Diagnostic Role of Platelet to Lymphocyte Ratio and Platelet Parameters in COVID-19 Disease

Backgrounds: This study aimed to analyze the applicability of platelet parameters in assessing the severity of COVID-19 disease. Material(s) and Method(s): Patients with RT-PCR confirmed COVID-19 in the Pathology department of a tertiary care hospital in south India from June to December 2020 were included in this study. Clinical details and laboratory parameters of these patients were obtained. The difference between the studied variables in two groups was assessed using independent t-test. The optimum cut-off value of platelet to lymphocyte ratio (PLR) to differentiate between the tested groups was estimated using ROC (receiver operator curve) analysis. Finding(s): This study was conducted on 218 COVID-19 patients, of whom 17.9% showed thrombocytopenia at the time of admission. Among the hematological parameters, PLR, absolute lymphocyte count (ALC), platelet distribution width (PDW), D-dimer, and erythrocyte sedimentation rate (ESR) were significantly different between the ICU (intensive care unit) and non-ICU groups. Increased PLR values were associated with the disease severity. Conclusion(s): PLR could be used as an additional biomarker in assessing the severity of COVID-19 disease, and a cut-off value of 210.27 is optimal to differentiate severe COVID-19 disease from its mild and moderate forms with 79% specificity.Copyright © 2023, TMU Press.

Comparison of PCR-negative patients with CT findings and PCR-positive COVID-19 patients

Aim: The gold standard diagnostic method for the diagnosis of COVID-19 is based on the demonstration of viral RNA in samples taken from the upper respiratory tract in reverse transcriptase-polymerase chain reaction (RT-PCR). However, in emergencies, the World Health Organization (WHO) also recommends to use computed tomography (CT) in order to reduce the loss of time and to provide rapid diagnosis, treatment and isolation of suspicious cases. In our study, we aimed to compare the laboratory values of patients with PCR negative CT findings and PCR positive patients. Material(s) and Method(s): The medical records of 1280 COVID-19 patients registered at our Family Medicine Center were reviewed retrospectively. Result(s): In our study, it was found that 66,70 % of PCR-negative patients with CT findings were aged 60 years and older, and 50.70% of PCR-positive COVID-19 patients were between the ages of 40-59 years;61.30% of the patients with CT findings and 48% of the PCR-positive patients were male;73% of PCR-positive patients had lung involvement. When CRP, fibrinogen and D-dimer values were examined, it was found that in PCR-negative COVID-19 patients with CT findings these values were statistically significantly higher. Discussion(s): Although the definitive diagnosis of the disease is made using a PCR test, it should not be overlooked that the patients may remain PCR negative, and it should not be forgotten that thoracic tomography findings are a good diagnostic method for this group.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Comparison of biomarkers of COVID-19 patients with the alpha variant (B.1.1.7), the delta variant (B.1.617), and no mutation detected

Objectives: We aimed to compare biomarkers of COVID-19 patients with the Alpha variant (B.1.1.7), the Delta variant (B.1.617), and no mutation detected in our study. Method(s): A total of 600 patients with positive COVID PCR test and Alpha, Delta variant and no mutation detected with Covid PCR mutation test were included in the study. Troponin I, creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Lactate Dehydrogenase (LDH), fibrinogen, D-dimer, ferritin, number of lymphocytes, lymphocytes (%), platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), trombosite ratio in the blood (PCT), C-reactive protein (CRP) values were analyzed retrospectively. The age, gender, and hospitalization of the patients were evaluated concurrently. Result(s): Age, troponin, creatinine, LDH, PLT, MPV, and D-dimer were laboratory parameters that vary significantly with COVID-19 virus mutation. Age, troponin, LDH, and MPV values were lower in patients with Delta variant according to patients with the Alpha variant. Lymphocytes (N) and lymphocytes (%) values were lower in hospitalized patients relative to outpatients while age, troponin, LDH, CRP, and D-dimer values were higher in hospitalized patients than outpatients irrespective of mutation. Creatinine values were higher only in hospitalized patients with no mutation detected while ferritin and fibrinogen values were higher in hospitalized patients with Delta variant and no mutation detected. Conclusion(s): Age, troponin, creatinine, LDH, PLT, MPV, D-dimer, fibrinogen, ferritin, CRP, lymphocytes (N), and lymphocytes (%) values can guide to evaluate the diagnosis and hospitalization of patients with future different mutations.Copyright © 2023 by Prusa Medical Publishing.

Prospective study of pulmonary embolism in patients with SARS CoV-2 pneumonia with high levels of D Dimer

Pulmonary embolism (PE) is common among hospitalized adults with SARS CoV-2 pneumonia. D-dimer (DD)>1 mug/mL has been found to be a severity risk factor. However, most of the studies are based on retrospective data and the real prevalence is unknown Objectives: To evaluate the prevalence of PE in patients with SARS CoV-2 pneumonia, regardless clinical suspicion. Demographic and laboratory data, comorbidities, and clinical outcomes were compared between patients with and without PE Methods: Single-center prospective study. All consecutive cases of SARS CoV-2 pneumonia with DD>1 mug/mL underwent computed tomography pulmonary angiography Results: 179 patients (64 (55-74 years), 65% male) were included. PE was diagnosed in 71 patients (39.7%), mostly with a peripheral location and low thrombotic load (Qanadli score 10%). We did not find disparity in PE prevalence between men and women, and between obese and not obese patients. There were no differences in the intensive care unit admission rate. Mortality rate was 8.5% in patients with PE vs. 3.7% in those without PE, but the differences were not significant. Patients with PE had more history of cardiovascular disease and required more fractional inspired oxygen. DD, platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), DD-lactate dehydrogenase ratio (DD/LDH), and DD-ferritin ratio values were significantly higher among PE patients. ROC analysis showed that PDW and DD/LDH had the greatest area under the curve Conclusion(s): Patients with SARS CoV2 pneumonia and DD>1mug/mL presented a high prevalence of PE, regardless of clinical suspicion. PDW, NLR, DD/LDH and DD/Ferritin may help to identify patients with high risk of PE.

Association of immature granulocytes (IG) with prognosis in severe COVID-19 patients Immature granulocytes and COVID-19

Aim: Recent research have shown that immature granulocytes (IG) can be utilized to predict severe infection, inflammation, and sepsis. As a result, the ability of IG levels to predict the severity of severe COVID-19 and its association with prognosis were studied in our study. Material and Mthods: A total of 317 patients diagnosed with severe COVID-19 in the emergency department were analyzed retrospectively. IGC and IG% levels were compared statistically between patient groups (survivors and non-survivors, those who received and did not get mechanical ventilation (MV) assistance, patients who required and did not require vasopressors, and hospital stays >=10 and <10 days). Result(s): When compared to patients who survived but did not get treatment, non-survivors who got MV and vasopressor support had substantially higher IGC and IG% values (for all p<0.001). Additionally, it was shown that the IG% of patients with hospital stays of >=10 days was substantially greater than that of patients with hospital stays of <10 days (p<0.001). While the IG% cut-off value was >0.45, it reached 75.5% sensitivity, 81.9% specificity, 87.6% NPV and 66.4% PPV for predicting mortality (AUC:0.86, p<0.001). Discussion(s): IG levels are a low-cost, easily accessible, and strong marker that may be used to predict mortality and prognosis in COVID-19 patients.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Are platelet volume indices of clinical use in COVID-19? A systematic review.

Background: The incidence of thrombotic complications is high in COVID-19 patients with severe disease. As key regulators of thrombus formation, platelets likely play a crucial role as mediators of severe acute respiratory syndrome coronavirus 2 associated pathogenesis. Studies have reported that parameters reflecting platelet size, known as platelet volume indices (PVI), are raised in patients with thrombosis and can predict poor outcomes. This systematic review evaluates the potential for PVI to be used as a predictor of COVID-19 morbidity and mortality. Methods: English and Chinese databases were searched electronically to identify studies reporting data on mean platelet volume, platelet distribution width or platelet-large cell ratio in COVID-19 patients. Included articles underwent a quality rating and descriptive narrative analysis. Results: Thirty-two studies were included in the systematic review. The results show a general trend for PVI to be raised in severe COVID-19 patients and non-survivors, with 14 studies reporting significant differences of baseline PVI between severe and mild disease. Nonetheless, longitudinal studies showed varying PVI trends over the course of the disease and evidence for PVI to be associated with disease progression was limited. The quality rating of 12 studies was poor, 16 were rated fair and four were good. Most studies were retrospective in design, used small study populations and did not consider confounding factors that influence platelet volume. Studies also contained technical flaws in PVI measurement, limiting the reliability of the results. Conclusion: The evidence on the clinical usefulness of PVI is greatly limited by the lack of prospective evaluation, together with technical problems in measuring PVI. Carefully designed prospective studies are warranted. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304305, identifier CRD42022304305.

Lab Parameter among Corona Patients

Introduction: The COVID-19 pandemic has been raging across the globe since early January 2020. Various geographical regions have been passing multiple swells of upsurge of cases which aren't matched temporally as well as in severity. The diapason of the complaint ranges from asymptomatic to severe life-hanging complaint. Advanced age and the presence of comorbidities similar as cardiovascular complaint, diabetes mellitus, hypertension, chronic lung complaint, chronic kidney complaint, cancer, and obesity are among the major threat factors for severe disease. Aims and objectives: Significance of lab parameter among Corona Patients. Materials and methods: The covid- 19 opinion was verified by reverse transcription- polymerase chain reaction (RT- PCR) assay of nasopharyngeal swab sample. Hematology blood samples were used to analyze by flow cytometry. Biochemical samples were used to analyze by completely auto analyzer diagnostic outfit. Serology tests were carried out the styles based on indirect ELISA technique, immune plates are coated with a admixture of purified viral antigen and probe using the patient serum. Results: It is found that there is statistically significant (p-value<0.05) mean difference within the lab parameters (IL-6, LDH and Ferritin) in Covid patients using the Post Hoc Analysis. It is also found that there statistically significant (p-value<0.05) mean difference between RBC, Hb level, Hematocrit, MCV, MCH, MCHC, Platelet, RDW, PCT and NL ratio while Age, WBC, MPV, M(Monocyte), E(Eosinophil), B(Basophil), D-dimer and PDW were found to be statistically insignificant (p-value>0.05) with respect to gender. Discussion: CBC, D- dimer, IL-6, LDH and Ferritin were analysed and found associated with adverse outcomes. There is significant association of age, gender, comorbidity. Conclusion: High NLR at admission associated with a higher mortality. Laboratory features (e.g., IL-6, LDH, Ferritin D-dimer etc.) were associated with poor outcomes.

Plasma-induced nanoparticle aggregation for stratifying COVID-19 patients according to disease severity.

Stratifying patients according to disease severity has been a major hurdle during the COVID-19 pandemic. This usually requires evaluating the levels of several biomarkers, which may be cumbersome when rapid decisions are required. In this manuscript we show that a single nanoparticle aggregation test can be used to distinguish patients that require intensive care from those that have already been discharged from the intensive care unit (ICU). It consists of diluting a platelet-free plasma sample and then adding gold nanoparticles. The nanoparticles aggregate to a larger extent when the samples are obtained from a patient in the ICU. This changes the color of the colloidal suspension, which can be evaluated by measuring the pixel intensity of a photograph. Although the exact factor or combination of factors behind the different aggregation behavior is unknown, control experiments demonstrate that the presence of proteins in the samples is crucial for the test to work. Principal component analysis demonstrates that the test result is highly correlated to biomarkers of prognosis and inflammation that are commonly used to evaluate the severity of COVID-19 patients. The results shown here pave the way to develop nanoparticle aggregation assays that classify COVID-19 patients according to disease severity, which could be useful to de-escalate care safely and make a better use of hospital resources.

Platelet Distribution Width and Increased D-Dimer at Admission Predicts Subsequent Development of ARDS in COVID-19 Patients.

In the current pandemic of coronavirus disease (COVID-19), the identification of the patients admitted with severe infection-who are disposed to a high risk of acute respiratory distress syndrome (ARDS) development, is of a major significance for the determination of the appropriate therapeutic strategy. Laboratory records in admission were retrospectively reviewed from 493 cases of severe COVID-19 divided into two groups: Group 1 with ARDS and Group 2 without ARDS. The platelet distribution width (PDW) difference between Group 1 and Group 2 is significant-15.10 ± 2.08 fl for those who developed ARDS versus 12.94 ± 2.12 fl for those without ARDS. The sensitivity and the specificity of this parameter is lower than that of D-dimer. After grouping of the PDW values into intervals and combining them with the rate of increase in D-dimer (D-PDWf index) to form a forecasting index, a significant increase in the specificity and sensitivity of the two parameters is identified-area under the ROC curve (AUC) is 0.874 for D-PDWf index, with respective AUC for PDW 0.768 and AUC for D-dimer 0.777. Conclusion: PDW is a significant predictive parameter at admission for subsequent development of ARDS in patients, with increased significance in combination with the degree of increase in D-dimer.

Platelet Indices Are the Promising Biomarkers in Monitoring Disease Activities in Patients with Syphilis.

OBJECTIVES: To uncover the role of the platelet indices in patients with syphilis. METHODS: A total of 2061 patients with syphilis and 528 healthy controls were enrolled in this retrospective cohort study. The data of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and indicators of syphilis activities were collected. The correlations between the platelet indices and disease activities were analyzed. RESULTS: A total of 425 (20.6%) of the 2061 patients were of primary and secondary syphilis, 433 (21.0%) latent, 463 (22.5%) serofast, 350 (17.0%) asymptomatic neurosyphilis, and 390 (18.9%) symptomatic neurosyphilis. Compared with the healthy controls, PLT was significantly increased in the primary and secondary syphilis group; whereas, MPV and PDW were significantly decreased in all stages of syphilis. These changes of platelet indices were reversed after anti-treponemal therapy. Further correlation analysis showed that PLT was positively associated with the syphilis activity indicators [rapid plasma reagin (RPR) titer, cerebrospinal fluid white blood cell (CSF-WBC), CSF-protein, and CSF-VDRL (venereal disease research laboratory)] and inflammatory markers [WBC, C-reaction protein (CRP), and erythrocyte sedimentation rate (ESR)]. Conversely, PDW was negatively correlated with all of these parameters. MPV had an inverse relationship with RPR, ESR, and CRP. CONCLUSIONS: Platelet indices are associated with syphilis activities.

Diagnostic value of platelet indices in COVID 19 infection: a case-control study from a single tertiary care center.

Introduction: Platelets are not only involved in hemostasis and coagulation, but play a significant role in innate immunity and inflammatory response. Excess production of cytokines and acute phase reactants affect megakaryopoiesis resulting in the release of immature platelets from the bone marrow altering platelet indices. Aim: To study platelet indices in RT-PCR-proven COVID patients and non-COVID patients. Methods: A case-control study was conducted on 199 COVID-19 patients and 198 normal individuals. Blood samples were analyzed in an automated hematology analyzer. The platelet indices like platelet count, mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell count (PLCC), and platelet large cell ratio (P-LCR) were compared among two groups. Results: Platelet count in COVID-19 patients were significantly low (p<0.01) compared to controls, and a significant number of COVID-19 patients had thrombocytopenia. Plateletcrit (PCT) was also significantly decreased in COVID-19 patients compared to non-COVID individuals. MPV, PDW, and PLCR were significantly (p<0.05) high in COVID-19 patients in comparison to controls, but was not significantly raised in a large number of cases. In contrast, there were no significant differences in platelet large cell count (PLCC) values between COVID-19 cases and non-COVID-19 controls. Conclusion: Platelet indices like platelet count, PCT, MPV, PDW, and P-LCR are significantly altered in COVID-19 infection and thereby can be used as biomarkers in COVID-19. Further research is needed to find if these simple, cost-effective parameters can be used to predict the severity and prognosis in COVID-19 infection.

COVID-19 AND LOW PLATELET COUNT-A RELATIONSHIP

BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 100 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patients had moderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

Blood and serum biomarkers correlated with severity and mortality of covid-19 infection in the elderly patients

BACKGROUND AND AIM: World has been dealing with the COVID-19 pandemic since December 2019. Despite vaccination, people are still infected people and died by COVID-19 worldwide. Since elderly population was categorized as risk group, we aim to evaluate serum and blood biomarkers indicating disease severity and mortality in those patients. METHODS: Blood and serum biomarkers of 22 patients (70-90 years old) were investigated and compared between deceased and survived patients. RESULTS: Fibrinogen, d-dimer, C-reactive protein (CRP) levels increased in the deceased patients compared to the survived ones. P and Mg levels increased in the deceased patients, where Ca levels significantly decreased. Glucose, blood urea nitrogen (BUN), alanine transaminase (ALT), aspartate aminotransferase (AST), troponin, lactate and procalcitonin levels significantly decreased in the deceased patients compared to the survived ones infected by COVID-19. Hematocrit (HCT), hemoglobin (Hb), total Hb, red blood cells (RBC), PDW and ferritin levels decreased in the deceased patients compared to the healthy ones, where red cell distribution width (RDW) and prothrombin time (PT) levels significantly increased in the deceased patients infected by COVID-19. WBC and NEU levels significantly increased in the deceased patients, controversially %NEU, %LYM, MONO, %MONO, EOS, %EOS, %BASO, MPV, PT and INR levels significantly decreased in the deceased patients compared to the survived ones. CONCLUSIONS: Clinical finding of our stud may help clinicians to predict severity and mortality of COVID-19 in the elderly population.

Diagnostic Utility of Platelet-Lymphocyte Ratio (PLR)and Platelet Parameters in COVID 19 Disease

Introduction: COVID-19 is an infectious disease caused by novelcoronavirus and changes in haematological parameters are recorded.Among which platelet parameters play an indirect role in assessingthe coagulation status of the patients.Aims &Objectives: The aim of this study is to (1) compare theplatelet parameters and PLR among ICU and non-ICU COVID-19patients (2) evaluate the role of platelet parameters in assessing theseverity in COVID-19 patients.Materials &Methods: This was a prospective observational studyfrom June 2020 to December 2020 (during the first wave of pandemic). The clinical data of patients were recruited from hospitalmedical records to stratify the disease severity. Parameters such asAbsolute lymphocyte count (ALC), Platelet count (PLT), MeanPlatelet Volume (MPV), Platelet Distribution Width (PDW), D-dimer,Prothrombin Time (PT) and activated Partial Thromboplastin Time(aPTT) were included. Values of Erythrocyte Sedimentation Rate(ESR) and Interlukein-6 (IL6) were also included wherever available.Serial platelet count values were noted for ICU patients for assessingthe platelet trend. From ALC and PLT count, platelet to lymphocyteratio (PLR) was calculated using the formula: PLR = ALC/PLT 9100. Non-parametric independent 't' test was used to obtain thedifference between the study variables. ROC analysis was done tofind the optimum cut-off value of PLR between the tested groups.Result: A total of 218 RT-PCR proven COVID-19 patients wereincluded. Of these 145 (66.5%) patients were treated in ICU and73(33.5%) patients were treated in wards (non-ICU group). 39%patients showed thrombocytopenia at the time of admission. PLR,ALC and PDW showed statistically significant difference betweenICU and non-ICU group. Table 1 depicts the results.Conclusions: Haematological parameters provide vital clues aboutdisease severity. The most significant of them observed in our studyare ALC, PLR, PDW, D-dimer and ESR. Low values of ALC and high values of PLR, PDW, D-dimer andESR were associated with severe COVID-19 disease requiringICU care. PLR, an easily derivable parameter at a cut-off of 210.27 wasuseful to differentiate severe COVID disease from mild/moderateCOVID disease with 79% specificity.

Efficacy of WBC and Platelet Parameters in Predicting Survival in Patients with COVID-19 Infection

Introduction: Coronavirus disease 2019 (COVID-19) is an infectioncaused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). Since there is activation of both inflammatory and thrombotic pathways in this disease, indices derived from routinelymeasured blood parameters, whose role is established in severe sepsis,are being evaluated worldwide as potential prognostic markers.Aims &Objectives: In this study we aimed to evaluate the role ofAbsolute Neutrophil count (ANC), Absolute Lymphocyte Count(ALC), Mean platelet volume (MPV), platelet distribution width(PDW), Plateletcrit (PCT), Platelet-large cell ratio(P-LCR), Neutrophil Platelet ratio (NPR) and Platelet Lymphocyte ratio (PLR) inpredicting survival amongst patients admitted with COVID-19infection.Materials &Methods: We conducted a retrospective chart review ofall moderate to severely ill adult patients admitted with COVID-19pneumonia admitted at All India Institute of Medical Sciences,Bhopal, a tertiary care hospital in Central India from April 2020-November 2020. Information about their demography, clinical features, laboratory investigations and in-hospital survival were collectedfrom charts.Result: The study included 1331 patients, out of these 1181 weresurvivors (389 females;792 males) and 150 were non survivors (35females;115 males). Amongst the various parameters studied ANC,NPR and PCT were found to be significantly lower amongst thesurvivors as compared to the non survivors whereas ALC was significantly higher amongst the survivors.Conclusions: The results of the current study showed that ANC,ALC, NPR and PCT can be used as useful cost-effective prognosticmarkers in patients with COVID-19 infection.

Profile of platelet parameters in coronavirus disease – Positive cases — An observational study

Background: Coronavirus disease affects mainly the respiratory system. Other systems, including blood, are also affected. Blood cell abnormalities have varied between studies. The majority of patients present with platelet abnormalities. Methods: This was a laboratory observation study. All cases positive for the coronavirus disease 2019 (COVID-19) by reverse transcriptase — polymerase chain reaction (RT-PCR) test during the study period were considered for inclusion. Platelet index data were captured from an automated hematology analyzer: platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet–large cell ratio (P-LCR). Platelet lymphocyte ratio (PLR), platelet neutrophil ratio (PNR), and platelet monocyte ratio (PMR) were calculated. The cases were classified into two groups: moderate and severe. The difference in alteration of platelet parameters between moderate and severe COVID-19 cases was analyzed using SPSS 22 version software. A p-value of < 0.05 was considered statistically significant. Results: Most cases (44.9%) were in the age group of 41 – 60 years. The male-to-female ratio was 1.9:1. Moderate cases comprised 53.4%, and 46.6% of cases were severe. The association of PLR and PNR between moderate and severe cases was statistically significant. PLR was higher in severe cases than moderate cases, whereas PNR was higher in moderate cases than severe cases. Conclusions: Studying platelet index profiles in COVID-19 patients can improve our limited knowledge of the disease progression regarding platelet parameters. PLR and PNR are the more reliable platelet parameters in managing COVID-19 patients, which help predict the prognosis and aid in improving therapeutic options for severe cases.

Significance of MPV, RDW and PDW with the Severity and Mortality of COVID-19 and Effects of Acetylsalicylic Acid Use.

We aimed to investigate association between mean platelet volume (MVP), platelet distribution width (PDW) and red cell distribution width (RDW) and mortality in patients with COVID-19 and find out in which patients the use of acetylsalicylic acid (ASA) affects the prognosis due to the effect of MPV on thromboxan A2. A total of 5142 patients were divided into those followed in the intensive care unit (ICU) and those followed in the ward. Patient medical records were examined retrospectively. ROC analysis showed that the area under curve (AUC) values were 0.714, 0.750, 0.843 for MPV, RDW and D-Dimer, the cutoff value was 10.45fl, 43.65fl, 500.2 ng/mL respectively. (all P < .001). Survival analysis showed that patients with MPV >10.45 f/l and D-Dimer >500.2 ng/mL, treatment with ASA had lower in-hospital and 180-day mortality than patients without ASA in ICU patients (HR = 0.773; 95% CI = 0.595-0.992; P = .048, HR = 0.763; 95% CI = 0.590-0.987; P = .036). Administration of low-dose ASA in addition to anti-coagulant according to MPV and D-dimer levels reduces mortality.

Dynamics of COVID-19 Lockdown on Blood Indices and Its Impact on Individuals' Immunological Health Status: A Cohort Study in Madinah, Saudi Arabia.

OBJECTIVE: The complete blood count (CBC) is an essential blood test that has been used for decades to assess individuals' overall health status. This study aimed to investigate the contributions of lockdown conditions to individuals' overall health status using blood indices as biological markers. During lockdown, people are limited to confined spaces, have access to limited nutritional supply options, experience increased stress, and are exposed to other environmental factors. METHODS: Our study's target population included all outpatients who were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative and requested CBC assessments as part of their routine health checks. A total of 2414 CBC results were included, covering a period from February 2019 to December 2020. The average of different blood indices during the COVID-19 lockdown was compared to the 10-month period preceding the lockdown. RESULTS: The average counts of RBCs, hemoglobin, and hematocrit showed a significant increase during the lockdown period, which lasted from May 2020 to September 2020. Reductions were observed for the RBC distribution width, total white blood cell count, platelets, and platelet distribution width. CONCLUSION: Our findings suggested that the overall health status of individuals improved during the lockdown period in the short term, but health status might be adversely affected under these conditions of a longer period. Both RDW and PDW could be used as indicators for the overall health status when assessed against other blood indices.

Artificial intelligence in clinical care amidst COVID-19 pandemic: A systematic review.

The worldwide health crisis caused by the SARS-Cov-2 virus has resulted in>3 million deaths so far. Improving early screening, diagnosis and prognosis of the disease are critical steps in assisting healthcare professionals to save lives during this pandemic. Since WHO declared the COVID-19 outbreak as a pandemic, several studies have been conducted using Artificial Intelligence techniques to optimize these steps on clinical settings in terms of quality, accuracy and most importantly time. The objective of this study is to conduct a systematic literature review on published and preprint reports of Artificial Intelligence models developed and validated for screening, diagnosis and prognosis of the coronavirus disease 2019. We included 101 studies, published from January 1st, 2020 to December 30th, 2020, that developed AI prediction models which can be applied in the clinical setting. We identified in total 14 models for screening, 38 diagnostic models for detecting COVID-19 and 50 prognostic models for predicting ICU need, ventilator need, mortality risk, severity assessment or hospital length stay. Moreover, 43 studies were based on medical imaging and 58 studies on the use of clinical parameters, laboratory results or demographic features. Several heterogeneous predictors derived from multimodal data were identified. Analysis of these multimodal data, captured from various sources, in terms of prominence for each category of the included studies, was performed. Finally, Risk of Bias (RoB) analysis was also conducted to examine the applicability of the included studies in the clinical setting and assist healthcare providers, guideline developers, and policymakers.

Prognosis of COVID-19: Red Cell Distribution Width, Platelet Distribution Width, and C-Reactive Protein.

Introduction Cytokine storm is central in the pathobiology of Coronavirus disease 2019 (COVID-19). The pro-inflammatory state and hypoxia disrupt erythropoiesis leading to alterations in red cell distribution width (RDW) and hematocrit. Platelet production increases alongside its destruction, inviting newly formed immature platelets into the circulation. Thus, the platelet distribution width (PDW) and mean platelet volume (MPV) are also affected. The study's objective is to analyze these indices and C-reactive protein (CRP) to elucidate prognostic insights in COVID-19 patients at the time of admission. Methodology This study was a retrospective cross-sectional study conducted at Chigateri General Hospital, attached to JJM Medical College, Davangere, over two months, July and August of 2020. Patients falling under categories B and C according to the interim guidelines issued by the Ministry of Health and Family Welfare, Government of India were enrolled in this study. Patients requiring mechanical ventilation and those with a prior diagnosis of malignancy were excepted from the study. Results The study population comprised a total of hundred patients. Seventy-five patients survived the disease and were discharged; twenty-five patients succumbed to the viral illness. The mean age of survivors (43.0 +/- 13.6 years) was significantly lesser than that of non-survivors (59.1 +/- 11.5 years) (p <0.001). RDW was significantly different among survivors (p=0.002); PDW and CRP were lower among the deceased (p=0.05 and p=0.10, respectively). Cut off values for RDW as 15%, CRP as 67 mg/l, and PDW as 17% were significantly associated with mortality. Hematocrit and MPV were not significantly associated with mortality. RDW has a sensitivity of 92% and a negative predictive value of 95% in predicting mortality. Discussion RDW showed a significant association with increased mortality. Impaired cell-mediated immunity at the onset of infection is responsible for rapid progression to moderate or even severe COVID disease. Since the investigations in our study were ordered at the time of admission, it may lead us to believe that higher RDW is associated with a better patient outcome. Lower C-reactive protein levels are associated with higher mortality. CRP is a non-specific marker for inflammation. Raised CRP is customarily an indicator of acute inflammation. Notwithstanding, the raised CRP may be an indicator of baseline immune response in early COVID infection. High PDW shows a significant association with increased mortality. The pathobiology of change in platelet indices in COVID-19 patients is presumably multifactorial: infection of the bone marrow; autoimmune platelet destruction; platelet sequestration.  Conclusion Red cell distribution width, platelet distribution width, and C-reactive protein are useful early predictive markers of mortality in COVID-19. Although serial investigations would provide a better picture, these indices at admission can gauge the clinical outcome early in the disease. As there is still a lot to be understood about the natural history of COVID-19, our study aims to propose relatively inexpensive indices of mortality that can aid efficient management.