Glucosaminylmuramyl dipeptide efficacy in post-COVID-19 patient rehabilitation treatment.

The COVID-19 pandemic has altered people's lifestyles around the world. Prevention of recurrent episodes of the disease and mitigation of its consequences are especially associated with effective post-COVID-19 rehabilitation in patients. The aim of the study was to evaluate the effects of the drug Likopid (glucosaminylmuramyl dipeptide, GMDP) for post-COVID-19 rehabilitation in patients. Material and methods. Patients who recovered from mild to moderate COVID-19 (n=60, mean age 54+/- 11.7 years) were randomized into the observation group (n=30, 15 men and 15 women) who received 2 courses of Licopid (1 mg twice a day) and the comparison group (n=30, 15 men and 15 women). Analysis of the phenotypic and functional characteristics of the innate immune cellular factors was carried out before the start of immunomodulatory therapy, immediately after the end of the course, and also after 6 months observations. In order to assess the quality of life of all patients, we used the SF-36 Health Status Survey and the Hospital Anxiety and Depression Scale questionnaires. Results. During assessing the effect of immunomodulatory therapy on the parameters of innate immunity of patients at the stage of rehabilitation after COVID-19, an increase in the protective cytolytic activity of CD16+ and CD8+Gr+ cells, as well as a persistent increase in TLR2, TLR4 and TLR9 expression was found, which indicates the antigen recognition recovery and presentation at the level of the monocytic link of the immune system. The use of GMDP as an immunomodulatory agent resulted in an 8-fold reduction in the frequency and severity of respiratory infections due to an increase in the total monocyte count. As a result of assessing patients' quality of life against the background of the therapy, a positive dynamic in role functioning was revealed in patients. In the general assessment of their health status, an increase in physical and mental well-being was noted during 6 months of observation. The comparison group showed no improvement in the psychoemotional state. Discussion. The study demonstrated the effectiveness of GMDP immunomodulatory therapy in correcting immunological parameters for post-COVID-19 rehabilitation in patients. The data obtained are consistent with the previously discovered ability of GMDP to restore impaired functions of phagocytic cells and induce the expression of their surface activation markers, which in turn contributes to an adequate response to pathogens. Conclusion. The study revealed that the correction of immunological parameters with the use of GMDP in COVID-19 convalescents contributed not only to a decrease in the frequency and severity of respiratory infections, but also to an improvement in the psycho-emotional state of patients, and a decrease in anxiety and depression.Copyright © Eco-Vector, 2023. All rights reserved.

Direct bilirubin and the neutrophil-to-monocyte ratio timely predict intensive care unit admission in patients with severe acute respiratory syndrome coronavirus-2 infection (COVID-19)

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.

The Association of COVID-19 Severity with Laboratory Parameters, Radiologic Findings, Maternal and Neonatal Outcomes in Pregnant Women: A Multicenter Study in Indonesia

Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.

Study of haematological parameters in Covid-19 positive patients at tertiary care hospital

Introduction: Apart from clinical symptoms and pulmonary computed tomography (CT) findings in, confirmed COVID-19 patients' Blood tests have an important role in early diagnosis of the disease and they provide valuable information to physicians regarding the inflammatory status in body. Material(s) and Method(s): A retrospective cross-sectional study was conducted from January 2020 to March 2020 in the Pathology Department of Rural Medical College, Loni. Total of 120 patients from different groups, both genders and between 18 and 75-year age were studied. Result(s): TLC, Neutrophil, NLR, PLR, D-Dimer values were found to have statistical significant (p<0.05) positive correlation with Covid -19 severity.Blood investigations like Lymphocyte and Monocyte count have statistical significant (p<0.05) negative correlation with Covid -19 severity. No significant correlation was observed between haematological tests like Hb, HCT, PLT, LMR and tests of coagulation like PT & APTT with Covid -19 severity. Conclusion(s): We concluded that TLC, NLR and D-dimer tests are important to predict about the severity of disease.Copyright © 2022 Pravara Institute of Medical Sciences. All rights reserved.

Glucosaminylmuramyl dipeptide efficacy in post-COVID-19 patient rehabilitation treatment.

The COVID-19 pandemic has altered people's lifestyles around the world. Prevention of recurrent episodes of the disease and mitigation of its consequences are especially associated with effective post-COVID-19 rehabilitation in patients. The aim of the study was to evaluate the effects of the drug Likopid (glucosaminylmuramyl dipeptide, GMDP) for post-COVID-19 rehabilitation in patients. Material and methods. Patients who recovered from mild to moderate COVID-19 (n=60, mean age 54+/- 11.7 years) were randomized into the observation group (n=30, 15 men and 15 women) who received 2 courses of Licopid (1 mg twice a day) and the comparison group (n=30, 15 men and 15 women). Analysis of the phenotypic and functional characteristics of the innate immune cellular factors was carried out before the start of immunomodulatory therapy, immediately after the end of the course, and also after 6 months observations. In order to assess the quality of life of all patients, we used the SF-36 Health Status Survey and the Hospital Anxiety and Depression Scale questionnaires. Results. During assessing the effect of immunomodulatory therapy on the parameters of innate immunity of patients at the stage of rehabilitation after COVID-19, an increase in the protective cytolytic activity of CD16+ and CD8+Gr+ cells, as well as a persistent increase in TLR2, TLR4 and TLR9 expression was found, which indicates the antigen recognition recovery and presentation at the level of the monocytic link of the immune system. The use of GMDP as an immunomodulatory agent resulted in an 8-fold reduction in the frequency and severity of respiratory infections due to an increase in the total monocyte count. As a result of assessing patients' quality of life against the background of the therapy, a positive dynamic in role functioning was revealed in patients. In the general assessment of their health status, an increase in physical and mental well-being was noted during 6 months of observation. The comparison group showed no improvement in the psychoemotional state. Discussion. The study demonstrated the effectiveness of GMDP immunomodulatory therapy in correcting immunological parameters for post-COVID-19 rehabilitation in patients. The data obtained are consistent with the previously discovered ability of GMDP to restore impaired functions of phagocytic cells and induce the expression of their surface activation markers, which in turn contributes to an adequate response to pathogens. Conclusion. The study revealed that the correction of immunological parameters with the use of GMDP in COVID-19 convalescents contributed not only to a decrease in the frequency and severity of respiratory infections, but also to an improvement in the psycho-emotional state of patients, and a decrease in anxiety and depression.Copyright © Eco-Vector, 2023. All rights reserved.

Prognosis Score for Overall Survival with CAR-T Therapy in Aggressive Lymphoma

Background: Despite the transformative potential of chimeric antigen receptor T (CAR-T) therapy, more tools to assist with identifying patients with increased likelihood of benefitting from this therapy will be helpful, particularly given the logistical complexity and socio-economic demands for CAR-T relative to other therapies. Health care resource restriction during the COVID-19 pandemic highlights the need for these tools. We present a simple survival score that uses 3 readily available clinical labs: platelet (plt), absolute lymphocyte count (ALC), and Lactate dehydrogenase (LDH), to predict the risk of dying within 6 months of CAR-T therapy in patients with aggressive lymphoma. Method(s): We conducted a retrospective chart review of patients with aggressive non-Hodgkin lymphoma (NHL) who received FDA-approved CAR-T between Jan 2018 to Jan 2022 at Mayo Clinic Rochester.(Table Presented)Results: Among a total of 110 pts who received CAR-T, 27 (25%) pts died within the first 6 months post CAR-T infusion (OS <= 6 months). Disease progression was the main cause of death (18/25, 72%), followed by infection (4/25, 16%), CAR-T related (HLH/MAS, 2/25, 8%), second primary malignancy (1/25, 4%) and unknown (2/25, 8%).Baseline demographics were comparable between the OS>6months and <=6months groups (Table 1). Patients' ECOG, Karnofsky performance status and 11 labs at the time of evaluation for CAR-T therapy (initial eligibility assessment, prior to leukapheresis) were compared between those who died from any cause within 6 months of CAR-T infusion and those who did not. Hemoglobin, plt, ALC, absolute monocyte count, CRP, ferritin, and LDH were selected as clinically and/or statistically significant variables for multivariate testing. Multivariate regression with boot-strap testing identified plt, ALC, and LDH as the most predictive variables with 80.9+/-11.7% accuracy for predicting death within 6 months of CAR-T infusion. Patients were scored 0-3 using these 3 labs, with 1 point assigned for plt <= 100 X109/L, ALC <= 0.4 X109/L, or LDH > 222 U/L (upper limit of normal). OS by this survival score is shown in Figure 1.(Figure Presented)Discussion: Due to the curative potential of CAR-T, patients with broader characteristics than those treated on registration studies have been treated in standard of care practice. While an estimated 5%-10% risk of CAR-T associated deaths in the first 3 months is seen across all patients in clinical trials, predictors for early death after CAR-T in real-world patient populations can provide additional context for pts and providers when selecting treatment. This survival score is important proof of concept that a simple model using readily accessible clinical labs at the time of CAR-T evaluation could provide additional context to help with additional clinical decision-making. Multicenter prospective studies will help define and validate the definitive survival scoring system.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Restoration of innate immunity receptors under the action of muramyl peptides reduces depression and anxiety at the stage of rehabilitation after COVID-19

Background: Effective rehabilitation of patients who have had a SARS CoV-2 infection is essential to prevent re-infections and will improve the quality of life of people and reduce the burden on the healthcare system. Muramylpeptides are used in the prevention of seasonal diseases in children and adults in order to correct immunodeficiency states and prevent infectious complications. The aim of this study was to study the dynamic changes in the state of cellular factors of innate immunity and the levels of anxiety and depression in patients treated with glucosaminyl muramyl dipeptide (GMDP). Method(s): Patients who underwent mild to moderate COVID-19 (N = 60, mean age 54 +/- 11.7 years) were randomized to the study group (30 people, 15 men and 15 women) who received 2 courses of licopid 1 mg twice per day and a comparison group (30 people, 15 men and 15 women). Analysis of the phenotypic and functional characteristics of the cellular factors of the innate immune response was carried out before the start of immunomodulatory therapy, immediately after the end of the course, and also after 6 months. observations. To assess the quality of life of all patients, the SF-36 Health Status Survey and HADS questionnaires were used before the use of licopid, at the end of the course and after 6 months of follow-up. Result(s): In the course of assessing the effect of immunomodulatory therapy on the parameters of innate immunity of patients at the stage of rehabilitation after suffering COVID-19, an increase in the protective cytolytic activity of CD16+, CD8+Gr+ cells, as well as a persistent increase in the expression of TLR2, TLR4 and TLR9 was found, which indicates the restoration of antigenic recognition and presentations at the level of the monocytic link of the immune system. The use of GMDP as an immunomodulatory agent resulted in an 8-fold decrease in the frequency and severity of respiratory infections due to an increase in the total monocyte count, which persisted for 6 months from the start of therapy, while the use of systemic antibiotic therapy was not required, while in the comparison group -7 people were forced to resort to this therapy due to the severity of acute respiratory infections. When analyzing the assessment of the quality of life of patients against the background of the therapy, patients showed positive dynamics in role functioning, general assessment of their health status, and an increase in physical and mental well-being during 6 months of observation. In the comparison group, there was no improvement in the psycho-emotional state of patients. Conclusion(s): In this study, for the first time, it was found that the correction of immunological parameters when exposed to GMDP after a previous illness contributed not only to a decrease in the frequency and severity of respiratory infections, but also to an improvement in the psycho-emotional state of patients, and a decrease in anxiety and depression.

evaluation of hematological abnormalities in subjects vaccinated with bnt162b2 in a longitudinal cohort of the coRe study

Background: Vaccination is considered the most effective preventive strategy to fight COVID-19. The aim of this study was to evaluate two critical concerns about: 1) the kinetic response of IgG and IgM, and: 2) the hematological abnormalities in a longitudinal cohort of health-care workers (HCW) who had received 2 doses of BNT162b2 mRNA-based vaccine. Method(s): Blood and nasopharyngeal swabs were collected from 46 volunteers' participants, previous written consensus, with presumable no symptoms of COVID-19. Anti-SARS-CoV-2 serum immunoglobulin G (IgG) and M (IgM) and hematological parameters were examined. Multivariable mixed-effects models for repeated measure analysis were adopted to evaluate time changes in IgG, IgM and hematological parameters, and to investigate associations with vaccination response. Result(s): Forty-six subjects (N.=46;31.8% men;68.2% women;mean age near 36 years-old) were enrolled among healthcare workers of IRCCS MultiMedica (Milan, Italy). Overall, increase in serological IgG concentration appeared mainly between 21-28 days after the 1st dose, whereas IgM did not reach positivity in all cases. Mean blood cells counts were in normal range but we observed a significant reduction of total white blood cells and absolute lymphocyte counts after the 1st dose, persisting until the day 28. The increase of monocytes and neutrophils the day after the 1st dose subsequently decayed significantly. Eosinophils concentration showed a tendency to increase over time. Peripheral blood smear showed a growing frequency of atypical lymphocytes (lympho-variants), and of plasmacytoid forms, whereas no difference was found in large granular lymphocytes (LGL), although a decay after the boost was evident. The stratification of subjects, relative to the timing of IgG increase, showed the occurrence of 3 different patterns after vaccination, namely early-responders (R+), late-responders (R-) and pauci-responders (PR) with a peculiar kinetics of hematological parameters. Lymphocytes were significantly associated with total IgG: lower in R+ and PR compared to R- (P=0.0193 and P=00054, respectively). Conclusion(s): In healthy subjects, anti SARS-CoV-2 vaccination induced a variety of non-pathologic abnormalities. The response to vaccination was not equal in the groups examined. In PR group a major difference occurred with respect to R- and R+. This work adds novel insight into the puzzle of changes induced by SARS-CoV-2 virus.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Altered lipid profile in patients with COVID-19 infection

Background: In this study, we aimed to investigate the pathological alterations of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides in COVID-19 patients during the acute phase of infection, and after recovery. Method(s): A retrospective study was performed to examine serum levels of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides on 55 COVID-19 patients who were hospitalized in our center between February and April 2020. The lipid profile and the hematological parameters were analyzed in the same group of patients before (Group before) and after clinical management (Group after). The laboratory tests results were compared between these two groups, as well as with a group of healthy subjects (Healthy controls), matched for age and sex and selected among the blood donors. Result(s): LDL-cholesterol, HDL-cholesterol, total cholesterol levels were significantly lower in COVID-19 patients (Group before) as compared with normal subjects (P<0.0001). Comparing healthy controls and the group after, statistically significant differences were observed for all parameters except for total cholesterol (P=0.9006). Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride were found to be significantly higher after recovery than during the acute phase of infection (P<0.0001). C-reactive protein levels were found to be inversely correlated with those of LDL-cholesterol (rs =-0573, P<0.0001), total cholesterol (r=-0.732, P<0.0001), and HDL-cholesterol (r=-0.700, P<0.0001). Conclusion(s): The results of our study seemingly attest that lipids, especially cholesterol, may play an important role in viral replication, internalization and immune activation in patients with COVID-19 infection. Moreover, lipid abnormalities observed during and after this infection could be used for assessing indirectly the response to clinical treatment.Copyright © Journal of Laboratory and Precision Medicine. All rights reserved.

Study of Haematological Profile in Covid-19 Patients

Introduction: Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 recognized on 31st December 2019 in Wuhan, China which was declared a worldwide pandemic by the World Health Organization on 11 March 2020. Haematological and inflammatory test results are found to be peculiar in COVID-19 patients. Aim(s): This study was conducted to add to the knowledge database of haematological values in Covid patients and to correlate with clinical findings wherever possible to carry out timely intervention. Method(s): This was a prospective cohort study conducted from July 2020 to December 2021 in a tertiary care centre at Pune in Western Maharashtra region. The study included 603 RTPCR Covid positive patients. The patients were grouped clinically according to the severity score based on the CT/chest x-ray and SpO2 findings and their blood samples were analyzed at the Central Clinical Laboratory of our hospital for complete haematological profile. Result(s): The haematological parameters were tabulated and statistically analyzed. The mean Hb, PCV, Eosinophil, Basophil, Lymphocyte and Monocyte counts were significantly low in severe category. The mean MCV, MCH, NLR, PLR, ESR and D-dimer was high in severe category. Leucocytosis and Neutrophilia were seen in severe category patients. The mean PT was prolonged in severe category patients. Overall, there were 15% deaths. Significantly, more deaths were found in severe category. Conclusion(s): Hematological and coagulation parameters are closely related to the covid-19 disease severity. Among various parameters, some like ESR, D-Dimer, NLR/PLR Ratio can be used as a reliable predictor of severity. Copyright © 2022 Authors. All rights reserved.

Different routine laboratory tests in assessment of COVID-19: A case-control study

Objective: To identify helpful laboratory paprameters for the diagnosis and prognosis of COVID-19. Methods: An observational retrospective study was conducted to analyze the biological profile of COVID-19 patients hospitalized in the Unit of Pulmonology at Setif hospital between January and December 2021. Patients were divided into two groups: the infection group and the control group with patients admitted for other pathologies. The infected group was further divided according to the course of the disease into non-severe and severe subgroups. Clinical and laboratory parameters and outcomes of admitted patients were collected. Results: The infection group included 293 patients, of whom 237 were in the non-severe subgroup and 56 in the severe subgroup. The control group included 88 patients. The results showed higher white blood cells, neutrophils, blood glucose, urea, creatinine, transaminases, triglycerides, C-reactive protein, lactate dehydrogenase, and lower levels of lymphocyte, monocyte and platelet counts, serum sodium concentration, and albumin. According to ROC curves, urea, alanine aminotransferase, C-reactive protein, and albumin were effective diagnosis indices on admission while neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase were effective during follow-up. Conclusions: Some biological parameters such as neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase are useful for the diagnosis of COVID-19.

ELEVATED CIRCULATING MONOCYTES AND MONOCYTE ACTIVATION IN PULMONARY POSTACUTE SEQUELAE OF SARS-COV-2 INFECTION

SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Nearly one third of patients who recover from acute SARS-CoV2 infection will experience persistent symptoms known as Post-Acute Sequelae of SARS-CoV2 infection (PASC). Among individuals with PASC, pulmonary complications are common. Patients with severe COVID-19 have observed high systemic levels of cytokines and profound immune dysregulation. During acute SARS-CoV-2 infection, CD169, a type I interferon-inducible receptor, is overexpressed on monocytes. CD169+ macrophages are involved in hyperinflammation, viral spread, and immune regulatory function. Although monocytes/macrophage play a pivotal role in inflammation during acute SARS-CoV2 infection, less is known about how these cells contribute to lung sequelae and immunopathology in PPASC. METHODS: Cross section study conducted comparing three groups: participants with PPASC with a reduced predicted diffusing capacity for carbon monoxide (DLCOc, <80%) on pulmonary function test;participants who fully recovered (RC) from SARS-CoV-2 with no residual symptoms;and healthy participants (HC) negative for SARS-CoV-2. These groups were age and gender matched from similar community settings. Among the groups, we compared the numbers of monocyte subsets (classical, intermediate and non-classical monocytes) and monocyte activation by assessing CD169 expression using flow cytometry analysis of peripheral blood mononuclear cells. RESULTS: Ten participants enrolled in each group with median age 53 years, 38.7% males. We found that PPASC and RC had higher median levels of total circulating monocytes than in HC, 59374 (IQR: 43161-91523), 65661 (40049-89490) and 2689 (1378-28125), respectively (p<0.01, p<0.01). Regarding monocyte subsets based on CD14+CD16+ expression, we observed significant increase in the number of classical (CD14+CD16-), intermediate (CD14+CD16+), and non-classical (CD14-CD16+) monocytes in PPASC and RC, compared to HC (p<0.01, p=0.01, respectively). There was no difference in the number of monocytes and in the proportion of each subset between PPASC and RC. We observed increased CD169+ monocyte counts in PPASC and RC compared to HC 56.8 (23.0-92.5), 66.75 (4.3-968.7), and 2.095 (0-16.9), respectively (p<0.01, p<0.01). Furthermore, a rising trend of CD169 expression was observed in intermediate and non-classical monocytes from PPASC compared to HC. In addition, CD169+ non-classical monocytes were positively correlated with D-dimer levels in PPASC (ρ=0.72, p=0.03). CONCLUSIONS: This study present evidence that patients with COVID infection exhibit persistent alterations in monocytes even after the acute COVID infection period. Correlation of D-dimer level with CD169+ non-classical monocytes in patients with PPASC provides a further rational for determining if a specific monocyte subset contributes to the pathogenesis of PPASC. CLINICAL IMPLICATIONS: Further studies are required for understanding of the development and progression of PPASC. DISCLOSURES: No relevant relationships by Dominic Chow No relevant relationships by Logan Dean No relevant relationships by Gehan Devendra No relevant relationships by FRITZIE IGNO No relevant relationships by Boonyanudh Jiyarom No relevant relationships by Juwon Park No relevant relationships by Parthav Shah No relevant relationships by Cecilia Shikuma No relevant relationships by Chathura Siriwardhana

Procalcitonin/Albumin Ratio as a Novel Biomarker for Predicting Mortality in COVID-19

Background: Coronavirus disease 2019 (COVID-19) first appeared in China in December 2019, and has become a global pandemic. Because the clinical progression of the disease is highly variable, better prediction of prognosis and mortality is important. In the present study, we investigated the role of procalcitonin/albumin ratio (PAR) as a new biomarker in predicting mortality in patients with COVID-19 infection. Methods: In this study, patients with COVID-19 diagnosis were enrolled from Sakarya Yenikent State Hospital and Ayancık State Hospital between 09.11.2020 and 04.05.2021. The demographic characteristics, biochemical and hematological parameters such as age, gender, length of hospital stay, and comorbidities of the patients were collected retrospectively from medical records. Results: Of the 105 patients, 51 were mild and 54 were critically ill. Between mild and critical cases, age, lymphocyte count, red cell distribution width, neutrophile count, mean corpuscular volume (MCV), monocyte count, albumin, C-reactive protein, ferritin, procalcitonin, D-dimer, and PAR were statistically different (p<0.001 for all). All patients in the critical group and only 2% of the mild group died. PAR showed the largest area under the curve (0.949) for the prediction of mortality (p<0.001). Conclusion: We report that PAR, a simple, cheap, and easily accessible biomarker, can be used to predict the prognosis in patients with COVID-19 infection.

ACUPRESSURE IN HOSPITALIZED PEDIATRIC ONCOLOGY PATIENTS WITH FEBRILE NEUTROPENIA - A PILOT STUDY

Background: Chemotherapy-induced neutropenia is an expected side effect during cancer therapy. Prolonged neutropenia can lead to treatment delays and chemotherapy dose reduction. Patients with neutropenia are at increased risk for life-threatening infections, and when febrile they require hospitalization and broad-spectrum IV antibiotics. Acupuncture and related techniques have received increased interest in several clinical trials in adult oncology, where their use has resulted in improved blood cell counts. Little is known regarding the impact of needleless acupressure intervention in pediatric oncology patients. Objectives: The purpose of this pilot study was to evaluate the effects of daily treatment using predetermined acupressure points on hospitalized pediatric oncology patients with febrile neutropenia. Our primary objective was to determine if this protocol decreased the time to blood cell count recovery, a requirement for hospital discharge. The metric used for count recovery was absolute phagocyte count (APC), which is ANC (absolute neutrophil count) + AMC (absolute monocyte count). The endpoint for count recovery was APC ≥ 500/μL. Design/Method: In this pilot study, pediatric oncology patients admitted to the University of Minnesota Masonic Children's Hospital who had febrile neutropenia (ANC < 500/μL and temperature > 100.3F) were offered enrollment. Enrolled subjects received daily acupressure treatments until APC recovery. Cases were disease-matched to historical controls by treatment protocol as closely as possible. Time variables, including time to APC recovery and length of stay (LOS), were analyzed using the non-parametric Wilcoxon rank sum test. Results: Twelve cases (enrolled October 2020-September 2021) were group-matched to thirty-four historical controls (pulled from the medical records database, January 2015-October 2019). APC recovery in days was the same in both groups, with a median of 3.0 days, p = 0.352. The LOS in days was also similar: cases 4.94 vs. controls 3.43 days, p = 0.431. No enrolled patients experienced treatment-related adverse events. One patient was removed from the study early due to contracting COVID-19 when there was a limited supply of personal protective equipment. Conclusion: Acupressure presents a unique non-pharmacologic method to potentially support count recovery. Although we were unable to demonstrate a significant impact of acupressure on APC recovery in our pediatric population, we note limited sample size. Only 12 of the goal 35 patients (per initial power analysis) were enrolled. This was due, in part, to impacts of the COVID-19 pandemic, including necessary restrictions on elective research protocols during the study window. Further studies are needed to explore the role of acupressure in pediatric oncology.

REMDESIVIR in AN OUTPATIENT SETTING IMPROVES BIOMARKERS for PROGRESSION of COVID-19

Background: There is currently no approved treatment for patients with COVID-19 who have not been hospitalized, a setting in which early intervention may curb progression to more severe disease requiring hospitalization. We report longitudinal biomarker sampling from a Phase III (PINETREE) clinical trial to evaluate prognostic biomarkers of COVID-19 and to better understand the early remdesivir (RDV) treatment response. Methods: A Phase III, randomized, double-blind, placebo controlled, multicenter study was conducted to evaluate the efficacy and safety of RDV for outpatients with early stage COVID-19 who are at higher risk of disease progression (NCT04501952). Inclusion criteria were ≥60 years of age or ≥12 years of age with at least one risk factor for severe COVID-19 disease. All individuals had ≤7 days of symptoms prior to randomization. A total of 562 participants were randomized 1:1 to RDV or placebo. Serum and plasma were collected for biomarker analyses in 312 patients at days 1, 3, and 14 post-treatment. All biomarker values were adjusted for baseline age and stratified by sex. Results: RDV demonstrated an 87% reduction in risk for the primary composite endpoint of COVID-19-related hospitalization or all-cause death by day 28 (0.7% [2/279]) compared with placebo (5.3% [15/283]) (p=0.008). RDV treatment was associated with improved clinical outcomes in participants with higher risk of hospitalization or death from COVID-19, including individuals ≥60 years of age, males, and/or those with diabetes, obesity, and hypertension. Furthermore, we found that biomarkers associated with inflammation and coagulation, including lactate dehydrogenase (p<0.001) and procalcitonin (p<0.001), were prognostic for COVID-19 related hospitalization or all-cause death by day 28. Finally, we found that RDV improved some biomarkers associated with COVID-19 severity by day 3 of treatment, including peripheral lymphopenia, monocyte count, and decreased neutrophil-to-lymphocyte ratio compared to placebo (pWilcox<0.05). Conclusion: Our findings suggest that RDV treatment improves COVID-19 outcomes in high-risk SARS-CoV-2 infected individuals, particularly in those ≥60 years of age, male, and/or with diabetes, obesity, and hypertension. Biomarkers of COVID-19 severity that were prognostic for poor outcomes were identified in early infection. Furthermore, our results suggest that RDV treatment leads to more rapid recovery in the lymphopenia that is commonly associated with more severe COVID-19.

COVID-19 HYPERINFLAMMATION CAN BE PREDICTED USING ROUTINE CLINICAL LABORATORY MARKERS

Background/Aims Since early in the COVID-19 pandemic, there has been interest in the concept that some morbidity and mortality may be due to excessive inflammation. Several definitions of COVID-19 hyperinflammation COV-HI) have been proposed, including Manson criteria (C-reactive protein, CRP ≥150mg/L or doubling above 50mg/L in 24 hours and/or ferritin 1500ug/L);and Webb criteria (includes CRP ≥150mg/L or ferritin ≥750ug/L). A consistent finding has been worse outcomes. Little is known regarding the underlying pathologies separating these patients from others. Aim To investigate whether machine learning using standard laboratory features can identify a distinguishing 'COV-HI signature'. Methods A database of daily clinical and laboratory features was collected from 611 patients admitted to hospital with confirmed COVID-19 during the first wave of community-acquired infection at University College London Hospitals, Sheffield Teaching Hospitals, Newcastle upon Tyne Hospitals and Royal Wolverhampton. All data prior to mechanical ventilation were interrogated. Patients were categorised as COV-HI based on Webb thresholds (CRP >150 mg/L or ferritin ≥750ug/L). Laboratory features (peak or nadir depending on recognised predictors of illness severity) included: minimum lymphocyte count 10

Clinical Characteristics and Laboratory Testing of Patients With COVID-19: A Retrospective Analysis

Objective: To explore the early warning signs of deterioration of patients with COVID-19. Methods: The data of thirty-six patients who were admitted to Handan Infectious Disease Hospital was collected. The clinical features and laboratory testing were analyzed retrospectively. The initial laboratory testing included blood chemistries, blood routine, D-dimer, coagulation function, etc. The patients were divided into mild/common group and severe/critical group. Results: The lymphocyte count, monocyte count, hemoglobin, and albumin levels in severe/critical group were lower compared with those in mild/common group, while the fibrinogen was higher. The lymphocyte count and monocyte count were positively correlated with hemoglobin, pre-albumin respectively. Conclusion: In conclusion, patients with lower initial prealbumin and hemoglobin level were more likely to progress into severe conditions. Decreased prealbumin and hemoglobin, combined with lymphocyte count and monocyte count, could be the early warning signs of deterioration of patients with COVID-19.

Association of monocyte count alterations with COVID-19 severity

Background: COVID-19 caused by SARS-CoV-2 has led to an ongoing pandemic with massive global health and socioeconomic consequences. Monocytes are recruited under pathological conditions like viral infections to the affected tissue to defend the organism against invading pathogens and to aid in efficient resolution of inflammation. Some studies had suggested a significant decrease of monocytes in COVID-19 patients with severe or critical disease whereas some others suggested monocytosis. Aim of the Study: To find the association of Monocyte count alterations with the severity of COVID-19. Methods: This is a retrospective study conducted in Dept of Respiratory Medicine, KIMS Hospital and Research Centre, Bengaluru. A total of 1000 COVID patients were taken in the order of their admission from Jan-May 2021. Monocyte count in the blood at the time of admission was collected. Ethical clearance was obtained from the institutional ethical committee. Results: Higher monocyte count was seen in the younger age group, particularly in Category B COVID-19 patients. Statistically significant association was found between low monocyte count and the disease severity and mortality in patients with COVID-19. Conclusion: It is inferred that monocytes proliferate to eliminate the viruses in mild patients, while the loss of monocytes in the critical patients suggest that innate immunity might be suppressed to a certain extent in critical COVID-19. Deviation in monocytes count from the normal is a valuable discriminator for diagnosis of COVID-19 and suitable anticipator of overall spectrum of adverse consequences.

Hematological Predictors of COVID-19 Severity

Introduction: COVID-19 pandemic has placed the health systemworldwide in unprecedented stress, therefore, prompt identification and management of patients having severe disease is essential fortriaging of patients at the time of admission.Aims &Objectives: To identify hematological biomarkers ofCOVID-19 disease severity in patients admitted in a tertiary carehospital.Materials &Methods: A retrospective study was conducted over aperiod of 17 months (20th March 2020-19 August 2021) on 7416COVID-19 patients. Patients with cancers, pregnancy and chronichematological diseases were excluded from the study. Patients wereclassified clinically as per severity of disease as non-severe (asymptomatic, mild, moderate) or severe and their hematological parameterswere analyzed.Mann-Whitney test was used to compare between the groups. Optimal predictive cut off points for the variables were defined by receiveroperating characteristic (AUC) curve to dichotomize the variables.Univariate analysis was performed to screen out independent variables to be used in the binary logistic regression (BLR). A p valueof< = 0.05 was considered as statistically significant.Result: Age, duration of hospital stay, RBC count, WBC, Plateletcount, RDW, Neutrophils %, Absolute neutrophil count (ANC),Absolute monocyte count (AMC), NLR, PLR, NMR were statisticallyhigher whereas hemoglobin, hematocrit, MCHC, lymphocyte %,Absolute lymphocyte count (ALC), Eosinophils %, Absolute eosinophil count (AEC), Monocytes %, Basophils %, Absolute Basophilcount (ABC) and Lymphocyte Monocyte ratio (LMR) were lower insevere group. MCV and MCHC were not significant, so wereexcluded from the logistic regression model. All variables were significant in univariate analysis. Age (>42 yrs), duration of hospitalstay (>10 days), RBC count (B 4.33 106/lL),WBC count (> 7.73103/lL), RDW (>14.8%), Neutrophils (>71.7%), Eosinophils(B 0.3%), Monocytes (B 5%), ALC (B 1.01 103/lL), LMR(B 3.125) with adjusted odd ratio of 1.8, 1.5, 1.3,1.3, 1.4, 2.0, 2.1, 1.5,2.0 and 1.3 respectively were found to be significant predictors ofseverity.Conclusions: Age, duration of hospital stay, RBC count, WBC,RDW, Neutrophils %, Eosinophils %, Monocytes %, ALC, LMRshould be assessed and monitor at the earliest to halt unfavorableoutcome of mortality or morbidity.

Lymphocyte Ratios Progressively Worsen in Non-Survivors of COVID-19

Background: Brazil became the South American epicenter for coronavirus disease (COVID-19) soon after the first case was diagnosed in February 2020 with the highest infection rate occurring in the state of Sao Paulo. COVID-19 is characterized by marked thrombo-inflammation mechanisms, and neutrophil-lymphocyte ratio (NLR) among many clinical and laboratory data, is becoming an inflammatory marker of severity and mortality of COVID-19. We evaluated the serial weekly lymphocyte ratios, which are easily derivable from the routine blood counts, in the survivors and non-survivors of COVID-19 at the Clinical Hospital of University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil, from time of diagnosis to the 3 rd week of care. This hospital is one of the referral centers for COVID-19 patients in this state. Methods: In this retrospective study, we reviewed the medical notes of 320 adults hospitalized patients with PCR-confirmed COVID-19 at the Clinical Hospital of UNICAMP, from March 2020 to March 2021. The serial weekly hematological parameters (analyzed using automated counter - XN 9000™, Sysmex, Japan) from the time of diagnosis were analyzed and lymphocytes ratios (neutrophil-lymphocyte, NLR, platelet-lymphocyte PLR, and monocyte-lymphocyte MLR) were calculated. The survivors (n=257) were those who recovered from the disease and were discharged from the hospital, while the non-survivors (n=63) were those who died in the course of treatment. Statistical analyses were performed using SPSS (version 22). Unpaired data of Survivors and Non-survivors with COVID-19 were compared using Mann-Whitney tests. Repeated measures were compared within and between groups using univariate and multivariate tests in general linear models. All results were considered significant if p<0.05. Results: Of the 320 patients, 257 (80.3%) were survivors and had lower mean age than the non-survivors (57.73 vs 64.65 years, p<0.001). At diagnosis, the non-survivors had a lower lymphocyte count (p=0.002), basophil count (p=0.049), and hematocrit (p=0.021) than the survivors, Table 1. We used general linear models for repeated measures and corrected for the patients who did not stay long enough to have a complete series of blood counts, Figure 1 A-G. Multivariate tests between the survivor and non-survivor groups showed significant variations with serial weekly lymphocyte count (p<0.001), neutrophil count (P=0.005), NLR (p=0.009), MLR (p=0.010), and PLR (p=0.035) but not with the weekly monocyte count (p=0.352) and platelet count (p=0.505). The NLR was higher and PLR was lower in the non-survivors at diagnosis (p<0.001 and p=0.047 respectively), both were higher in the 2 nd week post-diagnosis (p<0.001 and 0.043 respectively), and in the 3 rd week (p<0.001 and p=0.043 respectively) (Figure 1D and E). The MLR was not significantly different at diagnosis but became elevated in the following two weeks post-diagnosis (p=0.09, p=0.022, and p<0.001 respectively) (Figure 1F). Conclusions: The non-survivors were older and their NLR and MLR tend to increase from the time of diagnosis while their PLR tend to decrease after the 2 nd week post-COVID-19 diagnosis and treatment. On the other hand, all three ratios significantly decrease in the survivors. While neutrophilia and lymphopenia improved in the survivor, they worsen in non-survivors. These cells may have contributed towards the recovery by ameliorating the inflammatory response in survivors, and death by worsening the response in non-survivors of COVID-19. This study shows that serial lymphocyte count, neutrophil count, NLR, PLR, and MLR could serve as good and easily accessible markers of outcomes in patients with COVID-19 and could be used for monitoring of response to treatment. [Formula presented] Disclosures: Costa: Novartis: Consultancy.