The Value of Peripheral Blood Cell Ratios in Primary Membranous Nephropathy: A Single Center Retrospective Study.

Background: Primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome in adults. Forty percent of the patients continue to progress and eventually develop into chronic renal failure. Although phospholipase A2 receptor (PLA2R) is the major antigen of PMN, the clinical features do not often parallel with the antibody titers. Therefore, it is significant to find relative credible markers to predict the treatment response. Methods: One hundred and eighteen PMN patients were recruited. The response to treatment was defined as ALB≥30g/L at 6 months and complete remission (CR) or not at the end of the follow-up. Renal outcome endpoint was defined as 50% or more Cr increase at the end. Results: The patients with poor treatment effects had numerically higher platelet-lymphocytes ratio (PLR). For patients with CR or not, the difference was near to statistic significant (P=0.095). When analyzing CR or not, the fitting of the binary logistic regression model including both PLA2R Ab titer and PLR (Hosmer-Lemeshow test: χ 2=8.328, P = 0.402; OR (PLA2R Ab titer) = 1.002 (95% CI 1.000-1.004, P = 0.042); OR (PLR) = 1.006 (95% CI 0.999-1.013, P = 0.098)) was markedly better than that with only PLA2R Ab titer (Hosmer-Lemeshow test: χ 2=13.885, P = 0.016). The patients with renal function deterioration showed significantly higher monocyte-lymphocyte ratio (MLR) (0.26 (0.22-0.31) vs 0.18 (0.13-0.22), P = 0.012). Conclusion: PMN patients with poor treatment response tended to have higher PLR at the time of renal biopsy, and a higher MLR was associated with poor renal outcomes. Our findings suggested that PLR and MLR might be used to predict treatment efficacy and prognosis for PMN patients, respectively.

Emergence of SARS CoV-2 Variant B.1.1.7 in a Pandemic Hospital

Introduction: A clinically significant variant of SARS-CoV-2 was identified in the UK in December 2020 and was designated VOC‐202012/01 (lineage B.1.1.7) on 14 December 2020. Our study aimed to evaluate the lineage B.1.1.7 prevalence over time and demographic, hematological, coagulation, inflammation characteristics in hospitalized patients with B.1.1.7 during February-March 2021. Materials and Methods: Between 5 February and 20 March 2021, 182 inpatients with B.1.1.7 were included in this study. Bio-Speedy, SARS-CoV-2 Double Gene RT-qPCR (Bioeksen, Ístanbul, Türkiye) kit was used to diagnose COVID-19. Cycle threshold< 27 samples were taken into mutation study with Bio-Speedy SARS-CoV-2 Variant Plus kit. Results: Of the 5187 SARS-CoV-2 positive cases, 2288 (69.65%) were evaluated as variant B.1.1.7 positive. Throughout the study, the case number's daily increase rate was 8.78% in SARS CoV-2, 13.16% in B.1.1.7;the case number's doubling time was calculated as 7.9 days in SARS CoV-2 and 5.27 days in B.1.1.7. In ICU patients, hemoglobin (p< 0.001), platelet (p= 0.034) and lymphocyte (p< 0.001) levels were lower but neutrophil (p= 0.025), monocyte/lymphocyte ratio (MLR) (p= 0.002), neutrophil/lymphocyte (NLR) (p< 0.001) ratio and D-dimer (p= 0.008) levels were dedected higher than non-ICU patients. Conclusion: Our study demonstrated that the infectiousness of B.1.1.7 was higher than previous variants and became the dominant SARS-CoV-2 in six weeks in our region. Therefore, urgent and decisive measures should be taken to minimize morbidity and mortality associated with COVID-19. In addition, our findings indicate that first hematologic markers of the patients can be an important biomarker for the prognosis of COVID-19 disease.

Behavioral, Emotional Problems and Fatigue in Adolescents After COVID-19 Infection: A Cross-Sectional Study

Objective: This study aimed to investigate behavioral, emotional problems and fatigue in adolescents after COVID-19 infection. Also, we examined relationships between baseline inflammation levels, fatigue, and the current behavioral and emotional problems of adolescents. Material(s) and Method(s): A total of 110 adolescents (56 boys, 50.9%, mean age 14.72 years) and their parents were included in the study. Psychiatric assessments of the adolescents were performed 7.31+/-2.35 months after discharge from hospital. Behavioral and emotional problems was assessed using the Child Behavior Checklist (CBCL) 6-18 parent-rated questionnaire. Result(s): We collected baseline inflammatory markers including C-reactive protein (CRP), the neutrophil/lymphocyte ratio (NLR), the monocyte/lymphocyte ratio (MLR), and the systemic immune-inflammation index (SII). The proportions of adolescents that were in the clinical range in at least one behavioral and emotional domain were as follows: 44.5% in the entire sample, 35.7% in boys, and 53.7% in girls. Thought problems were the most common problems in the entire sample (25.5%). The rates of internalizing and externalizing symptoms were 33.6% and 16.4%, respectively. Somatic and attention symptoms were more frequent in females than in males. Inflammatory marker levels did not correlate with behavioral and emotional scores. Fatigue symptoms were determined in 36.4% of all adolescents. We found that somatic and attention problems are more common in fatigued adolescents. Conclusion(s): Our findings demonstrated that screening for behavioral, emotional problems, and fatigue in adolescents with COVID-19 infection is necessary. Future studies with a follow-up design are needed to determine whether a relationship exists between behavioral, emotional problems and baseline inflammation levels after COVID-19 infection. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Hemograms and serial hemogram-derived ratios in survivors and non-survivors of COVID-19 in Campinas, Brazil.

Introduction: The hemogram and hemogram-derivative ratios (HDRs) are becoming markers of the severity and mortality of COVID-19. We evaluated the hemograms and serial weekly HDRs [neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NPR) and systemic immune-inflammatory index (SII)] in the survivors and non-survivors of COVID-19. Methods: We retrospectively reviewed the medical notes and serial hemograms of real-time reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 adults hospitalized from April 2020 to March 2021 from the time of diagnosis to the 3rd week of diagnosis. Results: Of the 320 adults, 257 (80.3%) were survivors and had a lower mean age than the non-survivors (57.73 vs. 64.65 years, p < 0.001). At diagnosis, the non-survivors had lower lymphocyte (p = 0.002) and basophil (p = 0.049) counts and the hematocrit showed a p-value (Is this what you meant???) of 0.021); higher NLR (p < 0.001), PLR (p = 0.047), NPR (p = 0.022) and SII (p = 0.022). Using general linear models, the survivors and non-survivors showed significant variations with weekly lymphocyte count (p < 0.001), neutrophil count (p = 0.005), NLR (p = 0.009), MLR (p = 0.010) and PLR (p = 0.035). All HDRs remained higher in the non-survivors in the 2nd week and 3rd week of diagnosis and the HDRs were higher in the intubated patients than in the non-intubated patients. The NLR and SII were more efficient predictors of mortality in COVID-19 patients. Conclusions: This study shows that serial lymphocyte and neutrophil counts, NLR, PLR, MLR, NPR and SII could serve as good and easily accessible markers of severity and predictors of outcomes in COVID-19 patients and should be used for the monitoring of treatment response.

Evaluation of some biochemistry and hemogram parameters that can be used in the diagnosis of covid-19

BACKGROUND AND AIM: The COVID-19 pandemic has been devastating the world since its inception. Routine parameters used in the diagnosis and treatment process can be a potential biomarker for the prognosis of this inflammatory disease. In our study, it was aimed to compare some hemogram and biochemical parameters according to the need for intensive care (ICU) of laboratory-confirmed PCR (+) patients and to evaluate their potential role in determining the prognosis of the disease. METHODS: A total of 255 patients, who were diagnosed with COVID-19 by PCR test in Konya Selcuk University Faculty of Medicine hospital between April and December 2020, 62 of whom were in the ICU and 193 of them were treated for COVID-19 in the service, were included in the study. RESULTS: Considering the demographic and clinical findings of the patients, the mean age of the patients entering the ED was higher (64.65 ± 14.14 vs. 54.65 ± 17.43, p<0.001, respectively) and their saturation was lower (83.56±5.45 vs. 93.05±4.27, p<0.001, respectively). Those entering the ICU were mostly men (64.5% vs. 35.5%, p=0.036) and those with comorbidities (85.5% vs. 14.5%, p<0.001). All of them had Thorax CT involvement (n=62, 100%) and 53.2% were ex. WBC, troponin, procalcitonin, ferritin, D-dimer, CRP, LDH, fibrinogen, neutrophil, platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) of patients entering ICU were significantly high, lymphocyte value was low. On the other hand, there was no significant difference between the platelet and monocytes values of the patients who entered the ICU and those who did not (p=0.526 and p=0.123). When the results obtained by adjusting the patients' age, gender and comorbidities were analyzed, it was observed that the procalcitonin value lost its significance (p=0.480, p=0.529, and p=0.758). Similarly, it was observed that troponin, fibrinogen, and MLR lost significance when corrected (p=0.108, p=0.080, and p=0.124). CONCLUSIONS: It has been observed that in addition to the ferritin, D-dimer, CRP, LDH tests that are routinely used together with the PCR test in the diagnosis and follow-up of COVID-19, neutrophils, PLR and NLR can also be helpful, they are significant in those who need ICU, and procalcitonin measurement is not required.

Homocysteine as a marker for predicting disease severity in patients with COVID-19.

Aim: Our study was designed on the hypothesis that homocysteine levels are a prognostic parameter that can predict the severity of COVID-19 disease. Materials & methods: 117 COVID-19 patients and 34 non COVID-19 individuals were included in the study. Receiver operating characteristic (ROC) analysis was performed for homocysteine, D-dimer and monocyte/lymphocyte ratio (MLR) levels. Results: According to the ROC analysis, in COVID-19 patients group, Area under curve (AUC) values were 0.835 for homocysteine, 0.859 for D-dimer and 0.882 for MLR. According to the ROC analysis, in which homocysteine, MLR and D-dimer parameters were evaluated together, AUC values were 0.951 in the mild disease group, 1000 in severe disease group and 0.967 in COVID-19 patients group. Conclusion: It was concluded that homocysteine level is an important parameter in the follow-up of COVID-19 disease.

THE PREDICTIVE ACCCURACY FOR MORTALITY OF PERIPHERAL HEMATOLOGICAL MARKERS RATIOS IN MECHANICALLY VENTILATED COVID-19 PATIENTS

Background. Hematologic markers ratios have been proposed as indicators to assist in the diagnosis and risk stratification of infectious diseases. The objective of the study was to explore the predictive value of neutrophils and monocytes to lymphocytes ratios (NLR and MLR, respectively) and to determine their cut-off values for the early severity stratification in mechanically ventilated critically ill SARS-CoV-2 infected patients. Material and methods. This study was retrospectively conducted on 193 patients admitted with COVID-19 in a specialized center in Jordan. Data were retrieved from the electronic medical record system over 9 months, between April – December 2020. Patients aged below 18 years, with a hospital length of stay less than 7 days, and whose studied variables were totally or partially missed were excluded from our study. An Independent and One-Sample T-Tests were used for parametric comparative data while non-parametric comparative variables were analysed using Chi Square Test. A receiver operating characteristic (ROC) was plotted to investigate the area under each curve (AUROC) of the tested prognosticator. Results. The mean age of the entire study group was 58.37±9.96 years, and the survivor group was insignificantly older than the non-survivor group (58.55±9.95 years versus 58.09±10.05 years, respectively). The 28-day intensive care unit mortality was detected in 94 patients (48.70%) during a mean of 12.40±4.79 days. NLR and MLR were significantly lower in the survivor group compared to the non-survivor cohort (2.22±0.99 and 0.25±0.10 versus 5.16±2.08 and 0.89±0.19, respectively, p <0.05). Conclusions. In this study, the higher values of MLR and NLR in patients with COVID-19, particularly in those with mechanical ventilation, could be used as predictors for risk stratification of patients with COVID-19.

Correlation of Blood Parameters with Severityin COVID-19 Positive Patients

Introduction: Coronavirus Disease 2019(COVID-19) has beendeclared by World Health Organization (WHO) as a global emergency due to its pandemicity. Since its first emergence in Wuhan,China number of new cases and deaths are still increasing by the day.While most patient have mild influenza and may be asymptomatic, aminority of patients will develop severe pneumonia, acute respiratorydistress syndrome, multi organ failure and death. Clinical and Laboratory biomarkers to predict the mortality and severity of COVID-19are essential in this pandemic. According to studies and data Neutrophil Lymphocyte Ratio is the first and the most importantparameter that is found to be associated with the course of the disease.Following SARS-COV 2 infection, most of the patients presentedwith Lymphopenia and elevated levels of infection related biomarkers, more interestingly, a higher number of Neutrophils and lowernumber of Lymphocytes, the increase of Neutrophil LymphocyteRatio were found in non-survivors with COVID-19 compared tosurvivors along with monocyte lymphocyte ratio, platelet lymphocyteratio, D-Dimer level. These changes showed the degree of inflammation in the body was further intensified, triggering an inflammatorystorm and leading to increased tissue and cell damage.Aims &Objectives: Predicting the severity of COVID-19 patients byevaluating the blood parameters like neutrophils, lymphocyte, neutrophil lymphocyte ratio, monocyte lymphocyte ratio, plateletlymphocyte ratio, D-Dimer.Materials &Methods: A total of 100 confirmed COVID 19 patientsat DR PRABHAKAR KORE HOSPITAL OF JNMC, BELAGAVIbetween March 2021 and July 2021 were studied.Result: At hospital admission, the median leukocyte count was 5900cell/mm3. The median neutrophil count was 4240 cell/mm3 and themedian lymphocyte count was 925 cell/mm3. The median platelet-tolymphocyte ratio (PLR) was 191.7 while the median NLR was 4.5.Conclusions: Blood parameters could be used as significant indicators in predicting the severity of COVID-19 patients.

Predictors for imaging progression on chest CT from coronavirus disease 2019 (COVID-19) patients.

OBJECTIVE: This study aimed to investigate the potential parameters associated with imaging progression on chest CT from coronavirus disease 19 (COVID-19) patients. RESULTS: The average age of 273 COVID-19 patients enrolled with imaging progression were older than those without imaging progression (p = 0.006). The white blood cells, platelets, neutrophils and acid glycoprotein were all decreased in imaging progression patients (all p < 0.05), and monocytes were increased (p = 0.025). The parameters including homocysteine, urea, creatinine and serum cystatin C were significantly higher in imaging progression patients (all p < 0.05), while eGFR decreased (p < 0.001). Monocyte-lymphocyte ratio (MLR) was significantly higher in imaging progression patients compared to that in imaging progression-free ones (p < 0.001). Logistic models revealed that age, MLR, homocysteine and period from onset to admission were factors for predicting imaging progression on chest CT at first week from COVID-19 patients (all p < 0.05). CONCLUSION: Age, MLR, homocysteine and period from onset to admission could predict imaging progression on chest CT from COVID-19 patients. METHODS: The primary outcome was imaging progression on chest CT. Baseline parameters were collected at the first day of admission. Imaging manifestations on chest CT were followed-up at (6±1) days.