Covid-19: contribution of clinical characteristics and laboratory features for early detection of patients with high risk of severe evolution.

BACKGROUND: The aim of this study was to identify early clinical and laboratory predictive factors of a severe coronavirus disease 2019 (COVID-19). METHODS: A retrospective study was conducted on adult patients hospitalized for COVID-19 in our hospital. Diagnosis was based on a positive real-time reverse transcription-polymerase chain reaction (RT-PCR) on nasopharyngeal samples. The cohort was divided into two groups, i.e. a favorable evolution (FE) group and an unfavorable evolution (UFE) group, including intensive care unit (ICU) and deceased patients.Results: A total of 198 patients were enrolled in the study, with 138 FE (70%) and 60 UFE (30%). Older age, male gender, comorbidities and dyspnea at admission constituted significantly worse prognosis factors. Among laboratory features, lymphocyte and platelet counts as well as corrected glomerular filtration rate were significantly lower in UFE patients, while neutrophil to lymphocyte ratio, inflammation biomarkers, creatinine, aspartate aminotransferase, lactate dehydrogenase (LDH), glycemia and D-dimer were significantly higher. Procalcitonin and LDH appeared as the most accurate variables according to receiver operating characteristic curves. CONCLUSIONS: This Belgian study revealed clinical and laboratory features able to predict high risk of ICU requirement, or even death, at admission time. These results provide a potential tool for patient's triage in a context of pandemic.Abbreviations: COVID-19: coronavirus disease 2019; ARDS: acute respiratory distress syndrome; DIC: disseminated intravascular coagulopathy; MOF: multi-organ failure; RT-PCR: real-time reverse transcription-polymerase chain reaction; UFE: unfavorable evolution; ICU: intensive care unit; EDTA: ethylenediamine tetraacetic acid; WBC: white blood cell count; Hb: hemoglobin level; PCT: procalcitonin; Na: sodium; K: potassium; PT: total protein, CRP: c-reactive protein; Cr: creatinine; ALAT: alanine aminotransferase; ALAT: aspartate aminotransferase; TB: total bilirubin, LDH: lactate dehydrogenase, FERR: ferritin; hs-Tnt: high sensitive-troponin T; cGFR: corrected glomerular filtration rate; QR: quick ratio; DDIM: D-dimer; FIB: fibrinogen; SD: standard deviation; IQR: interquartile ranges; ROC: receiver operating characteristics; ECMO: extracorporeal membrane oxygenation; NLR: neutrophil to lymphocyte ratio; AUC: area under the curve; BMI: body mass index.

Massive bleeding following severe blunt trauma: the first minutes that can change everything.

The first hour following a major trauma with massive bleeding is certainly the most decisive period in global trauma care. Most of it takes place during the prehospital care. Those prehospital minutes are thus determinant as they can be used to correctly identified patient's clinical condition, initiate organization of the in-hospital needed resources and initiate specific therapies in the very early phase after trauma. Significant recent advances in this aspect of care have been made and but evidence to support some of those strategies is still lacking.