Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 11 de 11
Filter
1.
Saudi J Kidney Dis Transpl ; 32(2): 377-386, 2021.
Article in English | MEDLINE | ID: covidwho-1622688

ABSTRACT

Coronavirus disease-2019 (COVID-19) is a global pandemic, also affecting Pakistan with its first case reported on February 26, 2020. Since then, it has been declared a pandemic by the World Health Organization. Our study aimed to evaluate the renal derangements associated with COVID-19 infection in our population. A retrospective, observational study was conducted to include all the admitted patients having COVID-19 positive, and evaluated those for derangements of renal function (n = 362). Out of the 362 patients, 229were admitted in the ward, 133 were in intensive care unit (ICU), 258 of them recovered, while 104 deaths reported. At admission, the renal profile was deranged in almost one-half of ICU admissions and mortalities which increased to two-third during the hospital stay, with around 80% of deaths reported with increased urea and creatinine levels. Among the deceased patients, around one-third of the mortalities developed renal profile derangements during the hospital stay although they were admitted with a normal renal profile. An estimated glomerular filtration rate showed a mean increase of 13.37 mL/min/1.73 m2 during the hospital stay of surviving patients, while a decline of 19.92 in nonsurviving patients. A hazard ratio of 3.293 (P <0.001) for admitting serum urea and 3.795 (P = 0.009) at discharge and for serum creatinine at 5.392 (P <0.001) on discharge was associated significantly with mortality. Kaplan-Meier plot showed a significant decline in days of survival with deranged urea and creatinine (P <0.001). The deranged renal function in COVID-19 patients is associated with an increased number of ICU admissions as well as mortalities.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Hospital Mortality , Intensive Care Units/statistics & numerical data , SARS-CoV-2 , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , COVID-19/mortality , COVID-19 Nucleic Acid Testing , Creatinine/blood , Glomerular Filtration Rate , Humans , Incidence , Kidney Function Tests , Pakistan/epidemiology , Renal Dialysis , Retrospective Studies , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Tertiary Healthcare , Urea/blood
2.
J Med Virol ; 93(12): 6703-6713, 2021 12.
Article in English | MEDLINE | ID: covidwho-1544323

ABSTRACT

Scores to identify patients at high risk of progression of coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may become instrumental for clinical decision-making and patient management. We used patient data from the multicentre Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) and applied variable selection to develop a simplified scoring system to identify patients at increased risk of critical illness or death. A total of 1946 patients who tested positive for SARS-CoV-2 were included in the initial analysis and assigned to derivation and validation cohorts (n = 1297 and n = 649, respectively). Stability selection from over 100 baseline predictors for the combined endpoint of progression to the critical phase or COVID-19-related death enabled the development of a simplified score consisting of five predictors: C-reactive protein (CRP), age, clinical disease phase (uncomplicated vs. complicated), serum urea, and D-dimer (abbreviated as CAPS-D score). This score yielded an area under the curve (AUC) of 0.81 (95% confidence interval [CI]: 0.77-0.85) in the validation cohort for predicting the combined endpoint within 7 days of diagnosis and 0.81 (95% CI: 0.77-0.85) during full follow-up. We used an additional prospective cohort of 682 patients, diagnosed largely after the "first wave" of the pandemic to validate the predictive accuracy of the score and observed similar results (AUC for the event within 7 days: 0.83 [95% CI: 0.78-0.87]; for full follow-up: 0.82 [95% CI: 0.78-0.86]). An easily applicable score to calculate the risk of COVID-19 progression to critical illness or death was thus established and validated.


Subject(s)
COVID-19/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19/mortality , COVID-19/pathology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Male , Middle Aged , Reproducibility of Results , Risk Assessment , Risk Factors , Severity of Illness Index , Urea/blood , Young Adult
3.
Int Clin Psychopharmacol ; 37(1): 25-28, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1483713

ABSTRACT

Lithium, a mood stabilizer used in the treatment of bipolar disorder is known for its anti-inflammatory properties with the discussion of its potential use in COVID-19 infection. The SARS-CoV-2 virus causing COVID-19 infection is known to enter the target cells through angiotensin converting enzyme-2 receptors present in abundance in the lung and renal tissue. Recent research supports the evidence for direct renal injury by viral proteins. Here we report two patients with bipolar disorder presenting with lithium toxicity in the presence of COVID-19 infection. Two patients with bipolar disorder, maintaining remission on lithium prophylaxis, presented to the psychiatric emergency with recent-onset fever and altered sensorium. Both the patient's investigations revealed lithium toxicity, elevated serum creatinine, urea and inflammatory markers. Hypernatremia, hyperkalaemia, and hyperchloremia were seen in one patient. Lithium and other psychotropic medications were stopped immediately, and COVID-19 treatment was initiated. Patient with clinical signs of lithium toxicity, hypernatremia, hyperkalaemia, and hyperchloremia developed ventricular tachycardia. He survived and regained consciousness after 2 weeks of aggressive conservative management. However, another patient died of acute respiratory failure on day 3. Possible direct infection of the kidney by SARS-CoV-2 viral proteins can manifest with acute kidney injury and lithium toxicity among patients on long-term lithium therapy. Health professionals treating COVID-19 infection among individuals on lithium therapy should be aware of the possibility of lithium toxicity in the background of renal injury.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Antimanic Agents/adverse effects , COVID-19/complications , Lithium Compounds/adverse effects , Antimanic Agents/therapeutic use , Bipolar Disorder/complications , Bipolar Disorder/drug therapy , Creatinine/blood , Fatal Outcome , Humans , Hyperkalemia/chemically induced , Hypernatremia/chemically induced , Lithium Compounds/therapeutic use , Male , Middle Aged , Respiratory Insufficiency/chemically induced , Tachycardia, Ventricular/chemically induced , Urea/blood
4.
Int J Lab Hematol ; 43(5): 1243-1251, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1211529

ABSTRACT

INTRODUCTION: Although factors such as age, sex, diabetes, obesity and changes in certain laboratory investigations are important prognostic factors in COVID-19 infection, these may not apply to all ethnic/racial groups. We hypothesized differences in routine biochemistry and haematology indices in Caucasian and a combined group of Black, Asian and Minority Ethnic (BAME) patients who tested positive for COVID-19 who died, compared to survivors. METHODS: We tested our hypothesis in 445 patients (229 Caucasian, 216 BAME) admitted to secondary care with proven COVID-19 infection, in whom standard routine laboratory indices were collected on admission. RESULTS: After 28 weeks, 190 (42.7%) had died within 28 days of COVID diagnosis (97 Caucasians [42.4%], 93 BAMEs [43.1%], P = .923). A general linear model analysis found the ethnicity interaction with mortality to be significant for fibrinogen, ferritin and HbA1 c (after controlling for age). In a multivariate analysis, a neutrophil/lymphocyte ratio > 7.4 and a urea/albumin ratio > 0.28 increased the odds of death for both the Caucasian and the BAME group. Additional factors increasing the odds ratio in the BAME group included age >60 years and being diabetic. CONCLUSION: Neutrophil/lymphocyte ratio and urea/albumin ratio are simple metrics that predict death to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce mortality. In the BAME groups, intensive monitoring even at younger age and those with diabetes may also help reduce COVID-19 associated mortality.


Subject(s)
COVID-19/blood , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Ethnicity , Female , Ferritins/analysis , Fibrinogen/analysis , Glycated Hemoglobin A/analysis , Humans , Leukocyte Count , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Serum Albumin, Human/analysis , Urea/blood
5.
Eur Arch Psychiatry Clin Neurosci ; 272(1): 41-52, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1130771

ABSTRACT

The objective is to investigate coronavirus disease 2019 (COVID-19)-associated neurological and psychiatric effects and explore possible pathogenic mechanisms. This study included 77 patients with laboratory-confirmed COVID-19 in Wuhan, China. Neurological manifestations were evaluated by well-trained neurologists, psychologists, psychiatric presentations and biochemical changes were evaluated using the Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire-9, Brief Psychiatric Rating Scale, and electronic medical records. Eighteen (23.4%) patients presented with neurological symptoms. Patients with neurological presentations had higher urea nitrogen, cystatin C, and high-sensitivity C-reactive protein levels and lower basophil counts. Among them, patients with muscle involvement had higher urea nitrogen and cystatin C levels but lower basophil counts. In addition, patients with psychiatric presentations were older and had higher interleukin (IL)-6 and IL-10 levels and higher alkaline phosphatase, R-glutamate transferase, and urea nitrogen levels. Moreover, patients with anxiety had higher IL-6 and IL-10 levels than those without, and patients with moderate depression had higher CD8 + T cell counts and lower CD4 + /CD8 + ratios than other patients. This study indicates that the central nervous system may be influenced in patients with COVID-19, and the pathological mechanisms may be related to direct virus invasion of the central nervous system, infection-mediated overreaction of the immune system, and aberrant serum pro-inflammatory factors. In addition, basophils and cystatin C may also play important roles during these pathological processes. Our findings suggest that neurological and psychiatric presentations should be evaluated and managed in patients with COVID-19. Further studies are needed to investigate the underlying mechanisms.


Subject(s)
COVID-19 , Mental Disorders , Nervous System Diseases , C-Reactive Protein/analysis , COVID-19/physiopathology , COVID-19/psychology , China/epidemiology , Cystatin C/blood , Humans , Interleukin-10/blood , Mental Disorders/blood , Mental Disorders/epidemiology , Nervous System Diseases/blood , Nervous System Diseases/epidemiology , Urea/blood
6.
Anaesth Crit Care Pain Med ; 40(1): 100777, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-911995

ABSTRACT

PURPOSE: We have previously reported an association between high red blood cell distribution width (RDW) and mortality in septic and brain infarction patients. However, no association between RDW and mortality in coronavirus disease 2019 (COVID-19) patients has been reported so far; thus, the objective of this study was to determine if that association exists. METHODS: Prospective and observational study carried out in 8 Intensive Care Units from 6 hospitals of Canary Islands (Spain) including COVID-19 patients. We recorded RDW at ICU admission and 30-day survival. RESULTS: We found that patients who did not survive (n=25) compared to surviving patients (n=118) were older (p=0.004), showed higher RDW (p=0.001), urea (p<0.001), APACHE-II (p<0.001) and SOFA (p<0.001), and lower platelet count (p=0.007) and pH (p=0.008). Multiple binomial logistic regression analysis showed that RDW was associated with 30-day mortality after controlling for: SOFA and age (OR=1.659; 95% CI=1.130-2.434; p=0.01); APACHE-II and platelet count (OR=2.062; 95% CI=1.359-3.129; p=0.001); and pH and urea (OR=1.797; 95% CI=1.250-2.582; p=0.002). The area under the curve (AUC) of RDW for mortality prediction was of 71% (95% CI=63-78%; p<0.001). We did not find significant differences in the predictive capacity between RDW and SOFA (p=0.66) or between RDW and APACHE-II (p=0.12). CONCLUSIONS: Our study provides new information regarding the ability to predict mortality in patients with COVID-19. There is an association between high RDW and mortality. RDW has a good performance to predict 30-day mortality, similar to other severity scores (such as APACHE II and SOFA) but easier and faster to obtain.


Subject(s)
COVID-19/blood , COVID-19/mortality , Erythrocyte Indices , APACHE , Age Factors , Aged , Area Under Curve , Cell Shape , Cell Size , Erythrocyte Volume , Female , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Odds Ratio , Organ Dysfunction Scores , Platelet Count , Prospective Studies , Regression Analysis , Sensitivity and Specificity , Spain/epidemiology , Survival Analysis , Time Factors , Urea/blood
7.
BMJ Open ; 10(9): e041983, 2020 09 23.
Article in English | MEDLINE | ID: covidwho-791536

ABSTRACT

OBJECTIVES: Being able to predict which patients with COVID-19 are going to deteriorate is important to help identify patients for clinical and research practice. Clinical prediction models play a critical role in this process, but current models are of limited value because they are typically restricted to baseline predictors and do not always use contemporary statistical methods. We sought to explore the benefits of incorporating dynamic changes in routinely measured biomarkers, non-linear effects and applying 'state-of-the-art' statistical methods in the development of a prognostic model to predict death in hospitalised patients with COVID-19. DESIGN: The data were analysed from admissions with COVID-19 to three hospital sites. Exploratory data analysis included a graphical approach to partial correlations. Dynamic biomarkers were considered up to 5 days following admission rather than depending solely on baseline or single time-point data. Marked departures from linear effects of covariates were identified by employing smoothing splines within a generalised additive modelling framework. SETTING: 3 secondary and tertiary level centres in Greater Manchester, the UK. PARTICIPANTS: 392 hospitalised patients with a diagnosis of COVID-19. RESULTS: 392 patients with a COVID-19 diagnosis were identified. Area under the receiver operating characteristic curve increased from 0.73 using admission data alone to 0.75 when also considering results of baseline blood samples and to 0.83 when considering dynamic values of routinely collected markers. There was clear non-linearity in the association of age with patient outcome. CONCLUSIONS: This study shows that clinical prediction models to predict death in hospitalised patients with COVID-19 can be improved by taking into account both non-linear effects in covariates such as age and dynamic changes in values of biomarkers.


Subject(s)
Bilirubin/blood , C-Reactive Protein/metabolism , Coronavirus Infections/mortality , Creatinine/blood , Lymphocyte Count , Neutrophils , Pneumonia, Viral/mortality , Urea/blood , Aged , Aged, 80 and over , Area Under Curve , Betacoronavirus , Biomarkers/blood , COVID-19 , Cohort Studies , Coronavirus Infections/blood , Female , Hospitalization , Humans , Leukocyte Count , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Prognosis , ROC Curve , Retrospective Studies , Risk Assessment , SARS-CoV-2 , United Kingdom
8.
Sci Rep ; 10(1): 14042, 2020 08 20.
Article in English | MEDLINE | ID: covidwho-725830

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in thousands of deaths in the world. Information about prediction model of prognosis of SARS-CoV-2 infection is scarce. We used machine learning for processing laboratory findings of 110 patients with SARS-CoV-2 pneumonia (including 51 non-survivors and 59 discharged patients). The maximum relevance minimum redundancy (mRMR) algorithm and the least absolute shrinkage and selection operator logistic regression model were used for selection of laboratory features. Seven laboratory features selected in the model were: prothrombin activity, urea, white blood cell, interleukin-2 receptor, indirect bilirubin, myoglobin, and fibrinogen degradation products. The signature constructed using the seven features had 98% [93%, 100%] sensitivity and 91% [84%, 99%] specificity in predicting outcome of SARS-CoV-2 pneumonia. Thus it is feasible to establish an accurate prediction model of outcome of SARS-CoV-2 pneumonia based on laboratory findings.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/blood , Models, Statistical , Pneumonia, Viral/blood , Aged , Bilirubin/blood , COVID-19 , Coronavirus Infections/therapy , Coronavirus Infections/virology , Data Accuracy , Feasibility Studies , Female , Fibrin Fibrinogen Degradation Products/analysis , Forecasting/methods , Humans , Leukocytes , Machine Learning , Male , Myoglobin/blood , Pandemics , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Prognosis , Prothrombin/analysis , Receptors, Interleukin-2/blood , Retrospective Studies , SARS-CoV-2 , Sensitivity and Specificity , Treatment Outcome , Urea/blood
9.
Transpl Infect Dis ; 22(6): e13413, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-662540

ABSTRACT

BACKGROUND: The novel coronavirus has become a global threat and healthcare concern. The manifestations of COVID-19 pneumonia in transplant patients are not well understood and may have more severe symptoms, longer duration, and a worse prognosis than in immunocompetent populations. AIMS: This study proposed to evaluate the clinical characteristics of COVID-19 pneumonia in kidney transplant recipients. PATIENTS/METHODS: Clinical records, laboratory results, radiological characteristics, and clinical outcome of 24 kidney transplant patients with COVID-19 pneumonia were evaluated from March 20, 2020, to May 20, 2020. RESULTS: The most common symptom was shortness of breath (70.8%), followed by fever (62.5%) and cough (45.8%). Five patients had leukopenia, and only one patient had leukocytosis, while 75% of the patients had a white blood cell (WBC) count in the normal range, and 79% of recipients developed lymphopenia. All of the patients had an elevated concentration of C-reactive protein and an increase in blood urea levels. Chest CT images of 23 patients (95.8%) showed typical findings of patchy ground-glass shadows in the lungs. Of the 24 patients, 12 were admitted to ICU (invasive care unit), and ten of 24 patients (41.6%) died, and 14 patients were discharged after complete recovery. CONCLUSION: It seems that COVID-19 is more severe in transplant patients and has poorer outcomes. Multiple underlying diseases, low O2 saturation, and multilobar view in chest CT scan may be of prognostic value. However, many SARS-CoV-2 demonstrations are similar to those of the general population.


Subject(s)
COVID-19/diagnosis , Kidney Transplantation , Adult , C-Reactive Protein/metabolism , COVID-19/complications , COVID-19/immunology , COVID-19/physiopathology , Cough/etiology , Cross-Sectional Studies , Dyspnea/virology , Female , Fever/etiology , Humans , Hypoxia/virology , Immunosuppression Therapy , Leukopenia/etiology , Lymphopenia/etiology , Male , Middle Aged , Oxygen/metabolism , Pneumonia/virology , Respiratory Distress Syndrome/virology , SARS-CoV-2/genetics , Tomography, X-Ray Computed , Transplant Recipients , Urea/blood
10.
Clin Chem Lab Med ; 58(7): 1100-1105, 2020 06 25.
Article in English | MEDLINE | ID: covidwho-360981

ABSTRACT

Background Comprehensive information has been published on laboratory tests which may predict worse outcome in Asian populations with coronavirus disease 2019 (COVID-19). The aim of this study is to describe laboratory findings in a group of Italian COVID-19 patients in the area of Valcamonica, and correlate abnormalities with disease severity. Methods The final study population consisted of 144 patients diagnosed with COVID-19 (70 who died during hospital stay and 74 who survived and could be discharged) between March 1 and 30, 2020, in Valcamonica Hospital. Demographical, clinical and laboratory data were collected upon hospital admission and were then correlated with outcome (i.e. in-hospital death vs. discharge). Results Compared to patients who could be finally discharged, those who died during hospital stay displayed significantly higher values of serum glucose, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), urea, creatinine, high-sensitivity cardiac troponin I (hscTnI), prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), D-dimer, C reactive protein (CRP), ferritin and leukocytes (especially neutrophils), whilst values of albumin, hemoglobin and lymphocytes were significantly decreased. In multiple regression analysis, LDH, CRP, neutrophils, lymphocytes, albumin, APTT and age remained significant predictors of in-hospital death. A regression model incorporating these variables explained 80% of overall variance of in-hospital death. Conclusions The most important laboratory abnormalities described here in a subset of European COVID-19 patients residing in Valcamonica are highly predictive of in-hospital death and may be useful for guiding risk assessment and clinical decision-making.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Age Factors , Aged , Aged, 80 and over , Arginine/blood , Aspartate Aminotransferases/blood , Betacoronavirus , Blood Glucose/analysis , C-Reactive Protein/analysis , COVID-19 , COVID-19 Testing , Carnosine/blood , Clinical Laboratory Techniques , Comorbidity , Coronavirus Infections/physiopathology , Creatine Kinase/blood , Creatinine/blood , Drug Combinations , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products , Hospital Mortality , Humans , Italy , L-Lactate Dehydrogenase/blood , Leukocytes , Lymphocytes , Male , Middle Aged , Neutrophils , Pandemics , Partial Thromboplastin Time , Pneumonia, Viral/physiopathology , Prothrombin Time , SARS-CoV-2 , Serum Albumin, Human/analysis , Troponin I/blood , Urea/blood
SELECTION OF CITATIONS
SEARCH DETAIL