1
|
Damanti S, Ramirez GA, Bozzolo EP, Da Prat V, Di Lucca G, Di Terlizzi G, Marinosci A, Scotti R, Strada S, Scarpellini P, Castiglioni B, Oltolini C, Ripa M, Din CT, Centurioni CE, Di Scala F, Gobbi A, Alba AC, Casiraghi GM, Morgillo A, Tresoldi M. Frailty as a predictor of mortality in COVID-19 patients receiving CPAP for respiratory insufficiency. Aging Clin Exp Res 2022; 34:945-949. [PMID: 35298829 PMCID: PMC8927756 DOI: 10.1007/s40520-021-02070-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/29/2021] [Indexed: 01/16/2023]
Abstract
Objective Exploring the association between frailty and mortality in a cohort of patients with COVID-19 respiratory insufficiency treated with continuous positive airway pressure. Methods Frailty was measured using a Frailty Index (FI) created by using the baseline assessment data on comorbidities and body mass index and baseline blood test results (including pH, lactate dehydrogenase, renal and liver function, inflammatory indexes and anemia). FI > 0.25 identified frail individuals. Results Among the 159 included individuals (81% men, median age of 68) frailty was detected in 69% of the patients (median FI score 0.3 ± 0.08). Frailty was associated to an increased mortality (adjusted HR 1.99, 95% CI 1.02–3.88, p = 0.04). Conclusions Frailty is highly prevalent among patients with COVID-19, predicts poorer outcomes independently of age. A personalization of care balancing the risk and benefit of treatments (especially the invasive ones) in such complex patients is pivotal. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02070-z.
Collapse
|
2
|
Ceci FM, Fiore M, Gavaruzzi F, Angeloni A, Lucarelli M, Scagnolari C, Bonci E, Gabanella F, Di Certo MG, Barbato C, Petrella C, Greco A, Vincentiis MD, Ralli M, Passananti C, Poscia R, Minni A, Ceccanti M, Tarani L, Ferraguti G. Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section. Diagnostics (Basel) 2022; 12:diagnostics12010176. [PMID: 35054342 PMCID: PMC8774587 DOI: 10.3390/diagnostics12010176] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/28/2022] Open
Abstract
Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.
Collapse
Affiliation(s)
- Flavio Maria Ceci
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (F.M.C.); (A.A.); (M.L.); (E.B.); (G.F.)
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (F.G.); (M.G.D.C.); (C.B.); (C.P.)
- Correspondence:
| | - Francesca Gavaruzzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy;
| | - Antonio Angeloni
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (F.M.C.); (A.A.); (M.L.); (E.B.); (G.F.)
| | - Marco Lucarelli
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (F.M.C.); (A.A.); (M.L.); (E.B.); (G.F.)
| | - Carolina Scagnolari
- Laboratory of Virology, Department of Molecular Medicine, Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00185 Roma, Italy;
| | - Enea Bonci
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (F.M.C.); (A.A.); (M.L.); (E.B.); (G.F.)
| | - Francesca Gabanella
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (F.G.); (M.G.D.C.); (C.B.); (C.P.)
| | - Maria Grazia Di Certo
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (F.G.); (M.G.D.C.); (C.B.); (C.P.)
| | - Christian Barbato
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (F.G.); (M.G.D.C.); (C.B.); (C.P.)
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (F.G.); (M.G.D.C.); (C.B.); (C.P.)
| | - Antonio Greco
- Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (A.G.); (M.D.V.); (M.R.); (A.M.)
| | - Marco De Vincentiis
- Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (A.G.); (M.D.V.); (M.R.); (A.M.)
| | - Massimo Ralli
- Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (A.G.); (M.D.V.); (M.R.); (A.M.)
| | - Claudio Passananti
- Institute of Molecular Biology and Pathology (IBPM-CNR), 00185 Rome, Italy;
| | - Roberto Poscia
- Unita di Ricerca Clinica e Clinical Competence-Direzione Generale, AOU Policlinico Umberto I, 00161 Roma, Italy;
| | - Antonio Minni
- Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy; (A.G.); (M.D.V.); (M.R.); (A.M.)
| | - Mauro Ceccanti
- Società Italiana per il Trattamento dell’Alcolismo e le sue Complicanze (SITAC), 00184 Roma, Italy;
| | - Luigi Tarani
- Department of Pediatrics, Sapienza University of Rome, 00185 Roma, Italy;
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (F.M.C.); (A.A.); (M.L.); (E.B.); (G.F.)
| |
Collapse
|
3
|
Dzsudzsák E, Sütő R, Pócsi M, Fagyas M, Szentkereszty Z, Nagy B. Profiling of Lactate Dehydrogenase Isoenzymes in COVID-19 Disease. EJIFCC 2021; 32:432-441. [PMID: 35046761 PMCID: PMC8751399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Serum total lactate dehydrogenase (LDH) activity was elevated and showed a positive correlation with disease severity and outcome in severe COVID-19 disease. However, it is still unknown whether the relative abundance or calculated activity of any LDH isoenzyme is predominately increased in COVID-19 subjects. METHODS Twenty-two consecutive patients suffered from moderate or severe COVID-19 pneumonia were recruited into this study who showed enhanced total LDH activity. The ratio of LDH isoenzyme activities was further investigated using gel electrophoresis (Hydragel®, Sebia) with densitometric evaluation. Calculated activity values of these isoenzymes were correlated with routine laboratory parameters, the degree of lung parenchymal affection based on chest CT and clinical outcome. RESULTS Total LDH activity was raised in the range of 272-2141 U/L and significantly correlated with calculated LDH-3 and LDH-4 activities (r=0.765, P=0.0001; and r=0.783, P=0.0001, respectively). In contrast, the relative abundance of neither LDH isoenzyme was exclusively abnormal in COVID-19 patients. Calculated activity of LDH-3 and LDH-4 demonstrated a modest but statistically significant association with serum ferritin (r=0.437, P=0.042; r=0.505, P=0.016, respectively). When the relationship between the severity of pulmonary affection by SARS-CoV-2 infection and relative abundance of LDH isoenzymes was studied, a larger ratio of mid-zone fractions was observed in the presence of ≥ 50% lung parenchymal involvement. Finally, regardless of LDH isoenzyme pattern, abnormal relative ratio of LDH-4 and higher calculated LDH-3 and LDH-4 activity values were detected in subjects with unfavorable outcome. CONCLUSION No characteristic profile of LDH isoenzymes can be detected in COVID-19 pneumonia, however, elevated activities of LDH-3 and LDH-4 are associated with worse clinical outcomes.
Collapse
Affiliation(s)
- Erika Dzsudzsák
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Renáta Sütő
- Gyula Kenézy Campus, Intensive Care Unit, University of Debrecen, Debrecen, Hungary, Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marianna Pócsi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Fagyas
- Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szentkereszty
- Gyula Kenézy Campus, Intensive Care Unit, University of Debrecen, Debrecen, Hungary
| | - Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Corresponding author: Béla Nagy Jr, MD, PhD Department of Laboratory Medicine Faculty of Medicine University of Debrecen Nagyerdei krt. 98. H-4032, Debrecen Hungary
| |
Collapse
|