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1.
Asia Pac J Clin Nutr ; 30(2): 192-198, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1289218

ABSTRACT

BACKGROUND AND OBJECTIVES: To evaluate the nutritional status of critically ill patients with COVID-19 and to determine which route of nutrition support is advantageous. METHODS AND STUDY DESIGN: This retrospective study was conducted in the ICU of a designated COVID-19 hospital. Patients were divided into an enteral nutrition (EN) group and parenteral nutrition (PN) group according to the initial route of nutrition support. NRS-2002 and NUTRIC were used to assess nutritional status. Blood nutritional markers such as albumin, total protein and hemoglobin were compared at baseline and seven days later. The primary endpoint was 28-day mortality. RESULTS: A total of 27 patients were enrolled in the study - 14 in the EN group and 13 in the PN group - and there were no significant demographic differences between groups. Most patients (96.3% NRS2002 score ≥5, 85.2% NUTRIC score ≥5) were at high nutritional risk. There was no significant difference in baseline albumin, total protein and hemoglobin levels between groups. After 7 days, albumin levels were significantly higher in the EN group than in the PN group (p=0.030). There was no significant difference in the other two indicators. The 28-day mortality was 50% in the EN group and 76.9% in the PN group. Kaplan-Meier survival analysis revealed significant differences between the groups (p=0.030). Cox proportional risk regression indicated that route of nutrition support was also an independent prognostic risk factor. CONCLUSIONS: The incidence of nutritional risk in critically ill patients with COVID-19 is very high. Early EN may be beneficial to patient outcomes.


Subject(s)
COVID-19/therapy , Critical Illness/therapy , Enteral Nutrition , Intensive Care Units , Nutritional Status , Parenteral Nutrition , Aged , Aged, 80 and over , COVID-19/blood , COVID-19/mortality , China , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prognosis , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2 , Serum Albumin/metabolism
2.
Turk J Med Sci ; 51(2): 421-427, 2021 04 30.
Article in English | MEDLINE | ID: covidwho-1211944

ABSTRACT

Background/aim: The COVID-19 infection, which started in Wuhan City, China, in December 2019, turned into a pandemic in a very short time, affecting mainly the elderly and those with serious chronic illnesses. COVID-19 infections have been observed to have a high mortality rate, especially in patients undergoing maintenance hemodialysis. Materials and methods: Forty-two patients over 18 years of age who underwent a maintenance hemodialysis program at our unit, who tested positive for COVID-19 by PCR from nasopharyngeal swabs, and/or who were observed to have disease-related signs in their CTs were included in the study. Results: In this study, 23 of 42 patients receiving hemodialysis support in our clinic were included. The median age was 67 years old (min: 35; max: 91 years), and all of our patients had primary hypertension and other comorbidities. Their clinical evaluation showed that dry cough (47.8%) and shortness of breath (47.8%) were the most common symptoms. Fever was less pronounced (30.4%). The median time from the onset of symptoms to hospitalization was 1 day (min: 0; max:), and the time from hospitalization to death was 18 days (min: 1; max: 22). Transfer from the inpatient ward to the ICU took a median of 7 days (min: 1; max: 13). Among the 23 patients, 3 died during follow-up, and 20 were discharged with full recovery. Baseline ferritin, procalcitonin levels, and CRP/albumin rates were higher, and neutrophil/lymphocyte levels were lower in patients who eventually died. In these patients, despite being nonsignificant, there were more diabetic patients, and the D-dimer levels were higher than 1000 ugFEU/L. Conclusion: The COVID-19 infection is associated with increased mortality in chronic kidney diseases patients. Despite being nonsignificant, there was a trend towards increased mortality in patient with diabetes, D-dimer levels >1000 ugFEU/L, higher ferritin and prokalsitonin levels, an increased CRP/albumin ratio, and a lower neutrophil/lymphocyte ratio.


Subject(s)
COVID-19/physiopathology , Kidney Failure, Chronic/therapy , Adult , Aged , Aged, 80 and over , C-Reactive Protein/metabolism , COVID-19/complications , COVID-19/metabolism , COVID-19/mortality , Cough/physiopathology , Cross-Sectional Studies , Dyspnea/physiopathology , Female , Ferritins/metabolism , Fever/physiopathology , Hospital Mortality , Humans , Kidney Failure, Chronic/complications , Length of Stay , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Neutrophils , Procalcitonin/metabolism , Prognosis , Renal Dialysis , SARS-CoV-2 , Serum Albumin/metabolism , Time Factors
3.
Am J Emerg Med ; 48: 33-37, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1163282

ABSTRACT

INTRODUCTION: Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department. METHODS: A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. RESULTS: Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49-73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38-38.31] and 14.43 [10.84-20.42], respectively [p < 0.001]; BAR: 6.7 [4.7-10.1] and 3.4 [2.5-5.2], respectively [p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 ± 0.58 and 4.13 ± 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively). CONCLUSION: The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels.


Subject(s)
Blood Urea Nitrogen , COVID-19/diagnosis , COVID-19/mortality , Emergency Service, Hospital , Hospital Mortality , Serum Albumin/metabolism , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Area Under Curve , Biomarkers/blood , COVID-19/blood , Female , Humans , Male , Middle Aged , Odds Ratio , Predictive Value of Tests , Retrospective Studies , Turkey/epidemiology
4.
BMC Nephrol ; 22(1): 100, 2021 03 19.
Article in English | MEDLINE | ID: covidwho-1143187

ABSTRACT

BACKGROUND: We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19. METHODS: We conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission. RESULTS: One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9-3.8] vs. 3.8 g/dl [3.5-4.1], p = 0.002), higher serum ferritin (679 µg/L [184-2260] vs. 331 µg/L [128-839], p = 0.048), and lower lymphocyte counts (700/µl [460-950] vs. 860 /µl [545-1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis. CONCLUSION: Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.


Subject(s)
COVID-19/complications , COVID-19/therapy , Kidney Transplantation , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adult , Age Factors , COVID-19/blood , COVID-19/mortality , Creatinine/blood , Critical Care , Female , Graft Survival/physiology , Hospital Mortality , Humans , Length of Stay , Lymphocyte Count , Male , Middle Aged , Myocardial Ischemia/complications , Renal Replacement Therapy , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2 , Serum Albumin/metabolism , Transplant Recipients , Treatment Outcome , Turkey/epidemiology
5.
BMC Pulm Med ; 21(1): 64, 2021 Feb 24.
Article in English | MEDLINE | ID: covidwho-1102335

ABSTRACT

OBJECTIVES: We aimed to identify high-risk factors for disease progression and fatality for coronavirus disease 2019 (COVID-19) patients. METHODS: We enrolled 2433 COVID-19 patients and used LASSO regression and multivariable cause-specific Cox proportional hazard models to identify the risk factors for disease progression and fatality. RESULTS: The median time for progression from mild-to-moderate, moderate-to-severe, severe-to-critical, and critical-to-death were 3.0 (interquartile range: 1.8-5.5), 3.0 (1.0-7.0), 3.0 (1.0-8.0), and 6.5 (4.0-16.3) days, respectively. Among 1,758 mild or moderate patients at admission, 474 (27.0%) progressed to a severe or critical stage. Age above 60 years, elevated levels of blood glucose, respiratory rate, fever, chest tightness, c-reaction protein, lactate dehydrogenase, direct bilirubin, and low albumin and lymphocyte count were significant risk factors for progression. Of 675 severe or critical patients at admission, 41 (6.1%) died. Age above 74 years, elevated levels of blood glucose, fibrinogen and creatine kinase-MB, and low plateleta count were significant risk factors for fatality. Patients with elevated blood glucose level were 58% more likely to progress and 3.22 times more likely to die of COVID-19. CONCLUSIONS: Older age, elevated glucose level, and clinical indicators related to systemic inflammatory responses and multiple organ failures, predict both the disease progression and the fatality of COVID-19 patients.


Subject(s)
Blood Glucose/metabolism , COVID-19/blood , COVID-19/mortality , Disease Progression , Hyperglycemia/blood , Adult , Age Factors , Aged , Aged, 80 and over , Bilirubin/blood , C-Reactive Protein/metabolism , China/epidemiology , Critical Illness , Female , Fever/virology , Humans , Hyperglycemia/complications , L-Lactate Dehydrogenase/blood , Lymphocyte Count , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2 , Serum Albumin/metabolism , Time Factors
6.
Clin Exp Med ; 21(3): 343-354, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1053015

ABSTRACT

Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the most threatening pandemic in modern history. The aim of this systematic review and meta-analysis was to investigate the associations between serum albumin concentrations and COVID-19 disease severity and adverse outcomes. A systematic literature search was conducted in PubMed, from inception to October 30, 2020. Sixty-seven studies in 19,760 COVID-19 patients (6141 with severe disease or poor outcome) were selected for analysis. Pooled results showed that serum albumin concentrations were significantly lower in patients with severe disease or poor outcome (standard mean difference, SMD: - 0.99 g/L; 95% CI, - 1.11 to - 0.88, p < 0.001). In multivariate meta-regression analysis, age (t = - 2.13, p = 0.043), publication geographic area (t = 2.16, p = 0.040), white blood cell count (t = - 2.77, p = 0.008) and C-reactive protein (t = - 2.43, p = 0.019) were significant contributors of between-study variance. Therefore, lower serum albumin concentrations are significantly associated with disease severity and adverse outcomes in COVID-19 patients. The assessment of serum albumin concentrations might assist with early risk stratification and selection of appropriate care pathways in this group.


Subject(s)
COVID-19/metabolism , Down-Regulation , Serum Albumin/metabolism , C-Reactive Protein/metabolism , COVID-19/blood , Humans , Leukocyte Count , Severity of Illness Index
7.
BMC Infect Dis ; 21(1): 113, 2021 Jan 25.
Article in English | MEDLINE | ID: covidwho-1045608

ABSTRACT

BACKGROUND: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia. METHODS: A total of 156 patients diagnosed with COVID-19 pneumonia at the Central Hospital of Wuhan from January 29, 2020, to March 20, 2020, and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results, and disease outcomes were collected and analyzed. RESULTS: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea, and fatigue. Compared to survival cases, patients who died during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate, and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received antibiotics and anti-viral treatment. In addition, 60 patients received corticosteroids, and 51 received intravenous immunoglobulin infusion. Forty-four patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]), and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio] = 1.098, 95% CI [confidence interval]: 1.006-1.199, P = 0.037), shorter duration from onset to admission (OR = 0.853, 95% CI: 0.750-0.969, P = 0.015) and elevated lactate level upon admission (OR = 2.689, 95% CI: 1.044-6.926, P = 0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR = 0.787, 95% CI: 0.686-0.903, P = 0.001) indicated a better prognosis. CONCLUSIONS: In this study, we discovered that age, duration from onset to admission, LYM (%), and lactate level upon admission were independent factors that affecting the in-hospital mortality rate.


Subject(s)
COVID-19/mortality , Hospital Mortality , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/blood , COVID-19/complications , COVID-19/therapy , Cardiovascular Diseases/epidemiology , Child , China/epidemiology , Comorbidity , Cough , Creatine Kinase/blood , Creatinine/blood , Diabetes Mellitus/epidemiology , Disease Outbreaks , Female , Fever , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Hypertension/epidemiology , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , L-Lactate Dehydrogenase/blood , Lactic Acid/blood , Lymphocyte Count , Male , Middle Aged , Platelet Count , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Respiratory Insufficiency/etiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Sepsis/etiology , Serum Albumin/metabolism , Shock, Septic/etiology , Young Adult
8.
Am J Emerg Med ; 41: 110-119, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1002246

ABSTRACT

BACKGROUND: Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease. METHOD: We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19. RESULTS: There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05-0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10-44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31-0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10-126.49; p < 0.00001) but lower levels of albumin (mean difference -4.58; 95% CI -5.76 to -3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 µ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity. CONCLUSION: This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.


Subject(s)
Biomarkers/blood , COVID-19/diagnosis , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/complications , COVID-19 Serological Testing , Fibrin Fibrinogen Degradation Products/metabolism , Humans , L-Lactate Dehydrogenase/blood , Procalcitonin/blood , Prognosis , Risk Assessment , SARS-CoV-2 , Serum Albumin/metabolism , Severity of Illness Index
9.
Turk J Med Sci ; 51(3): 939-946, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-993716

ABSTRACT

Background and aim: Creating potential clinical markers for risk assessment in patients with COVID-19 continues to be an area of interest. In this study, we aimed to evaluate whether serum albumin level and thrombocyte/lymphocyte ratio are related to the severity of the disease. Materials and methods: The patients were divided into two groups according to the severity of disease. Demographic data, serum albumin value, lymphocyte count, TLO-1 values (thrombocyte/lymphocyte ratio-1), the highest thrombocyte count during hospitalization, TLO-2 (thrombocyte/lymphocyte ratio-2) values formed by the highest thrombocyte count, were recorded. Results: There was no statistically significant differences (P > 0.05) in terms of sex, thrombocyte count at the time of admission, and highest thrombocyte count during hospital follow-up. There were statistically significant differences in terms of age, comorbidity, lymphocyte value at the time of hospitalization, lymphocyte count during hospital follow-up, TLO 1, TLO 2, and serum albumin values between the groups. The ICU group were found to be older, had higher rates of comorbidity, lower lymphocyte values, higher TLO 1-2, and lower serum albumin levels (P < 0.05). Conclusion: TLO-2 ratio above 260 and lymphocyte level below 1 103 cells/µL, would be a predictor of further intensive care unit need.


Subject(s)
Blood Platelets/pathology , COVID-19/diagnosis , Lymphocytes/pathology , SARS-CoV-2 , Serum Albumin/metabolism , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , COVID-19/blood , COVID-19/epidemiology , Female , Follow-Up Studies , Humans , Intensive Care Units , Lymphocyte Count , Male , Middle Aged , Platelet Count , Prognosis , Retrospective Studies , Severity of Illness Index , Young Adult
10.
South Med J ; 113(12): 618-622, 2020 12.
Article in English | MEDLINE | ID: covidwho-953243

ABSTRACT

OBJECTIVES: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) epidemic is characterized by a global sense of uncertainty, partly driven by the paucity of real-life clinical data. This study assessed whether admission patient characteristics were associated with need for intensive care unit (ICU) care. METHODS: The observational study included consecutive patients admitted to a large community teaching hospital with a diagnosis of SARS-CoV-2 between March 6, 2020 and March 31, 2020. Comparisons were made based on the need for ICU admission. RESULTS: A total of 156 patients were admitted, 42 of whom (26.9%) required ICU admission and 114 (73.1%) did not. No difference in age (61.9 years vs 60.5 years, P = 0.67), race/ethnicity, or comorbidities were noted, except that patients requiring ICU care had lower serum albumin levels and lymphocyte counts and higher liver function tests, white blood cell count, and absolute neutrophil count on admission. The average time from admission to death was similar (10 days in an ICU subset vs 9.2 days in a non-ICU subset, P = 0.78), yet patients necessitating ICU care had longer hospital lengths of stay (10.2 vs 5.1 days, P = 0.0002). At the time of data extraction, 15 patients in the ICU had died, 7 were discharged from the hospital, and 20 were still admitted while 5 patients died in the non-ICU cohort with 97 discharged and 12 patients admitted. CONCLUSIONS: This is the largest study assessing clinical differences based on the need for ICU admission in inpatients with SARS-CoV-2. It found few major differences in clinical variables between subsets. Among patients admitted to the ICU, outcomes were generally poor.


Subject(s)
COVID-19/blood , Hospital Mortality , Intensive Care Units/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Adult , Age Factors , Aged , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Electrocardiography , Female , Hospitalization , Hospitals, Community , Hospitals, Teaching , Humans , Length of Stay/statistics & numerical data , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Neutrophils , Prognosis , Retrospective Studies , Serum Albumin/metabolism , Severity of Illness Index , Time Factors
11.
Respiration ; 99(9): 739-747, 2020.
Article in English | MEDLINE | ID: covidwho-934161

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global emerging infectious disease. OBJECTIVES: To analyze the initial clinical characteristics of COVID-19 suspected and confirmed patients on admission in order to find out which kinds may be more likely to get positive nucleic acid testing results, and to explore the risk factors associated with all-cause death. METHODS: Medical records from 309 highly suspected cases with pneumonia were collected from February 13, 2020, to March 14, 2020, in a COVID-19-designated hospital of Wuhan. The majority of the clinical data were collected on the first day of hospital admission. RESULTS: Of 309 patients with median age 64 years (interquartile ranges [IQR], 53-72 years), 111 patients (35.9%) were confirmed by nucleic acid testing (median age 64 years, IQR: 56-71 years; 48 males). Of those 111 patients, 13 (11.7%) patients died. In multivariate analysis, factors associated with positive testing included fatigue (odds ratios [OR] = 3.14; 95% confidence interval [CI]: 1.88-5.24, p < 0.001), cough (OR = 0.55; 95% CI: 0.32-0.95, p = 0.032), no less than 1 comorbidity (OR = 1.77; 95% CI: 1.06-2.98, p = 0.030), and severe pneumonia (OR = 2.67; 95% CI: 1.20-5.97, p = 0.016). Furthermore, age, dyspnea, noneffective antibiotic treatment, white blood cell, lymphocyte, platelets, and organ dysfunction (e.g., higher lactate dehydrogenase) were significantly associated with all-cause in-hospital death in patients with COVID-19. CONCLUSION: Patients with severe forms of this disease were more likely to get positive results. Age and organ dysfunction were associated with a greater risk of death.


Subject(s)
COVID-19/epidemiology , Cough/physiopathology , Fatigue/physiopathology , Hospital Mortality , Pneumonia/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Alanine Transaminase/metabolism , Anti-Bacterial Agents/therapeutic use , Aspartate Aminotransferases/metabolism , C-Reactive Protein/metabolism , COVID-19/diagnosis , COVID-19/metabolism , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Cause of Death , Child , Child, Preschool , China/epidemiology , Cohort Studies , Comorbidity , Creatine Kinase/metabolism , Female , Fever/physiopathology , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Immunoglobulin G , Immunoglobulin M , Infant , Infant, Newborn , L-Lactate Dehydrogenase/metabolism , Male , Middle Aged , Multivariate Analysis , Pneumonia/drug therapy , Pneumonia/microbiology , Pneumonia/physiopathology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Serum Albumin/metabolism , Severity of Illness Index , Treatment Failure , Young Adult
12.
Biomarkers ; 25(8): 641-648, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-885567

ABSTRACT

BACKGROUND: COVID-19 is a worldwide pandemic that is mild in most patients but can result in a pneumonia like illness with progression to acute respiratory distress syndrome and death. Predicting the disease severity at time of diagnosis can be helpful in prioritizing hospital admission and resources. METHODS: We prospectively recruited 1096 consecutive patients of whom 643 met the inclusion criterion with COVID-19 from Jaber Hospital, a COVID-19 facility in Kuwait, between 24 February and 20 April 2020. The primary endpoint of interest was disease severity defined algorithmically. Predefined risk variables were collected at the time of PCR based diagnosis of the infection. Prognostic model development used 5-fold cross-validated regularized logit regression. The model was externally validated against data from Wuhan, China. RESULTS: There were 643 patients with clinical course data of whom 94 developed severe COVID-19. In the final model, age, CRP, procalcitonin, lymphocyte percentage, monocyte percentages and serum albumin were independent predictors of a more severe illness course. The final prognostic model demonstrated good discrimination, and both discrimination and calibration were confirmed with an external dataset. CONCLUSION: We developed and validated a simple score calculated at time of diagnosis that can predict patients with severe COVID-19 disease reliably and that has been validated externally. The KPI score calculator is now available online at covidkscore.com.


Subject(s)
Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19/blood , Procalcitonin/blood , Serum Albumin/metabolism , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Disease Progression , Female , Humans , Internet , Kuwait/epidemiology , Male , Middle Aged , Pandemics , Prognosis , Prospective Studies , SARS-CoV-2/physiology , Severity of Illness Index
14.
J Int Med Res ; 48(9): 300060520955037, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-788436

ABSTRACT

BACKGROUND: The roles of inflammation and hypercoagulation in predicting outcomes of coronavirus disease 2019 (COVID-19) are unclear. METHODS: Adult patients diagnosed with COVID-19 from 28 January 2020 to 4 March 2020 in Tongji Hospital, Wuhan were recruited. Data on related parameters were collected. Univariate analysis and multivariable binary logistic regression were used to explore predictors of critical illness and mortality. RESULTS: In total, 199 and 44 patients were enrolled in the training and testing sets, respectively. Elevated ferritin, tumor necrosis factor-α and D-dimer and decreased albumin concentration were associated with disease severity. Older age, elevated ferritin and elevated interleukin-6 were associated with 28-day mortality. The FAD-85 score, defined as age + 0.01 * ferritin +D-dimer, was used to predict risk of mortality. The sensitivity, specificity and accuracy of FAD-85 were 86.4%, 81.8% and 86.4%, respectively. A nomogram was established using age, ferritin and D-dimer to predict the risk of 28-day mortality. CONCLUSIONS: Thrombo-inflammatory parameters provide key information on the severity and prognosis of COVID-19 and can be used as references for clinical treatment to correct inflammatory and coagulation abnormalities.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/mortality , Disseminated Intravascular Coagulation/mortality , Pneumonia, Viral/mortality , Thrombosis/mortality , Adult , Aged , Biomarkers/blood , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/virology , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Interleukin-6/blood , Logistic Models , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Prognosis , Research Design , Retrospective Studies , SARS-CoV-2 , Serum Albumin/metabolism , Severity of Illness Index , Survival Analysis , Thrombosis/complications , Thrombosis/diagnosis , Thrombosis/virology , Tumor Necrosis Factor-alpha/blood
15.
Respiration ; 99(8): 649-657, 2020.
Article in English | MEDLINE | ID: covidwho-742293

ABSTRACT

BACKGROUND: A new virus broke out in Wuhan, Hubei, China, that was later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical characteristics of severe pneumonia caused by SARS-CoV-2 are still not clear. OBJECTIVES: The aim of this study was to explore the clinical characteristics and risk factors of severe pneumonia caused by the SARS-CoV-2 in Wuhan, China. METHODS: The study included patients hospitalized at the Central Hospital of Wuhan who were diagnosed with COVID-19. Clinical features, chronic comorbidities, demographic data, laboratory examinations, and chest computed tomography (CT) scans were reviewed through electronic medical records. SPSS was used for data analysis to explore the clinical characteristics and risk factors of patients with severe pneumonia caused by SARS-CoV-2. RESULTS: A total of 110 patients diagnosed with COVID-19 were included in the study, including 38 with severe pneumonia and 72 with nonsevere pneumonia. Statistical analysis showed that advanced age, increased D-Dimer, and decreased lymphocytes were characteristics of the patients with severe pneumonia. Moreover, in the early stage of the disease, chest CT scans of patients with severe pneumonia showed that the illness can progress rapidly. CONCLUSIONS: Advanced age, decreased lymphocytes, and D-Dimer elevation are important characteristics of patients with severe COVID-19. Clinicians should focus on these characteristics to identify high-risk patients at an early stage.


Subject(s)
Coronavirus Infections/blood , Fibrin Fibrinogen Degradation Products/metabolism , Lung/diagnostic imaging , Lymphocyte Count , Pneumonia, Viral/blood , APACHE , Adult , Age Factors , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Cough/physiopathology , Disease Progression , Dyspnea/physiopathology , Fatigue/physiopathology , Female , Fever/physiopathology , Humans , Hypertension/epidemiology , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Organ Dysfunction Scores , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Procalcitonin/blood , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/epidemiology , Risk Assessment , SARS-CoV-2 , Serum Albumin/metabolism , Severity of Illness Index , Sex Factors , Tomography, X-Ray Computed
16.
Diabetes Res Clin Pract ; 167: 108351, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-664109

ABSTRACT

AIMS: Coronavirus disease (COVID-19), also referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is instigated by a novel coronavirus. The disease was initially reported in Wuhan, China, in December 2019. Diabetes is a risk factor associated with adverse outcomes. Herein, our objective was to investigate the characteristics of laboratory findings of type 2 diabetes mellitus (T2DM) patients infected with SARS-CoV-2. METHODS: This was a retrospective study and included 80 T2DM patients of Jinling Hospital from 2010 to 2020, as well as 76 COVID-19 patients without T2DM and 55 COVID-19 patients with T2DM who were treated at Huoshen hill Hospital from February 11 to March 18, 2020. We then compared the differences in laboratory test results between the three groups. RESULTS: The levels of lymphocytes, uric acid (UA), and globulin in the T2DM group were significantly higher. In contrast, C-reactive protein (CRP), creatinine, and lactic dehydrogenase (LDH)levels were lower than those in the COVID-19 (p < 0.05) and COVID-19 + T2DM groups (p < 0.05). No considerable difference was observed regarding the levels of alanine aminotransferase (ALT), white blood cell (WBC), aspartate aminotransferase (AST), globulin, and blood urea nitrogen (BUN) in the three groups (p > 0.05). CONCLUSION: T2DM patients infected with SARS-CoV-2 showed decreased levels of body mass index (BMI), lymphocytes, UA, and albumin, and increased CRP levels. The decreased BMI, UA, and albumin levels may be associated with oxidative stress response and nutritional consumption. The decreased lymphocyte counts and increased CRP levels may be related to the infection.


Subject(s)
Coronavirus Infections/metabolism , Diabetes Mellitus, Type 2/metabolism , Pneumonia, Viral/metabolism , Aged , Alanine Transaminase/metabolism , Aspartate Aminotransferases/metabolism , Betacoronavirus , Blood Urea Nitrogen , C-Reactive Protein/metabolism , COVID-19 , Case-Control Studies , Comorbidity , Coronavirus Infections/complications , Creatinine/metabolism , Diabetes Mellitus, Type 2/complications , Female , Globulins/metabolism , Humans , L-Lactate Dehydrogenase/metabolism , Lymphocyte Count , Lymphocytes , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Retrospective Studies , Risk Factors , SARS-CoV-2 , Serum Albumin/metabolism , Uric Acid/metabolism
18.
Eur J Clin Microbiol Infect Dis ; 39(12): 2447-2455, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-622381

ABSTRACT

This study compared the laboratory indexes in 40 non-severe COVID-19 patients with those in 57 healthy controls. In the peripheral blood system of non-severe symptom COVID-19 patients, lymphocytes, eosinophils, basophils, total procollagen type 1 amino-terminal propeptide, osteocalcin N-terminal, thyroid-stimulating hormone, growth hormone, and insulin-like growth factor-binding protein 3 significantly decreased, and total protein, albumin, alanine transaminase, alkaline phosphatase, γ-glutamyl transferase, activated partial thromboplastin time, prothrombin time, fibrinogen, D-dimer, fibrinogen degradation products, human epididymal protein 4, serum ferritin, and C-reactive protein were elevated. SARS-CoV-2 infection can affect hematopoiesis, hemostasis, coagulation, fibrinolysis, bone metabolism, thyroid, parathyroid glands, the liver, and the reproductive system.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Adult , Biomarkers/blood , Bone and Bones/metabolism , Bone and Bones/pathology , Bone and Bones/virology , C-Reactive Protein/metabolism , COVID-19 , Case-Control Studies , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Cross-Sectional Studies , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinolysis , Hematopoiesis , Hemostasis , Humans , Liver/metabolism , Liver/pathology , Liver/virology , Male , Middle Aged , Ovary/metabolism , Ovary/pathology , Ovary/virology , Parathyroid Glands/metabolism , Parathyroid Glands/pathology , Parathyroid Glands/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , SARS-CoV-2 , Serum Albumin/metabolism , Severity of Illness Index , Testis/metabolism , Testis/pathology , Testis/virology , Thyroid Gland/metabolism , Thyroid Gland/pathology , Thyroid Gland/virology
19.
J Infect Public Health ; 13(9): 1224-1228, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-610416

ABSTRACT

BACKGROUND: The aim of this study was to investigate the performance and predictive value of hypocalcemia in severe COVID-19 patients. METHODS: We retrospectively investigated the clinical and laboratory characteristics of severe COVID-19 patients. 107 patients were divided into hypocalcemia group and normal serum calcium group. The clinical and laboratory data were compared between two groups. The discriminative power of hypocalcemia regarding poor outcome were evaluated by receiver operating curves (ROC) analyses. RESULTS: Sixty seven patients (62.6%) had hypocalcemia. In hypocalcemia group, leukocytes, c-reactive protein (CRP), procalcitonin (PCT), Interleukin 6 (IL-6), and D-dimer levels was higher, while lymphocytes and albumin (ALB) levels was lower. No significant difference was identified in gender, age, signs and symptoms, comorbidities and other laboratory indicators. Serum calcium levels were negatively correlated with leukocytes, CRP, PCT, IL-6 and D-dimer, while positively correlated with lymphocytes and ALB. Patients with hypocalcemia more commonly presented poor outcome (47.8% (32/67) vs 25% (10/40), p=0.02). Median serum calcium levels were significantly lower in the patients with poor outcome (2.01(1.97-2.05) vs 2.10(2.03-2.20), p<0.001), and it could predict the prognosis with an area under the ROC curve (AUC) of 0.73(95% confidence interval (CI) 0.63-0.83, p<0.001). CONCLUSIONS: Hypocalcemia commonly occurred in severe COVID-19 patients and it was associated with poor outcome.


Subject(s)
Calcium/blood , Coronavirus Infections/blood , Hypocalcemia/blood , Patient Acuity , Pneumonia, Viral/blood , Aged , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Interleukin-6/blood , Lymphocyte Count , Male , Middle Aged , Pandemics , Predictive Value of Tests , Procalcitonin/blood , Prognosis , ROC Curve , Retrospective Studies , SARS-CoV-2 , Serum Albumin/metabolism
20.
Biomark Med ; 14(10): 827-837, 2020 07.
Article in English | MEDLINE | ID: covidwho-506060

ABSTRACT

Aim: We aimed to explore the biomarkers for disease progression or the risk of nonsurvivors. Materials & methods: This study included 134 hospitalized patients with confirmed COVID-19 infection. The outcome of moderate versus severe versus critically ill patients and survivors versus nonsurvivors were compared. Results: An increase in the severity of COVID-19 pneumonia was positively associated with lower levels of platelets and albumin (all p < 0.05). In the critical group, the plasma levels of albumin continued to have a significant association for the risk of nonsurvivors (p < 0.05), even after adjusting for confounding factors. Conclusion: Albumin levels could be used as an independent predictor of the risk of nonsurvivors in critically ill patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/diagnostic imaging , Critical Illness , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Serum Albumin/metabolism , Aged , Biomarkers/blood , COVID-19 , Coronavirus Infections/mortality , Critical Illness/mortality , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Predictive Value of Tests , Retrospective Studies , Risk Factors , SARS-CoV-2
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