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Background: COVID-19 has caused a considerable number of hospital admissions in China since December 2019. Many COVID-19 patients experience signs of acute respiratory distress syndrome, and some are even in danger of dying. Background: to measure the serum levels of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin in patients hospitalized with severe COVID-19 in Baghdad, Iraq. And to determine the cut-off values (critical values) of these markers for the distinction between the severe patients diagnosed with COVID-19 and the controls. Materials and methods: In this case-control study, we collect blood from 89 subjects, 45 were severe patients hospitalized in many Baghdad medical centers who were diagnosed with COVID-19 infection, and 44 were apparently healthy subjects as a control. The time of collection is from September 15 th to December 31 th, 2021. The optimal cut-off points (critical values) and prognostic relevance of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin were investigated using (ROC) curves analysis. Results: In severe patients hospitalized with COVID-19 the levels of D-dimer, NLR, and neopterin were statistically significantly higher than in control participants (P < 0.005). The D-dimer, NLR, and neopterin tests have areas under the receiver operating characteristic (ROC) curves of 0.920, 0.90, and 0.74 respectively, and their critical values for the differentiation between the severe patients and control were 0.22 micro g/ml, 2.56, and 3.02 nmol/L. Conclusions: D-dimer, NLR, and neopterin levels in sever COVID-19 patients were higher than control, with values of greater than 0.22 micro g/ml, 2.56 and 3.02 nmol/L respectively was linked to a severe COVID-19 infection with good sensitivity and selectivity.
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Introduction: Coronavirus infection is a disease that causes respiratory failure and complications in certain groups of people, leading to death. The factors associated with the severe course of COVID-19 have been fairly well studied by now;at the present stage, it is necessary to search for and study them in separate groups of people that differ in age, gender, ethnicity, the presence of background diseases, etc. to develop more personalized approaches to severe disease prevention. Background: To conduct a comparative analysis of the factors associated with the severe course of COVID-19 in people under and over 60 years of age and evaluate their prognostic significance in combination of factors. Materials and methods: A retrospective analysis of the clinical and laboratory parameters of 812 COVID-19 patients was carried out. Multiple logistic regression analysis was used to identify factors associated with the development of severe COVID-19. ROC analysis was performed to assess the prognostic significance of the set of identified statistically significant factors in the development of a severe course of COVID-19. Results: Multivariate logistic regression analysis showed that patients under 60 diabetes mellitus (OR=2,561, p=0,048), lymphopenia (OR=2,133, p=0,030), and pneumonia at admission (OR=2,556, p=0,011), rapid breathing (OR=3,497, p=0,001), low saturation (OR=4,076, p=0,006) were significantly associated with the development of severe COVID-19. At the same time, in patients older than 60 years, the presence of diabetes mellitus (OR=1,899, p=0,029), rapid breathing (OR=2,338, p=0,007) and low saturation (OR=4,248, p < 0,0001) were significantly associated with the development of a severe course of COVID-19. In groups under 60 and over 60 years of age, the prognostic value of the combination of all statistically significant factors corresponding to the groups was equal to the average level (AUC=0,760 and AUC=0,709, respectively) Conclusion: Factors associated with the development of a severe course of COVID-19 in elderly and middle-aged people have some differences related to the pathogenesis of the disease. For individuals under 60 years of age, factors associated with severe COVID-19 are diabetes mellitus, the presence of pneumonia on admission, dyspnea, low oxygen saturation, and lymphopenia. For individuals over 60 years of age, factors associated with severe COVID-19 are the presence of diabetes mellitus, shortness of breath, and low saturation. The combination of all the studied factors significantly increases the risk of developing a severe course of COVID-19 in both age groups.
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Background: COVID-19 develops severe inflammatory responses that can lead to death. It is essential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to-C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. Methods: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. Results: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR < 100 and mortality (HR 6.2;95% CI 1.6 to 23.5;p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. Conclusion: LPCR < 100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.
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Introduction: the daily increase in cases and deaths, the economic losses in the millions suffered by affected nations and the consequent strain on the human resources involved in reversing this situation have made the COVID-19 pandemic an unprecedented international challenge. Background: to describe the orchestrated immune response following SARS-CoV-2 infection. Methods: an up-to-date bibliometric study was conducted on the type of articles stated in the objective, using a total of 30 bibliographies. Documentary review and analysis-synthesis methods were used to prepare the final report. Resources available on the Infomed network were used to select the information, specifically: PubMed and SciELO, through the databases: Medline, Search Premier and Scopus. Development: the core elements in the immunopathology of COVID-19 involve innate immunity, with the sustained increase of pro-inflammatory interleukins associated with failures in the interferon system, which can trigger a potentially fatal cytokine storm. In terms of elements linked to adaptive immunity, there is evidence of marked lymphopenia which, depending on the degree, may indicate the severity of the disease. Conclusions: understanding the orchestrated immune response following SARS-CoV-2 infection and its temporal sequence allows us to choose timely and effective therapies, specifically when selecting anti-inflammatory drugs and the time of their application, as it is difficult to determine when they will be clearly beneficial, that they do not impair the response and that it is not too late, given the irreversibility of the process.
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As is shown in previous reports, arginine vasopressin (AVP), as one of the most important hormones within circulation in human beings, is of great clinically significance given that it could maintain the body fluid balance and vascular tone. However, the laboratory measurements AVP in daily clinical practice are shown to be difficult and with low accuracy. Concerning on this notion, it is unpractical to use the serum levels of AVP in diagnosing multiple diseases. On the other hand, another key serum biomarker, copeptin, is confirmed as the C-terminal of the AVP precursor which could be released in equal amounts with AVP, resultantly making it as a sensitive marker of arginine vasopressin release. Notably, emerging recent evidence has demonstrated the critical function of copeptin as a clinical indicator, especially in the diagnosis and prognosis of several diseases in diverse organs, such as cardiovascular disease, kidney disease, and pulmonary disease. In addition, copeptin was recently verified to play an important role in diagnosing multiple acute diseases when combined it with other gold standard serum biomarkers, indicating that copeptin could be recognized as a vital disease marker. Herein, in the current review, the functions of copeptin as a new predictive diagnostic and prognostic biomarker of various diseases, according to the most recent studies, are well summarized. Furthermore, the importance of using copeptin as a serum biomarker in diverse medical departments and the impact of this on improving healthcare service is also summarized in the current review.
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Arginine Vasopressin , Glycopeptides , Humans , Prognosis , BiomarkersABSTRACT
OBJECTIVES: To compare the values of the hematological and inflammatory markers in 1st and 4th waves to predict the outcome of COVID-19 in a hospital-based study. METHODOLOGY: This comparative study was conducted in the Department of Hematology, Hayatabad Medical Complex Peshawar, from April 2020 to 20 August 2021. Tests of significance (Independent t-test/Mann Whitney U test) and Chi-square test were used. Relevant information was recorded on a pre-designed proforma prepared following the study's objectives. RESULTS: A total of 178 patients, 71 from (the 1st wave) and 107 from (the 4th wave) with known outcomes, were studied. A statistically significant difference exists between the groups (1st vs 4th wave) regarding hematological markers;neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001). Similarly, significantly higher inflammatory markers values were recorded in the 1st wave compared with the 4th wave regarding inflammatory markers;CRP (p=0.002) and D-dimer (p=0.001). During the 1st wave, Total Leukocyte Count (TLC), ANC and d-dimer were the leading prognostic indicators to predict mortality/worst outcome in COVID-19 with an Area Under Curve (AUC) of 0.74, 0.70 and 0.7 on receiver operating characteristics (ROC) respectively. In 4th, the Area under the curve (AUC) of d-dimer was 0.84 to predict mortality. CONCLUSION: TLC, ANC, NLR, and low platelet count were the worst hematological markers in COVID-19 in the first wave, while d-dimer and CRP were the primary prognostic inflammatory markers. Unlikely in the 4th wave, the prognostic values of hematological markers were merely significant. The d-dimer values in both the waves proved to be reliable for predicting the severity and mortality of COVID-19.
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Sepsis is a global health problem, annually over 45 million patients are diagnosed and over 11 million deaths are recorded. Activation of monocytes in sepsis by the pathogen agent or hypoxia brings about functional, morphological and phenotypic changes in these cells. Monocyte Distribution Width (MDW) is a new biomarker, defined as a measure of monocyte size heterogeneity and has been approved by the Food and Drug Administration for the early diagnosis of sepsis in the adult patient in the emergency department. In intensive care services, this biomarker can be used as a prognostic index in the follow-up of patients with sepsis. The indicator is a measure of the increased morphological variability of monocytes in response to infections, regardless of bacterial, viral or fungal etiology. This new marker also has increased values in the infection with COVID-19 and correlates positively with the severity of the disease.
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BACKGROUND: Since its reporting in December 2019, SARC-COV-2 (COVID -19) has infected more than 230 million people over the world by colonising the respiratory tract, however very little is known about its effect on liver and how the liver injury affects disease prognosis. This study was done to assess the hepatic profile in SARC-COV-2 infection along with inflammatory markers. METHODS: This is a single centred prospective observational study. 400 patients with real time polymerase chain reaction (PCR) confirmed COVID 19 infection admitted in KIMS, Hubballi were taken for study. Patients with decompensated liver disease were excluded from the study. Clinical examination and laboratory investigations including liver function test (LFT), renal function test (RFT), complete blood count (CBC), chest X-ray, D-dimer, ferritin, lactate dehydrogenase (LDH), C reactive protein (CRP) was done for all the patients. RESULTS: Out of the 400 covid-19 positive patients admitted, 286 (71.5%) had abnormal liver enzymes. Significantly raised liver enzymes were seen in males. Raised liver enzymes and inflammatory markers were associated with poor outcome of the disease. Significant reduced albumin was associated with poor outcome of the disease. Significantly raised aspartate transaminase (AST), alanine transaminase (ALT) levels were associated with increased severity of the disease. (P = 0.009 and 0.029 respectively). Significant positive relation was found between liver profile and inflammatory markers. CONCLUSIONS: Majority of patients admitted with SARS-CoV-2 had deranged liver profile. Higher proportion of abnormal liver enzymes were seen in males. Degree of liver injury increases with increasing severity of the disease. Even though abnormal liver enzymes were positively associated with elevated inflammatory markers and severity of the disease, more studies are needed to study implications of liver injury in prognosis of SARS-CoV-2 infection.
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Background and purpose: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by severe respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide emergency. Various studies show conflicting and diverse results on the role of inflammatory cytokines in predicting the severity and prognosis in patients with COVID-19. The aim of this study was to compare the serum levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in predicting the severity of COVID-19 and prognosis in patients admitted to Qaemshahr Razi Hospital. Materials and methods: In this cross-sectional prospective study, the serum levels of interleukin 8 and 6 were measured in 51 patients with COVID-19 and compared with 25 healthy individuals in Qaemshahr Razi Hospital, 2021. ELISA method was used to measure these cytokines and data analysis was performed in SPSS V25. Results: The serum levels of IL6 and IL8 in the patient group were about 4 times and 6 times higher than those of the control group, respectively. Average levels of IL-6 (P=0.004) and IL-8 (P<0.001) were significantly higher in patients with severe COVID-19 compared to moderate form and control group. There was no correlation between the duration of hospitalization and the level of IL-6 (P=0.1), while there was a significant correlation between the length of hospital stay and the level of IL-8 (P=0.012). Conclusion: IL-6 and IL-8 serum levels in patients with COVID-19 can be helpful in predicting the severity of disease and prognosis of patients.
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Angiotensin II levels in COVID-19 are controversial. We studied 12 hospitalized patients, including their baseline levels of peripheral lymphocyte subsets (via flow cytometry) and plasma angiotensin II (via radioimmunoassay). Controls comprised radioimmunoassay's 124 healthy subjects. Angiotensin II levels (pg/ml) were elevated among patients versus controls (Mean +or- standard deviation: 98.8 +or- 146.9 versus 23.7 +or- 15.6, p < 0.0001;Median, interquartile range: 27, 20 to 116 versus 22, 14 to 28). Half the patients had lymphocytopenia (< 1000 cells/mm3), and the CD3+/CD4+ counts were negatively associated with body mass index, viral load, hospital stay and non-home discharge. Angiotensin II imbalance appears to be a biomarker for COVID-19 morbidity and merits further investigation.
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Background: Single nucleotide polymorphisms provide information on individuals' potential reactions to environmental factors, infections, diseases, as well as various therapies. A study on SNPs that influence SARS-CoV-2 susceptibility and severity may provide a predictive tool for COVID-19 outcomes and improve the customized coronavirus treatment. Aim: To evaluate the role of human leukocyte antigens DP/DQ and IFNλ4 polymorphisms on COVID-19 outcomes among Egyptian patients. Participants and Methods: The study involved 80 patients with severe COVID-19, 80 patients with mild COVID-19, and 80 non-infected healthy volunteers. Genotyping and allelic discrimination of HLA-DPrs3077 (G/A), HLA-DQrs7453920 (A/G), and IFNλ4 rs73555604 (C/T) SNPs were performed using real-time PCR. Results: Ages were 47.9 ± 8, 44.1 ± 12.1, and 45.8 ± 10 years in severe, mild and non-infected persons. There was a statistically significant association between severe COVID-19 and male gender (p = 0.002). A statistically significant increase in the frequency of HLA-DPrs3077G, HLA-DQrs7453920A, and IFNλ4rs73555604C alleles among severe COVID-19 patients when compared with other groups (p < 0.001). Coexistence of these alleles in the same individual increases the susceptibility to severe COVID-19 by many folds (p < 0.001). Univariate and multivariate logistic regression analysis for the studied parameters showed that old age, male gender, non-vaccination, HLA-DQ rs7453920AG+AA, HLA-DPrs3077GA+GG, and IFNλ4rs73555604CT+CC genotypes are independent risk factors for severe COVID-19 among Egyptian patients. Conclusion: HLA-DQ rs7453920A, HLA-DPrs3077G, and IFNλ4rs73555604C alleles could be used as markers of COVID-19 severity.
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COVID-19 , HLA-DP Antigens , HLA-DQ Antigens , Interleukins , Humans , Male , Alleles , Case-Control Studies , COVID-19/genetics , Genetic Predisposition to Disease , Genotype , HLA-DP Antigens/genetics , HLA-DQ Antigens/genetics , Polymorphism, Single Nucleotide/genetics , SARS-CoV-2 , Interleukins/geneticsABSTRACT
On March 11. 2020, the World Health Organization declared the coronavirus disease-2019 (COVID-19) outbreak a pandemic. The surge in the number of infected patients has strained healthcare systems globally. The insufficient number of hospital and intensive care unit (ICU) beds has caused a serious problem in patient care and follow-up worldwide. We determined patients who were admitted to the emergency department and hospitalized with a preliminary diagnosis of COVID-19 between March 11, 2020 and November 15, 2020. We recorded all subjects' admission vital signs, anamnesis, physical examination notes, laboratory tests and notes describing the hospital stay from the hospital information system. Patients discharged without requiring ICU admission were included in the good clinical prognosis (GCP) group. Patients who were admitted to the ICU or died in hospital were included in the poor clinical prognosis (PCP) group. When hematological and biochemical parameters were compared, white cell, neutrophil, platelet counts, glucose, urea, creatinine and bilirubin levels were significantly higher and lymphocyte count, hemoglobin, hematocrit, sodium and chlorine levels were lower in the PCP group. Moreover, sedimentation, C Reactive Protein (CRP), ferritin, High Sensitive Troponin I, D-dimer and lactate levels were significantly higher among patients with a poor prognosis. We assessed and identified the more important potential early indicators of prognosis mentioned in the literature that are applicable in the emergency setting. In light of this information, we aimed to establish a basis for the development of future scoring systems. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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Many studies have identified predictors of outcomes for inpatients with coronavirus disease 2019 (COVID-19), especially in intensive care units. However, most retrospective studies applied regression methods to evaluate the risk of death or worsening health. Recently, new studies have based their conclusions on retrospective studies by applying machine learning methods. This study applied a machine learning method based on decision tree methods to define predictors of outcomes in an internal medicine unit with a prospective study design. The main result was that the first variable to evaluate prediction was the international normalized ratio, a measure related to prothrombin time, followed by immunoglobulin M response. The model allowed the threshold determination for each continuous blood or haematological parameter and drew a path toward the outcome. The model's performance (accuracy, 75.93%; sensitivity, 99.61%; and specificity, 23.43%) was validated with a k-fold repeated cross-validation. The results suggest that a machine learning approach could help clinicians to obtain information that could be useful as an alert for disease progression in patients with COVID-19. Further research should explore the acceptability of these results to physicians in current practice and analyze the impact of machine learning-guided decisions on patient outcomes.
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COVID-19 , Humans , Inpatients , Retrospective Studies , Prospective Studies , Decision Trees , Immunoglobulin MABSTRACT
The exceptional conditions sweeping the world due to the Corona virus epidemic have prompted researchers to race to study each of the symptoms, phenomena and relevant clinical biochemical parameters to provide science and scientists with valuable information to achieve victory over the virus. The aim of this investigation is to study the early inflammatory features caused by the immune system before a cell storm occurs in Iraqi Corona patients. The investigation was conducted at Yarmouk Teaching Hospital, Baghdad, Iraq, during the period from January 2021 until the end of March 2021. Our team obtained five milliliters of venous blood from 50 participants newly diagnosed with the Coronavirus (24 males and 26 females). Their ages ranged between (25-55) years compared to 38 individuals (18 males and 20 females). Corona virus patients had statistically significant higher (P<0.01) with Low density lipoproteins-cholesterol (LDL-C), urea, C-Reactive Protein (CRP), and (P<0.001) with D-dimer when they were compared with control group. There was a significant increase in the value of Interleukin-6(IL-6) in people infected with the virus compared to the reviewers whose swab results showed that they were not infected with the virus. For both interferon-? (IFN) and Tumor necrosis factor -a (TNF- a), the data showed a significant decrease in morale of reviewers diagnosed with acute respiratory syndrome (COVID-19) against their non-infected peers. These data indicate that early intervention for IFN antiviral infection could be fundamental in inhibiting fibrosis to improve functional recovery. Any source of cytokine control, such as interferon-? and Tumor necrosis factor -a combined with combination therapies for clinical treatment, will be important in the future for COVID-19 infection.
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Background: Invasive mechanical ventilation as a therapeutic strategy is not without complications. It is imperative to have protective ventilation parameters in those patients who are subjected to it. We aim to demonstrate whether mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with prolonged invasive mechanical ventilation. Material and Methods: An analytical cross-sectional study was carried out of critically ill patients on prolonged invasive mechanical ventilation due to Acute Respiratory Distress Syndrome due to COVID-19 who were admitted to the Intensive Care Unit of the Hospital Regional de Trujillo during the March 2020 to March 2021 period.
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Background: Coronavirus disease 2019 (COVID-19) can infect the human respiratory system and causes 6.93% of all deaths in East Java Province. Comorbid diabetes mellitus and hypertension can exacerbate COVID-19 patients. Purpose: This study aims to analyze the relationship between diabetes mellitus and hypertension with mortality in COVID-19 Patients in Lamongan District.
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Background: In general, the entire population is vulnerable to COVID-19, but epidemiological research shows that the elderly and people with comorbid are more susceptible to COVID-19 and has a high risk of experiencing poor outcomes and death if infected with COVID-19. Purpose: This study aims to identify comorbidities with a high risk of death common among COVID-19 patients in China and the United States to provide learning for Indonesia in COVID-19 management.
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The major causes of death of patients with COVID-19 include metabolic acidosis, septic shock, pulmonary edema, multiple organ failure and deep venous thrombosis. These systemic manifestations are associated with severe pathological damages of vital organs like lung and kidney that are caused by inflammatory storms. The occurrence, development and deterioration of disease is closely associated with the immune imbalance mechanisms such as disorder of lymphocyte subsets and emergence of cytokine storm. The cellular immunity plays a vital role. The expression levels of some blood inflammatory factors of the severe COVID-19 patients are remarkably elevated, IL-6 is a typical proinflammatory factor that causes the cytokine storm, which can be used for prediction of prognosis. IL-6 blockade may be an effective method to block the cytokine storm.
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Objectives: To investigate the epidemiological characteristics of pathogens and changes in inflammatory factors in patients with sepsis in the Xinjiang area and to analyze factors influencing the prognosis for patients with sepsis.
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Introduction: Abnormal laboratory parameters can be detected in severe patients with COVID-19, which are associated with adverse outcomes. Increased lactate dehydrogenase (LDH) is usually associated with tissue damage. Cardiovascular disease is a common comorbidity in COVID-19 disease. In the current report, the objective was to examine the relationship between LDH levels and atrial fibrillation (AF) in COVID-19 patients. Materials and Methods: This investigation involved a retrospective and cross-sectional study. A total of 195 consecutive COVID-19 [45 AF (+) and 150 AF (-)] subjects were enrolled in the study. COVID-19 cases were determined from analysis of an oropharyngeal/nasopharyngeal swab using RT-PCR. LDH, procalcitonin, and D-dimer were recorded from the hospital records.