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Ahnach M, Zbiri S, Nejjari S, Ousti F, Elkettani C. C-reactive protein as an early predictor of COVID-19 severity. J Med Biochem 2020; 39:500-507. [PMID: 33312067 DOI: 10.5937/jomb0-27554] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Data for predicting severity of patients with COVID-19 infection are sparse and still under investigation. We retrospectively studied whether the admission serum C-reactive protein level (CRP) can serve as nearly predictor of disease severity during COVID-19 infection in comparison with other hematologic and inflammatory markers. Methods We included all consecutive patients who were admitted in Cheikh Khalifa International University Hospital, Casablanca, Morocco, between February to April 2020, with a confirmed diagnosis of COVID-19 infection using SARS-CoV-2 viral nucleic acid via RT-PCR. The complete blood count and serum CRP level were routinely measured on admission. All clinical and laboratory data of patients were collected and analyzed. The classification of the disease severity was in accordance with the clinical classification of the WHO interim guidance, and the management of patients were adapted to the national management guideline. We estimated receiver operating characteristic (ROC) curves of blood routine parameters as well as their association with COVID-19 disease severity. Results 145 COVID-19 patients were included in the study. The median age (range) was 50 (32-63) years, and 75 (51.7%) were men. 101 patients were classified in the non-severe group and 44 patients in the severe group. Based on disease severity, significant differences were observed in the age, gender, comorbidities, and respiratory symptom. Similarly, the biological analysis found significant differences for the neutrophil count, lymphocyte count, eosinophil count, and CRP level. However, according to ROC curves of these laboratory biomarkers, the AUC of CRP at 0.872 was significantly higher than all other parameters. Further, CRP was independently associated with severity of COVID-19 disease (OR = 1.11, 95% IC (1.01-1.22) and or = 1.13, 95% IC (1.04-1.23)). Conclusions This study found that the CRP level at admission represent a simple and independent factor that can be useful for early detection of severity during COVID-19 and the easy guidance of primary care.
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Affiliation(s)
- Maryame Ahnach
- Mohammed VI University of Health Sciences (UM6SS), Cheikh Khalifa International University Hospital, Department of Hematology, Casablanca, Morocco
| | - Saad Zbiri
- Mohammed VI University of Health Sciences (UM6SS), International School of Public Health, Laboratory of Medical Evaluation and Health Economics, Casablanca, Morocco
| | - Sara Nejjari
- Mohammed VI University of Health Sciences (UM6SS), Cheikh Khalifa International University Hospital, Department of Hematology, Casablanca, Morocco
| | - Fadwa Ousti
- Mohammed VI University of Health Sciences (UM6SS), National Reference Laboratory, Casablanca, Morocco
| | - Chafik Elkettani
- Mohammed VI University of Health Sciences (UM6SS), Cheikh Khalifa International University Hospital, Department of Anesthesiology and Reanimation, Casablanca, Morocco
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152
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Mousavi-Nasab SD, Mardani R, Nasr Azadani H, zali F, Ahmadi Vasmehjani A, Sabeti S, Alavi Darazam I, Ahmadi N. Neutrophil to lymphocyte ratio and C-reactive protein level as prognostic markers in mild versus severe COVID-19 patients. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2020; 13:361-366. [PMID: 33244379 PMCID: PMC7682970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/18/2020] [Indexed: 11/24/2022]
Abstract
AIM This research aimed to investigate neutrophil-to-lymphocyte ratio (NLR) with C-reactive protein to identify potential clinical predictors and analyze differences among severe and non-severe COVID-19 patients. BACKGROUND NLR and CRP are established markers that reflect systemic inflammatory, and these parameters alter in patients with novel coronavirus (SARS-CoV-2) pneumonia (COVID-19). METHODS A population of patients with COVID-19 referred to Loghman Hospital in Tehran was analyzed. The baseline data of laboratory examinations, including NLR and CRP levels, was collected. Pearson analysis was used to assess the independent relationship between the NLR with disease severity and CRP levels. RESULTS COVID-19 cases comprised 14 (20%) patients with severe disease and 56 (80%) with non-severe infection. The mean values of WBC, NEU, LYM, and NLR of the severe patients were significantly higher than those of the non-severe patients. Forty-six patients (65.7%) had NLR >1, and the remaining patients had NLR <1. Plasma CRP levels were higher in severe cases than in non-severe cases, and this difference was significant. The results showed that NLR was positively correlated with CRP levels (R=0.23) and negatively correlated with WBC (R=-0.38). CRP (AUC = 0.97, 95% CI: 0.95-0.99) and NLR (AUC = 0.87, 95% CI: 0.81-0.93) had very good accuracy in predicting the severity of COVID-19 disease. CONCLUSION The findings of this study indicated that the integration of NLR and CRP may lead to improved predictions and is recommended as a valuable early marker to assess prognosis and evaluate the severity of clinical symptoms in COVID-19 patients.
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Affiliation(s)
- Seyed Dawood Mousavi-Nasab
- Viral vaccine research center, Pasteur Institute of Iran, Tehran, Iran
- Department of Research and Development, Production and Research Complex, Pasteur Institute, Tehran, Iran
| | - Rajab Mardani
- Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran
| | - Hosein Nasr Azadani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh zali
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Abbas Ahmadi Vasmehjani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Sabeti
- Pathology Ward, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nayebali Ahmadi
- Proteomics Research Center, Department of Medical Lab Technology, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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153
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Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, Singh MK, Gopal PB, Chaudhry D, Govil D, Dixit SB, Samavedam S. Basic Critical Care for Management of COVID-19 Patients: Position Paper of the Indian Society of Critical Care Medicine, Part II. Indian J Crit Care Med 2020; 24:S254-S262. [PMID: 33354049 PMCID: PMC7724927 DOI: 10.5005/jp-journals-10071-23593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In a resource-limited country like India, rationing of scarce critical care resources might be required to ensure appropriate delivery of care to the critically ill patients suffering from COVID-19 infection. Most of these patients require critical care support because of respiratory failure or presence of multiorgan dysfunction syndrome. As there is no pharmacological therapy available, respiratory support in the form of supplemental oxygen, noninvasive ventilation, and invasive mechanical ventilation remains mainstay of care in intensive care units. As there is still dearth of direct evidence, most of the data are extrapolated from the experience gained from the management of general critical care patients. How to cite this article: Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, et al. Basic Critical Care for Management of COVID-19 Patients: Position Paper of the Indian Society of Critical Care Medicine, Part II. Indian J Crit Care Med 2020;24(Suppl 5):S254–S262.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Rahul A Pandit
- Department of Intensive Care, Fortis Hospital, Mulund, Mumbai, Maharashtra, India
| | - Suresh Ramasubban
- Department of Critical Care, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Pavan K Reddy
- Department of Critical Care, CARE-Banjara, Hyderabad, Telangana, India
| | - Manoj K Singh
- Department of Critical Care, Apollo Hospitals International Limited, Ahmedabad, Gujarat, India
| | - Palepu Bn Gopal
- Department of Critical Care, Continental Hospital, Hyderabad, Telangana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
| | - Subhal B Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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154
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Yates PA, Newman SA, Oshry LJ, Glassman RH, Leone AM, Reichel E. Doxycycline treatment of high-risk COVID-19-positive patients with comorbid pulmonary disease. Ther Adv Respir Dis 2020; 14:1753466620951053. [PMID: 32873175 PMCID: PMC7476338 DOI: 10.1177/1753466620951053] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Infection with novel SARS-CoV-2 carries significant morbidity and mortality in patients with pulmonary compromise, such as lung cancer, autoimmune disease, and pneumonia. For early stages of mild to moderate disease, care is entirely supportive.Antiviral drugs such as remdesivir may be of some benefit but are reserved for severe cases given limited availability and potential toxicity. Repurposing of safer, established medications that may have antiviral activity is a possible approach for treatment of earlier-stage disease. Tetracycline and its derivatives (e.g. doxycycline and minocycline) are nontraditional antibiotics with a well-established safety profile, potential efficacy against viral pathogens such as dengue fever and chikungunya, and may regulate pathways important in initial infection, replication, and systemic response to SARS-CoV-2. We present a series of four high-risk, symptomatic, COVID-19+ patients, with known pulmonary disease, treated with doxycycline with subsequent rapid clinical improvement. No safety issues were noted with use of doxycycline.Doxycycline is an attractive candidate as a repurposed drug in the treatment of COVID-19 infection, with an established safety profile, strong preclinical rationale, and compelling initial clinical experience described here.The reviews of this paper are available via the supplemental material section.
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MESH Headings
- Adenocarcinoma of Lung/complications
- Adenocarcinoma of Lung/diagnosis
- Adenocarcinoma of Lung/therapy
- Adult
- Aged
- Aged, 80 and over
- COVID-19
- Comorbidity
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/drug therapy
- Doxycycline/administration & dosage
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Multimorbidity
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pulmonary Disease, Chronic Obstructive/complications
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/therapy
- Risk Assessment
- Sampling Studies
- Sarcoidosis, Pulmonary/complications
- Sarcoidosis, Pulmonary/diagnosis
- Sarcoidosis, Pulmonary/therapy
- Treatment Outcome
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Affiliation(s)
- Paul A. Yates
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Steven A. Newman
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lauren J. Oshry
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Ashton M. Leone
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Elias Reichel
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA
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