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Objectives: It is important to predict the prognosis during hospital admission of Covid-19 patients. The purpose of this study was to see how CRP/ Albumin (CAR) and Platelet/Lymphocyte (PLR) ratios, obtained from patients in the intensive care unit (ICU) within the first 24 hours of their hospitalization with a Covid-19 diagnosis, predictmortality and how they correlated with acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA). Method(s): Using hospital records, records of 83 patients hospitalized in the ICU with a diagnosis of Covid-19 between 11.03.2020 and 01.01.2021 were retrospectively analyzed . Patients were divided into two groups discharged (Group I) and exits (ex) group (Group II). CAR and PLR were recorded during the first 24 hours of ICU admission, and APACHE II and SOFA scores were computed. The calculated CAR and PLR were correlated with APACHE II and SOFA scores and their association with mortality was investigated. Result(s): SOFA, APACHE II, PLO, and age were higher, and albumin was lower in patients in the mortal course (p<0.05). ROC analysis revealed that APACHE II and SOFA scores could be employed to estimate mortality. Conclusion(s): We believe that APACHE II and SOFA scores can be used to predict mortality in patients admitted to the ICU due to Covid-19, whereas CRP/Albumin and Platelet/Lymphocyte ratios cannot. Copyright © 2023 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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BACKGROUND: Hepatopancreatobiliary (HPB) cancer incidence and mortality are increasing worldwide. An initial diagnostic predictor is needed for recommending further diagnostic modalities, referral, and curative or palliative decisions. There were no studies conducted in area with limited accessibility setting of the COVID-19 pandemic, coupled with limited human resources and facilities. AIM: We aimed to investigate the advantages of total bilirubin for predicting malignant obstructive jaundice, a combination of the pandemic era and limited resources settings. METHOD(S): Data from all cholestasis jaundice patients at M. Djamil Hospital in Pandemic COVID-19 period from July 2020 to May 2022 were retrospectively collected. The data included demographics, bilirubin fraction results, and final diagnosis. Bivariate analysis for obtain demographic risk factor, and Receiver Operating Characteristics (ROC) analysis for getting bilirubin value. RESULT(S): Of a total 132 patients included, 35.6% were malignant obstructive jaundice, and Pancreatic adeno ca was the most malignant etiology (34.4%). Bivariate analysis showed a significant correlation between age and malignant etiology (p = 0,024). Direct and total Bilirubin reach the same level of Area Under Curve (AUC). Total bilirubin at the cutoff point level of 10.7 mg/dl had the most optimal results on all elements of ROC output, AUC 0.88, sensitivity 76.6%, specificity 90.1%, +LR 8.14, and-LR 0.26. CONCLUSION(S): The bilirubin fraction is a good initial indicator for differentiating benign and malignant etiology (AUC 0.8-0.9) in pandemic era and resource-limited areas to improve diagnostic effectiveness and reduce referral duration.Copyright © 2023 Avit Suchitra, M. Iqbal Rivai, Juni Mitra, Irwan Abdul Rachman, Rini Suswita, Rizqy Tansa.
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Introduction: Acute appendicitis is the most common cause of acute abdominal pain as well as one of the most frequently performed procedures in general surgery. Different prognostic laboratory markers have been studied to identify patients with complicated appendicitis and it is unknown whether the level of procalcitonin in adults could be used as a predictive marker. From a cut-off point, Does procalcitonin have predictive value for complicated appendicitis? Methods: Prospective, observational study. Patients from the Civil Hospital of Guadalajara with a diagnosis of Appendicitis, presurgical laboratory studies and Procalcitonin, and undergo appendectomy in this institution. A calculated sample was obtained based on the surgeries performed annually. Result(s): 80 appendicectomies were performed in the 12-month period (2021;COVID pandemic) obtaining: 37 patients with uncomplicated appendicitis (Phase I and II) 43 patients with complicated appendicitis (Phase III and IV) The procalcitonin levels of both groups were analyzed to demonstrate differences between them, Mann-Whitney U test gives us as a result a p value <0.05. For the cut-off point at the most suitable procalcitonin level for this sample we decided to use the Yauden index method in the analysis of the ROC curve: it is observed that the cut-off point with a sensitivity of 72.1% and a specificity of 81.1% for the sample is 0.305. Conclusion(s): Procalcitonin has been shown to be a useful marker for discriminating the severity of appendicitis and that the best cutoff point for this sample is 0.3 ng/dl.
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The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).Mortality attributable to COVID-19 remains considerably high, with case fatality rates as high as 8-11%. Early medical intervention in patients who are seriously and critically ill with COVID-19 reduces fatal outcomes. Thus, there is an urgent need to identify biomarkers that could help clinicians determine which patients with SARS-CoV-2 infection are at a higher risk of developing the most adverse outcomes, which include intensive care unit (ICU) admission, invasive ventilation, and death. In COVID-19 patients experiencing the most severe form of the disease, tests of liver function are frequently abnormal and liver enzymes are found to be elevated. For this reason, we examine the most promising liver biomarkers for COVID-19 prognosis in an effort to help clinicians predict the risk of ARDS, ICU admission, and death at hospital admission. In patients meeting hospitalization criteria for COVID-19, serum albumin < 36 g/L is an independent risk factor for ICU admission, with an AUC of 0.989, whereas lactate dehydrogenase (LDH) values > 365 U/L accurately predict death with an AUC of 0.943.The clinical scores COVID-GRAM and SOFA that include measures of liver function such as albumin, LDH, and total bilirubin are also good predictors of pneumonia development, ICU admission, and death, with AUC values ranging from 0.88 to 0.978.Thus, serum albumin and LDH, together with clinical risk scores such as COVID-GRAM and SOFA, are the most accurate biomarkers in the prognosis of COVID-19.Copyright © 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.
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Background: Easy availability, low cost, and low radiation exposure make chest radiography an ideal modality for coronavirus disease 2019 (COVID-19) detection. Objective(s): In this study, we propose the use of an artificial intelligence (AI) algorithm to automatically detect abnormalities associated with COVID-19 on chest radiographs. We aimed to evaluate the performance of the algorithm against the interpretation of radiologists to assess its utility as a COVID-19 triage tool. Material(s) and Method(s): The study was conducted in collaboration with Kaushalya Medical Trust Foundation Hospital, Thane, Maharashtra, between July and August 2020. We used a collection of public and private datasets to train our AI models. Specificity and sensitivity measures were used to assess the performance of the AI algorithm by comparing AI and radiology predictions using the result of the reverse transcriptase-polymerase chain reaction as reference. We also compared the existing open-source AI algorithms with our method using our private dataset to ascertain the reliability of our algorithm. Result(s): We evaluated 611 scans for semantic and non-semantic features. Our algorithm showed a sensitivity of 77.7% and a specificity of 75.4%. Our AI algorithm performed better than the radiologists who showed a sensitivity of 75.9% and specificity of 75.4%. The open-source model on the same dataset showed a large disparity in performance measures with a specificity of 46.5% and sensitivity of 91.8%, thus confirming the reliability of our approach. Conclusion(s): Our AI algorithm can aid radiologists in confirming the findings of COVID-19 pneumonia on chest radiography and identifying additional abnormalities and can be used as an assistive and complementary first-line COVID-19 triage tool.Copyright © Cancer Research, Statistics, and Treatment.
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Objective. To evaluate a potential of cystatin C blood concentration to predict acute kidney injury (AKI) in patients with severe and extremely severe pneumonia associated with a COVID-19. Materials and methods. An observational prospective study of 117 patients with severe and extremely severe pneumonia associated with a COVID-19 in an ICU setting was conducted in 2020-2022 (site: multifunctional Medical Center, 1586 Military Clinical Hospital of the Ministry of Defense of Russia, Moscow Region, Russia). Routine laboratory tests and instrumental examinations were performed according to generally accepted protocols. Cystatin C concentrations in blood (s-CysC) and urine (u-CysC) were measured by immunoturbidimetric method. Results. AKI was diagnosed in 21 (17.9%) patients, kidney dysfunction without AKI was found in 22 (18.8%) patients with severe and extremely severe pneumonia associated with COVID-19. s-CysC and u-CysC levels in the group of patients with AKI were statistically significantly higher compared to the levels in the group of patients without AKI. The levels of s-CysC obtained within Day 1 - T (-1), and Day 2 - T (-2) prior to AKI onset turned out to be the independent factors for AKI development in patients with severe and extremely severe pneumonia associated with COVID-19: OR 5.37, Wald chi-square 5.534 (CI: 1.324;21.788);P=0.019 and OR 3.225, Wald chi-square 4.121 (CI: 1.041;9.989);P=0.042, respectively. s-CysC T (-2) value is informative, and s- CysC T (-1) is a highly informative predictor of AKI development in severe and extremely severe pneumonia associated with COVID-19: ROC AUC 0.853 (95% CI, 0.74-0.966), P_0.001) with 90% sensitivity and 73% specificity at a cut-off of 1.67 mg/L, and ROC AUC 0.905 (95% CI, 0.837-0.973), P_0.001) with 90% sensitivity and 73% specificity at a cut-off of 1.69 mg/l, respectively. Serum CysC levels started increasing 3 days prior to AKI onset, outpacing the increase of SCr levels. The u-CysC levels were not predictive of AKI development. Impaired renal function probability was increasing with patients' age (P_0.0001). Conclusions. Serum CysC seems to be a statistically significant predictor of AKI. s-CysC levels started increasing 3 days prior to AKI onset, surpassing the increase of SCr levels in patients with severe and extremely severe pneumonia associated with COVID-19. Urine CysC did not achieve statistical significance as a predictor for AKI, although u-CysC concentrations were significantly higher on days 3, 2, 1 prior to AKI onset and on the day of AKI onset in the group of patients with AKI.Copyright © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
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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.
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Objective To investigate the clinical significance of serum interleukin 6 (IL-6) in elderly patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant and its correlation with underlying diseases. Methods A total of 22 elderly patients (80 years old) infected with omicron variant, who were admitted to Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. to Jun. 2022 and tested positive for SARS-CoV-2 RNA, were included. The level of serum IL-6 was measured by flow cytometry, and the level of serum C reactive protein (CRP) was measured by immunonephelometry. Patients were divided into pneumonia group (16 cases) and non-pneumonia group (6 cases) according to the imaging examination results, and were divided into severe group (severe and critical type, 5 cases) and non-severe group (mild and normal type, 17 cases) according to the condition. Binary logistic regression model and receiver operating characteristic (ROC) curve were used to analyze the correlation between serum IL-6 and CRP levels and the severity of the disease and whether it would progress to pneumonia. Meanwhile, the relationships between underlying diseases and serum IL-6 level were explored. Results Among the 22 patients, 6 were mild, 11 were normal, 3 were severe, and 2 were critical. The baseline serum IL-6 level in the pneumonia group was significantly higher than that in the non-pneumonia group (20.16+/-12.36pg/mL vs 5.42+/-1.57 pg/mL, P=0.009), and there was no significant difference in baseline serum CRP level between the 2 groups (P0.05). There were no significant differences in baseline serum IL-6 or CRP levels between the severe group and the non-severe group (both P0.05). Logistic regression analysis showed that the baseline serum IL-6 and CRP might be related to pneumonia after infection with omicron variant (odds ratio OR=2.407, 95% confidence interval CI0.915-6.328;OR=1.030, 95% CI 0.952-1.114). ROC curve analysis showed that the area under curve values of serum IL-6 and CRP in predicting the progression to pneumonia were 0.969 (95% CI 0.900-1.000) and 0.656 (95% CI 0.380-0.932), respectively, with statistical significance (Z=2.154, P=0.030). There were no significant differences in the baseline serum IL-6 level or proportions of severe patients or pneumonia patients among patients with or without hypertension, diabetes mellitus, coronary heart disease, chronic kidney disease or chronic obstructive pulmonary disease (all P0.05). The baseline serum IL-6 levels of the omicron variant infected elderly patients with 1, 2, and 3 or more underlying diseases were 12.50 (9.15, 21.75), 23.55 (9.63, 50.10), and 10.90 (5.20, 18.88) pg/mL, respectively, with no statistical significance (P0.05). Conclusion For omicron variant infected patients, serum IL-6 level is significantly increased in patients with pneumonia manifestations and is correlated with disease progression. Serum IL-6 level is of great guiding significance to judge disease progression and evaluate efficacy and prognosis of elderly coronavirus disease 2019 patients.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Background/Objectives: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease (COVID-19) enters the lung tissue through exocytosis, leading to the release of a large amount of pro-inflammatory cytokines called 'cytokine storm'. The aim was to provide more insight into relationship between plasma cytokines profile and fatal outcome of COVID-19. Method(s): Plasma cytokines (IL-17F,GM-CSF,IFNg,IL-10,CCL20/ MIP3a,IL-12P70,IL-13, IL-15,IL-17A,IL-22,IL-9,IL-1b,IL-33,IL-2,IL-21,IL-4,IL-23,IL-5,IL-6,IL-17E/IL-25,IL-27,IL-31,TNFa,TNFb,IL-28A) were detected in 30 patients with severe COVID-19 by a Luminex assay system with Milliplex Human Th17 Magnetic Premix 25 Plex Kit (HT17MG-14K-PX-25, Merk-Millipore, USA) according to the instructions. Patients were followed up for 30 days since admission to intensive care. 18 patients died and 12 patients survived during the period of observation. The control group comprised 10 individuals who had never been diagnosed with COVID-19. Result(s): IL-10 and CCL20/MIP3a plasma levels were elevated in non-survivors patients with COVID-19 compared to controls (p = 0.0027, p = 0.012, respectively). IL-15, IL-6, IL-27 plasma levels were higher in survivors with COVID-19 compared to controls (p = 0.049, p = 0.026, p = 0.00032, respectively). Interestingly, IL-15, IL-27 plasma levels were increased in non-survivors with COVID-19 compared to controls and survivors with severe COVID-19 (IL-15: p = 0.00098, p = 0.00014, respectively;IL-27: p = 0.011, p < 0.0001, respectively). Receiver operating characteristic (ROC) analysis has been conducted for IL-15 and IL-27. Cut-off value was estimated as 25.50 pg/ml for IL-15 and 1.51 pg/ml for IL-27. Conclusion(s): Our study demonstrated a more pronounced immune response in non-surviving patients with severe COVID-19. IL-15, IL-27 could be considered as a sensitive biomarker of the fatal outcome from COVID-19.
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Background. After the first wave of the new SARS-CoV-2 coronavirus infection, the researchers focused on identifying potential short-and long-term complications of COVID-19, especially in high-risk patients, after prolonged hospitalization and intensive care. Objective. To study the outcomes, adverse effects of severe COVID-19 and their predictors 90 days after hospital discharge in elderly patients with asthma. Material and methods. The study included elderly patients (101 subjects, 42 males and 59 females;median age 74 (67;79) years) with asthma, discharged from the hospital after treatment of severe COVID-19. They were followed up for 90 days after discharge. In the hospital, COVID-19 was confirmed by laboratory tests (polymerase chain reaction method) and/or clinically and radiologically. All patients had a documented history of asthma according to GINA 2020 criteria. Results and discussion. During the 90-day post-hospital follow-up, 86 (85%) patients survived, and 15 (15%) died after discharge. Deaths were reported within 1 to 4 weeks after discharge: 6 subjects died during re-hospitalization, 6 at home, and 3 in a rehabilitation center. The multivariate regression analysis model, adjusted for all statistically significant indicators, and the ROC analysis showed the most significant predictors of 90-day post-hospital mortality and their threshold values. They include the Charlson comorbidity index >=4 points, lung damage according to computed tomography >=30%, the absolute number of eosinophils <=100 cells/muL, and concomitant diabetes mellitus. The analysis showed that 90-day post-hospital mortality depends on combinations of identified risk factors;a combination of two, three, and especially four risk factors statistically significantly is associated with patients' lower average survival time. Conclusion. The key risk factors for 90-day post-hospital mortality in elderly patients with asthma after severe COVID-19 include the Charlson comorbidity index, lung damage >=30% according to computed tomography, the absolute number of eosinophils <=100 cells/muL, and concomitant diabetes mellitus. The 90-day post-hospital survival rate is correlated with the number of risk factors identified in patients. The effect of asthma severity on 90-day post-hospital mortality in elderly patients was not observed.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Objective To investigate the clinical significance of serum interleukin 6 (IL-6) in elderly patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant and its correlation with underlying diseases. Methods A total of 22 elderly patients (>80 years old) infected with omicron variant, who were admitted to Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. to Jun. 2022 and tested positive for SARS-CoV-2 RNA, were included. The level of serum IL-6 was measured by flow cytometry, and the level of serum C reactive protein (CRP) was measured by immunonephelometry. Patients were divided into pneumonia group (16 cases) and non-pneumonia group (6 cases) according to the imaging examination results, and were divided into severe group (severe and critical type, 5 cases) and non-severe group (mild and normal type, 17 cases) according to the condition. Binary logistic regression model and receiver operating characteristic (ROC) curve were used to analyze the correlation between serum IL-6 and CRP levels and the severity of the disease and whether it would progress to pneumonia. Meanwhile, the relationships between underlying diseases and serum IL-6 level were explored. Results Among the 22 patients, 6 were mild, 11 were normal, 3 were severe, and 2 were critical. The baseline serum IL-6 level in the pneumonia group was significantly higher than that in the non-pneumonia group ([20.16+/-12.36]pg/mL vs [5.42+/-1.57] pg/mL, P=0.009), and there was no significant difference in baseline serum CRP level between the 2 groups (P>0.05). There were no significant differences in baseline serum IL-6 or CRP levels between the severe group and the non-severe group (both P>0.05). Logistic regression analysis showed that the baseline serum IL-6 and CRP might be related to pneumonia after infection with omicron variant (odds ratio [OR]=2.407, 95% confidence interval [CI]0.915-6.328;OR=1.030, 95% CI 0.952-1.114). ROC curve analysis showed that the area under curve values of serum IL-6 and CRP in predicting the progression to pneumonia were 0.969 (95% CI 0.900-1.000) and 0.656 (95% CI 0.380-0.932), respectively, with statistical significance (Z=2.154, P=0.030). There were no significant differences in the baseline serum IL-6 level or proportions of severe patients or pneumonia patients among patients with or without hypertension, diabetes mellitus, coronary heart disease, chronic kidney disease or chronic obstructive pulmonary disease (all P>0.05). The baseline serum IL-6 levels of the omicron variant infected elderly patients with 1, 2, and 3 or more underlying diseases were 12.50 (9.15, 21.75), 23.55 (9.63, 50.10), and 10.90 (5.20, 18.88) pg/mL, respectively, with no statistical significance (P>0.05). Conclusion For omicron variant infected patients, serum IL-6 level is significantly increased in patients with pneumonia manifestations and is correlated with disease progression. Serum IL-6 level is of great guiding significance to judge disease progression and evaluate efficacy and prognosis of elderly coronavirus disease 2019 patients.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Background: COVID-19 is still going on with lots of uncertainties. There is a need for early and effective marker for prognostication of COVID-19 patients. Coagulation dysfunction and increased D-dimer levels are seen in this disease. Thus, present study was aimed to compare D-dimer value in relation to disease severity and disease mortality, and to evaluate prognostic significance of D-dimer. Method(s): All symptomatic SARS-CoV-2 RT-PCR confirmed COVID-19 patients admitted in Hospital from March 31, 2021, to May 31, 2021 were evaluated and clinical, demographical and laboratory findings were collected and analysed. According to disease severity patients were grouped and death events and D-dimer value were assessed. Optimal D-dimer cut off point in all groups were evaluated. Result(s): 388 patients were included in the study out of which 142 (36.5%) died during hospital stay. Mean D-dimer value in mild disease was 1.17+/-0.21, moderate disease was 1.47+/-0.17 and in severe disease was 2.92+/-0.23 FEUmicrog/ml. Mean D-dimer value in non-survivors were significantly (P<0.001) different and higher (59.3%) as compared to survivors. ROC curve analysis showed a prognostic value of D-dimer in mild (AUC=0.755, Z=3.30, P=0.001), moderate (AUC=0.762, Z=4.65, P<0.001) and severe (AUC=0.694, Z=5.08, P<0.001) patients. Optimal cut off of D-dimer between survivor and non survivors was >0.78 in mild cases, >1.05 in moderate patients and >2.11 in severe cases. Conclusion(s): Mean D-dimer value showing increasing trend with increase disease severity and prognostic significance was found highest in moderate patients followed by mild patients and least in severe patients in terms of mortality.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: The Brixia Chest X-ray (CXR) score, C-reactive protein (CRP), and the absolute neutrophil count (ANC) have been useful to predict outcomes in Coronavirus disease 2019 (COVID-19 patients). We studied the utility of the Brixia CXR score, CRP, and ANC in predicting the outcomes in terms of the need for invasive mechanical ventilation, length of stay, and mortality in moderate-severe COVID-19 patients. Material(s) and Method(s): This was a single-centre, retrospective, study on 122 COVID-19 patients. Brixia CXR score, CRP, and ANC on admission to the hospital and the fifth day of hospital stay were noted along with the need for invasive mechanical ventilation (IMV), prolonged length of stay (LOS) >= 14 days, and mortality. Result(s): 122 patients were included for analysis. The median and interquartile range (IQR) for baseline CRP was 81.50 (39-151) mg/L and 11.0 (4-30) mg/L (p < 0.001) on the fifth day. The median and IQR for baseline Brixia score was 10.0 (7-13), and on the fifth day was 7 (4-11) (p <0.001). The receiver operating characteristic curve (ROC) showed that the baseline CRP >= 52.5mg/L predicted both the need for IMV, with an area under the curve (AUC) of 0.628, and prolonged LOS with an AUC of 0.608. The ROC curve depicted that the baseline ANC >8500/muL predicted IMV requirement with an AUC of 0.657. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality in hospitalized patients. Conclusion(s): Baseline CRP (> 52.5mg/L) predicts the need for IMV and a prolonged LOS, but not mortality. Baseline ANC (> 8500/muL) predicted the need for IMV. CRP, Brixia CXR score, and ANC on the fifth day were not useful to predict LOS or mortality, though there was a significant reduction in CRP and Brixia CXR score on the fifth day compared to baseline after treatment. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.
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The recent studies have indicated the requisite of computed tomography scan analysis by radiologists extensively to find out the suspected patients of SARS-CoV-2 (COVID-19). The existing deep learning methods distribute one or more of the subsequent bottlenecks. Therefore, a straight forward method for detecting COVID-19 infection using real-world computed tomography scans is presented. The detection process consists of image processing techniques such as segmentation of lung parenchyma and extraction of effective texture features. The kernel-based support vector machine is employed over feature vectors for classification. The performance parameters of the proposed method are calculated and compared with the existing methodology on the same dataset. The classification results are found outperforming and the method is less probabilistic which can be further exploited for developing more realistic detection system.Copyright © 2023 Inderscience Enterprises Ltd.
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Objectives: In the management of COVID-19, bio-inflammatory cytokines (IL-6 and others) can be measured as inflammatory markers to detect conditions in response to treatment, risk assessment, monitoring disease progression, prognosis determination and treatment selection. The purpose of this study is to identify changes in inflammation markers of COVID-19 patients and to determine whether it should be used as a prognosis marker. Materials-Methods: Three groups of the patients consisting of 138 patients (12 non-survived, 35 severe and 91 mild/moderate) aged 16 to 86 years who were diagnosed with COVID-19 by real-time polymerase chain reaction were included in the study. Acute phase serum levels such as CRP, D-Dimer, Ferritin, IL-1B and IL-6 were measured and compared in serum samples taken from these patients. It was examined whether these parameters can be a biomarker that can be monitored for the course of the disease. IL-6 and ferritin were measured with CLIA, D-dimer immunassay, CRP with photometry and IL1-B was measured with flow cytometry methods. Result(s): It has been observed that all parameters, except for ferritin (P=0.94), increase significantly during the transition from mild to severe form of the disease. (CRP P:0.005, D-Dimer P<0.0001, IL-1B P:0.03, IL-6 P:0.002). A significant difference was observed in the levels of CRP, IL-6 and D-Dimer in the patient survival. (P=0.003, P=0.03, P:0,0001). According to our results, the use of IL-1B in the prognosis monitoring of patients with severe forms was not found to be significant (P:0.48). ROC curve analysis showed that the area under the ROC curve (AUC) of CRP, D-Dimer and IL-6 was 0.645 (0,559 to 0,725), 0.637 (0,551 to 0,717) and 0.663 (0,577 to 0,741) respectively, and the cutoff values were >3.77 (sensitivity, 72.3%;specificity, 55%), >0.48 (sensitivity 68.1%;specificity, 57.1%) and <14.9 (sensitivity, 65,9%;specificity, 62.6%), respectively. Conclusion(s): Our results confirmed that the dynamic change in IL-6, CRP, D-Dimer can be used as a marker for disease monitoring in patients with severe COVID-19.
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Objectives: A new type of coronavirus that emerged in Wuhan, China at the end of 2019, caused the Covid-19 (SARS-COV2) pandemic. Common cold symptoms are seen, but in more severe cases, pneumonia, Acute Respiratory Distress Syndrome (ARDS), coagulopathy, multi-organ failure are seen, and it causes death in the course of time. In this study, among the laboratory parameters followed in cases diagnosed with Covid-19 and followed in home isolation, service and intensive care unit;It is aimed to retrospectively evaluate CRP, procalcitonin, ferritin, D-Dimer, fibrinogen AST, ALT and LDH levels with ROC and other statistical analyzes in terms of predicting mortality in the treatment and follow-up of the disease. Materials-Methods: Between 01.04.2020 and 01.10.2020, the patients who applied to Necmettin Erbakan University Meram Medical Faculty Hospital with cold symptoms and were diagnosed with Covid-19 with RT-PCR positivity, were analyzed from Covid-19 infected serum and plasma. The results of the biomarkers were examined. Demographic data, vital signs and laboratory findings of the cases were compared. The results were statistically evaluated with the SPSS 22.0 package program. Result(s): 300 cases who received home isolation, service and supportive treatment in the intensive care unit were included in the study. Crp, Pct, D-dimer, ferritin, fibrinogen, LDH, AST and ALT values were found to be statistically significant. According to the results of ROC (Receiver Operating Characteristic) analysis performed to determine the predictive values of laboratory parameters that were significant as a result of univariate statistical analysis, Crp (0.890775), Pct (0.86795), D-dimer (0.856975), ferritin (0.836975), LDH (0.7829), fibrinogen (0.773925), AST (0.685925) and ALT (0.594025) were found. Conclusion(s): The high mutation ability of SARS-CoV-2 makes it difficult to control the pandemic. Therefore, early diagnosis of the disease has gained importance for the treatment of patients with high mortality risk. According to the ROC results we obtained in this study, it supports that CRP, Procalcitonin, Ferritin, D-dimer and LDH levels can be used as effective parameters in determining the prognosis and mortality risk in Covid-19 patients.
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Introduction: APACHE II severity scoring system has been successfully used for mortality risk assessment in the ICU, however its validity in the subgroup of COVID-19 patients has been questionable. We aimed to examine the predictive value of APACHE II score in a cohort of critically ill COVID-19 patients. Method(s): We performed a retrospective analysis of prospectively collected data in a cohort of COVID-19 patients admitted to our 50-bed ICU between October 2020 and April 2022. Using a ROC analysis we assessed the performance of APACHE II score and identified the optimal cut-off value for mortality prediction. Result(s): Our cohort included 783 patients (66% male) with positive PCR forSARS-Cov-2 and respiratory failure. Mean age was 66 years. Invasive mechanical ventilation was used in 92%of patients and 89.3% had at least one comorbidity. The mean APACHE II score of the whole cohort was 20.3 (+/- 8.5). ICU mortality was 44.7%. Death rate was similar between sexes but significantly higher in those who were older and those suffering from COPD, chronic renal or heart failure, atrial fibrillation or any kind of malignancy. Non-survivors had a significantly higher APACHE II score compared to survivors (25.2 +/- 7.9 vs 16.3 +/- 6.7, p < 0.001). ROC analysis showed an AUC 0.81 (95% CI 0.78-0.84, p < 0.001). At a cut-off value of 19.5 APACHE II score could predict death with a sensitivity of 77.1% (95% CI 72.4-81.4%), a specificity of 70.7% (95% CI 66.1-74.9%), PPV 68% (95% CI 63.2-72.6%) and NPV 79.3% (95% CI 74.9-83.2%). Conclusion(s): APACHE II score is an effective tool for mortality prediction in critically ill COVID-19 patients. A cut-off value of 19.5 can be used for risk stratification in this patient population.
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Introduction: Early prediction by the use of serum and urinary biomarkers for the detection of acute kidney injury (AKI) may be very valuable to optimize the management and helps in improving the outcomes. This study aims to investigate whether daily measurement of urinary and plasma renal biomarkers have a role in earlier predicting COVID-19 associated AKI. Method(s): The study was conducted as a single-center, prospective, observational cohort study between August 2020 and December 2020 in hospitalized COVID-19 patients. A total of 65 moderate and severe COVID-19 positive adult (>= 18 years) patients were enrolled for this study. We measured serum creatinine, cystatin C, NGAL, KIM-1, Urine-Klotho, TIMP-2, IL-6 level, and urinary microalbumin/urinary creatinine on various days. The receiver operating characteristic curve (ROC) analysis was used to find the sensitivity and specificity of various markers to predict the incidence of AKI. Result(s): A total of 24 moderate and 41 severe COVID-19 patients were included. Out of which 47 patients developed (72.3%) acute kidney injury (AKI) over the course of COVID-19. Among these subjects, 18/47 (38.2%) developed severe AKI (KDIGO 2 + 3), and 5/47 (10.6%) required RRT. NGAL was found to be the best marker to predict the probability of AKI (Area under curve AUC of 0.713-0.786) with a sensitivity of 76-90% and specificity of 56-79% on different days of assessment from Day 1 to Day 7. IL-6 had moderate accuracy of prediction and cystatin C, KIM-1, Urine-Klotho, TIMP-2, IL-6 had poor accuracy for predicting the incidence of AKI. Conclusion(s): Urinary biomarkers like NGAL have good predictability for AKI.
ABSTRACT
Objective: Coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome-coronavirus-2 continues across the world. Some patients with COVID-19 develop cytokine storm secondary to virally driven hyper-inflammation. This study aimed to assess the relationship of interleukin-6 (IL-6), procalsitonin (PCT) and C-reactive protein (CRP) levels with the severity of the disease in patients with COVID-19. Material(s) and Method(s): This retrospective study included 63 patients diagnosed with COVID-19 from January 2020 to March 2021. Data on demographic characteristics and clinical characteristics with the levels of IL-6, CRP, and PCT on admission were collected. ROC analysis was performed to determine whether interleukin-6 had a diagnostic value in predicting mortality. IL-6, CRP and procalcitonin values were evaluated by the Spearman correlation analysis. Result(s): In the ROC analysis performed in terms of predicting mortality, it was observed that IL-6 level predicted mortality at a statistically significant level (area under the curve: 0.708, p=0.004, 95% confidence interval: 0.583-0.833). A value of >358.3 pg/mL for IL-6 showed prognostic significance on mortality. In the Spearman correlation analysis performed between IL-6, CRP and procalcitonin values, a positive correlation was observed between CRP and procalcitonin (r=0.474, p=0.001). Conclusion(s): The serum levels of IL-6 and CRP can effectively assess disease severity in patients with COVID-19.Copyright © Telif Hakki 2022 Turk Immunoloji Dernegi. Turk Immunoloji Dergisi, Galenos Yayinevi tarafindan yayinlanmistir.
ABSTRACT
Introduction: High-flow oxygen therapy (HFOT) is used to provide oxygenation and reduce the need for intubation in severe pneumonia cases caused by SARS-CoV-2 virus. In this study, causes of mortality during hospitalization in the intensive care unit (ICU) in patients receiving HFOT therapy were investigated. Method(s): The data of 215 adult patients, who were admitted to ICU of a university hospital between April 2020 and October 2021, with severe COVID pneumonia and received HFOT were enrolled retrospectively in our study. Result(s): Total mortality among patients was 158 (73.4%). The overall mean age was 72 years, 61 in the survivor group and 73 in the mortality group (p < 0.001). It was determined that mortality rates decreased as the length of stay (LoS) in ICU and HFOT duration of the patients increased (p = 0.008 and < 0.001, respectively). The increase in respiratory rate on arrival was found to be significantly associated with increased mortality. Although the goal of HFOT is to improve oxygenation, no significant mortality-related difference was found in terms of pO2, pCO2 and P/F values calculated at the time of admission. The ROC curve was applied to examine the differential effect of Apache-II, SOFA, ROX and Procalcitonin measurements according to the survival. The area under the curve (AUC) and cut-off values were calculated as follows: APACHE-II (63.9%, 5,) SOFA (62.8%, 2), ROX index (66.8%, 4.72), Procalcitonin (65.7%, 0.23) (Fig. 1). Conclusion(s): Unlike reports in literature on mortality in ICU, LoS was found to have a decreasing effect on mortality rate [1]. In addition to the well-known scoring systems such as APACHE-II and SOFA, the ROX index, which is used to predict the success of HFOT, has emerged as a predictive value for mortality at admission to the intensive care unit [2].