /min) and D-dimer (186.37 +/- 410.23 vs. 1339.04 +/- 2183.87 ng/mL) were significantly lower in the NAC group (P = 0.004 and P = 0.030, respectively). Also, a lower percentage of patients in the NAC group had lactate dehydrogenase (LDH) <= 245 U/L (0% vs. 25%, P = 0.047). Although the length of ward and ICU stay was shorter in the NAC group than in controls, the difference was statistically insignificant (P = 0.598 and P = 0.629, respectively). Mortality, on the other hand, was 75% in the control group and 50% in the NAC group, with no statistically significant difference (P = 0.102). Concerning the change in the study parameters, only the decrease in diastolic blood pressure (DBP) was significantly higher with NAC (P = 0.042). The intubation and mechanical ventilation rates were higher, while oxygen with mask and nasal oxygen rates were lower with NAC, but the difference was statistically insignificant. Conclusion(s): Based on the current research, NAC is related to a significant decrease in RR, D-dimer, and DBP in severe COVID-19. Also, LDH was significantly lower in the NAC group than in the controls. More research with larger sample sizes is needed to validate the current study results.Copyright © 2023, Author(s).
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OBJECTIVE: Coronavirus disease 2019 is an ongoing disease with high morbidity and mortality. We aimed to investigate the relationship between demographics, lymphocytes, eosinophils, and the coronavirus disease 2019 severity at hospital admission. MATERIAL AND METHODS: A retrospective, observational cross-sectional study was carried out with 5828 coronavirus disease 2019 patients between March 11, 2020, and November 30, 2020. Patients were divided into 3 groups according to where they were followed up as an indicator of disease severity, namely outpatients, inpatients, and critically ill patients. The patients' demographics and hemogram values on admission were recorded. The predictive accuracies of lymphocyte count, lymphocyte percentage, eosinophil count, and eosinophil percentage for predicting severity were determined using receiver operating characteristic curves. Logistic regression analysis was used to predict intensive care unit demand according to lymphocyte and eosinophil values. RESULT(S): Of the 5828 coronavirus disease 2019 patients, 4050 were followed up as outpatients, 1581 were hospitalized in a ward, and 197 were hospitalized in the intensive care unit. Lymphocyte count and lymphocyte percentage were significantly different between the groups, but the difference for eosinophil count and eosinophil percentage was not significant as it was for lymphocytes. Cutoff values for lymphocyte count (1.0 x 109/L), lymphocyte percentage (22%), eosinophil count (0.052 x 109/L), and eosinophil percentage (0.08%) were found to indicate a high risk for intensive care unit admission. Coronavirus disease 2019 patients >55 years of age, with a lymphocyte count <1.0 x 109/L, a lymphocyte percentage <22%, and an eosinophil percentage <0.08% had a 2-fold higher risk of requiring intensive care unit management. CONCLUSION(S): Lymphocyte counts and percentages are quick and reliable biomarkers for predicting coronavirus disease 2019 severity and may guide physicians for proper management earlier.Copyright © Author(s).
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Background: The Computed Tomography Scan (CT scan) was widely used for SARS-CoV-2 pneumonia evaluation and its correlation with clinical and laboratory findings is useful in clinical management. Aims and objectives: This study examines the clinical and functional features of COVID-19 pneumonia in relation with the extent of ground glass (GGO) and consolidation areas defined by volumetric investigations on CT scan. Method(s): Sixty-one patients attending the emergency department were enrolled. A semi-automatic segmentation software was used to extract volumetric data that has been compared with clinical and laboratory findings. Result(s): The decrease of aerated lung volume with the increase of GGO and consolidation areas were strongly related with a decrease of P/F ratio (p<0.0001, p<0.0001 and p=0.0002 respectively). An inverse correlation was observed between GGO and consolidation areas with P/F (R= -0.62, p<0.0001 and R= -0.4 and p=0.003, respectively). No significant correlation was observed between consolidation versus ground glass opacities ratio (C/GGO) and P/F. The increase of GGO and consolidation corresponded to an increase in CRP (R=-0.68, p<0.0001) and LDH (R=-0.55, p<0.0001) and a decrease in both the absolute number and the percentage of lymphocytes (respectively: R= 0.48, p<0.0001 and R= 0.54, p<0.0001) with a similar increase of neutrophils (respectively: R= -0.33, p=0.01 and R= -0.54, p<0.0001). These parameters had a stronger correlation with GGO than with consolidation areas. Conclusion(s): The extension and the characteristics in terms of GGO and consolidation of the lung lesions have a significant correlation with P/F reduction, CRP and LDH increase and lymphocytes decrease.
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Background: Although many aspects of the COVID-19 disease have not yet been clarified, dysregulation of the immune system may play a crucial role in the progression of the disease. In this study, the lymphocyte subsets were evaluated in patients with different severities of COVID-19. Material(s) and Method(s): In this prospective study, the frequencies of peripheral lymphocyte subsets (CD3+, CD4+, and CD8+ T cells;CD19+ and CD20+ B cells;CD16+/CD56+ NK cells, and CD4+/CD25+/FOXP3+ regulatory T cells) were evaluated in 67 patients with confirmed COVID-19 on the first day of their admission. Result(s): The mean age of patients was 51.3 +/- 14.8 years. Thirty-two patients (47.8%) were classified as severe cases, and 11 (16.4%) were categorized as critical. The frequencies of blood lymphocytes, CD3+ cells, CD25+FOXP3+ T cells, and absolute count of CD3+ T cells, CD25+FOXP3+ T cells, CD4+ T cells, CD8+ T cells, and CD16+56+ lymphocytes were lower in more severe cases compared to the milder patients. The percentages of lymphocytes, T cells, and NK cells were significantly lower in the deceased patients. (p= 0.002 and p= 0.042, p=0.006, respectively). Conclusion(s): Findings of this cohort study demonstrated that the frequencies of CD4+, CD8+, CD25+FOXP3+ T cells, and NK cells differed in the severe cases of COVID-19. Moreover, lower frequency of T cells and NK cells could be predictors of mortality in these patients.Copyright © 2022, Shaheed Beheshti University of Medical Sciences and Health Services. All rights reserved.
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Coronavirus-19 (COVID-19) infection presents in a many ways, from asymptomatic or mild symptoms to death or serious illness. Coughing, shortness of breath, and fever are the common symptoms. Other symptoms include weakness, muscle discomfort, lethargy, sore throat, breathing problems, and loss of smell and/or taste. COVID-19 is diagnosed using clinical indicators, CT scans or chest x-rays, serological tests, and molecular diagnostics of the viral genome using reverse transcription polymerase chain reaction. This study analyzes the duration of fever, the most important symptom of the disease, and its association with other patient characteristics. The cross-sectional study was conducted in Iraq's Al-Diwaniyah Province, located in the Mid-Euphrates region. The study included 99 COVID-19 cases, 50 males and 49 females aged 16–81 years. Age, gender, white blood cell (WBC) count, lymphocyte percent, lung involvement assessed by CT scan, duration of fever at the time of presentation, and duration until the fever subsides following initiation of treatment were the main variables studied, in addition to the presence of chronic medical illnesses such as diabetes mellitus, systemic hypertension, asthma, and pulmonary tuberculosis. The mean age of all patients was 50.38 ± 16.27 years, with no significant difference between males and females (P = 0.924). There was also no significant difference in mean WBC count and lymphocyte percent between males and females (P > 0.05). Lung involvement from CT scan ranged from 0 to 80% and the mean was 26.77 ± 21.43%, with no significant difference between males and females (P = 0.770). The mean duration of fever at the time of presentation was 6.61 ± 3.60 days and it ranged from 1 to 21 days. The duration of subsiding fever ranged between 2 and 25 days in all patients with a mean of 5.82 ± 3.53 days, with no significant difference between males and females (P = 0.214). The duration needed for the fever to subside was positively and significantly correlated to the WBC count, the duration of fever at presentation, and the presence of diabetes mellitus (P < 0.05). Longer duration of fever after diagnosis and treatment of COVID-19 can be predicted with a high WBC count. Patients with diabetes having a longer duration of fever are at high risk of developing severe complications and death.
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Introduction: The association of hematological abnormalities in severe COVID-19 pneumonia is multifactorial. The hemostatic abnormalities in COVID-19 are related with disease progression, severity and mortality. In this study, we aim to investigate the association of routine hematological parameters along with newer CBC parameters in COVID-19 disease Methods: Retrospective study of 164 RT PCR confirmed COVID-19 patients between May' 20 to Dec'20 D-dimer was estimated by immunometric assay with a reference range of 0-0.35ug/L (Instrument -Nephle plus one) and CBC was run on Sysmex 2000 XN. The patients were divided into mild/moderate, severe and the nonsurvivor outcome groups according to the MoHFW India guidelines.Data are expressed as the mean +/- sd for continuous variable and frequency percentage for categorical variable. Comparisons of three groups were performed using Kruskall Wallis test for continuous variables and Chi square test, Fisher's exact test as appropriate for categorical variables. Result(s): RESULTS Of the 164 admitted cases with an age range of 28-90 years, the majority were males(n-117-71.3%) The Receiver operating characteristic curve analysis showed that Neutrophil lymphocyte ratio at discharge had the highest area under curve (0.713) followed by lymphocyte percentage at discharge (0.712).In advanced CBC parameters lymphocyte Y and lymphocyte Z at discharge had the highest area under the curve (Table Presented) Conclusion(s): As the Pandemic draws to an end and Covid 19 becomes an endemic disease ,the routine and advanced CBC parameters can be used -As a Biomarker for severity of disease at admission -For serial monitoring and prognosis of the patients.
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Background: Pediatric Infammatory Multisystem Syndrome Associated With SARS-CoV-2 (PIMS) is a new insidious disease which in several points may mimic Kawasaki disease. Patients diagnosed with one of the aforementioned conditions are initially treated with intravenous immunoglobulin (IVIG). However, up to 20% of children diagnosed with Kawasaki disease appear to be resistant to such therapy. Similarly, substantial portion of PIMS patients requires second line treatment including systemic glucocorticoids. There are several calculative models, including the Kobayashi Score, which are utilized to predict patients' response to such treatment. To our best knowledge, the scoring systems derived from Kawasaki disease have not yet been assessed whether they can fulfl similar role in PIMS patients. Objectives: There were two essential questions to be addressed in the study: (1) Can the Kobayashi Score be utilized in making clinical decisions regarding concomitant treatment in PIMS patients? (2) Is there any modifcation that may increase the accuracy of the original score? Methods: First step of the study involved 19 patients diagnosed with PIMS between July 2020 and June 2021. The statistical analysis including each parameter of the Kobayashi Score has been performed in order to determine potential alterations of the score. Then, the numerous variants of modifed score have been compared in terms of their positive and negative predictive values in order to determine new PIMS IVIG Resistance Score (PIRS). In the next phase of the study, both scores have been validated in the second cohort involving 16 patients diagnosed with PIMS between July and December 2021. The fnal assessment has been performed in the unifed study group (35 PIMS patients). Results: The Kobayashi Score (see Table 1) signifcantly differentiated PIMS patients in terms of good response or resistance to IVIG (p=0.03967). However, the score returned a few false positive (3 out of 9) and false negative (2 out of 10) results. After step-by-step verifcation of clinical and laboratory parameters, authors developed a tentative PIRS (see Table 1) including the following criteria: hyponatremia, days of fever and platelet count (derived from the Kobayashi Score but with different cut-off levels) supplemented with procalcitonin level and percentage of lymphocytes. In the validatory phase of the study, both scores had equal accuracy to predict treatment response. The analysis of receiver operating characteristic curve in the unifed study group has shown better performance of PIRS (Youden index 0,72) than the Kobayashi Score (Youden index 0,49). Conclusion: The Kobayashi Score is worth being considered to estimate the risk of resistance to IVIG in PIMS patients. Nonetheless, it is not free from false positive and false negative results. The postulated modifed score called PIRS can become a promising alternative but it requires further validation in larger cohorts of patients.
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In severe Covid-19 pneumonia, acute respiratory distress syndrome (ARDS) associated with cytokine storm is the leading cause of death. Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit in these severe covid-19 pneumonia. In this retrospective cohort study, we evaluated patients with severe COVID-19 pneumonia admitted between May 2021 and June, 2021. Patients who were received tocilizumab during treatment, were enrolled for the study. Systemic steroids, hydroxychloroquine, and azithromycin were concomitantly used for the patients. The outcome was measured as an improvement in peripheral oxygen saturation by change in mode of oxygen therapy and improvement in laboratory parameters after tocilizumab administration. Out of 23 treated patients (18 Male, 5 Females), 19 patients received a single dose of tocilizumab and another four patients received two doses of it. Of these 23 patients, 3/3 with NRBM (non-rebreather mask) showed improvement and shifted to nasal cannula for oxygenation. 11/12 patients with NIV(non-invasive) showed improvement. 5/8 patients with invasive ventilation showed gradual improvement and shifted to NIV. A total of 4/23 (17%) patients didn’t show any improvement and died. Inflammatory markers like CRP, percentage of lymphocytes, and ferritin also showed significant improvement after administration of tocilizumab. Our study showed that in patients with severe COVID-19, tocilizumab was associated with significant improvement in clinical and laboratory parameters. These findings require further validation from ongoing clinical trials of Tocilizumab in COVID-19 patients.
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SARS-CoV-2 can cause a decrease in the number of lymphocytes and their functional activity. In patients with COVID-19, especially with a severe course of the disease, a decrease in the quantitative composition of the main populations of lymphocytes is recorded. These indicators do not recover for a long time after recovery. However, it is still not known how long the quantitative and qualitative changes in the composition of lymphocytes will last and whether the severity of the infection affects this process. The aim of our study was to assess the quantitative and qualitative composition of the main populations and subpopulations of lymphocytes in patients with a new coronavirus infection of varying severity. 65 patients with a new coronavirus infection were examined. The average age of the subjects was 47.3±14.5 years. The volunteers were divided into three groups according to the severity of the infection: asymptomatic (n = 21);moderate (n = 32);severe (n = 12). The relative and absolute number of T-lymphocytes (CD3+), T-helper cells (CD3+CD4+), cytotoxic lymphocytes (CD3+CD8+), natural killers (CD3–CD16+CD56+), TNK-lymphocytes (CD3+CD16–CD56+) and B-lymphocytes (CD45+CD19+) were determined. To calculate the percentage of lymphocytes, whole blood was lysed with OPTILYSE C solution (Beckman Coulter, USA) and stained with monoclonal antibodies CD3+-FITC/CD8+-ECD/CD4+PC5/CD16+CD56+PE and CD45+-Pacific Blue/CD19+-PC5 (Beckman Coulter, USA). Cytofluorometry was performed on a flow cytofluorometer “Navios™” (Beckman Coulter, USA). The results of our studies showed that there were no statistically significant changes in the relative and absolute number of immunocompetent cells in asymptomatic patients with a new coronavirus infection, compared with the control group. With an average severity of the disease, a decrease in the relative and absolute content of CD3+ and CD8+ lymphocytes was revealed, these indicators were restored to control values six months after recovery. In patients with severe infection, there was a decrease in the relative and absolute number of T cells and cytotoxic lymphocytes. These values remained significantly below normal for six months and returned to normal only seven to eight months after recovery. Also, the volunteers of this group were found to have a decrease in the number of natural killers and TNK cells. Thus, the data obtained by us indicate that pathological changes concerning the relative and absolute number of the main populations and subpopulations of lymphocytes in patients with COVID-19 depend on the severity of the disease. The number of T-lymphocytes, cytotoxic lymphocytes, natural killer cells, that is, populations of cells that play a crucial role in effective antiviral protection, has been reduced in those who have undergone a new coronavirus infection in moderate and severe form. This information can be useful for expanding methodological approaches to the diagnosis, treatment of a new coronavirus infection, as well as measures for the rehabilitation of those who have suffered it.
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Introduction: Epistaxis and gingival bleeding are among the most common presentation to the emergency department for patients with thrombocytopenia. Here, we present a case who was admitted to the emergency department with thrombocytopenia and was diagnosed with metastatic cancer of unknown primary origin. Case Report: A 26-year-old male patient was admitted to the emergency department with gingival bleeding and epistaxis. The body temperature was 38.3 °C. Petechial rash, ecchymosis or organomegaly was not detected on physical examination. Laboratory results revealed thrombocytopenia as 31 × 103 (159-388 × 103/μL). Although hemoglobin and leukocyte counts were normal, no band or precursor cell was observed in the patient's peripheral blood smear. There was no history of weight loss, night sweats, arthritis, malar rash, photosensitivity, contact with ticks, animals, or a COVID-19 patient. Serological tests performed for infections such as HIV, EBV, HCV, Crimean-Congo hemorrhagic fever were negative. Bone marrow biopsy was performed due to the unexplained cytopenia, reported as "signet ring cell metastatic adenocarcinoma". Gastrointestinal system endoscopy was performed to detect primary cancer. A biopsy was taken from the antrum and corpus revealed gastritis. An FDG PET-CT was revealed heterogeneously pathologically increased FDG attitude in all axial and appendicular bones. Despite all the modalities of diagnosis, the origin was not found and the patient was transferred to the oncology department for treatment with a diagnosis of cancer of unknown origin with bone marrow infiltration. Conclusion: Bone marrow metastases should be kept in mind in patients presenting with thrombocytopenia.
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BACKGROUND AND AIM: Markers that predict the need for intensive care unite of COVID-19 patients may reduce disease-related mortality. The aim of study is to evaluate diagnostic value of neutrophil-lymphocyte count and percentage in predicting intensive care requirement and mortality. METHODS: The study included 141 patients followed-up/treated for COVID-19 in Sivas Numune Hospital and 63 healthy controls. In the patient group, 65 people were treated as outpatients but, 76 patients needed intensive care. 30 of patients in intensive care unite did not survive. Blood count, CRP, and ferritin values were obtained retrospectively. Performance of markers in predicting the need for intensive care was evaluated by regression analysis and ROC curves. RESULTS: Lymphocyte count, neutrophil-lymphocyte percentage, CRP and ferritin concentrations showed significant differences for all groups (p<0.05), but there was no difference between intensive care patients and mortal cases. While lymphocyte count and percentage were low in mortal cases, other parameters were higher. In the linear regression analysis, lymphocyte percentage, CRP, and ferritin values were found to have significance in predicting the need for intensive care for patient group (p<0.05). In the ROC analysis, the areas under the curve for these parameters were found to be 0.907, 0.859, and 0.842, respectively. CONCLUSIONS: Since there was no significant difference between intensive care patients and dead cases, we could not determine a parameter to distinguish between two groups. However, evaluation of lymphocyte percentage, CRP, and ferritin values together can be used to predict intensive care requirements in COVID-19 patients.
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Background. New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods. We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results. The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P < 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (< .0001), SGOT or AST (IU/L) ≥ 54 (p < 0.001), SGPT or ALT (IU/L) ≥ 41 (p < 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P < 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) > 465 (OR = 2.18, P = 0.001), systolic blood pressure < 90 mm Hg (OR = 4.28, p = .02), respiratory rate > 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion. Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation.
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Background. To determine whether CBC differentials of COVID+ inpatients can predict, at admission, both maximum oxygen requirements (MOR) and 30-day mortality. Methods. Based on an approved IRB protocol, CBC differentials from the first 3 days of hospitalization of 12 SARS CoV-2 infected patients were retrospectively extracted from hospital records and analyzed with a privately owned Pattern Recognition Software (PRS, US Patent 10,429,389 B2) previously validated in sepsis, HIV, and hantavirus infections. PRS partitions the data into subsets immunologically dissimilar from one another, although internally similar. Results. Regardless of the angle considered, the classic analysis -which measured the percentages of lymphocytes, monocytes, and neutrophils- did not distinguish outcomes (A). In contrast, non-overlapping patterns generated by the PRS differentiated 3 (left, vertical, and right) groups of patients (B). One subset was only composed of survivors (B). The remaining subsets included the highest oxygenation requirements (B). At least two immunologically interpretable, multi-cellular indicators distinguished the 3 data subsets with statistically significant differences (C, p≤ 0.05). Survivors (the left subset) showed lower N/L and/or higher M/L ratios than non-survivors (the vertical subset, C).Therefore, PRS partitioned the data into subsets that displayed both biological and significant differences. Because it offers visually explicit information, clinicians do not require a specialized training to interpret PRS-generated results. CBCs vs. outcomes - Software-analyzed CBCs vs. outcomes Conclusion. (1) Analysis of blood leukocyte data predicts MOR and 30-d mortality. (2) Real time PRS analysis facilitates personalized medical decisions. (3) PRS measures two dimensions rarely assessed: multi-cellularity and dynamics. (4) Even with very small datasets, PRS may achieve statistical significance. (5) Larger COVID+ infected cohort is being analyzed for potential commercialization.
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Background The clinical course of pneumonia caused by SARS-CoV-2 is quite peculiar and is characterized by a rapid deterioration of the clinical condition of patients. The aim of this study is to characterize immunological dysfunctions in COVID-19 patients and correlate them with markers of hyperactivation of the inflammatory response, in an attempt to find threshold values indicative of patient outcome. Methods A total of 100 patients were recruited. All patients had a positive PCR test for SARS-COV-2 from nasopharyngeal sample. Patients were grouped into those who did not require mechanical ventilation (n=72) and those who required mechanical ventilation (n=28). Blood samples were collected and analyzed at the point of admission in all patients. Patient immune phenotyping was performed in whole blood samples of patients by flow cytometric analysis. The flow cytometric analysis was performed in an Aquios cytometer (Aquios -Beckman Coulter CA, USA). Antibodies used for cell staining are TETRA-1 Panel (CD45, CD4, CD8, CD3). Data were analyzed using flow cytometric analysis software. Data from the routine biochemical assessment performed in the first 24 hrs after admission to infectious diseases unit will be collected. Results Both the percentage and the absolute number of neutrophils were higher in patients needing ICU care than non-ICU patients, whereas absolute lymphocyte count, and especially the percentage of lymphocytes, presented a deep decline in critical patients. There was no difference between the two groups of patients for CD4 Tlymphocytes, neither in percentage of lymphocyte nor in absolute number, however for CD8 T-cells the differences were significant for both parameters which were in decline in ICU patients. There was a firm correlation between the highest values of inflammation indicators with the decrease in percentage of CD8 T-lymphocytes. This effect was not seen with CD4 cells. Conclusion Our results describe the immune response of severe COVID-19 patients and highlight the value of a novel ratio of CD4/CD8 as a putative marker of poor prognosis. Nevertheless, further research is warranted in order to fully comprehend the transition of the different stages of COVID-19 progression in the context of successful combat of this novel disease.
ABSTRACT
Background: The present study aimed to describe the association of hematological parameters and common clinico-epidemiological features wit hdisease severity among COVID-19 patients. Methods: This is a hospital based observational study done in Dhaka Medical College Hospital from 01 July 2020 to 15 September 2020. Findings from hematological tests along with patient clinic-pathological features were recorded from a total of 309 COVID-19 patients. All the data were analyzed by SPSS 23.0 software. Results: Among the studied hematological parameters hemoglobin percentage, total WBC count, lymphocyte percentage, platelet count, CRP, serum ferritin, d-dimer, and ESRwere significantly associated with disease severity (p<0.05). Association was found between disease severity and other biochemical markers, such as AST, ALT, LDH, and serum bilirubin. Conclusion: With limited resources these cheap, yet highly indicative biochemical markers could be used to assess, treat, and prognose COVID-19 patients in Bangladesh.