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Vazquez-Colon Z, Marcus JE, Levy E, Shah A, MacLaren G, Peek G. Infectious diseases and infection control prevention strategies in adult and pediatric population on ECMO. Perfusion 2024:2676591241249612. [PMID: 38860785 DOI: 10.1177/02676591241249612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
As survival after ECMO improves and use of ECMO support increases in both pediatric and adult population, there is a need to focus on both the morbidities and complications associated with ECMO and how to manage and prevent them. Infectious complications during ECMO often have a significant clinical impact, resulting in increased morbidity or mortality irrespective of the underlying etiology necessitating cardiorespiratory support. In this review article, we discuss the prevention, management, challenges, and differences of infectious complications in adult and pediatric patients receiving ECMO support.
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Affiliation(s)
- Zasha Vazquez-Colon
- Congenital Heart Center, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Joseph E Marcus
- Infectious Diseases Services, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA
- Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Emily Levy
- Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aditya Shah
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore
- Antimicrobial Stewardship Program, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Giles Peek
- Congenital Heart Center, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
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Zhang J, Zhao Q, Liu S, Yuan N, Hu Z. Clinical predictive value of the CRP-albumin-lymphocyte index for prognosis of critically ill patients with sepsis in intensive care unit: a retrospective single-center observational study. Front Public Health 2024; 12:1395134. [PMID: 38841671 PMCID: PMC11150768 DOI: 10.3389/fpubh.2024.1395134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Background Sepsis is a complex syndrome characterized by physiological, pathological, and biochemical abnormalities caused by infection. Its development is influenced by factors such as inflammation, nutrition, and immune status. Therefore, we combined C-reactive protein (CRP), albumin, and lymphocyte, which could reflect above status, to be the CRP-albumin-lymphocyte (CALLY) index, and investigated its association with clinical prognosis of critically ill patients with sepsis. Methods This retrospective observational study enrolled critically ill patients with sepsis who had an initial CRP, albumin, and lymphocyte data on the first day of ICU admission. All data were obtained from the Affiliated Hospital of Jiangsu University. The patients were divided into quartiles (Q1-Q4) based on their CALLY index. The outcomes included 30-/60-day mortality and acute kidney injury (AKI) occurrence. The association between the CALLY index and these clinical outcomes in critically ill patients with sepsis was evaluated using Cox proportional hazards and logistic regression analysis. Results A total of 1,123 patients (63.0% male) were included in the study. The 30-day and 60-day mortality rates were found to be 28.1 and 33.4%, respectively, while the incidence of AKI was 45.6%. Kaplan-Meier analysis revealed a significant association between higher CALLY index and lower risk of 30-day and 60-day mortality (log-rank p < 0.001). Multivariate Cox proportional hazards analysis indicated that the CALLY index was independently associated with 30-day mortality [HR (95%CI): 0.965 (0.935-0.997); p = 0.030] and 60-day mortality [HR (95%CI): 0.969 (0.941-0.997); p = 0.032]. Additionally, the multivariate logistic regression model showed that the CALLY index served as an independent risk predictor for AKI occurrence [OR (95%CI): 0.982 (0.962-0.998); p = 0.033]. Conclusion The findings of this study indicated a significant association between the CALLY index and both 30-day and 60-day mortality, as well as the occurrence of AKI, in critically ill patients with sepsis. These findings suggested that the CALLY index may be a valuable tool in identifying sepsis patients who were at high risk for unfavorable outcomes.
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Affiliation(s)
- Jinhui Zhang
- Department of Critical Care Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | | | | | | | - Zhenkui Hu
- Department of Critical Care Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
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Lin S, Depczynski B, Varndell W, Hui SA, Chiew A. Clinical significance of an elevated on-admission beta-hydroxybutyrate in acutely ill adult patients without diabetes. Emerg Med Australas 2024. [PMID: 38439135 DOI: 10.1111/1742-6723.14393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To determine the relationship between point-of-care β-hydroxybutyrate (BHB) concentration and outcomes in adult patients without diabetes admitted through ED. METHODS This was a prospective study from 10 March to 2 July 2021. Admitted patients without diabetes had capillary BHB sampled in ED. Outcomes of length-of-stay (LOS), composite mortality/ICU admission rates and clinical severity scores (Quick Sepsis Organ Failure Assessment score/National Early Warning Score [qSOFA/NEWS]) were measured. BHB was assessed as a continuous variable and between those with BHB above and equal to 1.0 mmol/L and those below 1.0 mmol/L. RESULTS A total of 311 patients were included from 2377 admissions. Median length-of-stay was 4.1 days (IQR 2.1-9.8), 18 (5.8%) died and 37 (11.8%) were admitted to ICU. Median BHB was 0.2 mmol/L (IQR 0.1-0.4). Twenty-five patients had BHB ≥1.0 mmol/L and five were >3.0 mmol/L. There was no significant difference in median LOS for patients with BHB ≥1.0 mmol/L compared to non-ketotic patients, 5.3 days (IQR 2.2-7.5) versus 4.1 days, respectively (IQR 2.0-9.8) (P = 0.69). BHB did not correlate with LOS (Spearman ρ = 0.116, 95% confidence interval: 0.006-0.223). qSOFA and NEWS also did not differ between these cohorts. For those 25 patients with BHB ≥1.0 mmol/L, an infective/inflammatory diagnosis was present in 11 (44%), at least 2 days of fasting in 10 (40%) and ethanol intake >40 g within 48 h in 4 (16%). CONCLUSIONS Routine BHB measurement in patients without diabetes does not add to clinical bedside assessment and use should be limited to when required to confirm a clinical impression.
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Affiliation(s)
- Samuel Lin
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Depczynski
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Wayne Varndell
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Su An Hui
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angela Chiew
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
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Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, Dudda J, Brück LM, Hoffmann U, Bertsch T, Akin I, Behnes M. C-reactive protein and procalcitonin during course of sepsis and septic shock. Ir J Med Sci 2024; 193:457-468. [PMID: 37204560 PMCID: PMC10196281 DOI: 10.1007/s11845-023-03385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The study investigates the diagnostic and prognostic value of C-reactive protein (CRP) and procalcitonin (PCT) in patients with sepsis and septic shock. BACKGROUND Limited data regarding the prognostic value of CRP and PCT during the course of sepsis or septic shock is available. METHODS Consecutive patients with sepsis and septic shock from 2019 to 2021 were included monocentrically. Blood samples were retrieved from the day of disease onset (day 1), day 2, 3, 5, 7, and 10. Firstly, the diagnostic value of CRP and PCT for the diagnosis of a septic shock, as well as for the discrimination of positive blood cultures, was tested. Secondly, the prognostic value of the CRP and PCT was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman's correlations, C-statistics, and Kaplan-Meier analyses. RESULTS A total of 349 patients were included, of which 56% had a sepsis and 44% a septic shock on day 1. The overall rate of all-cause mortality at 30 days was 52%. With an area under the curve (AUC) of 0.861 on day 7 and 0.833 on day 10, the PCT revealed a superior AUC than the CRP (AUC 0.440-0.652) with regard to the discrimination between patients with sepsis and septic shock. In contrast, the prognostic AUCs for 30-day all-cause mortality were poor. Both higher CRP (HR = 0.999; 95% CI 0.998-1.001; p = 0.203) and PCT levels (HR = 0.998; 95% CI 0.993-1.003; p = 0.500) were not associated with the risk of 30-day all-cause mortality. During the first 10 days of ICU treatment, both CRP and PCT declined irrespective of clinical improvement or impairment. CONCLUSION PCT was a reliable diagnostic tool for the diagnosis of septic shock compared to CRP. Both CRP and PCT were shown to have poor predictive value with regard to 30-day all-cause mortality and were not associated with the risk of all-cause mortality in patients admitted with sepsis or septic shock.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Schanas Jawhar
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Floriana Dulatahu
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Lea Marie Brück
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ursula Hoffmann
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
- First Department of Medicine, University Medical Center Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Lichter Y, Gal Oz A, Carmi U, Adi N, Nini A, Angel Y, Nevo A, Aviram D, Moshkovits I, Goder N, Stavi D. Kinetics of C-reactive protein during extracorporeal membrane oxygenation. Int J Artif Organs 2024; 47:41-48. [PMID: 38031425 PMCID: PMC10787388 DOI: 10.1177/03913988231213511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND The exposure of blood to the artificial circuit during extracorporeal membrane oxygenation (ECMO) can induce an inflammatory response. C-reactive protein (CRP) is a commonly used biomarker of systemic inflammation. METHODS In this retrospective observational study, we analyzed results of daily plasma CRP measurements in 110 critically ill patients, treated with ECMO. We compared CRP levels during the first 5 days of ECMO operation, between different groups of patients according to ECMO configurations, Coronavirus disease 2019 (COVID-19) status, and mechanical ventilation parameters. RESULTS There was a statistically significant decrease in CRP levels during the first 5 days of veno-venous (VV) ECMO (173 ± 111 mg/L, 154 ± 107 mg/L, 127 ± 97 mg/L, 114 ± 100 mg/L and 118 ± 90 mg/L for days 1-5 respectively, p < 0.001). Simultaneously, there was a significant reduction in ventilatory parameters, as represented by the mechanical power (MP) calculation, from 24.02 ± 14.53 J/min to 6.18 ± 4.22 J/min within 3 h of VV ECMO initiation (p < 0.001). There was non-significant trend of increase in CRP level during the first 5 days of veno arterial (VA) ECMO (123 ± 80 mg/L, 179 ± 91 mg/L, 203 ± 90 mg/L, 179 ± 95 mg/L and 198 ± 93 for days 1-5 respectively, p = 0.126) and no significant change in calculated MP (from 14.28 ± 8.56 J/min to 10.81 ± 8.09 J/min within 3 h if ECMO initiation, p = 0.071). CONCLUSIONS We observed a significant decrease in CRP levels during the first 5 days of VV ECMO support, and suggest that the concomitant reduction in ventilatory MP may have mitigated the degree of alveolar stress and strain that could have contributed to a decrease in the systemic inflammatory process.
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Affiliation(s)
- Yael Lichter
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Gal Oz
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Carmi
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Adi
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaph Nini
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Angel
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrey Nevo
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Aviram
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Moshkovits
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Goder
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dekel Stavi
- Division of Anesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Toner AJ, Corcoran TB, Vlaskovsky PS, Nierich AP, Bain CR, Dieleman JM. Inflammation risk before cardiac surgery and the treatment effect of intraoperative dexamethasone. Anaesth Intensive Care 2024; 52:28-36. [PMID: 38000008 DOI: 10.1177/0310057x231195098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Patients who exhibit high systemic inflammation after cardiac surgery may benefit most from pre-emptive anti-inflammatory treatments. In this secondary analysis (n = 813) of the randomised, double-blind Intraoperative High-Dose Dexamethasone for Cardiac Surgery trial, we set out to develop an inflammation risk prediction model and assess whether patients at higher risk benefit from a single intraoperative dose of dexamethasone (1 mg/kg). Inflammation risk before surgery was quantified from a linear regression model developed in the placebo arm, relating preoperatively available covariates to peak postoperative C-reactive protein. The primary endpoint was the interaction between inflammation risk and the peak postoperative C-reactive protein reduction associated with dexamethasone treatment. The impact of dexamethasone on the main clinical outcome (a composite of death, myocardial infarction, stroke, renal failure, or respiratory failure within 30 days) was also explored in relation to inflammation risk. Preoperatively available covariates explained a minority of peak postoperative C-reactive protein variation and were not suitable for clinical application (R2 = 0.058, P = 0.012); C-reactive protein before surgery (excluded above 10 mg/L) was the most predictive covariate (P < 0.001). The anti-inflammatory effect of dexamethasone increased as the inflammation risk increased (-0.689 mg/L per unit predicted peak C-reactive protein, P = 0.002 for interaction). No treatment-effect heterogeneity was detected for the main clinical outcome (P = 0.167 for interaction). Overall, risk predictions from a model of inflammation after cardiac surgery were associated with the degree of peak postoperative C-reactive protein reduction derived from dexamethasone treatment. Future work should explore the impact of this phenomenon on clinical outcomes in larger surgical populations.
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Affiliation(s)
- Andrew J Toner
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Tomas B Corcoran
- Royal Perth Hospital, Perth, Australia
- University of Western Australia, Perth, Australia
- Monash University, Melbourne, Australia
| | | | | | - Chris R Bain
- Monash University, Melbourne, Australia
- Alfred Hospital, Melbourne, Australia
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Shanmugavel Geetha H, Prabhu S, Sekar A, Gogtay M, Singh Y, Mishra AK, Abraham GM, Martin S. Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease? World J Virol 2023; 12:286-295. [PMID: 38187498 PMCID: PMC10768391 DOI: 10.5501/wjv.v12.i5.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance. AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19. METHODS We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L. RESULTS 290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%). CONCLUSION Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.
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Affiliation(s)
| | - Sushmita Prabhu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Abinesh Sekar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Hospice and Palliative Medicine, University of Texas Health-San Antonio, San Antonio, TX 78201, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Suzanne Martin
- Department of Nephrology, Saint Vincent Hospital, Worcester, MA 01608, United States
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8
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Koozi H, Lidestam A, Lengquist M, Johnsson P, Frigyesi A. A simple mortality prediction model for sepsis patients in intensive care. J Intensive Care Soc 2023; 24:372-378. [PMID: 37841294 PMCID: PMC10572475 DOI: 10.1177/17511437221149572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Sepsis is common in the intensive care unit (ICU). Two of the ICU's most widely used mortality prediction models are the Simplified Acute Physiology Score 3 (SAPS-3) and the Sequential Organ Failure Assessment (SOFA) score. We aimed to assess the mortality prediction performance of SAPS-3 and SOFA upon ICU admission for sepsis and find a simpler mortality prediction model for these patients to be used in clinical practice and when conducting studies. Methods A retrospective study of adult patients fulfilling the Sepsis-3 criteria admitted to four general ICUs was performed. A simple prognostic model was created using backward stepwise multivariate logistic regression. The area under the curve (AUC) of SAPS-3, SOFA and the simple model was assessed. Results One thousand nine hundred eighty four admissions were included. A simple six-parameter model consisting of age, immunosuppression, Glasgow Coma Scale, body temperature, C-reactive protein and bilirubin had an AUC of 0.72 (95% confidence interval (CI) 0.69-0.75) for 30-day mortality, which was non-inferior to SAPS-3 (AUC 0.75, 95% CI 0.72-0.77) (p = 0.071). SOFA had an AUC of 0.67 (95% CI 0.64-0.70) and was inferior to SAPS-3 (p < 0.001) and our simple model (p = 0.0019). Conclusion SAPS-3 has a lower prognostic value in sepsis than in the general ICU population. SOFA performs less well than SAPS-3. Our simple six-parameter model predicts mortality just as well as SAPS-3 upon ICU admission for sepsis, allowing the design of simple studies and performance monitoring.
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Affiliation(s)
- Hazem Koozi
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Kristianstad Central Hospital, Anaesthesia and Intensive Care, Kristianstad, Sweden
| | - Adina Lidestam
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Maria Lengquist
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, Lund, Sweden
| | - Patrik Johnsson
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, Malmö, Sweden
| | - Attila Frigyesi
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, Lund, Sweden
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9
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Taraș R, Mahler B, Bălgrădean M, Derewicz D, Lazăr MI, Vidlescu R, Berghea F. The Role of Mannose-Binding Lectin and Inflammatory Markers in Establishing the Course and Prognosis of Community-Acquired Pneumonia in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1744. [PMID: 38002835 PMCID: PMC10670250 DOI: 10.3390/children10111744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most significant childhood diseases worldwide and a leading infectious cause of death in children. This study aimed to evaluate the prognostic value of the inflammatory markers-C-reactive protein (CRP) and procalcitonin (PCT)-and the polymorphic glycoprotein mannose-binding lectin (MBL), deficiency of which is associated with severe infections, in the determination of the optimal type and timing of therapeutic intervention for CAP in childhood. METHODS Retrospective evaluation was conducted on a cohort of 204 children aged 4 months-17 years hospitalized with CAP. Their levels of CRP, PCT, and MBL were assessed for their association with a variety of outcomes, including the incidence of local and systemic complications, admission to the ICU, duration of antibiotic treatment and hospital stay, and death. RESULTS CRP and PCT proved to be better predictors of complications of CAP than MBL. The area under the curve (AUC) value was highest for PCT as a predictor of systemic complications (AUC = 0.931, 95%CI 0.895-0.967), while CRP (AUC = 0.674, 95%CI 0.586-0.761) performed best as a predictor of local complications (AUC = 0.674, 95%CI 0.586-0.761). Regarding admission to the ICU, CRP was the weakest predictor (AUC = 0.741), while PCT performed the best (AUC = 0.833), followed by MBL (AUC = 0.797). Sensitivity and specificity were calculated for the optimal threshold generated by receiver operating characteristic (ROC) curves, rendering sensitivity of 90% and specificity of 87% for PCT in assessing the risk of systemic complications, compared to sensitivity of 83% and specificity of 90% for CRP. MBL showed relatively high sensitivity (96%) but low specificity (25%) for predicting the need for ICU admission. CONCLUSIONS Early measurement of CRP, PCT, and MBL provides clinicians with important information regarding the course and prognosis of children diagnosed with CAP, thus ensuring prompt, optimal therapeutic management.
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Affiliation(s)
- Roxana Taraș
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Beatrice Mahler
- Department of Pneumophthisiology II, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
- “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania
| | - Mihaela Bălgrădean
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Diana Derewicz
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Miruna Ioana Lazăr
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Ruxandra Vidlescu
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Florian Berghea
- Department of Internal Medicine and Rheumatology, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Sfânta Maria” Clinical Hospital, 011172 Bucharest, Romania
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10
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Fumagalli RM, Gloor E, Kaufmann PA, Frehner M, Voci D, Konstantinides SV, Kucher N, Nicoletti TF, Pecci A, Valerio L, Barco S. Common laboratory tests and their correlation with the clinical presentation and prognosis of Lemierre syndrome. Anaerobe 2023; 83:102773. [PMID: 37595866 DOI: 10.1016/j.anaerobe.2023.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Lemierre syndrome is a thromboembolic complication following an acute bacterial infection of the head/neck area, often due to anaerobes. Data on the prognostic role of laboratory parameters is lacking. METHODS We analyzed individual-patient level data from a multinational cohort of patients with Lemierre-syndrome. Patients had an infection in the head/neck area, and contiguous vein thrombosis or septic embolism, irrespective of the causal pathogen. We studied the patterns of white blood cell count, platelet count, and C-reactive protein concentration investigating their association with baseline characteristics and in-hospital clinical outcomes (septic embolism, major bleeding, all-cause death). RESULTS A total of 447 (63%) patients had complete data for analysis. White blood cells were elevated across all subgroups (median 17 × 103/μL; Q1-Q3:12-21). Median platelet count was 61 × 103/μL (Q1-Q3:30-108) with decreasing levels with increasing age. Males, patients with renal failure or cardiopulmonary impairment, and those with typical Lemierre syndrome (tonsillitis, septic thromboembolism, positivity for Fusobacterium spp.) had the lowest platelet count. Median C-reactive protein was 122 (Q1-Q3:27-248) mg/L with higher values in patients who also had more severe thrombocytopenia. The overall risk of complications was similar across subgroups of patients stratified according to white blood cell and C-reactive protein levels. Patients in the lowest third of platelet count (<42 × 103/μL) had the highest rate of complications (26%), as opposed to those in the highest third (11%), notably septic embolic events. CONCLUSIONS Common laboratory tests correlate with the clinical presentation of Lemierre syndrome. However, extreme values did not appear to be prognostically relevant for in-hospital complications and potentially able to improve clinical management.
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Affiliation(s)
| | - Elvira Gloor
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | - Maurus Frehner
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stavros V Konstantinides
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Luca Valerio
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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11
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Pham HM, Nguyen DLM, Duong MC, Phan XT, Tran LT, Trang DHT, Pham TTN. Neutrophil CD64-a prognostic marker of sepsis in intensive care unit: a prospective cohort study. Front Med (Lausanne) 2023; 10:1251221. [PMID: 37746077 PMCID: PMC10514672 DOI: 10.3389/fmed.2023.1251221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Little is known about the prognostic ability of nCD64 in critically ill patients. This study aimed to assess the prognostic values of nCD64 in adult ICU patients with sepsis. Methods A prospective cohort study was conducted at the ICU of Cho Ray Hospital in Vietnam between January 2019 to September 2020. All newly admitted 86 septic patients diagnosed based on sepsis-3 criteria were included. An evaluation of nCD64 was performed at admission (T0) and 48 h thereafter (T48). Delta nCD64 (nCD64 T48 - nCD64 T0), %delta nCD64 [(nCD64 T48 - nCD64 T0)/nCD64 T0 x 100%], APACHE II and SOFA scores were calculated and examined. Serum procalcitonin levels and white blood cell counts were documented. Spearman's rank correlation coefficient was used to test the correlation between nCD64 and severity scores. Receiver-operating characteristic (ROC) curve was performed to evaluate the predictive efficacy of the sepsis parameters. Results Patients with septic shock had significantly higher nCD64 levels than septic patients [3,568 (2,589; 5,999) vs. 1,514 (1,416;2,542) molecules/cell, p < 0.001]. nCD64 T0 and SOFA scores had a moderately positive linear correlation (R = 0.31, p = 0.004). In the survivor group, nCD64 levels significantly decreased within the first 48 h of admission (p < 0.001), while this trend was not statistically significant in the non-survivor group (p = 0.866). The area under the ROC curve (AUC) value of %delta nCD64 combined with APACHE II score (0.81) was higher than that of any other parameter alone or in combination with each other. Conclusion The nCD64 index may serve as a valuable biomarker for predicting the course of sepsis. Monitoring changes in nCD64 during the initial 48 h of admission can aid in predicting the prognosis of septic patients. The use of a combination of the trends of nCD64 index in the first 48 h with APACHE II score would further enhance the predictive accuracy. More studies with longer follow-ups are needed to fully understand the implications of serial trend and kinetics of nCD64 in septic patients.
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Affiliation(s)
- Huy Minh Pham
- Department of Emergency and Critical Care, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Minh Cuong Duong
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Xuan Thi Phan
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Linh Thanh Tran
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Thao Thi Ngoc Pham
- Department of Emergency and Critical Care, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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12
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Wyman M, Dargan D, Kazzazi D, Caddick J, Giblin V. Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases. Hand (N Y) 2023; 18:987-993. [PMID: 35130740 PMCID: PMC10470241 DOI: 10.1177/15589447211066346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation. METHODS We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available. RESULTS Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%). CONCLUSION C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.
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Affiliation(s)
- Matthew Wyman
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
| | - Dallan Dargan
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
| | - Diana Kazzazi
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Victoria Giblin
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
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13
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Lee SM, Jo YH, Lee JH, Hwang JE, Park I, Baek S, Jeong H, Um YW, Kim HE. ASSOCIATIONS OF THE SERUM ALBUMIN CONCENTRATION AND SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE AT DISCHARGE WITH 1-YEAR MORTALITY IN SEPSIS SURVIVORS: A RETROSPECTIVE COHORT STUDY. Shock 2023; 59:547-552. [PMID: 36652385 DOI: 10.1097/shk.0000000000002083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Introduction: This study was performed to investigate the predictors of 1-year mortality at discharge in sepsis survivors. Methods: This study was a retrospective analysis of patients with sepsis and septic shock at a single center. Patients who survived hospitalization for sepsis or septic shock between January 2016 and December 2017 were included in this study. Age, sex, body mass index, laboratory results such as blood cell count, C-reactive protein (CRP) and albumin levels, the Sequential Organ Failure Assessment (SOFA) score at the time of discharge and site of infection were compared between the survivors and nonsurvivors at 1 year postdischarge. Multivariate logistic regression was performed to identify the predictors of 1-year mortality. Results: During the study period, 725 sepsis patients were included in the analysis, 64 (8.8%) of whom died within the first year. The nonsurvivors were older and had a lower body mass index and a higher SOFA score at discharge than the survivors ( P < 0.05). Among the laboratory results at discharge, hemoglobin, platelet counts, and albumin concentrations were lower in the nonsurvivors than in the survivors, whereas CRP was higher in the nonsurvivors than in the survivors. In the multivariate logistic regression analysis, serum albumin <2.5 mg/dL and SOFA score ≥2 at discharge were identified as independent prognostic factors for 1-year mortality (odds ratio, 2.616; 95% confidence interval, 1.437-4.751 for albumin <2.5 mg/dL and 2.106, 1.199-3.801 for SOFA score ≥2, respectively). Conclusions: A low serum albumin concentration of <2.5 mg/dL and a high SOFA score of ≥2 at the time of discharge were prognostic factors for 1-year mortality in survivors of sepsis.
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Affiliation(s)
- Sang-Min Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | | | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ji Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Inwon Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sumin Baek
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hwain Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young Woo Um
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hee Eun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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14
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Geetha HS, Singh G, Sekar A, Gogtay M, Singh Y, Abraham GM, Trivedi N. Hyperglycemia in COVID-19 infection without diabetes mellitus: Association with inflammatory markers. World J Clin Cases 2023; 11:1287-1298. [PMID: 36926123 PMCID: PMC10013116 DOI: 10.12998/wjcc.v11.i6.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/17/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND New onset hyperglycemia is common in patients with severe coronavirus disease 2019 (COVID-19) infection. Cytokine storm due to COVID-19 infection is an essential etiology for new-onset hyperglycemia, but factors like direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pancreatic β-cell failure have also been postulated to play a role.
AIM We plan to investigate further the mechanisms underlying SARS-CoV-2 infection-induced hyperglycemia, particularly the rationale of the cytokine-induced hyperglycemia hypothesis, by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with COVID-19 infection.
METHODS We conducted a retrospective case-control study on adults without diabetes mellitus hospitalized for COVID-19 infection. The serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were collected. Hyperglycemia was defined as glucose levels ≥ 140 mg/dL. C-Reactive protein (CRP) ≥ 100 mg/L, ferritin ≥ 530 ng/mL, lactate dehydrogenase (LDH) ≥ 590 U/L, and D-dimer ≥ 0.5 mg/L were considered elevated. We used the χ2 test for categorical variables and the Mann-Whitney U test for continuous variables and calculated the logistic regression for hyperglycemia.
RESULTS Of the 520 patients screened, 248 met the inclusion criteria. Baseline demographics were equally distributed between patients with hyperglycemia and those who were normoglycemic. Serum inflammatory markers in patients with or without new-onset hyperglycemia were elevated as follows: CRP (58.1% vs 65.6%, P = 0.29), ferritin (48.4% vs 34.9%, P = 0.14), D-dimer (37.1% vs 37.1%, P = 0.76) and LDH (19.4% vs 11.8%, P = 0.02). Logistic regression analysis showed LDH odds ratio (OR) = 1.623 (P = 0.256). We observed significantly higher mortality (24.2% vs 9.1%, P = 0.001; OR = 2.528, P = 0.024) and length of stay (8.89 vs 6.69, P = 0.026) in patients with hyperglycemia.
CONCLUSION Our study showed no association between CRP, ferritin, LDH, D-dimer levels, and new-onset hyperglycemia in non-diabetic patients with COVID-19 infection. It also shows an increased mortality risk and length of stay in patients with hyperglycemia. With new-onset hyperglycemia being closely associated with poor prognostic indices, it becomes pivotal to understand the underlying pathophysiological mechanisms behind the SARS-CoV-2 infection-induced hyperglycemia. We conclude that the stress hyperglycemia hypothesis is not the only mechanism of SARS-CoV-2 infection-induced hyperglycemia but rather a multicausal pathogenesis leading to hyperglycemia that requires further research and understanding. This would help us improve not only the clinical outcomes of COVID-19 disease and inpatient hyperglycemia management but also understand the long-term effects of SARS-CoV-2 infection and further management.
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Affiliation(s)
| | - Garima Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Abinesh Sekar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Maya Gogtay
- Department of Hospice and Palliative Medicine, University of Texas Health, San Antonio, TX 78229, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - George M Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Nitin Trivedi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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15
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Méndez Hernández R, Ramasco Rueda F. Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence. J Pers Med 2023; 13:jpm13020333. [PMID: 36836567 PMCID: PMC9965041 DOI: 10.3390/jpm13020333] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
A biomarker is a molecule that can be measured in a biological sample in an objective, systematic, and precise way, whose levels indicate whether a process is normal or pathological. Knowing the most important biomarkers and their characteristics is the key to precision medicine in intensive and perioperative care. Biomarkers can be used to diagnose, in assessment of disease severity, to stratify risk, to predict and guide clinical decisions, and to guide treatments and response to them. In this review, we will analyze what characteristics a biomarker should have and how to ensure its usefulness, and we will review the biomarkers that in our opinion can make their knowledge more useful to the reader in their clinical practice, with a future perspective. These biomarkers, in our opinion, are lactate, C-Reactive Protein, Troponins T and I, Brain Natriuretic Peptides, Procalcitonin, MR-ProAdrenomedullin and BioAdrenomedullin, Neutrophil/lymphocyte ratio and lymphopenia, Proenkephalin, NefroCheck, Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin 6, Urokinase-type soluble plasminogen activator receptor (suPAR), Presepsin, Pancreatic Stone Protein (PSP), and Dipeptidyl peptidase 3 (DPP3). Finally, we propose an approach to the perioperative evaluation of high-risk patients and critically ill patients in the Intensive Care Unit (ICU) based on biomarkers.
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16
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Flamant L, Giordano Orsini G, Ramont L, Gornet M, De Ruffi S, Leroux P, Kanagaratnam L, Gennai S. Association between admission biomarkers and clinical outcome in older adults diagnosed with an infection in the emergency department. Acta Clin Belg 2022:1-6. [DOI: 10.1080/17843286.2022.2146929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucas Flamant
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | | | - Laurent Ramont
- Biochemistry Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
- Université de Reims Champagne-Ardenne, CHU Reims, SFR CAP-Santé, Reims, France
| | - Marion Gornet
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Sebastien De Ruffi
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Pierre Leroux
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Lukshe Kanagaratnam
- Clinical Research Unit, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
- Université de Reims Champagne-Ardenne, CHU Reims, INSERM, P3Cell, U 1250, Reims, France
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17
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Yan YM, Gao J, Jin PL, Lu JJ, Yu ZH, Hu Y. C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery. World J Clin Cases 2022; 10:11381-11390. [PMID: 36387784 PMCID: PMC9649545 DOI: 10.12998/wjcc.v10.i31.11381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The relationship between C-reactive protein (CRP) levels and prolonged intensive care unit (ICU) length of stay (LoS) has not been well defined.
AIM To explore the association between CRP levels at ICU admission and prolonged ICU LoS in gastrointestinal cancer (GC) patients after major surgery.
METHODS A retrospective study was performed to quantify serum CRP levels and to establish their association with prolonged ICU LoS (≥ 72 h) in GC patients admitted to the ICU. Univariate and multivariate regression analyses were conducted, and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to explore non-linearity assumptions.
RESULTS A total of 408 patients were enrolled. Among them, 83 (20.3%) patients had an ICU LoS longer than 72 h. CRP levels were independently associated with the risk of prolonged ICU LoS [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.00–2.17]. Restricted cubic spline analysis revealed a non-linear relationship between CRP levels and OR for the prolonged ICU LoS (P = 0.035 for non-linearity). After the cut-off of 2.6 (log transformed mg/L), the OR for prolonged ICU LoS significantly increased with CRP levels. The adjusted regression coefficient was 0.70 (95%CI 0.31–1.57, P = 0.384) for CRP levels less than 2.6, whereas it was 2.43 (95%CI 1.39–4.24, P = 0.002) for CRP levels higher than 2.6.
CONCLUSION Among the GC patients, CRP levels at ICU admission were non-linearly associated with prolonged ICU LoS in survivors. An admission CRP level > 2.6 (log transformed mg/L) was associated with increased risk of prolonged ICU LoS.
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Affiliation(s)
- Ya-Min Yan
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian Gao
- Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai 200032, China
| | - Pei-Li Jin
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing-Jing Lu
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zheng-Hong Yu
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yan Hu
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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18
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Inoue S, Nakanishi N, Sugiyama J, Moriyama N, Miyazaki Y, Sugimoto T, Fujinami Y, Ono Y, Kotani J. Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study. J Clin Med 2022; 11:jcm11185257. [PMID: 36142904 PMCID: PMC9505847 DOI: 10.3390/jcm11185257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023] Open
Abstract
Post-intensive care syndrome (PICS) comprises physical, mental, and cognitive disorders following a severe illness. The impact of PICS on long-term prognosis has not been fully investigated. This study aimed to: (1) clarify the frequency and clinical characteristics of PICS in sepsis patients and (2) explore the relationship between PICS occurrence and 2-year survival. Patients with sepsis admitted to intensive care unit were enrolled. Data on patient background; clinical information since admission; physical, mental, and cognitive impairments at 3-, 6-, and 12-months post-sepsis onset; 2-year survival; and cause of death were obtained from electronic medical records and telephonic interviews with patients and their families. At 3 months, comparisons of variables were undertaken in the PICS group and the non-PICS group. Among the 77 participants, the in-hospital mortality rate was 11% and the 2-year mortality rate was 52%. The frequencies of PICS at 3, 6, and 12 months were 70%, 60%, and 35%, respectively. The 2-year survival was lower in the PICS group than in the non-PICS group (54% vs. 94%, p < 0.01). More than half of the survivors had PICS at 3 and 6 months after sepsis. Among survivors with sepsis, those who developed PICS after 3 months had a lower 2-year survival.
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Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
- Correspondence: ; Tel.: +81-78-3826521; Fax: +81-78-3415254
| | - Nobuto Nakanishi
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Jun Sugiyama
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Naoki Moriyama
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Yusuke Miyazaki
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Takashi Sugimoto
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Chuo Hospital, Honmachi 439, Kakogawa 675-8611, Japan
| | - Yuko Ono
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Joji Kotani
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
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19
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Huang N, Chen J, Wei Y, Liu Y, Yuan K, Chen J, He M, Liu N. Multi-marker approach using C-reactive protein, procalcitonin, neutrophil CD64 index for the prognosis of sepsis in intensive care unit: a retrospective cohort study. BMC Infect Dis 2022; 22:662. [PMID: 35907785 PMCID: PMC9339197 DOI: 10.1186/s12879-022-07650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
Background We aimed to explore the prognostic utilities of C-reactive protein (CRP), procalcitonin (PCT), neutrophil CD64 (nCD64) index, in combination or alone, in septic patients. Methods We retrospectively included 349 septic patients (based on Sepsis 3.0 definition). The primary outcome was 28-day all-cause mortality. Cox regression model, receiver-operating characteristic (ROC) curve, reclassification analysis, Kaplan–Meier survival curves were performed to evaluate the predictive efficacy of the above parameters. Results CRP, nCD64 index were independent predictors of 28-day mortality for sepsis in the Cox regression model [CRP, HR 1.004 (95% CI 1.002–1.006), P < 0.001; nCD64 index, HR 1.263 (95% CI 1.187–1.345, P < 0.001]. Area under the ROC curve (AUC) of CRP, PCT, nCD64 index, nCD64 index plus PCT, nCD64 index plus CRP, were 0.798 (95% CI 0.752–0.839), 0.833 (95% CI 0.790–0.871), 0.906 (95% CI 0.870–0.935), 0.910 (95% CI 0.875–0.938), 0.916 (95% CI 0.881–0.943), respectively. nCD64 plus CRP performed best in prediction, discrimination, and reclassification of the 28-day mortality risk in sepsis. The risk of 28-day mortality increased stepwise as the number of data exceeding optimal cut-off values increased. Conclusions nCD64 index combined with CRP was superior to CRP, PCT, nCD64 index and nCD64 index plus PCT in predicting 28-day mortality in sepsis. Multi-marker approach could improve the predictive accuracy and be beneficial for septic patients.
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Affiliation(s)
- Na Huang
- Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Jing Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of GuangZhou University of Chinese Medicine, Guangzhou, China
| | - Yu Wei
- Basic Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongrui Liu
- Emergency Department, The First Affiliated Hospital of GuangZhou University of Chinese Medicine, Guangzhou, China
| | - Kang Yuan
- Emergency Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Jingli Chen
- Emergency Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Mingfeng He
- Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Nan Liu
- Emergency Department, The First Affiliated Hospital of GuangZhou University of Chinese Medicine, Guangzhou, China.
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20
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Thromboprophylaxis and clinical outcomes in moderate COVID-19 patients: A comparative study. Res Social Adm Pharm 2022; 18:4048-4055. [PMID: 35864037 PMCID: PMC9288247 DOI: 10.1016/j.sapharm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/28/2022] [Accepted: 07/10/2022] [Indexed: 01/08/2023]
Abstract
Background Many thrombotic complications are linked to coronavirus disease 2019 (COVID-19). Antithrombotic treatments are important for prophylaxis against these thrombotic events. Objectives This study was designed to compare enoxaparin and rivaroxaban as prophylactic anticoagulants in moderate cases of COVID-19 in terms of efficacy, safety, and clinical outcomes. Methods The study involved 124 patients with moderate COVID-19 (pneumonia without hypoxia) divided into two groups. The first group (G1) comprised 66 patients who received enoxaparin subcutaneously at a dose of 0.5 mg/kg every 12 h until discharge from the hospital. The second group (G2) comprised 58 patients who received oral rivaroxaban at a dose of 10 mg once daily until discharge from the hospital. The outcomes evaluated in this study were as follows: intermediate care unit (IMCU) duration, the number of patients transferred from the IMCU to the intensive care unit (ICU), ICU duration, the total length of hospital stay, in-hospital mortality, and thrombotic and bleeding complications. Results No significant differences in IMCU duration (p = 0.39), ICU duration (p = 0.96), and total length of hospital stay (p = 0.73) were observed between the two groups. The percentage of patients requiring ICU admission after hospitalization was 21.2% in G1 and 22.4% in G2 (p = 0.87). The mortality rate was 12.1% in G1 and 10.3% in G2 (p = 0.76). The proportion of patients who had thrombotic complications was 9.1% in G1 and 12.1% in G2 (p = 0.59). The incidence of mild bleeding was 3% in G1 and 1.7% in G2 (p = 0.64). Conclusion Either enoxaparin or rivaroxaban may be used as thromboprophylaxis agents in managing patients with moderate COVID-19. Either medication has no clear advantage over the other.
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Malik SUF, Chowdhury PA, Hakim A, Islam MS, Alam MJ, Azad AK. Blood biochemical parameters for assessment of COVID-19 in diabetic and non-diabetic subjects: a cross-sectional study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1344-1358. [PMID: 33504213 DOI: 10.1080/09603123.2021.1879741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
This study aims to identify blood biomarkers for rapidly predicting progression and severity assessment of COVID-19 in type 2 diabetic (DM) and non-DM (NDM) patients. Among 211 hospitalized patients suspected of COVID-19, 98 were confirmed COVID-19 by rRT-PCR. The COVID-19 positive group contained 58 DM and 40 NDM patients with total death 9 of which 7 were males and 6 were DM, indicating males and DM individuals as more susceptible to COVID-19. Blood biomarkers notably serum ferritin, CRP, D-dimer, ALT, troponin I, and Hb1Ac were significantly (p < 0.05) higher in COVID-19 patients. Ferritin and HbA1c levels were significantly (p < 0.05) higher in DM than NDM COVID-19 patients. The present study suggests that ferritin and HbA1c levels for DM patients, and ferritin, D-dimer, ALT for NDM patients could be routinely used as biomarkers for progression and severity assessment of COVID-19. CRP and Troponin-I could be the predictor only for poor prognosis of COVID-19.
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Affiliation(s)
- Syeda Umme Fahmida Malik
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
- Department of Biochemistry, North East Medical College Hospital, Sylhet, Bangladesh
| | | | - Al Hakim
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Mohammad Shahidul Islam
- Department of Statistics, School of Physical Sciences, Shahjalal University of Science & Technology, Sylhet, Bangladesh
| | - Md Jahangir Alam
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Abul Kalam Azad
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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Comparative Clinical Characteristics, Laboratory Findings, and Outcomes of Hypoxemic and Non-Hypoxemic Patients Treated at a Makeshift COVID-19 Unit in Bangladesh: A Retrospective Chart Analysis. J Clin Med 2022; 11:jcm11112968. [PMID: 35683357 PMCID: PMC9181205 DOI: 10.3390/jcm11112968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Starting on 31 December 2019, from Wuhan City, China, Coronavirus disease 2019 (COVID-19) caused a global pandemic by 11 March 2020. Bangladesh detected its first case on 8 March 2020, only 66 days later the detection of the first case in China. We aimed to describe the epidemiology, clinical features, laboratory characteristics, and outcomes of Bangladeshi COVID-19 patients. Methods: This retrospective chart analysis compared Bangladeshi COVID-19 patients with hypoxemia compared to those without hypoxemia treated in a makeshift COVID-19 unit of icddr,b. Results: By March 2021, 207 remained in-patient. Nineteen patients (9.2%) died, whereas 10 (4.8%) were referred to different facilities for definitive care. Out of 207 in-patients, 88 patients required oxygen therapy. Multivariable logistic regression identified age (1.07 (1.02−1.13)), dyspnea (3.56 (1.06−11.96)), high CRP (1.13 (1.03−1.25)), and lymphopenia (6.18 (1.81−21.10)) as the independent predictors for hypoxemia in patients hospitalized for COVID 19 (for all, p < 0.05). Conclusion: Older age, dyspnea, high CRP, and lymphopenia are simple, but important, clinical and laboratory parameters. These may help clinicians to identify COVID-19 patients early who are at risk of fatal hypoxemia. Close monitoring, and prompt and aggressive treatment of these patients would curb their morbidity and mortality, especially in resource-limited settings.
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Kurien SS, David RS, Chellappan AK, Varma RP, Pillai PR, Yadev I. Clinical Profile and Determinants of Mortality in Patients With COVID-19: A Retrospective Analytical Cross-Sectional Study in a Tertiary Care Center in South India. Cureus 2022; 14:e23103. [PMID: 35464560 PMCID: PMC8999019 DOI: 10.7759/cureus.23103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 01/08/2023] Open
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Development and validation of a new risk scoring system for solid tumor patients with suspected infection. Sci Rep 2022; 12:3442. [PMID: 35236914 PMCID: PMC8891281 DOI: 10.1038/s41598-022-07477-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/14/2022] [Indexed: 01/08/2023] Open
Abstract
This study aimed to develop a new prognostic model for predicting 30-day mortality in solid tumor patients with suspected infection. This study is a retrospective cohort study and was conducted from August 2019 to December 2019 at a single center. Adult active solid tumor patients with suspected infection were enrolled among visitors to the emergency room (ER). Logistic regression analysis was used to identify potential predictors for a new model. A total of 899 patients were included; 450 in the development cohort and 449 in the validation cohort. Six independent variables predicted 30-day mortality: Eastern Cooperative Oncology Group (ECOG) performance status (PS), peripheral oxygen saturation (SpO2), creatinine, bilirubin, C-reactive protein (CRP), and lactate. The C-statistic of the new scoring system was 0.799 in the development cohort and 0.793 in the validation cohort. The C-statistics in the development cohort was significantly higher than those of SOFA [0.723 (95% CI: 0.663–0.783)], qSOFA [0.596 (95% CI: 0.537–0.655)], and SIRS [0.547 (95% CI: 0.483–0.612)]. The discriminative capability of the new cancer-specific risk scoring system was good in solid tumor patients with suspected infection. The new scoring model was superior to SOFA, qSOFA, and SIRS in predicting mortality.
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Heuer A, Strahl A, Viezens L, Koepke LG, Stangenberg M, Dreimann M. The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission. J Clin Med 2022; 11:jcm11030660. [PMID: 35160110 PMCID: PMC8836753 DOI: 10.3390/jcm11030660] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Patients with spondylodiscitis often present with unspecific and heterogeneous symptoms that delay diagnosis and inevitable therapeutic steps leading to increased mortality rates of up to 27%. A rapid initial triage is essential to identify patients at risk for a complicative disease course. We therefore aimed to develop a risk assessment score using fast available parameters to predict in-hospital mortality of patients admitted with spondylodiscitis. (2) Methods: A retrospective data analysis of 307 patients with spondylodiscitis recruited from 2013 to 2020 was carried out. Patients were grouped according to all-cause mortality. Via logistic regression, individual patient and clinical characteristics predictive of mortality were identified. A weighted sum score to estimate a patient's risk of mortality was developed and validated in a randomly selected subgroup of spondylodiscitis patients. (3) Results: 14% of patients with spondylodiscitis died during their in-hospital stay at a tertiary center for spinal surgery. Univariate and logistic regression analyses of parameters recorded at hospital admission showed that age older than 72.5 years, rheumatoid arthritis, creatinine > 1.29 mg/dL and CRP > 140.5 mg/L increased the risk of mortality 3.9-fold, 9.4-fold, 4.3-fold and 4.1-fold, respectively. S. aureus detection increased the risk of mortality by 2.3-fold. (4) Conclusions: The novel Hamburg Spondylodiscitis Assessment Score (HSAS) shows a good fit identifying patients at low-, moderate-, high- and very high risk for in hospital mortality on admission (AUC: 0.795; p < 0.001). The implementation of the HSAS into clinical practice could ease identification of high-risk patients using readily available parameters alone, improving the patient's safety and outcome.
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Affiliation(s)
- Annika Heuer
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
- Correspondence:
| | - André Strahl
- Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| | - Leon-Gordian Koepke
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
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Hanger J, Bush A, Lunt A, Adams M, Keatley B, Munro A, Jaralla N, Christopoulos P. The Early Changes in Emergency General Surgery Following Implementation of UK COVID-19 Policy: A Retrospective Cohort Study. Cureus 2021; 13:e19832. [PMID: 34824951 PMCID: PMC8610436 DOI: 10.7759/cureus.19832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. On 23rd March 2020, the UK introduced measures in an effort to curb the disease spread. The aim of this study was to analyse the effect of government and Royal College measures on the general surgical take. Materials and methods A retrospective analysis of patients referred to the acute general surgical take between 2nd March 2020 and 5th April 2020, including acuity at the time of referral, management, and patient outcomes, was undertaken. Data fit into a ‘pre-COVID measures’ cohort (prior to 23rd March 2020) and a ‘post-COVID measures’ cohort (on or after 23rd March 2020). Results A total of 465 patient referrals were included. There was a decrease in admissions rate in the post-COVID measures’ cohort (p=0.001), but with an increase in patient acuity with white cell count (WCC) (p=0.024) and C-reactive protein (CRP) (p=0.036). Laparoscopic surgery decreased (p=0.004); however, the proportion of patients having an operation remained constant. There was no increase in short-term morbidity and mortality or length of stay (LOS). Discussion The data suggests that UK lockdown introduction influenced people’s behaviour. Fewer patients presented to the surgical take; however, these patients were of higher acuity. Despite changes in royal college guidelines, there was no decrease in the proportion of patients undergoing operations; however, a higher proportion were open procedures. The change in national and college guidelines did not affect short-term morbidity, mortality or LOS.
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Affiliation(s)
- Joseph Hanger
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
| | - Alexander Bush
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
| | - Adam Lunt
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
| | - Matthew Adams
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
| | - Ben Keatley
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
| | - Alicia Munro
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
| | - Nasir Jaralla
- Gastrointestinal Surgery, Torbay and South Devon Hospital, Torquay, GBR
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Sukrisman L, Sinto R. Coagulation profile and correlation between D-dimer, inflammatory markers, and COVID-19 severity in an Indonesian national referral hospital. J Int Med Res 2021; 49:3000605211059939. [PMID: 34796762 PMCID: PMC8619746 DOI: 10.1177/03000605211059939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Coagulopathy and inflammation are associated with coronavirus disease 2019
(COVID-19) severity. This study assessed D-dimer concentration and its
correlation with inflammatory markers and COVID-19 severity. Methods This was a retrospective cross-sectional study involving 194 COVID-19 cases,
with the severity of infection graded in accordance with the World Health
Organization (WHO) guidelines. We measured D-dimer, C-reactive protein
(CRP), and ferritin on admission and determined the cutoff values for
D-dimer and CRP and evaluated the correlation between D-dimer and CRP and
ferritin. Results Median D-dimer, CRP, and ferritin concentrations were 2240 µg/L, 73.2 mg/L,
and 1173.8 µg/mL, respectively. The highest median D-dimer value was seen in
mild and moderate acute respiratory distress syndrome (ARDS). The highest
ferritin concentration was seen in severe ARDS. There was a significant
correlation between D-dimer value and CRP (r = 0.327), but no significant
correlation between D-dimer and ferritin (r = 0.101). The area under the
receiver operating characteristic curve (AUC) for the combination of CRP
≥72.65 mg/L and D-dimer ≥1250 µg/L as a marker of COVID-19 severity was
0.722 (95% confidence interval (CI): 0.615–0.781). Conclusion The combination of CRP ≥72.65 mg/L and D-dimer ≥1250 µg/L can be used as
marker of COVID-19 severity, with moderate accuracy.
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Affiliation(s)
- Lugyanti Sukrisman
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Robert Sinto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
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Bayram M, Yildirim O, S Ozmen R, Soylu B, Dundar AS, Koksal AR, Ekinci I, Akarsu M, Tabak O. Prognostic Nutritional Index and CRP, age, platelet count, albumin level score in predicting mortality and intensive care unit admission for COVID-19. Biomark Med 2021; 15:1733-1740. [PMID: 34784756 PMCID: PMC8597666 DOI: 10.2217/bmm-2021-0337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Aim: In our study, we investigated the efficiency of the prognostic nutritional index (PNI) score and the CRP, age, platelet count, albumin level (CAPA) score predicting mortality and intensive care unit (ICU) admission in COVID-19 disease. Materials & methods: PNI and CAPA score of patients confirmed with COVID-19 calculated by using the complete blood count and biochemical parameters at admission to the hospital, in predicting the COVID-19-associated mortality and ICU admission were analyzed. Results: PNI and CAPA scores in predicting mortality were detected as AUC: 0.67 (p < 0.001), AUC: 0.71 (p < 0.001), respectively. For predicting ICU admission AUC was 0.66 (p < 0.001), AUC was 0.77 (p < 0.001), respectively. Conclusion: PNI and CAPA scores are effective scores in COVID-19, with CAPA score being better in predicting mortality and ICU admission.
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Affiliation(s)
- Mehmet Bayram
- Department of Gastroenterology, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ozgur Yildirim
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Raye S Ozmen
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Beyza Soylu
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ahmet S Dundar
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ali R Koksal
- Department of Gastroenterology & Hepatology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Iskender Ekinci
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Murat Akarsu
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Omur Tabak
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
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Ma H, Liu H, Wu C, Huang L. Diagnostic Value of Serum Heparin Binding Protein, Blood Lactic Acid Combined with hs-CRP in Sepsis and Its Relationship with Prognosis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5023733. [PMID: 34795784 PMCID: PMC8594982 DOI: 10.1155/2021/5023733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore the diagnostic value of serum heparin binding protein (HBP), blood lactic acid (Lac) combined with high-sensitivity C- reactive protein (hs-CRP) in sepsis and its relationship with prognosis. METHODS The clinical data of 127 patients with sepsis from March 2019 to March 2021 in our hospital were retrospectively analyzed. 120 outpatients undergoing physical examination in the same period in our hospital were selected as the control group. According to the severity of the disease, 127 sepsis patients were divided into the mild sepsis group (n = 45), severe sepsis group (n = 53), and septic shock group (n = 29). According to the clinical prognosis, the patients were divided into the survival group (n = 96) and death group (n = 31). Serum HBP, Lac, and hs-CRP levels were measured in all subjects. The ROC curves of the subjects were drawn to analyze the predictive value of serum HBP, Lac, and hs-CRP for the prognosis of sepsis patients. RESULTS The levels of serum HBP, Lac, and hs-CRP in the sepsis group were higher than those in the control group (P < 0.05). With the increase of the severity of sepsis, serum HBP, Lac, and hs-CRP levels of patients gradually increased (P < 0.05). The levels of serum HBP, Lac, and hs-CRP in the death group were higher than those in the survival group (P < 0.05). The AUC of serum HBP, Lac, and hs-CRP for predicting the prognosis of sepsis patients was 0.858 (95% CI: 0.763-0.953), 0.694 (95% CI: 0.589-0.799), and 0.843 (95% CI: 0.759-0.927). The AUC of serum HBP, Lac combined with hs-CRP for predicting the prognosis of sepsis patients was 0.961 (95% CI: 0.000-1.000). CONCLUSION The levels of serum HBP, Lac, and hs-CRP in patients with sepsis were significantly increased and increased with the severity of sepsis. Serum HBP, Lac, and hs-CRP have a good value in predicting the prognosis of patients with sepsis and worthy of clinical application.
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Affiliation(s)
- Hongsong Ma
- Department of Clinical Laboratory, Zhoushan Women and Children Hospital, Zhoushan, Zhejiang 316000, China
| | - Huasheng Liu
- Department of Infectious Disease, Zhoushan Women and Children Hospital, Zhoushan, Zhejiang 316000, China
| | - Changyu Wu
- Department of Internal Medicine, Zhoushan Women and Children Hospital, Zhoushan, Zhejiang 316000, China
| | - Lieping Huang
- Department of Pediatrics, Zhoushan Women and Children Hospital, Zhoushan, Zhejiang 316000, China
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Preexisting Clinical Frailty Is Associated With Worse Clinical Outcomes in Patients With Sepsis. Crit Care Med 2021; 50:780-790. [PMID: 34612849 DOI: 10.1097/ccm.0000000000005360] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Frailty is a multidimensional syndrome or state of increased vulnerability to poor resolution of homoeostasis following a stressor event. Frailty is common in patients with sepsis. Sepsis and frailty are both associated with older age and chronic medical conditions. However, there is limited evidence about the direct association between frailty and sepsis. The aim of this study is to determine the association between preexisting clinical frailty and clinical outcomes in patients with sepsis. DESIGN A nationwide propensity score-matched cohort study analyzing data prospectively collected between September 2019 and February 2020. SETTING Nineteen tertiary or university-affiliated hospitals in South Korea. PATIENTS Adult patients who were diagnosed with sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Frailty status was assessed using the Clinical Frailty Scale. All patients were classified as "frail" (Clinical Frailty Scale score, 5-9) or "nonfrail" (Clinical Frailty Scale score, 1-4). Propensity score matching identified comparable nonfrail patients. The primary outcome was inhospital mortality. Multivariable logistic regression analysis was used to evaluate the association between frailty and inhospital mortality. The propensity score-matched cohort comprised 468 nonfrail patients and 468 frail patients; all covariate imbalances were alleviated. In the matched cohort (mean age, 69 ± 14 yr), 27.2% had septic shock at presentation. Inhospital mortality was 34.2% in the frail group and 26.9% in the nonfrail group (p = 0.019). The adjusted odds ratio for inhospital mortality in the frail group compared with the nonfrail group was 2.00 (95% CI, 1.39-2.89; p < 0.001). Among the patients who survived to discharge, the frail group was less likely to be discharged home compared with the nonfrail group, 64.0% versus 81.3%, respectively (p < 0.001). CONCLUSIONS In patients with sepsis, preexisting clinical frailty is associated with worse clinical outcomes than that in nonfrail patients, including inhospital mortality and discharge to home.
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Bian Z, Zhu R, Chen S. The predict value of serum/urocystatin C on acute kidney injury in elderly patients with sepsis. Exp Gerontol 2021; 155:111576. [PMID: 34597711 DOI: 10.1016/j.exger.2021.111576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the predict value of serum/urocystatin C in acute kidney injury (AKI) in elderly patients with sepsis. METHODS A retrospective study was performed and 80 senile patients with sepsis in ** hospital of China was included. According to the diagnosis of AKI, all patients were divided into non-AKI group and AKI group. The clinical characteristics, laboratory and physiological indicators of the two groups were compared. The receiver operating characteristic curve (ROC) was used to analyze the accuracy of the variables, including serum cystatin C, urocystatin C, and serum creatinine, to predict the occurrence of AKI in patients with sepsis. RESULTS Of the 80 elderly patients with sepsis in China, 29 patients had AKI. Compared with the non-AKI group, patients in the AKI group had higher APACHE II scores, higher SOFA scores, higher procalcitonin, and lower mean arterial pressure (P < 0.05). The levels of serum cystatin C, urocystatin C, and serum creatinine in the AKI group were significantly higher than those in the non-AKI group (P < 0.05), while the difference in intensive care unit (ICU) mortality rate between the two groups was not significantly different (P > 0.05). The ROC curve showed that the area under the curve of serum cystatin C was 0.893, the area under the curve of urocystatin C was 0.898, and the area under the curve of serum creatinine was 0.652. CONCLUSION Serum cystatin and urocystatin could be used to predict the occurrence of AKI in elderly patients with sepsis.
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Affiliation(s)
- Zhixiang Bian
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Rui Zhu
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China.
| | - Shunjie Chen
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China.
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Irwinda R, Wibowo N, Prameswari N. Cytokines storm in COVID-19 with dengue co-infection in pregnancy: Fatal maternal and fetal outcome. IDCases 2021; 26:e01284. [PMID: 34513593 PMCID: PMC8420090 DOI: 10.1016/j.idcr.2021.e01284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 01/11/2023] Open
Abstract
We report a 23-year-old pregnant woman who presented with acute high-grade fever, vomiting, and diarrhea for 5 days. She was first hospitalized in RSUD Tangerang-a secondary hospital based in Tangerang and were referred to Cipto Mangunkusumo General Hospital as a tertiary hospital. Initial laboratory results from previous hospital revealed leukopenia, low platelet, elevated aspartate transaminase, and alanine transaminase. Chest radiograph showed no pulmonary infiltration. Reverse transcriptase-PCR (RT-PCR) of the nasopharyngeal swab detected SARS-CoV-2, and NS1 antigen or IgM dengue-specific antibodies were positive. COVID-19 with dengue fever co-infection was diagnosed. Hemorrhagic manifestations were seen in both the mother (gum and gastrointestinal bleeding) and pregnancy (placental abruption). Patient was put on ventilator and was unfortunately lead to her death that were caused by multiorgan dysfunction failure due to co-infection of dengue and COVID-19. Both dengue and COVID-19 had similar manifestation, as it is a warning sign in pregnant patient experienced both that can lead to fatal result in mother and baby. Early diagnosis and management of co-infection is high clinical importance, especially in endemic area of dengue like Indonesia.
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Affiliation(s)
- Rima Irwinda
- Department of Obstetrics and Gynecology, Fetomaternal Division, Universitas Indonesia, Indonesia
| | - Noroyono Wibowo
- Department of Obstetrics and Gynecology, Fetomaternal Division, Universitas Indonesia, Indonesia
| | - Natasya Prameswari
- Department of Obstetrics and Gynecology, Universitas Indonesia, Indonesia
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Li T, Wang X, Zhuang X, Wang H, Li A, Huang L, Zhang X, Xue Y, Wei F, Ma C. Baseline characteristics and changes of biomarkers in disease course predict prognosis of patients with COVID-19. Intern Emerg Med 2021; 16:1165-1172. [PMID: 33565034 PMCID: PMC7872821 DOI: 10.1007/s11739-020-02560-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of coronavirus disease (COVID-19) has brought great challenges to the world. The objectives of this study were to describe the baseline characteristics and changes of biomarkers of these COVID-19 patients and identify predictive value of the above markers for patient death. Using patient death as the observational endpoints, clinical data of inpatients in a special ward for COVID-19 in Wuhan, China were retrospectively collected. Univariate and multivariate Cox regression analyses were used to evaluate prognostic value of baseline characteristics and laboratory data changes. This study included clinical data of 75 patients. Age, c-reactive protein (CRP) and interleukin-6 levels were independent predictors of patient death. Survivors were characterized as having declining neutrophil counts, D-dimer, N-terminal pronatriuretic peptide, troponin I (TnI) and c-reactive protein levels, while counts of lymphocyte gradually came back. Non-survivors were characterized with increasing white blood cell counts (WBC) and neutrophil counts. Changes of WBC, TnI and interleukin-6 were also independently associated with patient death. Older age, baseline CRP and IL-6 levels may be used as meaningful predictors to identify patients with poor prognosis. Changes of biomarkers should be closely monitored in the management of patients with COVID-19, while constantly increasing levels of WBC, TnI and interleukin-6 in the disease course also predict patient death.
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Affiliation(s)
- Tao Li
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Infectious Disease and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Wang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China
| | - Xianghua Zhuang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Wang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Respiratory Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ai Li
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Laigang Huang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Rehabilitation Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xingqian Zhang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China
| | - Yan Xue
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Infectious Disease and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengtao Wei
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China.
| | - Cheng'en Ma
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
- Department of Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China.
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ABC 2-SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores. Int J Infect Dis 2021; 110:281-308. [PMID: 34311100 PMCID: PMC8302820 DOI: 10.1016/j.ijid.2021.07.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. METHODS Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. RESULTS Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). CONCLUSIONS An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.
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GENÇ AB, YAYLACI S, DHEİR H, GENÇ AC, İŞSEVER1 K, ÇEKİÇ1 D, KOCAYİĞİT H, ÇOKLUK E, KARACAN A, ŞEKEROĞLU MR, TOPTAN ÇAKAR H, GÜÇLÜ5 E. The predictive and diagnostic accuracy of long pentraxin-3 in COVID-19 pneumonia. Turk J Med Sci 2021; 51:448-453. [PMID: 33315349 PMCID: PMC8219078 DOI: 10.3906/sag-2011-32] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background/aim The purpose of this study is to evaluate serum pentraxin-3 (PTX-3) levels in Sars-CoV-2 virus infection (COVID-19) patients and to investigate whether PTX-3 predicts the disease prognosis. Materials and methods This study was conducted on 88 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia between April 15 and August 15, 2020. The patients were divided into two groups as survived patients and non-survived patients. Both groups were compared according to demographic features, comorbid conditions and measurement of the PTX-3 and other laboratory parameters of the patients. Results Of 88 patients with COVID-19, 59 (67%) were discharged with complete cure and 29 (33%) resulted in death. 46 (52.3%) of the patients were men. PTX-3 median value (IQR) was 3.66 ng/mL (0.9–27.9) in all patients, 3.3 ng/mL (0.9–27.9) in survivors and 3.91 ng/mL (1.9–23.2) in nonsurvivors which was significantly higher (P = 0.045). As a receiver operating characteristic curve analysis the cut-off value of PTX-3 for predicting mortality in patients was 3.73 with 65% sensitivity and 65% specificity (AUC: 0.646, 95% CI: 0.525– 0.767, P = 0.045). Also, we found significant cut-off values with respect to D-dimer, D-dimer/PTX-3, high-sensitivity troponin, high- sensitivity troponin/PTX-3, lymphocyte, PTX-3/lymphocyte, procalcitonin, procalcitonin/PTX-3, CRP, and CRP/PTX-3 (P < 0.05). Conclusion In this study, as far as we know, for the first time, we have shown PTX-3 as the new mortality biomarker for COVID-19 disease.
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Affiliation(s)
- Ahmed Bilal GENÇ
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Selçuk YAYLACI
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Hamad DHEİR
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Ahmed Cihad GENÇ
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Kubilay İŞSEVER1
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Deniz ÇEKİÇ1
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Havva KOCAYİĞİT
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Erdem ÇOKLUK
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Alper KARACAN
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | | | - Hande TOPTAN ÇAKAR
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Ertuğrul GÜÇLÜ5
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
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Savla SR, Prabhavalkar KS, Bhatt LK. Cytokine storm associated coagulation complications in COVID-19 patients: Pathogenesis and Management. Expert Rev Anti Infect Ther 2021; 19:1397-1413. [PMID: 33832398 PMCID: PMC8074652 DOI: 10.1080/14787210.2021.1915129] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction SARS-CoV-2, the causative agent of COVID-19, attacks the immune system causing an exaggerated and uncontrolled release of pro-inflammatory mediators (cytokine storm). Recent studies propose an active role of coagulation disorders in disease progression. This hypercoagulability has been displayed by marked increase in D-dimer in hospitalized patients. Areas Covered This review summarizes the pathogenesis of SARS-CoV-2 infection, generation of cytokine storm, the interdependence between inflammation and coagulation, its consequences and the possible management options for coagulation complications like venous thromboembolism (VTE), microthrombosis, disseminated intravascular coagulation (DIC), and systemic and local coagulopathy. We searched PubMed, Scopus, and Google Scholar for relevant reports using COVID-19, cytokine storm, and coagulation as keywords. Expert Opinion A prophylactic dose of 5000–7500 units of low molecular weight heparin (LMWH) has been recommended for hospitalized COVID-19 patients in order to prevent VTE. Treatment dose of LMWH, based on disease severity, is being contemplated for patients showing a marked rise in levels of D-dimer due to possible pulmonary thrombi. Additionally, targeting PAR-1, thrombin, coagulation factor Xa and the complement system may be potentially useful in reducing SARS-CoV-2 infection induced lung injury, microvascular thrombosis, VTE and related outcomes like DIC and multi-organ failure.
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Affiliation(s)
- Shreya R Savla
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India
| | - Kedar S Prabhavalkar
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India
| | - Lokesh K Bhatt
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (West), Mumbai, 400056, India
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Mastroianni F, Leisman DE, Fisler G, Narasimhan M. General and Intensive Care Outcomes for Hospitalized Patients With Solid Organ Transplants With COVID-19. J Intensive Care Med 2021; 36:494-499. [PMID: 33034239 PMCID: PMC7548542 DOI: 10.1177/0885066620965163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE COVID-19 has been associated with a dysregulated inflammatory response. Patients who have received solid-organ transplants are more susceptible to infections in general due to the use of immunosuppressants. We investigated factors associated with mechanical ventilation and outcomes in solid-organ transplant recipients with COVID-19. MATERIALS AND METHODS We conducted a retrospective cohort study of all solid-organ transplant recipients admitted with a diagnosis of COVID-19 in our 23-hospital health system over a 1-month period. Descriptive statistics were used to describe hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. RESULTS Twenty-two patients with solid-organ transplants and COVID-19 were identified. Eight patients were admitted to the ICU, of which 7 were intubated. Admission values of CRP (p = 0.045) and N/L ratio (p = 0.047) were associated with the need for mechanical ventilation. Seven patients (32%) died during admission, including 86% (n = 6) of patients who received mechanical ventilation. CONCLUSIONS In solid-organ transplant recipients with COVID-19, initial CRP and N/L ratio were associated with need for mechanical ventilation.
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Affiliation(s)
- Fiore Mastroianni
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Daniel E. Leisman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Grace Fisler
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA
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Zhou W, Liu Y, Xu B, Wang S, Li S, Liu H, Huang Z, Luo Y, Hu M, Wu W, Zhang Z, Long X, Zou W, Bian Y, Zou X, Elliott M, Yue L, Deng H, Chen H, Gao X, Wu Y, Fang M, Zhang B, Gao Y. Early identification of patients with severe COVID-19 at increased risk of in-hospital death: a multicenter case-control study in Wuhan. J Thorac Dis 2021; 13:1380-1395. [PMID: 33841931 PMCID: PMC8024856 DOI: 10.21037/jtd-20-2568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Most evidence regarding the risk factors for early in-hospital mortality in patients with severe COVID-19 focused on laboratory data at the time of hospital admission without adequate adjustment for confounding variables. A multicenter, age-matched, case-control study was therefore designed to explore the dynamic changes in laboratory parameters during the first 10 days after admission and identify early risk indicators for in-hospital mortality in this patient cohort. Methods Demographics and clinical data were extracted from the medical records of 93 pairs of patients who had been admitted to hospital with severe COVID-19. These patients had either been discharged or were deceased by March 3, 2020. Data from days 1, 4, 7, and 10 of hospital admission were compared between survivors and non-survivors. Univariate and multivariate conditional logistic regression analyses were employed to identify early risk indicators of in-hospital death in this cohort. Results On admission, in-hospital mortality was associated with five risk indicators (ORs in descending order): aspartate aminotransferase (AST, >32 U/L) 43.20 (95% CI: 2.63, 710.04); C-reactive protein (CRP) greater than 100 mg/L 13.61 (1.78, 103.941); lymphocyte count lower than 0.6×109/L 9.95 (1.30, 76.42); oxygen index (OI) less than 200 8.23 (1.04, 65.15); and D-dimer over 1 mg/L 8.16 (1.23, 54.34). Sharp increases in D-dimer at day 4, accompanied by decreasing lymphocyte counts, deteriorating OI, and persistent remarkably high CRP concentration were observed among non-survivors during the early stages of hospital admission. Conclusions The potential risk factors of high D-dimer, CRP, AST, low lymphocyte count and OI could help clinicians identify patients at high risk of death early in the hospital admission. This might assist with rationalization of health care resources.
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Affiliation(s)
- Wei Zhou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yisi Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University Health Science Center, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sa Wang
- Emergency department, The Second affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shusheng Li
- Emergency and Intensive Care Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Liu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Ziting Huang
- Medical Informatics Center, Peking University Health Science Center, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yan Luo
- Medical Informatics Center, Peking University Health Science Center, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ming Hu
- Intensive Care Unit, Wuhan Pulmonary Hospital, Wuhan, China
| | - Wenjuan Wu
- Intensive Care Unit, Jinyintan Hospital, Wuhan, China
| | - Zhanguo Zhang
- Hepatobiliary surgery Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Long
- Hepatobiliary surgery Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbin Zou
- Thoracic Surgery Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Bian
- Emergency and Intensive Care Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojing Zou
- Emergency and Intensive Care Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Malcolm Elliott
- School of Nursing & Midwifery, Monash University, Melbourne, Australia
| | - Lanxin Yue
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Huifang Deng
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Hairong Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Xueli Gao
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Minghao Fang
- Emergency and Intensive Care Unit, Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Intensive Care Unit, Jinyintan Hospital, Wuhan, China
| | - Boli Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yue Gao
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
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Álvarez-Mon M, Ortega MA, Gasulla Ó, Fortuny-Profitós J, Mazaira-Font FA, Saurina P, Monserrat J, Plana MN, Troncoso D, Moreno JS, Muñoz B, Arranz A, Varona JF, Lopez-Escobar A, Barco AAD. A Predictive Model and Risk Factors for Case Fatality of COVID-19. J Pers Med 2021; 11:36. [PMID: 33430129 PMCID: PMC7827846 DOI: 10.3390/jpm11010036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February-June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Príncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (<5%), medium-risk level (5-20%), and high-risk level (>20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU-death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19.
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Affiliation(s)
- Melchor Álvarez-Mon
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
| | - Óscar Gasulla
- Hospital Universitari de Bellvitge–Universitat de Barcelona, 08907 L´Hospitalet de Llobregat, Spain;
| | | | - Ferran A. Mazaira-Font
- Departament d’Econometria, Estadística I Economia Aplicada–Universitat de Barcelona, 08007 Barcelona, Spain;
| | - Pablo Saurina
- Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - María N. Plana
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Daniel Troncoso
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
| | - José Sanz Moreno
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
| | - Benjamin Muñoz
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
| | - Alberto Arranz
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
| | - Jose F. Varona
- Service of Internal Medicine, Hospital Universitario HM Montepríncipe, HM Hospitales, 28660 Boadilla del Monte, Spain;
- Faculty of Medicine, Universidad San Pablo-CEU, CEU Universities, Fundación de Investigación HM Hospitales, 28003 Madrid, Spain;
| | - Alejandro Lopez-Escobar
- Faculty of Medicine, Universidad San Pablo-CEU, CEU Universities, Fundación de Investigación HM Hospitales, 28003 Madrid, Spain;
- Service of Pediatrics, Hospital Universitario HM Puerta del Sur, 28938 Móstoles, Spain
| | - Angel Asúnsolo-del Barco
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, University of New York, New York, NY 10027, USA
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Serum Amylase and Lipase for the Prediction of Pancreatic Injury in Critically Ill Children Admitted to the PICU. Pediatr Crit Care Med 2021; 22:e10-e18. [PMID: 33044412 DOI: 10.1097/pcc.0000000000002525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Pancreatic injury is multifactorial and potentially devastating for critically ill children. We aimed to evaluate whether serum amylase and lipase among critically ill children could serve as an independent biomarker to predict pancreatic injury. DESIGN Retrospective cohort. SETTING PICU of a tertiary, pediatric medical center. PATIENTS Seventy-nine autopsies. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A group of 79 children who died of different causes were investigated by autopsy. They were divided into pancreatic injury group and pancreatic noninjury group according to autopsy findings. Data based on patients' demographics, vital signs, laboratory findings, and clinical features at admission were collected and compared. Logistic regression was used to identify predictive factors for pancreatic injury. Receiver operating characteristic curve was constructed for assessing serum amylase and serum lipase to predicting pancreatic injury. Forty-one patients (51.9%) exhibited the pathologic changes of pancreatic injury. The levels of lactate, erythrocyte sedimentation rate, alanine transaminase, aspartate transaminase, and troponin-I in the injury group were significantly higher than that in the noninjury group, whereas the level of calcium was significantly lower than that in the noninjury group (p < 0.05). Multivariable logistic regression analysis showed that serum amylase, serum lipase, and septic shock were significantly associated with the occurrence rate of pancreatic injury. The statistically significant area under the curve results were as follows: serum amylase: area under the curve = 0.731, at a cutoff value of 97.5, sensitivity = 53.7, and specificity = 81.6; and serum lipase: area under the curve = 0.727, at a cutoff value of 61.1, sensitivity = 36.6, and specificity = 92.1. CONCLUSIONS Serum amylase and lipase could serve as independent biomarkers to predict pancreatic injury in critically ill children.
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Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, Ye L, Xiong J, Jiang Z, Liu Y, Zhang B, Yang W. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin Infect Dis 2020; 71:2174-2179. [PMID: 32445579 PMCID: PMC7314209 DOI: 10.1093/cid/ciaa641] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An elevated serum C-reactive protein (CRP) level was observed in most patients with coronavirus disease 2019 (COVID-19). METHODS Data for COVID-19 patients with clinical outcome in a designated hospital in Wuhan, China, were retrospectively collected and analyzed from 30 January 2020 to 20 February 2020. The prognostic value of admission CRP was evaluated in patients with COVID-19. RESULTS Of 298 patients enrolled, 84 died and 214 recovered. Most nonsurvivors were male, older, or with chronic diseases. Compared with survivors, nonsurvivors showed significantly elevated white blood cell and neutrophil counts, neutrophil to lymphocyte ratio (NLR), systemic immune inflammation index (defined by platelet count multiplied by NLR), CRP, procalcitonin, and D-dimer and showed decreased red blood cell, lymphocyte, and platelet counts. Age, neutrophil count, platelet count, and CRP were identified as independent predictors of adverse outcome. The area under the receiver operating characteristic (ROC) curve (AUC) of CRP (0.896) was significantly higher than that of age (0.833), neutrophil count (0.820), and platelet count (0.678) in outcome prediction (all P < .05). With a cutoff value of 41.4, CRP exhibited sensitivity of 90.5%, specificity of 77.6%, positive predictive value of 61.3%, and negative predictive value of 95.4%. CRP was also an independent discriminator of severe/critical illness on admission with an AUC (0.783) comparable to age (0.828) and neutrophil count (0.729) (both P > .05). CONCLUSIONS In patients with COVID-19, admission CRP correlated with disease severity and tended to be a good predictor of adverse outcome.
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Affiliation(s)
- Xiaomin Luo
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Zhou
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaojie Yan
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tangxi Guo
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Benchao Wang
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongxia Xia
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Ye
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Xiong
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zongping Jiang
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Liu
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weize Yang
- Department of Emergency, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, China
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Standardized visual EEG features predict outcome in patients with acute consciousness impairment of various etiologies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:680. [PMID: 33287874 PMCID: PMC7720582 DOI: 10.1186/s13054-020-03407-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early prognostication in patients with acute consciousness impairment is a challenging but essential task. Current prognostic guidelines vary with the underlying etiology. In particular, electroencephalography (EEG) is the most important paraclinical examination tool in patients with hypoxic ischemic encephalopathy (HIE), whereas it is not routinely used for outcome prediction in patients with traumatic brain injury (TBI). METHOD Data from 364 critically ill patients with acute consciousness impairment (GCS ≤ 11 or FOUR ≤ 12) of various etiologies and without recent signs of seizures from a prospective randomized trial were retrospectively analyzed. Random forest classifiers were trained using 8 visual EEG features-first alone, then in combination with clinical features-to predict survival at 6 months or favorable functional outcome (defined as cerebral performance category 1-2). RESULTS The area under the ROC curve was 0.812 for predicting survival and 0.790 for predicting favorable outcome using EEG features. Adding clinical features did not improve the overall performance of the classifier (for survival: AUC = 0.806, p = 0.926; for favorable outcome: AUC = 0.777, p = 0.844). Survival could be predicted in all etiology groups: the AUC was 0.958 for patients with HIE, 0.955 for patients with TBI and other neurosurgical diagnoses, 0.697 for patients with metabolic, inflammatory or infectious causes for consciousness impairment and 0.695 for patients with stroke. Training the classifier separately on subgroups of patients with a given etiology (and thus using less training data) leads to poorer classification performance. CONCLUSIONS While prognostication was best for patients with HIE and TBI, our study demonstrates that similar EEG criteria can be used in patients with various causes of consciousness impairment, and that the size of the training set is more important than homogeneity of ACI etiology.
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Sharifpour M, Rangaraju S, Liu M, Alabyad D, Nahab FB, Creel-Bulos CM, Jabaley CS. C-Reactive protein as a prognostic indicator in hospitalized patients with COVID-19. PLoS One 2020; 15:e0242400. [PMID: 33216774 PMCID: PMC7679150 DOI: 10.1371/journal.pone.0242400] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
Recent studies have reported that CRP levels are elevated in patients with COVID-19 and may correlate with severity of disease and disease progression. We conducted a retrospective cohort analysis of the medical records of 268 adult patients, who were admitted to one of the six cohorted COVID ICUs across Emory Healthcare System and had at least two CRP values within the first seven days of admission to study the temporal progression of CRP and its association with all-cause in-hospital mortality. The median CRP during hospitalization for the entire cohort was 130 mg/L (IQR 82–191 mg/L), and the median CRP on ICU admission was 169 (IQR 111–234). The hospitalization-wide median CRP was significantly higher amongst the patients who died, compared to those who survived [206 mg/L (157–288 mg/L) vs 114 mg/L (72–160 mg/L), p<0.001]. CRP levels increased in a linear fashion during the first week of hospitalization and peaked on day 5. Compared to patients who died, those who survived had lower peak CRP levels and earlier declines. CRP levels were significantly higher in patients who died compared to those who survived (p<0.001). Our findings support the utility of daily CRP values in hospitalized COVID-19 patients and provide early thresholds during hospitalization that may facilitate risk stratification and prognostication.
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Affiliation(s)
- Milad Sharifpour
- Department of Anesthesiology and Critical Care, Emory University Hospital, Atlanta, Georgia, United States of America
- * E-mail:
| | - Srikant Rangaraju
- Department of Neurology, Emory University Hospital, Atlanta, Georgia, United States of America
| | - Michael Liu
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Darwish Alabyad
- Morehouse University School of Medicine, Atlanta, Georgia, United States of America
| | - Fadi B. Nahab
- Department of Neurology, Emory University Hospital, Atlanta, Georgia, United States of America
| | - Christina M. Creel-Bulos
- Department of Anesthesiology and Critical Care, Emory University Hospital, Atlanta, Georgia, United States of America
| | - Craig S. Jabaley
- Department of Anesthesiology and Critical Care, Emory University Hospital, Atlanta, Georgia, United States of America
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First, Do No Harm: Caution Against Use of Tocilizumab in COVID-19. Chest 2020; 158:2233. [PMID: 33160536 PMCID: PMC7640891 DOI: 10.1016/j.chest.2020.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 01/08/2023] Open
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Lv SJ, Zhang GH, Xia JM, Yu H, Zhao F. Early use of high-dose vitamin C is beneficial in treatment of sepsis. Ir J Med Sci 2020; 190:1183-1188. [PMID: 33094466 DOI: 10.1007/s11845-020-02394-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/07/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Vitamin C has shown benefits in patients with sepsis in addition to standard therapy recently. However, further evidence is required to verify the efficacy of vitamin C in clinical practice. This study aimed to investigate the effect of adjunctive intravenous high-dose vitamin C treatment on hospital mortality in patients with sepsis. METHODS One hundred seventeen patients with sepsis in our department from June 2017 to May 2019 were randomly divided into two groups: the control group (56 cases) and the vitamin C group (61 cases). The control group was treated by the routine and basic therapy with intravenous drip of 5% dextrose and placebo (100 ml/time, 2 times/day), while the vitamin C group was administered intravenously by 3.0 g vitamin C dissolved into 5% dextrose (100 ml/time, 2 times/day) based on the control group. The mortality and efficacy were statistically analyzed and compared between the two groups. RESULTS The 28-day mortality differed significantly between the control group and the vitamin C group (42.97% vs. 27.93%) (p < 0.05). The changes in the sepsis-related organ failure assessment (ΔSOFA) scores at 72 h after ICU admission (4.2 vs. 2.1), the application time of vasoactive drugs (25.6 vs. 43.8), and the procalcitonin clearance (79.6% vs. 61.3%) differed significantly between groups (p < 0.05). CONCLUSION The early treatment of sepsis with intravenous high-dose vitamin C in combination with standard therapy showed a beneficial effect on sepsis, in terms of the reduced 28-day mortality, the decreased SOFA score, and the increased clearance rate of procalcitonin.
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Affiliation(s)
- Shi-Jin Lv
- Department of Emergency, Hangzhou Normal University Affiliated Hospital, Wenzhou Road 126, Hangzhou, 310015, Zhejiang, People's Republic of China
| | - Guo-Hu Zhang
- Department of Emergency, Hangzhou Normal University Affiliated Hospital, Wenzhou Road 126, Hangzhou, 310015, Zhejiang, People's Republic of China.
| | - Jin-Ming Xia
- Department of Emergency, Hangzhou Normal University Affiliated Hospital, Wenzhou Road 126, Hangzhou, 310015, Zhejiang, People's Republic of China
| | - Huan Yu
- Department of Emergency, Hangzhou Normal University Affiliated Hospital, Wenzhou Road 126, Hangzhou, 310015, Zhejiang, People's Republic of China
| | - Fei Zhao
- Department of Emergency, Hangzhou Normal University Affiliated Hospital, Wenzhou Road 126, Hangzhou, 310015, Zhejiang, People's Republic of China
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Niederwanger C, Varga T, Hell T, Stuerzel D, Prem J, Gassner M, Rickmann F, Schoner C, Hainz D, Cortina G, Hetzer B, Treml B, Bachler M. Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis. PeerJ 2020; 8:e9993. [PMID: 33083117 PMCID: PMC7543722 DOI: 10.7717/peerj.9993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Background Scores can assess the severity and course of disease and predict outcome in an objective manner. This information is needed for proper risk assessment and stratification. Furthermore, scoring systems support optimal patient care, resource management and are gaining in importance in terms of artificial intelligence. Objective This study evaluated and compared the prognostic ability of various common pediatric scoring systems (PRISM, PRISM III, PRISM IV, PIM, PIM2, PIM3, PELOD, PELOD 2) in order to determine which is the most applicable score for pediatric sepsis patients in terms of timing of disease survey and insensitivity to missing data. Methods We retrospectively examined data from 398 patients under 18 years of age, who were diagnosed with sepsis. Scores were assessed at ICU admission and re-evaluated on the day of peak C-reactive protein. The scores were compared for their ability to predict mortality in this specific patient population and for their impairment due to missing data. Results PIM (AUC 0.76 (0.68-0.76)), PIM2 (AUC 0.78 (0.72-0.78)) and PIM3 (AUC 0.76 (0.68-0.76)) scores together with PRSIM III (AUC 0.75 (0.68-0.75)) and PELOD 2 (AUC 0.75 (0.66-0.75)) are the most suitable scores for determining patient prognosis at ICU admission. Once sepsis is pronounced, PELOD 2 (AUC 0.84 (0.77-0.91)) and PRISM IV (AUC 0.8 (0.72-0.88)) become significantly better in their performance and count among the best prognostic scores for use at this time together with PRISM III (AUC 0.81 (0.73-0.89)). PELOD 2 is good for monitoring and, like the PIM scores, is also largely insensitive to missing values. Conclusion Overall, PIM scores show comparatively good performance, are stable as far as timing of the disease survey is concerned, and they are also relatively stable in terms of missing parameters. PELOD 2 is best suitable for monitoring clinical course.
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Affiliation(s)
- Christian Niederwanger
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Varga
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Tobias Hell
- Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria
| | - Daniel Stuerzel
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jennifer Prem
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Gassner
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Rickmann
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Schoner
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Hainz
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerard Cortina
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Benedikt Treml
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Mirjam Bachler
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.,Department of Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S, Roomi S, Madara J, Boigon M, Haas DC, Fischman DL. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J Community Hosp Intern Med Perspect 2020; 10:402-408. [PMID: 33235672 PMCID: PMC7671719 DOI: 10.1080/20009666.2020.1798141] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the C-reactive protein (CRP) and D-Dimer levels for predicting in-hospital outcomes in COVID-19. Methods A retrospective cohort study was performed to determine the association of CRP and D-Dimer with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results A total of 176 patients with confirmed COVID-19 diagnosis were included. On presentation, the unadjusted odds for the need of IMV (OR 2.5, 95% CI 1.3-4.8, p = 0.012) and upgrade to ICU (OR 3.2, 95% CI 1.6-6.5, p = 0.002) were significantly higher for patients with CRP (>101 mg/dl). Similarly, the unadjusted odds of in-hospital mortality were significantly higher in patients with high CRP (>101 mg/dl) and high D-Dimer (>501 ng/ml), compared to corresponding low CRP (<100 mg/dl) and low D-Dimer (<500 ng/ml) groups on day-7 (OR 3.5, 95% CI 1.2-10.5, p = 0.03 and OR 10.0, 95% CI 1.2-77.9, p = 0.02), respectively. Both high D-Dimer (>501 ng/ml) and high CRP (>101 mg/dl) were associated with increased need for upgrade to the ICU and higher requirement for IMV on day-7 of hospitalization. A multivariate regression model mirrored the overall unadjusted trends except that adjusted odds for IMV were high in the high CRP group on day 7 (aOR 2.5, 95% CI 1.05-6.0, p = 0.04). Conclusion CRP value greater than 100 mg/dL and D-dimer levels higher than 500 ng/ml during hospitalization might predict higher odds of in-hospital mortality. Higher levels at presentation might indicate impending clinical deterioration and the need for IMV.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Nishanth Thalambedu
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA.,Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shujaul Haq
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Rehan Saeed
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Shristi Khanal
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Shafaq Tariq
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - John Madara
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Margot Boigon
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Donald C Haas
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - David L Fischman
- Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis 2020; 14:1753466620937175. [PMID: 32615866 PMCID: PMC7336828 DOI: 10.1177/1753466620937175] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients critically ill with coronavirus disease-2019 (COVID-19) feature hyperinflammation, and the associated biomarkers may be beneficial for risk stratification. We aimed to investigate the association between several biomarkers, including serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin, and COVID-19 severity. METHODS We performed a comprehensive systematic literature search through electronic databases. The outcome of interest for this study was the composite poor outcome, which comprises mortality, acute respiratory distress syndrome, need for care in an intensive care unit, and severe COVID-19. RESULTS A total of 5350 patients were pooled from 25 studies. Elevated CRP was associated with an increased composite poor outcome [risk ratio (RR) 1.84 (1.45, 2.33), p < 0.001; I2: 96%] and its severe COVID-19 (RR 1.41; I2: 93%) subgroup. A CRP ⩾10 mg/L has a 51% sensitivity, 88% specificity, likelihood ratio (LR) + of 4.1, LR- of 0.5, and an area under curve (AUC) of 0.84. An elevated PCT was associated with an increased composite poor outcome [RR 3.92 (2.42, 6.35), p < 0.001; I2: 85%] and its mortality (RR 6.26; I2: 96%) and severe COVID-19 (RR 3.93; I2: 63%) subgroups. A PCT ⩾0.5 ng/ml has an 88% sensitivity, 68% specificity, LR+ of 2.7, LR- of 0.2, and an AUC of 0.88. An elevated D-dimer was associated with an increased composite poor outcome [RR 2.93 (2.14, 4.01), p < 0.001; I2: 77%], including its mortality (RR 4.15; I2: 83%) and severe COVID-19 (RR 2.42; I2: 58%) subgroups. A D-dimer >0.5 mg/L has a 58% sensitivity, 69% specificity, LR+ of 1.8, LR- of 0.6, and an AUC of 0.69. Patients with a composite poor outcome had a higher serum ferritin with a standardized mean difference of 0.90 (0.64, 1.15), p < 0.0001; I2: 76%. CONCLUSION This meta-analysis showed that an elevated serum CRP, PCT, D-dimer, and ferritin were associated with a poor outcome in COVID-19. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Ian Huang
- Department of Internal Medicine, Universitas
Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
- Faculty of Medicine, Universitas Pelita Harapan,
Tangerang, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan,
Tangerang, Banten, 15810, Indonesia
| | | | - Amaylia Oehadian
- Division of Hematology and Oncology, Department
of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan
Sadikin General Hospital, Bandung, Indonesia
| | - Bachti Alisjahbana
- Division of Tropical and Infectious Disease,
Department of Internal Medicine, Faculty of Medicine, Universitas
Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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