Haematological indices and coagulation profile as predictors of disease severity and associations with clinical outcome among COVID-19 patients in Lagos, Nigeria.

Background: This study aims to evaluate the use of haematological indices and coagulation profiles as possible low-cost predictors of disease severity and their associations with clinical outcomes in COVID-19-hospitalized patients in Nigeria. Materials and Methods: We carried out a hospital-based descriptive 3-month observational longitudinal study of 58 COVID-19-positive adult patients admitted at the Lagos University Teaching Hospital, Lagos, Nigeria. We used a structured questionnaire to obtain the participants' relevant sociodemographic and clinical data, including disease severity. Basic haematologic indices, their derivatives, and coagulation profile were obtained from patients' blood samples. Receiver Operating Characteristic (ROC) analysis was used to compare these laboratory-based values with disease severity. A P < 0.05 was considered statistically significant. Results: The mean age of the patients was 54.4 ± 14.8 years. More than half of the participants were males (55.2%, n = 32) and most had at least one comorbidity (79.3%, n = 46). Significantly higher absolute neutrophil count (ANC), neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), lower absolute lymphocyte count (ALC) and lymphocyte-monocyte ratio (LMR) were associated with severe disease (P < 0.05). Patients' hemoglobin concentration (P = 0.04), packed cell volume (P < 0.001), and mean cell hemoglobin concentration (P = 0.03) were also significantly associated with outcome. Receiver operating characteristic (ROC) analysis of disease severity was significant for the ANC, ALC, NLR, LMR, and SII. The coagulation profile did not show any significant associations with disease severity and outcomes in this study. Conclusion: Our findings identified haematological indices as possible low-cost predictors of disease severity in COVID-19 in Nigeria.

Résumé Contexte: Cette étude avait pour objectif d'évaluer l'utilité des indices hématologiques et profils de coagulation comme prédicteurs à faible coût de la sévérité de la maladie et leurs associations avec les résultats cliniques chez les patients hospitalisés pour COVID-19 au Nigéria. Méthodes: Nous avons mené une étude longitudinale observationnelle descriptive pendant 3 mois portant sur 58 patients adultes positifs au COVID-19, admis à Lagos University Teaching Hospital, Lagos, Nigéria. Un questionnaire structuré a été établit pour obtenir les données sociodémographiques et cliniques pertinentes des participants, y compris les données sur la sévérité de la maladie. Les indices hématologiques de base, leurs dérivés, et le profil de coagulation ont été obtenus à partir d'échantillons de sang de patients. La courbe caractéristique opérante du récepteur (ROC) a été utilisée pour comparer ces indices biologiques avec la sévérité de la maladie. Une valeur de P < 0.05 a été considéré statistiquement significatif. Résultats: L'âge moyen des patients était 54.4 ± 14.8 ans. Plus de la moitié des participants étaient des hommes (55.2 %, n = 32), et la majorité des participants présentaient au moins une comorbidité (79.3 %, n = 46). Un nombre absolu de neutrophiles (CNA), un rapport neutrophiles-lymphocytes (NLR), et une indice d'inflammation immunitaire systémique (SII) significativement élevé, et un nombre absolu de lymphocytes (ALC) et un rapport lymphocyte-monocytes (LMR) bas étaient associés à un maladie sévère (P < 0.05). La taux d'hémoglobine des patients (P = 0.04), l'hématocrite (P < 0.001), et concentration moyenne d'hémoglobine cellulaire (P = 0.03) étaient également significativement associés avec la sévérité de la maladie. L'analyse ROC de la gravité de la maladie était significative pour le ANC, ALC, NLR, LMR, et SII. Le profil de coagulation n'a montré aucune association significative avec la gravité de la maladie dans cette étude. Conclusion: Nos résultats ont identifié les indices hématologiques comme des prédicteurs potentielle à faible coût de la sévérité du COVID-19 au Nigeria. Mots-clés: Profil de coagulation, COVID-19, indices hématologiques, Nigéria, prédicteur.

Haematological indices and coagulation profile as predictors of disease severity and associations with clinical outcome among COVID­19 patients in Lagos, Nigeria

Background: This study aims to evaluate the use of haematological indices and coagulation profiles as possible low cost predictors of disease severity and their associations with clinical outcomes in COVID 19 hospitalized patients in Nigeria. Materials and Methods: We carried out a hospital based descriptive 3 month observational longitudinal study of 58 COVID 19 positive adult patients admitted at the Lagos University Teaching Hospital, Lagos, Nigeria. We used a structured questionnaire to obtain the participants' relevant sociodemographic and clinical data, including disease severity. Basic haematologic indices, their derivatives, and coagulation profile were obtained from patients' blood samples. Receiver Operating Characteristic (ROC) analysis was used to compare these laboratory based values with disease severity. A P < 0.05 was considered statistically significant. Results: The mean age of the patients was 54.4 ± 14.8 years. More than half of the participants were males (55.2%, n = 32) and most had at least one comorbidity (79.3%, n = 46). Significantly higher absolute neutrophil count (ANC), neutrophil­lymphocyte ratio (NLR), systemic immune inflammation index (SII), lower absolute lymphocyte count (ALC) and lymphocyte­monocyte ratio (LMR) were associated with severe disease (P< 0.05). Patients' hemoglobin concentration (P= 0.04), packed cell volume (P< 0.001), and mean cell hemoglobin concentration (P= 0.03) were also significantly associated with outcome. Receiver operating characteristic (ROC) analysis of disease severity was significant for the ANC, ALC, NLR, LMR, and SII. The coagulation profile did not show any significant associations with disease severity and outcomes in this study. Conclusion: Our findings identified haematological indices as possible low cost predictors of disease severity in COVID 19 in Nigeria

Health-Related Quality of Life Among Patients With Sickle Cell Disease in an Adult Hematology Clinic in a Tertiary Hospital in Lagos, Nigeria.

Background Sickle cell disease (SCD) is a genetic disease of public health concern. Improved quality healthcare has increased the life expectancy of these patients; however, they also face an increased frequency of vaso-occlusive crises and other SCD complications. These complications affect their quality of life, an area of care, which healthcare providers often overlook. We sought to determine the health-related quality of life among patients living with sickle cell disease in Lagos, Nigeria.  Materials and methods We conducted a cross-sectional study of 198 patients with sickle cell disease who attended the adult sickle cell clinic at a tertiary hospital in Lagos, Nigeria, during the period from October 1, 2018, to February 28, 2019. A self-administered questionnaire was used to obtain the clinical and socio-demographic characteristics of the patients and the 35-item Short-Form Health Survey (SF-36) questionnaire was used to determine their health-related quality of life (HRQoL). Determinants of HRQoL were established using bivariate and multivariate regression analysis.  Results The mean age of the 198 patients who participated in the study was 28.4±9.1 years, mean steady-state hemoglobin was 8.2 ± 1.3 g/dl, and 85 (42.9%) patients had a monthly income of 150 USD or less. In the previous year, 65 (32.1 %) and 33 (16.6%) patients, respectively, suffered one to two episodes (s) of acute bone pain crises and acute chest syndrome, and 43 (24.7%) had blood transfusion. Using the scoring system for SF-36 provided by RAND Health, role limitation due to physical health had the lowest median score of 50 (interquartile range {IQR}: 0-100). On bivariate analysis, bone pain crisis was associated with statistically significant low scores across all the 8 HRQoL domains of the SF36 questionnaire. Other variables, including having received blood transfusion, recent hospitalization, acute chest syndrome, lower level of income, and younger age, were also associated with significantly low scores. On regression analysis, bone pain crisis, level of income, and acute chest syndrome were found to be independent determinants of quality of life in the patients. Conclusion Sickle cell disease has a negative impact on the health-related quality of life of those affected. The presence of bone pain crisis is an important predictor of health-related quality of life in sickle cell disease patients. To improve patient outcomes, healthcare providers should take a holistic approach in evaluating and managing this disease, taking into cognizance how the complications and the financial burden of this disease impact the quality of life of affected patients.

The relationship between pre-operative lymphocyte to monocyte ratio and serum cancer antigen-125 among women with epithelial ovarian cancer in Lagos, Nigeria.

Ovarian cancer (OC) is the second most common genital cancer worldwide, and the most lethal of all genital cancers. The role of inflammation and markers of systemic inflammation such as neutrophils, lymphocytes and monocytes in cancer biology have been investigated and reported in many studies. Cancer antigen 125 (CA-125) is currently in use as an adjunct to diagnosis, prognostication and monitoring of epithelial OC (EOC). This test is not readily available in many centres in sub-Saharan Africa, creating a need to identify alternative markers that are available and affordable. This study aimed to determine the relationship between pre-operative serum lymphocyte to monocyte ratio (LMR) and CA-125 in EOC. This was a retrospective cross-sectional study among 70 women, diagnosed with EOC in Lagos University Teaching Hospital from January 2013 to December 2019. Data were extracted from the case notes of the patients. LMR was calculated as the absolute lymphocyte count divided by the absolute monocyte count and analysed using Statistical Package for Social Sciences (SPSS) version 25.0. The correlation between LMR and CA-125 was determined using Pearson's correlation coefficient. The mean age of the patients was 48.57 ± 13.97 years. Serous adenocarcinoma was the most common subtype of EOC making up 94.3% of the cases. The median serum CA-125 was 393.5 (215.00-765.67) U/mL. The median LMR was 6.77 (1.28-43.0). There was a statistically significant negative correlation between CA-125 and LMR, r = -0.28, p = 0.02. LMR was negatively associated with CA-125 in women with EOC. LMR may be considered as a simple, affordable alternative marker to CA-125 in the management of EOC.

Pretreatment Neutrophil-to-Lymphocyte Ratio: A Prognostic Biomarker of Survival in Patients With Epithelial Ovarian Cancer.

Background Inflammation is pathognomonic of all stages of tumor formation, and therefore, there is renewed interest in systemic inflammatory response (SIR) markers including haematological inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) as prognostic predictors in several cancers. Aim This study was aimed to investigate the effect of pretreatment peripheral blood NLR on the survival prognosis of patients with epithelial ovarian cancer (EOC). Methods We identified 93 patients with a complete clinical record from a cohort of 155 patients who received treatment for EOC between 2009 and 2018. Patients' sociodemographic and clinicopathologic characteristics, and updated three-year follow-up status were extracted from medical records. Pretreatment peripheral blood NLR was calculated by dividing the neutrophil count by the lymphocyte count. We employed the receiver operating characteristic (ROC) curve to identify the optimal cut-off value of the NLR in estimating progression-free survival (PFS) and overall survival (OS). The PFS and OS were assessed using the Kaplan-Meier method, and survival differences were compared using the Log Rank (Mantel-Cox) test. Independent prognostic predictors were determined using Cox regression analysis. Results According to the ROC curves, the optimal cut-off values for the NLR were 2.23 and 1.93 for PFS and OS, respectively. A high NLR was associated with poor PFS (P = 0.033) and OS (P = 0.013) in the univariate analyses. In the multivariate analyses, a high NLR was still an independent predictor of OS (hazard ratio [HR] = 2.23; 95% CI, 1.08 to 4.61) but not PFS (hazard ratio [HR] = 2.43; 95% CI, 0.95 to 6.27). Conclusion The NLR at an optimum cut-off value of 1.93 is an independent prognostic predictor of OS in patients with EOC.