A new logistic regression derived combined index for early prediction of in-hospital mortality in COVID-19 patients

BACKGROUND: While the type and the number of treatments for Coronavirus Disease 2019 (COVID-19) have substantially evolved since the start of the pandemic a significant number of hospitalized patients continue to succumb. This requires ongoing research in the development and improvement of early risk stratification tools. METHOD(S): We developed a prognostic score using epidemiological, clinical, laboratory, and treatment variables collected on admission in 130 adult COVID-19 patients followed until in-hospital death (N.=38) or discharge (N.=92). Potential variables were selected via multivariable logistic regression modelling conducted using a logistic regression univariate analysis to create a combined index. RESULT(S): Age, Charlson Comorbidity Index, P/F ratio, prothrombin time, C-reactive protein and troponin were the selected variables. AUROC indicated that the model had an excellent AUC value (0.971, 95% CI 0.926 to 0.993) with 100% sensitivity and 83% specificity for in-hospital mortality. The Hosmer-Lemeshow calibration test yielded non-significant P values (chi2=1.79, P=0.99) indicates good calibration. CONCLUSION(S): This newly developed combined index could be useful to predict mortality of hospitalized COVID-19 patients on admission.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Efficacy of N-acetyl Cysteine in Severe COVID-19 Patients: A Randomized Controlled Phase III Clinical Trial

Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has been used as a mucolytic in pulmonary diseases. This drug apparently contributes to the retrieval of the intracellular antioxidant system. Objective(s): This study aimed to determine the efficacy of NAC in severe COVID-19 patients admitted to the intensive care unit (ICU). Method(s): This single-blinded randomized controlled phase III clinical trial included 40 patients with confirmed COVID-19 (based on polymerase chain reaction) admitted to the Shahid Mohammadi Hospital's ICU, Bandar Abbas, Iran, in 2020. All cases had severe COVID-19. They were allocated randomly to two equal groups. Patients in the control group received standard drug therapy based on the treatment protocol of the national COVID-19 committee, while those in the NAC group received a single dose of intravenous NAC (300 mg/kg) upon admission to the ICU in addition to standard drug treatment. Clinical status and laboratory tests were done on admission to the ICU and then 14 days later or at discharge without knowing the patient grouping. Result(s): The two groups were comparable regarding age, gender, and other baseline laboratory and clinical parameters. At the final evaluation, respiratory rate (21.25 +/- 4.67 vs. 27.37 +/- 6.99 /min) and D-dimer (186.37 +/- 410.23 vs. 1339.04 +/- 2183.87 ng/mL) were significantly lower in the NAC group (P = 0.004 and P = 0.030, respectively). Also, a lower percentage of patients in the NAC group had lactate dehydrogenase (LDH) <= 245 U/L (0% vs. 25%, P = 0.047). Although the length of ward and ICU stay was shorter in the NAC group than in controls, the difference was statistically insignificant (P = 0.598 and P = 0.629, respectively). Mortality, on the other hand, was 75% in the control group and 50% in the NAC group, with no statistically significant difference (P = 0.102). Concerning the change in the study parameters, only the decrease in diastolic blood pressure (DBP) was significantly higher with NAC (P = 0.042). The intubation and mechanical ventilation rates were higher, while oxygen with mask and nasal oxygen rates were lower with NAC, but the difference was statistically insignificant. Conclusion(s): Based on the current research, NAC is related to a significant decrease in RR, D-dimer, and DBP in severe COVID-19. Also, LDH was significantly lower in the NAC group than in the controls. More research with larger sample sizes is needed to validate the current study results.Copyright © 2023, Author(s).

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.

Clinical features and prognostic factors affecting survival of ambulatory followed COVID-19 patients aged over 65 years

Aim: The majority of the patients with COVID-19 are followed ambulatory. Determination of prognostic factors of mortality in risky groups is essential to improve patient management. The aim of this study is to describe the clinical presentation in patients over 65 years of age with COVID-19 who are followed up at home by a physician and provide insights into the initial prognostic factors in this distinctive population. Material(s) and Method(s): This is a retrospective and observational study. Clinical records of the patients aged over 65 years who were visited by the filiation team, including a physician at home, due to the diagnosis of COVID-19 disease within 2 months were reviewed. Factors affecting mortality were examined. Result(s): Our study included 51 deceased (mean age: 75,1+/-9,0 years, 40,2% males), and 102 patients with COVID-19 who survived (mean age: 73,0+/-6,9 years, 68,6% male). Platelet count ( < 150.000, OR 7,26, p=0,001), CRP level ( < 4, OR 4,55, p=0,02), albumin level ( OR 3,24, p=0,02), and Troponin I level (OR 0,03, p=0,02) were the strongest predictors for death. When propensity score matching was applied, gender (male, OR 7,14, p=0,02) and platelet count (< 150.000, OR 5,34, p=0,02) were the strongest predictors. Discussion(s): Elderly COVID-19 patients have a high mortality rate. An easily measurable and accessible platelet count may be a predictor of a bad outcome. Close follow-up and timely treatment may significantly reduce mortality in high-risk elderly patients under.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Comparison of first admission hemogram parameters and chest computed tomography findings of pediatric COVID-19 patients Blood parameters of pediatric COVID-19 patients

Aim: We use computed tomography, which is one of the frequently used imaging tests, both as a disease diagnosis method and to follow the clinical course in COVID-19 patients. This also means radiation exposure. Radiation exposure, especially in pediatric patients, can cause life-threatening diseases. Is there a blood parameter that will reduce this undesirable event and allow estimation of computed tomography findings? Are hemogram analysis, one of the most commonly used blood tests, and tomography findings of the disease related? We designed this study based on the questions. Material(s) and Method(s): Among the patients under the age of 18 who applied to the emergency department, those with a positive reverse transcription-polymerase chain reaction (RT-PCR) and chest CT and hemogram were included in the study. Chest CT findings were classified according to the CO-RADS classification. We compared the CO-RADS classification with hemogram parameters and the ratios of these parameters. Result(s): Platelet-to-lymphocyte ratio (PLR) rates were found to be significantly lower as imaging findings became more severe (<0.05). The ratio of MedianPlatelet Volume and Platelet (MPV/Plt) was found to be significantly higher as the imaging findings worsened (p<0.05). When the relationship between laboratory parameters according to imaging groups in our study was evaluated, there was a moderate negative correlation between lymphocyte and platelet levels and imaging findings (p<0.05). A moderate positive correlation with the monocyte level was found (p<0.05). Discussion(s): For the CO-RADS classification, it can be said that the patient was established to classify possible COVID-19 patients only according to chest CT. There is no study in the literature on the classification of pediatric patients with RT-PCR positive definite COVID-19 according to chest CT scans and the comparison of laboratory findings of patients with this classification. The combination of laboratory parameters and CO-RADS classification will guide clinicians in pediatric COVID-19 patient management.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Association Between Red Blood Cell Distribution Width and COVID-19 Severity in Delta Variant SARS-CoV-2 Infection.

Studies have discovered that wild-type SARS-CoV-2 infections are commonly linked to abnormalities in the hematological profiles of COVID-19 patients, one such abnormality being characterized by elevations in red blood cell distribution width (RDW). Whether this linkage reoccurs in delta variant SARS-CoV-2 infection remains unexamined. Here we compared baseline blood parameters in COVID-19 patients infected by wild type and its delta variant, respectively. Our results here point to that although the delta variant has shown increased virulence, transmissibility, and vaccine escape, it has a minimally negative impact on RDW values that were previously found prognostic for COVID-19 severity.

Multisystem Inflammatory Syndrome in a Young Adult During the Second Wave of COVID-19 Pandemic in India ABS0116)

Aim and background: Since June 2020, there have been several reports of multisystem inflammatory syndrome in adults (MIS-A). There is a paucity of a description of MIS-A from India. Materials and methods: A 26-year-old, healthy male, with a previous history of COVID-19, without any known history of chronic disease, with clinical characteristics resembling MIS-A was hospitalised on May 30, 2021. Results: Case presentation: The patient presented with 1 week of persistent high-grade fever (102-degree F) with chills and rigor. The concomitant complaints were left-sided pain in the buccal cavity, left facial swelling, intra-orbital pain, and watery eyes. The respiratory rate was 24/minute, SpO2 was 96% on room air. Ever since the recovery from COVID-19 (1 week back), there was severe pain in the throat with difficulty in breathing, generalised weakness, and loss of appetite. BP was 130/80 mm Hg. The hospital course was notable for profound systemic inflammation, requiring ICU admission. MRI revealed discrete subcentimetric bilateral deep cervical lymph nodes. Blood tests at admission revealed, lymphopenia 15.3%, CRP 61.84 mg/L, total leucocyte count 12.93 (1000/μL), neutrophils 78.7%. Red distribution width (RDW) was marginally elevated to 15%. The patient was managed by IV fluids, IV immunoglobulin. Scrub typhus was excluded by IgM ELISA IgM with a negative titre (0.095). Widal test was negative and excluded enteric fever. d-dimer was within normal limits (125 ng/ mL). Borderline elevation of hepatic enzymes was noted. There was a high SARS-CoV-2 IgII titres (12050.4). The patient improved following intravenous immunoglobulin (IVIG), IV ascorbic acid, dexamethasone, supportive care and was discharged on day 4, with methylprednisolone for 1 week. Conclusion: Specific treatment is yet to be determined. However, dexamethasone and IVIG allowed controlling the inflammatory process. MIS-A, as a delayed immune complication, requires early recognition, with a multidisciplinary approach and aggressive therapeutic intervention, to yield favourable outcomes. MIS-A should be considered in adults, during the recovery phase from COVID-19. This is perhaps, the first description of MIS-A from India during the second wave of the COVID-19 pandemic. The role of IVIG needs further exploration.

Dynamic Changes in Routine Laboratory Parameters with COVID-19: In-depth Analysis of 17 Patients Requiring Critical Care

—Dynamic changes in routine blood parameters in COVID-19 patients might be helpful to prognosticate deterioration in COVID-19 patients and evaluate treatment effect. Our study aimed to evaluate the temporal changes in red blood cell indices (MCV, MCH, MCHC, RDW) in COVID-19 patients and the association of other relevant clinical parameters. We analysed 17 medical records of COVID-19 patients in retrospect who required critical care from 1 January 2020 until 28 February 2021 in Hospital Tuanku Fauziah, Perlis, Malaysia. Data extracted include details with regards to escalation and de-escalation of oxygen therapy, clinical and laboratory parameters. There were three time points of interest in our study: (i) admission (Adm), (ii) highest mode of oxygen therapy (HighM), and (iii) weaned off oxygen therapy (WeanOxy). The result showed that the mean duration to clinical deterioration requiring the highest mode of oxygen delivery was 2.3 ±1.85 days and the highest escalation device for oxygen delivery was high flow nasal cannula (n=7, 41.2%). There was no statistically significant difference in RDW, MCV, MCH, and MCHC at different clinical time points, p>0.05. However, there was a statistically significant increment in TWBC trend between Adm-HighM-WeanOxy, χ2(2)=7.023, p=0.030. Our study did not find evidence of structural RBC changes reflected in RBC indices. However, recovery from COVID-19 was reflected in the rise of TWBC and ANC, similar to that observed with other viral illnesses.

Clinicohaematological Patterns of Anemia and Correlation with Clinical Conditions in Children Aged 5 to 12 Years in Tertiary Care Centre

Objective: To classify the haematological pattern, severity of anemia in children 5-12 years age admitted and to find its correlation with the clinical conditions. Methods Crossectional study of 160 patients in two years was done. Patients satisfying the inclusion criteria were selected for study. Relevant clinical data were recorded in a structured proforma including detailed history was recorded with particular symptoms suggestive of anemia such as weakness and easily fatigability, breathlessness on exertion and pica. A thorough clinical examination of every child was done followed by routine investigations for anemia Results Patients between 7-8 year were found to be the most affected. Anemia was found to be more common in female children as compared to male children (F:M=1.13). Anemia is more common in undernourished child. Most common presenting symptoms were gastrointestinal including vomiting, diarrhea and pain abdomen. Most common sign was Pallor followed by other common signs included signs of dehydration associated with diarrhea, hepatosplenomegaly. microcytic hypochromic anemia was the most common morphological type of anemia and macrocytic anemia was the least common.Thalassemia cases were most common among hemolytic anemias. Iron Deficiency Anemia (Nutritional Anemia) was the most common etiology of anemia. Conclusion Dietary deficits affect children aged 5 to 12, creating financial, emotional, and psychological burden for patients and their families, as well as depleting critical national resources. As a result, screening for these illnesses, as well as early detection of anemia and related problems, is essential.

Diagnostic Accuracy of the RDW for Predicting Death in COVID-19.

Background and Objectives: An association between high red blood cell distribution width (RDW) and mortality has been found in several diseases, including infection and sepsis. Some studies have aimed at determining the association of elevated RDW with adverse prognosis in COVID-19, but its usefulness has not been well established. The objective of this study was to determine the accuracy of the RDW, measured at hospital admission and discharge, for predicting death in patients with COVID-19. Materials andMethods: An observational, retrospective, longitudinal, and analytical study was conducted in two different COVID-19 reference centers in the state of Guanajuato, Mexico. A total of 323 patients hospitalized by COVID-19 were included. Results: We found higher RDW levels at the time of hospital admission in the non-survivors group compared to levels in survivors (median = 13.6 vs. 13.0, p < 0.001). Final RDW levels were even higher in the deceased group when compared with those of survivors (median = 14.6 [IQR, 12.67-15.6] vs. 12.9 [IQR, 12.2-13.5], p < 0.001). For patients who died, an RDW > 14.5% was more common at the time of death than for patients who survived at the time of discharge (81 vs. 13 patients, p < 0.001; RR = 2.3, 95% CI 1.89-2.81). Conclusions: The RDW is an accessible and economical parameter that, together with other characteristics of the presentation and evolution of patients with COVID-19, can be helpful in determining the prognosis. An RDW that increases during hospitalization could be a more important mortality predictor than the RDW at hospital admission.

Comparison of the Haematological and Psychological Parameters between COVID-19 Positive Pregnant and Non Pregnant Female: A Case-control Study from Tertiary Care Centre, Puducherry, India

Introduction: Pregnancy is associated with lot of physiological and psychological changes, and it becomes important to study these changes in the background of COVID-19. A simple Complete Blood Count (CBC) can help to indicate the COVID-19 disease severity. Aim: To understand the differences in the haematological and psychological parameters between COVID-19 infected pregnant females and age-matched non pregnant COVID-19 infected females. Materials and Methods: This case-control study was conducted in Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India, from October 2020 to December 2020. Data collection was in an ambispective manner. Haematological values {Total Leukocyte Count, neutrophil, lymphocyte, Neutrophil-Lymphocyte ratio (NLR) and Red Cell Distribution Width (RDW)} were obtained from routine CBC and for the psychological component (scales-beliefs, practices for prevention of infection, fear, global) a pretested validated questionnaire was used. The questionnaire used the Likert scale and comprised of a total of 29 questions with a maximum score of 145. These scales analysed psychological apprehensions in general population and its impact on pregnancy and reproductive health of women. Categorical variables were expressed as mean±Standard Deviation (SD). Student t-test was used for comparison of means. Results: The present study included 80 participants with 40 in each of the pregnant and non pregnant group. The total leukocyte count, neutrophil, lymphocyte, NLR and RDW were the haematological parameters with statistically significant difference between the two groups (p-value <0.001). While the mean total score of COVID-19 psychological impact in the COVID-19 pregnant women was 79.42±20.18 and higher in COVID-19 non pregnant women (88.92±20.77). Conclusion: The significant difference in the haematological parameters of both the groups indicates the differential impact of COVID-19 in pregnant women. 'Coronaphobia' is on the rise and addressing this concern is important for holistic delivery of health care in patients.

Red blood cell distribution width: A severity indicator in patients with COVID-19.

Red blood cell distribution width (RDW) was frequently assessed in COVID-19 infection and reported to be associated with adverse outcomes. However, there was no consensus regarding the optimal cutoff value for RDW. Records of 98 patients with COVID-19 from the First People's Hospital of Jingzhou were reviewed. They were divided into two groups according to the cutoff value for RDW on admission by receiver operator characteristic curve analysis: ≤11.5% (n = 50) and >11.5% (n = 48). The association of RDW with the severity and outcomes of COVID-19 was analyzed. The receiver operating characteristic curve indicated that the RDW was a good discrimination factor for identifying COVID-19 severity (area under the curve = 0.728, 95% CI: 0.626-0.830, p < 0.001). Patients with RDW > 11.5% more frequently suffered from critical COVID-19 than those with RDW ≤ 11.5% (62.5% vs. 26.0%, p < 0.001). Multivariate logistic regression analysis showed RDW to be an independent predictor for critical illness due to COVID-19 (OR = 2.40, 95% CI: 1.27-4.55, p = 0.007). A similar result was obtained when we included RDW > 11.5% into another model instead of RDW as a continuous variable (OR = 5.41, 95% CI: 1.53-19.10, p = 0.009). RDW, as an inexpensive and routinely measured parameter, showed promise as a predictor for critical illness in patients with COVID-19 infection. RDW > 11.5% could be the optimal cutoff to discriminate critical COVID-19 infection.

Laboratory diagnostics in COVID-19

Multiple laboratory parameters have been Mproposed for use in the diagnosis and prognosis in COVID-19. They are useful as prognostic factors, in choosing certain therapeutic agents and in determining trophism of the disease in particular organ systems or particular inflammatory syndrome like secondary hemophagocytic lymphohistiocytosis (S-HLH). ?ISARIC 4C? score, using 8 variables, including 2 laboratory markers (CRP and urea) is used in predicting disease outcome. However, to capture nuances in disease behaviour, wider biomarker assessment is required. Ddimer, Lactate dehydrogenase, Ferritin all represented disease severity. Procalcitonin can differentiate bacterial infection from inflammation. Troponin has been associated with mortality in patients with and without underlying coronary artery disease. This is also associated with myocarditis. IL-6 and CRP (cutoff>75mg/dL in RECOVERY trial) has been used in selecting patients for Tocilizumab. Ferritin has been shown to predict Methyl Prednisolone response and in identifying S-HLH. Neutrophil:Lymphocytic ratio and Red Cell Distribution Width (RDW) trajectory have been shown to be useful predictor of disease outcome. Circulatory histone has been shown to play important role in COVID-associated coagulopathy and mortality. In ISARIC study, multiple markers (GM-CSF, CCL-4, CXCL 10 )have been shown to have role in prognostication. Genomic study showed strong genetic predisposition towards mortality in critically ill patients, suggesting accurate prognostication is impossible without genetic data. Given that multiple laboratory parameters have role in COVID-19 in variable degree, there is a need for a holistic view of the patients, keeping in mind their demographic and physiological factors and also the subtle interplay between different laboratory features.

Early prediction of COVID-19 mortality risk based on demographic, vital sign and blood test

Background: Early prediction of the outcome situation of COVID-19 patients can decrease mortality risk by assuring efficient resource allocation and treatment planning. This study introduces a very accurate and fast system for the prediction of COVID-19 outcomes using demographic, vital signs, and laboratory blood test data. Methods: In this analytic study, which is done from May 2020 to June 2021 in Tehran, 41 features of 244 COVID-19 patients were recorded on the first day of admission to the Masih Daneshvari Hospital. These features were categorized into eight different groups, demographic and patient history features, vital signs, and six different groups of laboratory blood tests including complete blood count (CBC), coagulation, kidney, liver, blood gas, and general. In this study, first, the significance of each of the extracted features and then the eight groups of features for prediction of mortality outcomes were considered, separately. Finally, the best combination of different groups of features was assessed. The statistical methods including the area under the receiver operating characteristic curve (AUC-ROC) based on binary Logistic Regression classification algorithm were used for evaluation. Results: The results revealed that red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular volume (MCV) in CBC features have the highest AUC with values of 85.29, 80.96, 79.94 and 79.70, respectively. Then, blood oxygen saturation level (SPO2) in vital features has a higher AUC with a value of 79.28. Moreover, combinations of features in the CBC group have the highest AUC with a value of 95.57. Then, coagulation and vital signs groups have the highest AUC with values of 85.20 and 83.84, respectively. Finally, triple combinations of features in CBC, vital signs, and coagulation groups have the highest AUC with the value of 96.54. Conclusion: Our proposed system can be used as an assistant acceptable tool for triage of COVID-19 patients to determine which patient will have a higher risk for hospitalization and intensive care in medical environments.

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.

Study of Haematological Parameters in Patientswith COVID-19 during Second Wave: Experience from a Tertiary Care Institute in Northern India

Introduction: The Coronavirus disease is a systemic infection associated with changes in haematological parameters, which have asignificant role in early risk stratification and prognostication in theaffected patients.Aims &Objectives: To study the haematological parameters Hemoglobin(Hb), Mean Corpuscular Volume(MCV),Red celldistribution width(RDW),total leukocyte count(TLC), NeutrophilLymphocyte ratio (NLR), Absolute eosinophil count(AEC), Absolutelymphocyte count(ALC) and platelet count(PC)] in patients ofCOVID-19 s wave, at our tertiary care institute.Materials &Methods: The study was conducted on 214 COVID-19patients admitted to our institute from April 2021 to June 2021.Data was collected from Central laboratory records in Microsoft exceland analysed using student SPSS version 26.0.Result: The mean age of the patients was 53.46 ± 13.09 years with amale to female ratio of 1.9:1. Anemia was observed in 143 patients(66.82%).Normal MCV was observed in 128 (59.81%) and RDW wasincreased in 159(74.29%) while TLC was normal in 109(50.93%)followed by leukocytosis in 99 (46.26%) and leukopenia in 6(2.8%)patients. NLR was raised in 207 (96.72%) patients. Eosinopenia in205(95.79%), lymphopenia in 156(72.89%) while normal PC wasobserved in 140(65.42%), decreased in 69 (32.24%) and increased in5(2.42%) patients.Conclusions: Anaemia, increased RDW, increased NLR, lymphopenia and eosinopenia were associated with COVID 19 disease.

Complete Blood Count Parameters Outperform Putative Inflammatory Markers in Predicting COVID-19 Mortality: A Multimodal Machine Learning Model

Introduction: SARS-CoV-2 evoked immunodysregulation drives inflammation, morbidity, and mortality across COVID-19 presentation spectrum. We sought to identify baseline cell counts and proportions reported with a complete blood count (CBC) that contribute independent information to a model predicting mortality in hospitalized patients with laboratory confirmed SARS-CoV-2 infection. Such a model may complement or improve presentation risk stratification informed by putative inflammatory markers. Methods: Our retrospective design, analyses and interpretations followed constructs detailed in the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. Under IRB exemption, discharge medical electronic health records underwent extraction of administrative and clinical data. Demographics, anthropometrics, vital signs, laboratory test and ICD-10-CM-based Elixhauser comorbidity categories were included. Univariate logistic regression was used to identify CBC parameters and attendant ratios associated (p<.05) with hospital mortality. Generalized regression with adaptive LASSO modeling was used to evaluate explanatory probability while eliminating collinearities in identified CBC parameters (individual and ratio) associated with mortality while controlling age, sex, race, baseline vital signs, Elixhauser comorbidities and COVID-19 epoch quarters / treatment. Additional analysis with Bootstrap Forest (BF) was employed to evaluate aggregated synergies and retain parameters that optimized generalized RSquared representing multivariate prediction accuracy and explained variance proportion (EV%) in mortality provided by each variable. Further BF analysis was used to examine relative magnitude of EV% versus putative COVID-19 inflammatory markers. CBC variables included in final BF model were temporally parsed in 24h intervals then pooled when measured after 120h since first vital sign at hospitalization. Results were averaged when a patient underwent multiple assays within an interval. A two-way ANOVA was employed to compare survival vs. non-survival pathways. Results: Among patients consecutively discharged between March 14, 2020 through May 31, 2021, 208 (10 %) of 2153 died. Survivor vs. non-survivor patient and clinical characteristics are summarized in Table 1. CBC parameters identified as independently associated with hospital mortality included WBC, lymphocytes, bands, segmented neutrophils, monocytes, and RDW-CV. (Table 2) Ratios of CBC parameters associated with mortality included AMC/ALC and APC/ALC (Table 2). Results of BF EF% modeling including CBC parameters respectively without (Rsquare = 0.65) and with (Rsquare = 0.70) inclusion of putative inflammatory markers are illustrated in Figure 1a and 1b. Inflammatory markers alone exhibited lowest Rsquare (0.52) (Figure 1c). Figure 2 illustrates temporal kinetics of modeled CBC parameters across hospitalization. Intergroup differences at baseline were sustained, save for RDW-CV after 5-days. Conclusions: Machine learning approaches identified several CBC parameters measured at presentation that when modeled with putative COVID-19 inflammatory markers, enhanced early prediction of hospital mortality. CBC parameters are usually more often measured compared to other inflammatory markers that show COVID-19 severity and serve as an easily obtainable source of information to determine which patients may require a higher level of care before clinical symptoms follow. This includes progression to critical illness and hospital mortality. We recommend that CBC parameters, especially bands, APC/ALC ratio and AMC/ALC ratio be considered for baseline risk stratification of COVID-19 severity, as these trends are sustained at least 5-days after hospitalization. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Red blood cell distribution width: a new predictor of disease severity in COVID-19 patients

Importance Coronavirus disease 2019 (COVID-19) is the main global health problem nowadays. It is the primary cause of many deaths all over the world, as well as associated with many morbidities and consumption of medical resources. Objective To assess the relation between red blood cell distribution width (RDW) level in the blood of COVID-19-infected patients on one side and various criteria of disease severity and mortality risk on the other side, to help answer the question, 'can we use RDW as a predictor of COVID-19 disease severity?' Patients and methods This study included 184 adult patients (98 males and 86 females) with positive nasopharyngeal swab for acute respiratory syndrome coronavirus 2 infection diagnosed at Mansoura University Hospitals. Patients underwent clinical, laboratory, and radiological evaluation of COVID-19 cases with close follow-up till complete cure or death. Cases were divided according to the disease severity into four groups (six mild cases, 45 moderate cases, 48 severe cases, and 85 critical cases). We compared RDW level at the time of hospitalization in the four groups. Results A highly significant difference (P≤0.001) was found between mean RDW in mild and moderate groups compared with severe and critical groups. Moreover, there was a positive linear correlation between RDW level and disease severity (P≤0.001). RDW level more than 13.65 could predict severe disease with 79.2% sensitivity and 66.7% specificity. RDW level more than 13.85 could predict critical disease with 78.8% sensitivity and 66.7% specificity. Mean RDW was significantly lower in cured cases compared with those died owing to COVID-19 complications (P=0.004). RDW level more than 13.95 could predict increased mortality risk, with 73.5% sensitivity and 52.5% specificity. Conclusion Higher RDW levels in COVID-19-infected patients, upon hospital admission, were associated with increased disease severity and mortality risk.

Hematologic parameters as potential diagnostic tools for COVID-19 in emergency setting

Currently, the real-time reverse transcription-polymerase chain reaction test is the gold stan-dard for diagnosing COVID-19. However, real-time reverse transcription-polymerase chain reaction requires a long turnaround time, expensive equipment, specialized laboratory, and trained personnel. Thus, accessible, fast, and accurate tests are needed, especially in emergency settings. This study aims to evaluate roles and cut off points in hematological parameters for COVID-19 screening in emergency settings. We retrospectively evaluated hematological features in 250 patients who have visited the emergency department with suspect COVID-19 infection. Hematological parameters were compared in patients with positive and negative COVID-19 group. Receiver operating characteristic curves were made to determine significant hematological parameter cutoff point for diagnosing COVID-19 patients. Comparisons between positive and negative COVID-19 groups revealed there was no statisti-cal significant difference (p>0.05) between test groups regarding eosinophil, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, throm-bocytes, red blood cell distribution width, erythrocyte sedimentation rate, sodium, potassium, calcium, and high-sensitivity C-reactive protein. Significant differences (p<0.05) were found between test groups regarding hemoglobin, leukocyte, neutrophil, lymphocyte, monocyte, basophil, hematocrit, erythrocyte, mean platelet volume, neutrophil-lymphocyte ratio, absolute lymphocyte count, platelet-to-lymphocyte ratio, and monocyte-lymphocyte ratio. The highest area under the curve was found in lymphocyte with cut off point ≥17.6 (area under curve: 0.721;p=0.000;95% confidence interval: 0.656-0.785). Blood test analysis might be used as a screening method for COVID-19 using certain hematologi-cal parameters. It is instrumental in the emergency department, which needs a fast screening method.