Biochemical tests in the diagnosis, classification, and management of patients with malignant lymphoma and leukemia

Potential role of biochemical markers in the prognosis of COVID-19 patients

The global pandemic due to coronavirus disease 2019 (COVID-19) has posed an overall threat to modern medicine. The course of the disease is uncertain with varying forms of presentation that cannot be managed solely with clinical skills and vigor. Since its inception, laboratory medicine forms a backbone for the proper diagnosis, treatment, monitoring, and prediction of the severity of the disease. Clinical biochemistry, an integral component of laboratory medicine, has been an unsung hero in the disease prognosis and severity assessment in COVID-19. This review attempts to highlight the biomarkers which have shown a significant role and can be used in the identification, stratification, and prediction of disease severity in COVID-19 patients. It also highlights the basis of the use of these biomarkers in the disease course and their implications.

Predictive Modeling of Morbidity and Mortality in Patients Hospitalized With COVID-19 and its Clinical Implications: Algorithm Development and Interpretation

Background

The COVID-19 pandemic began in early 2021 and placed significant strains on health care systems worldwide. There remains a compelling need to analyze factors that are predictive for patients at elevated risk of morbidity and mortality.

Objective

The goal of this retrospective study of patients who tested positive with COVID-19 and were treated at NYU (New York University) Langone Health was to identify clinical markers predictive of disease severity in order to assist in clinical decision triage and to provide additional biological insights into disease progression.

Methods

The clinical activity of 3740 patients at NYU Langone Hospital was obtained between January and August 2020; patient data were deidentified. Models were trained on clinical data during different parts of their hospital stay to predict three clinical outcomes: deceased, ventilated, or admitted to the intensive care unit (ICU).

Results

The XGBoost (eXtreme Gradient Boosting) model that was trained on clinical data from the final 24 hours excelled at predicting mortality (area under the curve [AUC]=0.92; specificity=86%; and sensitivity=85%). Respiration rate was the most important feature, followed by SpO₂ (peripheral oxygen saturation) and being aged 75 years and over. Performance of this model to predict the deceased outcome extended 5 days prior, with AUC=0.81, specificity=70%, and sensitivity=75%. When only using clinical data from the first 24 hours, AUCs of 0.79, 0.80, and 0.77 were obtained for deceased, ventilated, or ICU-admitted outcomes, respectively. Although respiration rate and SpO₂ levels offered the highest feature importance, other canonical markers, including diabetic history, age, and temperature, offered minimal gain. When lab values were incorporated, prediction of mortality benefited the most from blood urea nitrogen and lactate dehydrogenase (LDH). Features that were predictive of morbidity included LDH, calcium, glucose, and C-reactive protein.

Conclusions

Together, this work summarizes efforts to systematically examine the importance of a wide range of features across different endpoint outcomes and at different hospitalization time points.

Predictive modeling of morbidity and mortality in COVID-19 hospitalized patients and its clinical implications

Clinical activity of 3740 de-identified COVID-19 positive patients treated at NYU Langone Health (NYULH) were collected between January and August 2020. XGBoost model trained on clinical data from the final 24 hours excelled at predicting mortality (AUC=0.92, specificity=86% and sensitivity=85%). Respiration rate was the most important feature, followed by SpO2 and age 75+. Performance of this model to predict the deceased outcome extended 5 days prior with AUC=0.81, specificity=70%, sensitivity=75%. When only using clinical data from the first 24 hours, AUCs of 0.79, 0.80, and 0.77 were obtained for deceased, ventilated, or ICU admitted, respectively. Although respiration rate and SpO2 levels offered the highest feature importance, other canonical markers including diabetic history, age and temperature offered minimal gain. When lab values were incorporated, prediction of mortality benefited the most from blood urea nitrogen (BUN) and lactate dehydrogenase (LDH). Features predictive of morbidity included LDH, calcium, glucose, and C-reactive protein (CRP). Together this work summarizes efforts to systematically examine the importance of a wide range of features across different endpoint outcomes and at different hospitalization time points.

Lactate dehydrogenase: an old enzyme reborn as a COVID-19 marker (and not only)

Background Historically, the lactate dehydrogenase (LDH) measurement was introduced into Laboratory Medicine as component (together with creatine kinase (CK) and aspartate aminotransferase) of the classical enzyme triad employed for the diagnosis of myocardial infarction, which was subsequently replaced by CK-MB, and more recently by cardiac troponins. Afterwards, for many years, the clinical application of serum LDH measurement has been limited to the evaluation of anemias and to as a rough prognostic tool for certain tumors. Content In the last few years, significant changes have happened. First, the test has been confirmed as a robust predictor of poor outcomes in many neoplastic conditions. Furthermore, in the Revised International Staging System adopted in the 2015 by the International Myeloma Working Group, LDH acts as determinant of disease biology in differentiating myeloma stages. Finally, in the last few months, LDH is definitively reborn given its proven significant contribution in defining the COVID-19 severity. Conclusions This increased clinical role calls for an improvement of LDH assay standardization through the implementation of traceability of results of clinical samples to the available reference measurement system.

A study of children, fathered by men treated for testicular cancer, conceived before, during, and after chemotherapy

One hundred fifty children of 113 fathers with testicular tumour treated from 1979 on the National Institute of Oncology, Budapest, were studied. Three groups were formed on the basis of the time of conception; 69 children were born before the illness of the fathers, 40 during the 12 pretreatment months, and 41 during or after combined chemotherapy. One hundred fifty control children underwent tonsillectomy/appendectomy, but were otherwise healthy. They were matched according to age, sex, and place of inhabitance with index children. Family anamnesis, perinatal, and gestational data were listed; thereafter, physical, laboratory, immunological, and, if required, radiological examinations were made. No difference was detectable in the somatic and psychiatric status of the three groups, and development was well balanced, corresponding to age. Protocols of the combined chemotherapy applied, and the incidence of anomalies, abnormalities, malignancies, and other diseases was recorded. Incidence was similar in all three groups. Incidence of congenital malformations was not increased in children conceived before and after therapy; however, a complex congenital abnormality, an atrial septal defect with horseshoe kidney, occurred in one young girl, conceived after the end of her father's treatment. The interval between conception and the end of therapy was established in the case of children conceived either during or after therapy. This was shorter in the case of healthy children; the number of healthy children conceived during cytostatic treatment was also remarkable. Further detailed analysis of data and individual evaluation of case reports are recommended.

Changes of CSF-Cu and -Zn in children with acute lymphoblastic leukemia

In 20 Dutch children with acute lymphoblastic leukemia (ALL), Cu and Zn levels in cerebrospinal fluid (CSF) were studied during standard treatment (Protocol ALL-BFM-86/SNWLK-ALL-VII). CSF-Cu in 10 controls was 0.04 +/- 0.02 mumol/L, lower compared to values in adults. At the moment of diagnosis, CSF-Cu values were higher, 0.06 +/- 0.03 mumol/L, and during maintenance therapy lower, 0.01 +/- 0.01 mumol/L. Children with central nervous system (CNS) involvement ALL as judged by CAT Scan and EEG--in addition to cytology--showed lower CSF-Cu values compared to children without. CSF-Zn values were also measured. CSF-Zn was 0.05 mumol/L and did not vary. Cu/Zn molar ratios were increased at the onset of treatment, and decreased during maintenance therapy. The changes in CSF-Cu may follow the natural course of the disease or may relate to the success of treatment, reflecting a decrease of leukemia activity. Another explanation concerns a risk of CNS damage by low CSF-Cu causing neuron dysfunction. Conditions necessary for the interpretation of these results into a clinical strategy for followup study are outlined.

Hair zinc and copper concentrations and zinc: copper ratios in pediatric malignancies and healthy children from southeastern Turkey

Twenty-eight healthy and forty-six children with malignancy admitted to the Pediatrics Oncology Clinic and Outpatient Clinic of Dicle University, Medical Faculty, Department of Pediatrics in 1989-1990 were included into this study. The children under investigation were divided into three groups. Group 1 consisted of 28 healthy children. Twenty-eight children with newly diagnosed malignant disease, before the start of treatment, formed Group 2. Group 3 consisted of eight of these 28 children together with 18 other children with malignancy in complete remission. 1. Mean hair zinc and copper levels, and zinc/copper values for Group 2 were found to be 100.7 +/- 6.8 micrograms/g, 11.0 +/- 0.8 micrograms/g, and 10.0 +/- 0.8, respectively. 2. The corresponding values for Group 3 were obtained as 143.5 +/- 6.3 micrograms/g, 7.6 +/- 0.4 micrograms/g, and 20.2 +/- 1.4. 3. The values for Group 1 were 142.6 +/- 4.5 micrograms/g, 8.4 +/- 0.5 micrograms/g, and 19.0 +/- 1.4, respectively. 4. The differences between control-active-phase and active-phase-remission groups were statistically significant (p < 0.01), whereas almost the same values were obtained for the control and remission groups (p > 0.05). These results were valid in cases where the comparisons of these three groups were performed also for the subgroups. It was shown that hair zinc and copper levels and zinc/copper values are useful parameters for the diagnosis and treatment of the children with malignancy because of the fact that hair reflects the integrated trace element concentrations of the body, not the present one.

Serum fructosamine and lipid profile in children with malignant diseases

Serum levels of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and fructosamine (FA) were determined in thirty-three children with malignant diseases and twenty healthy controls aged 1-14 years. Of them, FA was the parameter measured in children with malignancy for the first time. Mean serum TC, HDL-C, LDL-C and FA showed statistically significant decreases in malignancy compared to healthy children, whereas a statistically significant increase was observed for TG concentrations in serum. From these data, we conclude that significant relations between serum lipids and lipoproteins and the state of malignancy exist in the children studied, and it should be remembered that serum FA concentrations are affected by abnormal serum protein turnover when one deals with any type of neoplastic disease.