ABSTRACT
The severity of lung involvement is the main prognostic factor in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Carbohydrate antigen 15-3 (CA 15-3), a marker of lung damage and fibrosis, could help predict the prognosis of SARS-CoV-2 pneumonia. This was a retrospective and observational study. CA 15-3 was analyzed in the blood samples of patients consecutively admitted for SARS-CoV-2 pneumonia and whose blood samples were available in the biobank. Other prognostic markers were also measured (interleukin 6 [IL6], C-reactive protein [CRP], D-dimer, troponin T, and NT-ProBNP). The occurrence of in-hospital complications was registered, including death, the need for medical intensive care, and oxygen therapy at discharge. In this study, 539 patients were recruited (54.9% men, mean age: 59.6 ± 16.4 years). At admission, the mean concentrations of CA 15-3 was 20.5 ± 15.8 U/mL, and the concentration was correlated with male sex, older age, and other severity markers of coronavirus disease of 2019 (COVID-19) (IL6, CRP, D-dimer, troponine T, and NT-ProBNP). CA 15-3 levels were higher in patients who died (n = 56, 10.4%) (35.33 ± 30.45 vs. 18.8 ± 12.11, p < 0.001), who required intensive medical support (n = 78, 14.4%; 31.17 ± 27.83 vs. 18.68 ± 11.83; p < 0.001), and who were discharged with supplemental oxygen (n = 64, 13.3%; 22.65 ± 14.41 vs. 18.2 ± 11.7; p = 0.011). Elevated CA 15-3 levels (above 34.5 U/mL) were a strong predictor of a complicated in-hospital course, in terms of a higher risk of death (adjusted odds ratio [OR] 3.74, 95% confidence interval [CI]: 1.22-11.9, p = 0.022) and need for intensive care (adjusted OR 4.56, 95% CI: 1.37-15.8) after adjusting for all other risk factors. The degree of lung damage and fibrosis evaluated in terms of CA 15-3 concentrations may allow early identification of the increased risk of complications in patients with SARS-CoV-2 pneumonia.
Subject(s)
COVID-19 , Pneumonia , Adult , Aged , Biomarkers , C-Reactive Protein , COVID-19/diagnosis , Female , Fibrosis , Humans , Interleukin-6 , Male , Middle Aged , Mucin-1 , Oxygen , Prognosis , Retrospective Studies , SARS-CoV-2ABSTRACT
It is necessary to ensure the quality of sleep studies conducted at home given that there can be potential variations. Automatic analysis is simple and could help in an audit. The objective is to find a predictive model of visual reading using an automatic analysis of saturation and respiratory signal in order to establish a reading standard with a polygraph used at home on patients who have sleep apnea-hypopnea clinical symptoms. The analysis was carried out using the following two definitions of hypopnea: an event with a duration of >or= 10 s with a decrease of > 30% of the respiratory signal; and an event associated either with a desaturation of >or= 3% or with a desaturation of >or= 4%. A total of 189 studies were selected from a representative sample of 218 patients. Two pneumologists carried out the readings together. The agreement between the visual respiratory disturbance index (RDI) [ie, apneas plus hypopneas] for both definitions and the automatic respiratory signal analysis (ie, automatic RDI [RDIa]) or the automatic desaturation index of 3% (DI3%a) and of 4% (DI4%a) showed limits from a Bland-Altman plot that were too large. However, a multiple linear regression analysis with RDIa and DI3%a or RDIa and DI4%a presented an acceptable level of agreement with RDI for both definitions (p < 0.001; r(2) = 96.2% and 97%, respectively). The 95% confidence interval for the differences between the RDI and the model was +/- 10.1 or +/- 8.8 events per hour, so a study should be revised outside of these limits. A predictive multiple regression model that uses the automatic analysis of the oximetry and respiratory signal could establish a standard for the visual reading of polygraphy at home.
Subject(s)
Home Care Services , Monitoring, Ambulatory , Polysomnography , Signal Processing, Computer-Assisted , Sleep Apnea Syndromes/diagnosis , Algorithms , Humans , Linear Models , Oximetry , Predictive Value of Tests , Prospective Studies , Quality Control , Reproducibility of Results , Sleep Apnea Syndromes/physiopathologyABSTRACT
Presentamos cuatro casos clínico-citológicos del aparato respiratorio, poco habituales en la práctica diaria, donde la morfología además de las técnicas especiales, son suficientes para llegar a un diagnóstico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide)
Four clinical-cytological cases of the respiratory apparatus appear, little habitual actually daily, where the morphology in addition to the special techniques, is sufficient to arrive at a correct diagnosis (Strongyloides stercoralis, ferruginous Bodies, Aspergillus and virus herpes in epidermoide carcinoma)
Subject(s)
Male , Middle Aged , Aged , Humans , Carcinoma, Squamous Cell/pathology , Respiratory Tract Neoplasms/pathology , Aspergillus/pathogenicity , Simplexvirus/pathogenicity , Strongyloides stercoralis/pathogenicity , Asbestosis/pathologyABSTRACT
Presentamos cuatro casos clínico-citológicos del aparato respiratorio, poco habituales en la práctica diaria, donde la morfología además de las técnicas especiales, son suficientes para llegar a un diagnóstico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide)
Four clinical-cytological cases of the respiratory apparatus appear, little habitual actually daily, where the morphology in addition to the special techniques, is sufficient to arrive at a correct diagnosis (Strongyloides stercoralis, ferruginous Bodies, Aspergillus and virus herpes in epidermoide carcinoma)
