[Usefulness of COVID-19 patients first analysis made at the Emergency Department as a prediction tool for mortality (PMCovid Score).] / Utilidad de la primera analítica de Urgencias realizada en pacientes con COVID-19 como predictora de mortalidad (PMCOVID SCORE).

OBJECTIVE: The COVID-19 pandemic has generated a high demand for hospital resources taking the national health system to its limit. In order to reduce this over burden and to avoid a potential system collapse, it would be beneficial to generate scientific evidence for the prognosis of the disease and to count with models that are able to forecast the mortality and progression of the disease. Identify mortality risk factors in COVID-19 patients from analytic data obtained from the Emergency Service at our hospital and to elaborate a prognostic score for predicting 30-day mortality (PMCovid Score) that will be included in the report submitted by the Emergency Clinic Laboratory. METHODS: Transversal descriptive study in a population that came to the Emergency Service at the University Hospital of Jaén between March 8th and April 7th 2020. We obtained the variables for the prognosis by a univariate data analysis. On this basis, we applied a multivariate analysis of the logistical regression of the mortality after 30 days in order to generate a prognostic score which was validated subsequently by the TRIPOD method. RESULTS: 298 patients were included. PMCovid Score assigns 1 point to patients age ≥77 years old; 1 point to patients with a urea level ≥49 mg/dL, 1 point to erythrocyte values <4.6x106/µL, 2 points to platelet values <165x103/µL; 1 point to patients with a percentage of lymphocytes below 18.1%; 1 point to those with a % of monocytes <6.8% and 2 points if the % of eosinophils is <0.4%.Our score had a predictive accuracy of 88.6% (AUC 0.886 IC at 95%; 0.842-0.931), with a sensibility of 91.7% (IC at 95% 82.810-100) and a specificity of 69.7% (IC at 95% 63.840-75.680). CONCLUSIONS: PMCovid Score provides the doctor with information on the prognosis of the positive COVID-19 patient along with the usual first analysis data, the necessary parameters for the calculations are available at all Emergency Laboratory Clinics. This information can be very useful for the management of this kind of patients and their classification based on the risk supplied by the PMCovid Score.

OBJETIVO: La pandemia por COVID-19 ha generado una alta demanda de recursos hospitalarios llevando al límite al sistema nacional de salud. Es por ello que para reducir dicha sobrecarga y el posible colapso del sistema, sería beneficioso generar evidencia científica sobre el pronóstico de la enfermedad y disponer de modelos que permitan predecir la mortalidad y la progresión de la enfermedad. El objetivo de este trabajo fue identificar factores de riesgo de mortalidad en pacientes COVID-19 a partir de los datos analíticos solicitados por el Servicio de Urgencias del hospital y elaborar un score pronóstico de mortalidad a 30 días. METODOS: Estudio transversal descriptivo en pacientes con COVID-19 que acudieron al Servicio de Urgencias del Hospital Universitario de Jaén entre el 8 de marzo y el 7 de abril de 2020. Las variables con utilidad para el pronóstico se obtuvieron mediante un análisis univariante de los datos, a partir de ellas se aplicó un análisis multivariante de regresión logística de mortalidad a los 30 días para generar el score pronóstico que posteriormente fue validado mediante el método TRIPOD. RESULTADOS: Se incluyeron 298 pacientes. PMCovid Score asigna 1 punto a pacientes con edad ≥77 años; 1 punto a los pacientes con niveles de urea ≥49 mg/dL, 1 punto a valores de hematíes <4,6x106/µL, 2 puntos a valores de plaquetas <165x103/µL; 1 punto a pacientes con un porcentaje de linfocitos inferior al 18,1%; 1 punto a los que tenga un porcentaje de monocitos menores a 6,8% y 2 puntos si el porcentaje de eosinófilos es menor del 0,4%. La capacidad pronóstica de nuestro score fue del 88,6% (AUC 0,886 IC al 95%; 0,842-0,931), con una sensibilidad del 91,7% (IC al 95% 82,810-100) y una especificidad del 69,7% (IC al 95% 63,840-75,680). CONCLUSIONES: PMCovid Score proporciona al clínico información acerca del pronóstico del paciente con COVID-19 positivo con los datos habituales de la primera analítica, los parámetros necesarios para el cálculo están disponibles en la totalidad de los Laboratorios Clínicos de Urgencias.

Bad Prognosis in Critical Ill Patients with COVID-19 during Short-Term ICU Stay regarding Vitamin D Levels.

BACKGROUND AND AIMS: Vitamin D inadequacy may be involved in the mechanisms of SARS-CoV-2 infection and in potential risk factors for disease propagation or control of coronavirus disease 2019 (COVID-19). This study assessed a short-term evolution of vitamin D status and its influence upon different clinical parameters in critically ill patients with COVID-19. METHODS: A prospective analytical study in which 37 critically ill volunteers between 41 and 71 years of age with COVID-19 were evaluated at baseline and three days of intensive care unit (ICU) stay. 25-OH-D3 and 25-OH-D2 were analyzed by liquid chromatography-tandem mass spectrometry and total 25-OH-D levels were calculated as the sum of both. RESULTS: All patients presented low 25-OH-D levels at baseline, decreasing total 25-OH-D (p = 0.011) mainly through 25-OH-D2 (p = 0.006) levels during ICU stay. 25-OH-D2 levels decreased a mean of 41.6% ± 89.6% versus 7.0% ± 23.4% for the 25-OH-D3 form during the ICU stay. Patients who did not need invasive mechanical ventilation presented higher levels of 25-OH-D2 at baseline and follow-up. Lower 25-OH-D and 25-OH-D3 levels were associated with higher D-dimer at baseline (p = 0.003; p = 0.001) and at follow up (p = 0.029), higher procalcitonin levels (p = 0.002; p = 0.018) at follow up, and lower percentage lymphocyte counts (p = 0.044; p = 0.040) during ICU stay. CONCLUSIONS: Deficient vitamin D status in critical patients was established at the admission and further worsened after three days of stay. Lower vitamin D levels were related to key altered clinical and biochemical parameters on patients with SARS-CoV-2 infection. Given the different response of the 25-OH-D3 and 25-OH-D2 forms, it would be useful to monitor them on the evolution of the critically ill patient.

Isolated elevation of aspartate aminotransferase (AST) in an asymptomatic patient due to macro-AST.

BACKGROUND: A rare and benign cause of isolated aspartate aminotransferase (AST) increase is due to the presence of macro aspartate aminotransferase (macro-AST). Macro-AST is not usually considered by clinicians, leading to a large number of unnecessary and even invasive tests before diagnosed. Most commonly used laboratory methods for detection of macro-enzymes are precipitation with polyethylene glycol (PEG), ultracentrifugation and gel filtration chromatography (GFC). METHODS: We report a case of an asymptomatic patient with persistent isolated AST elevation. PEG precipitation and an alternative method based on the low stability of this macro-enzyme were performed on the patient serum. RESULTS: Macro-AST was early detected by the laboratory observing a significant decrease in AST concentrations when the serum is stored at 4ºC. CONCLUSIONS: Macro-AST detection based in this method can be very useful as screening, especially in those laboratories where other technologies are not available. Macro-AST must be considered as cause of unexplained isolated AST elevations before prior investigations to avoid the consequent cost and potential harm to the patient. In our case, early detection of macro-AST with this method avoided unnecessary treatment and invasive test such as liver biopsy.