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Chen J, Wang L, Xu L, Qian X, Chen X. Association between neutrophil-to-lymphocyte ratio and epidural-related maternal fever in Chinese parturients: a prospective cohort study. J Matern Fetal Neonatal Med 2024; 37:2376657. [PMID: 38977394 DOI: 10.1080/14767058.2024.2376657] [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: 03/26/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE Epidural analgesia could increase the risk of maternal fever during labor, and the potential mechanisms involved inflammation. Neutrophil-to-lymphocyte ratio (NLR) was a sensitive inflammatory composite indicator and related to adverse outcomes in parturients. This study aimed to investigate the association between NLR levels and epidural related maternal fever (ERMF). METHODS This prospective cohort study included 614 parturients who underwent epidural analgesia at the Women's Hospital School of Medicine Zhejiang University from November 2021 to May 2023. NLR level was calculated before epidural analgesia for women. The outcome was ERMF. Univariate and multivariate logistic regression models were utilized to explore the association between NLR level and ERMF. And the association was further investigated in subgroups of age, body mass index (BMI) before pregnancy, and parity of delivery. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Totally, 614 parturients, of whom 171 (27.85%) had ERMF. High NLR level was associated with higher incidence of ERMF (OR = 2.70, 95% CI: 1.58-4.69). Parturients with ERMF had higher proportion of postpartum hemorrhage, longer labor times, and other adverse outcomes in parturients. The association also observed in subgroups of age <35 years old (OR = 2.74, 95% CI: 1.55-4.29), BMI <24 kg/m2 before pregnancy (OR = 2.32, 95% CI: 1.32-4.13), BMI ≥24 kg/m2 before pregnancy (OR = 38.28, 95%CI: 3.67-854.66), primipara (OR = 2.26, 95% CI:1.27-4.04), and multipara (OR = 30.60, 95% CI: 3.73-734.03). CONCLUSION High NLR levels were associated with ERMF in women. It indicated that physicians may measure NLR levels as a regular measurement, which may beneficial for pregnancy outcomes.
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Affiliation(s)
- Jiaxin Chen
- Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Liping Wang
- Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Linglan Xu
- Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Xiaowei Qian
- Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Xinzhong Chen
- Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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Méndez Rodríguez ML, Ponciano-Gómez A, Campos-Aguilar M, Tapia-Sánchez WD, Duarte-Martínez CL, Romero-Herrera JS, Olivas-Quintero S, Saucedo-Campos AD, Méndez-Cruz AR, Jimenez-Flores R, Ortiz-Navarrete V, Romero-Ramírez H, Santos-Argumedo L, Rosales-García VH. Neutrophil-to-Lymphocyte Ratio and Cytokine Profiling as Predictors of Disease Severity and Survival in Unvaccinated COVID-19 Patients. Vaccines (Basel) 2024; 12:861. [PMID: 39203987 PMCID: PMC11360520 DOI: 10.3390/vaccines12080861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, identifying reliable biomarkers for predicting disease severity and patient outcomes in unvaccinated individuals is essential. This study evaluates the efficacy of key hematological markers, including leukocyte and neutrophil counts, Neutrophil-to-Lymphocyte Ratio (NLR), and cytokine profiles (IL-6, INF-γ, TNF-α, IL-17A, CCL2, and CXCL10) for predicting the necessity for mechanical ventilation and assessing survival probabilities. METHODS We conducted an in-depth analysis on a cohort of COVID-19 patients, emphasizing the relationship between NLR, cytokine profiles, and clinical outcomes, utilizing routine leukocyte counting and cytokine quantification by flow cytometry. RESULTS Elevated leukocyte and neutrophil counts, increased NLR, and significant cytokine elevations such as IL-6 and IL-10 were strongly associated with the need for mechanical ventilation, reflecting a pronounced systemic inflammatory response indicative of severe disease outcomes. CONCLUSION Integrating hematological markers, particularly NLR and cytokine profiles, is crucial in predicting mechanical ventilation needs and survival in non-vaccinated COVID-19 patients. Our findings provide critical insights into the pathophysiology of COVID-19, supporting the development of more targeted clinical interventions and potentially informing future strategies for managing infectious disease outbreaks.
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Affiliation(s)
- Miguel Leonardo Méndez Rodríguez
- Servicio de Inmunología y Alergia, Centro Médico Naval (CEMENAV), Secretaria de Marina (SEMAR), Avenida Heroica Escuela Naval Militar 745, Coapa, Presidentes Ejidales 1ra Sección, Coyoacán, Mexico City 04470, Mexico; (M.L.M.R.); (J.S.R.-H.)
| | - Alberto Ponciano-Gómez
- Laboratorio de Inmunología (UMF), Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Los Barrios N° 1, Los Reyes Iztacala, Tlalnepantla 54090, Estado de México, Mexico; (A.P.-G.); (M.C.-A.); (A.D.S.-C.); (A.R.M.-C.); (R.J.-F.)
| | - Myriam Campos-Aguilar
- Laboratorio de Inmunología (UMF), Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Los Barrios N° 1, Los Reyes Iztacala, Tlalnepantla 54090, Estado de México, Mexico; (A.P.-G.); (M.C.-A.); (A.D.S.-C.); (A.R.M.-C.); (R.J.-F.)
| | - Wilfrido David Tapia-Sánchez
- Diagnóstico Molecular de Leucemias y Terapia Celular (DILETEC), Basiliso Romo Anguiano 124, Industrial, Gustavo A. Madero, Mexico City 07800, Mexico; (W.D.T.-S.); (C.L.D.-M.)
| | - Carlos Leonardo Duarte-Martínez
- Diagnóstico Molecular de Leucemias y Terapia Celular (DILETEC), Basiliso Romo Anguiano 124, Industrial, Gustavo A. Madero, Mexico City 07800, Mexico; (W.D.T.-S.); (C.L.D.-M.)
| | - Jesús Salvador Romero-Herrera
- Servicio de Inmunología y Alergia, Centro Médico Naval (CEMENAV), Secretaria de Marina (SEMAR), Avenida Heroica Escuela Naval Militar 745, Coapa, Presidentes Ejidales 1ra Sección, Coyoacán, Mexico City 04470, Mexico; (M.L.M.R.); (J.S.R.-H.)
| | - Sandra Olivas-Quintero
- Departamento de Ciencias de la Salud Culiacán, Universidad Autónoma de Occidente, Culiacan 80020, Sinaloa, Mexico;
| | - Alberto Daniel Saucedo-Campos
- Laboratorio de Inmunología (UMF), Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Los Barrios N° 1, Los Reyes Iztacala, Tlalnepantla 54090, Estado de México, Mexico; (A.P.-G.); (M.C.-A.); (A.D.S.-C.); (A.R.M.-C.); (R.J.-F.)
| | - Adolfo Rene Méndez-Cruz
- Laboratorio de Inmunología (UMF), Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Los Barrios N° 1, Los Reyes Iztacala, Tlalnepantla 54090, Estado de México, Mexico; (A.P.-G.); (M.C.-A.); (A.D.S.-C.); (A.R.M.-C.); (R.J.-F.)
| | - Rafael Jimenez-Flores
- Laboratorio de Inmunología (UMF), Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Los Barrios N° 1, Los Reyes Iztacala, Tlalnepantla 54090, Estado de México, Mexico; (A.P.-G.); (M.C.-A.); (A.D.S.-C.); (A.R.M.-C.); (R.J.-F.)
| | - Vianney Ortiz-Navarrete
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City 07360, Mexico; (V.O.-N.); (H.R.-R.); (L.S.-A.)
| | - Hector Romero-Ramírez
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City 07360, Mexico; (V.O.-N.); (H.R.-R.); (L.S.-A.)
- Centro de Investigación Sobre el Envejecimiento, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City 07360, Mexico
| | - Leopoldo Santos-Argumedo
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City 07360, Mexico; (V.O.-N.); (H.R.-R.); (L.S.-A.)
- Centro de Investigación Sobre el Envejecimiento, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City 07360, Mexico
| | - Victor Hugo Rosales-García
- Diagnóstico Molecular de Leucemias y Terapia Celular (DILETEC), Basiliso Romo Anguiano 124, Industrial, Gustavo A. Madero, Mexico City 07800, Mexico; (W.D.T.-S.); (C.L.D.-M.)
- Laboratorios Nacionales de Servicios Experimentales, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City 14330, Mexico
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Asteris PG, Gandomi AH, Armaghani DJ, Kokoris S, Papandreadi AT, Roumelioti A, Papanikolaou S, Tsoukalas MZ, Triantafyllidis L, Koutras EI, Bardhan A, Mohammed AS, Naderpour H, Paudel S, Samui P, Ntanasis-Stathopoulos I, Dimopoulos MA, Terpos E. Prognosis of COVID-19 severity using DERGA, a novel machine learning algorithm. Eur J Intern Med 2024; 125:67-73. [PMID: 38458880 DOI: 10.1016/j.ejim.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
It is important to determine the risk for admission to the intensive care unit (ICU) in patients with COVID-19 presenting at the emergency department. Using artificial neural networks, we propose a new Data Ensemble Refinement Greedy Algorithm (DERGA) based on 15 easily accessible hematological indices. A database of 1596 patients with COVID-19 was used; it was divided into 1257 training datasets (80 % of the database) for training the algorithms and 339 testing datasets (20 % of the database) to check the reliability of the algorithms. The optimal combination of hematological indicators that gives the best prediction consists of only four hematological indicators as follows: neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase, ferritin, and albumin. The best prediction corresponds to a particularly high accuracy of 97.12 %. In conclusion, our novel approach provides a robust model based only on basic hematological parameters for predicting the risk for ICU admission and optimize COVID-19 patient management in the clinical practice.
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Affiliation(s)
- Panagiotis G Asteris
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Amir H Gandomi
- Faculty of Engineering & IT, University of Technology Sydney, Sydney, NSW 2007, Australia; University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary
| | - Danial J Armaghani
- School of Civil and Environmental Engineering, University of Technology Sydney, NSW 2007, Australia
| | - Styliani Kokoris
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Greece
| | - Anastasia T Papandreadi
- Software and Applications Department, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Greece
| | - Anna Roumelioti
- Department of Hematology and Lymphoma BMTU, Evangelismos General Hospital, Athens, Greece
| | - Stefanos Papanikolaou
- NOMATEN Centre of Excellence, National Center for Nuclear Research, ulica A. Sołtana 7, 05-400 Swierk/Otwock, Poland
| | - Markos Z Tsoukalas
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Leonidas Triantafyllidis
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Evangelos I Koutras
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Abidhan Bardhan
- Civil Engineering Department, National Institute of Technology Patna, Bihar, India
| | - Ahmed Salih Mohammed
- Engineering Department, American University of Iraq, Sulaimani, Kurdistan-Region, Iraq
| | - Hosein Naderpour
- Institute of Industrial Science, University of Tokyo, Tokyo, Japan
| | - Satish Paudel
- Department of Civil and Environmental Engineering, University of Nevada, Reno, US
| | - Pijush Samui
- Civil Engineering Department, National Institute of Technology Patna, Bihar, India
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, Medical School, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, Medical School, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Medical School, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece.
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Song S, Zeng L, Xu J, Shi L, Lu L, Ling Y, Zhang L. Proteomic lung analysis revealed hyper-activation of neutrophil extracellular trap formation in cases of fatal COVID-19. Heliyon 2024; 10:e31878. [PMID: 38882332 PMCID: PMC11177151 DOI: 10.1016/j.heliyon.2024.e31878] [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: 09/05/2023] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
The molecular pathology of lung injury in patients with Corona Virus Disease 2019 (COVID-19) remain unclear. In this study, we performed a proteomic study of lung tissues from seven patients with COVID-19, and eight without. Lung parenchymal tissues with COVID-19 were obtained from autopsy samples, while control samples were obtained from paracancerous tissues. Proteins were extracted using phenol extraction. A tandem mass tag-based quantitative proteomic approach combined with bioinformatic analysis was used to detect proteomic changes in the SARS-CoV-2-infected lung tissues. A total of 6,602, and 6,549 proteins were identified in replicates 1 and 2, respectively. Of these, 307, and 278, respectively, were identified as differentially expressed proteins (DEPs). In total, 216 DEPs were identified in this study. These proteins were enriched in 189 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The downregulated proteins are mainly involved in focal adhesion (n = 5), and the PI3K-Akt signaling pathway (n = 4). The upregulated proteins were related to neutrophil extracellular trap (NET) formation (n = 16), and the phagosome pathway (n = 11). The upregulated proteins in these two pathways interact with one another. Further immunohistochemistry verified NET enrichment in the tissues with COVID-19 compared to the controls. Our results systematically outlined the proteomic profiles of the lung's response to SARS-CoV-2 infection and indicated that NET formation was hyper-activated. These results will hopefully provide new evidence for understanding the mechanism behind fatal COVID-19.
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Affiliation(s)
- Shu Song
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Liyan Zeng
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
- Intelligent Medicine Institute, Fudan University, Shanghai, 200032, China
| | - Jingjing Xu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Lei Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Lingqing Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Yun Ling
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Lijun Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
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5
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Chen L, Li M, Wu Z, Liu S, Huang Y. A nomogram to predict severe COVID-19 patients with increased pulmonary lesions in early days. Front Med (Lausanne) 2024; 11:1343661. [PMID: 38737763 PMCID: PMC11082326 DOI: 10.3389/fmed.2024.1343661] [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: 11/24/2023] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives This study aimed to predict severe coronavirus disease 2019 (COVID-19) progression in patients with increased pneumonia lesions in the early days. A simplified nomogram was developed utilizing artificial intelligence (AI)-based quantified computed tomography (CT). Methods From 17 December 2019 to 20 February 2020, a total of 246 patients were confirmed COVID-19 infected in Jingzhou Central Hospital, Hubei Province, China. Of these patients, 93 were mildly ill and had follow-up examinations in 7 days, and 61 of them had enlarged lesions on CT scans. We collected the neutrophil-to-lymphocyte ratio (NLR) and three quantitative CT features from two examinations within 7 days. The three quantitative CT features of pneumonia lesions, including ground-glass opacity volume (GV), semi-consolidation volume (SV), and consolidation volume (CV), were automatically calculated using AI. Additionally, the variation volumes of the lesions were also computed. Finally, a nomogram was developed using a multivariable logistic regression model. To simplify the model, we classified all the lesion volumes based on quartiles and curve fitting results. Results Among the 93 patients, 61 patients showed enlarged lesions on CT within 7 days, of whom 19 (31.1%) developed any severe illness. The multivariable logistic regression model included age, NLR on the second time, an increase in lesion volume, and changes in SV and CV in 7 days. The personalized prediction nomogram demonstrated strong discrimination in the sample, with an area under curve (AUC) and the receiver operating characteristic curve (ROC) of 0.961 and a 95% confidence interval (CI) of 0.917-1.000. Decision curve analysis illustrated that a nomogram based on quantitative AI was clinically useful. Conclusion The integration of CT quantitative changes, NLR, and age in this model exhibits promising performance in predicting the progression to severe illness in COVID-19 patients with early-stage pneumonia lesions. This comprehensive approach holds the potential to assist clinical decision-making.
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Affiliation(s)
- Lina Chen
- Department of Radiology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei Province, China
| | - Min Li
- Department of Radiology, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, Hubei Province, China
| | - Zhenghong Wu
- Department of Radiology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei Province, China
| | - Sibin Liu
- Department of Radiology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei Province, China
| | - Yuanyi Huang
- Department of Radiology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei Province, China
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Harte JV, Coleman-Vaughan C, Crowley MP, Mykytiv V. It's in the blood: a review of the hematological system in SARS-CoV-2-associated COVID-19. Crit Rev Clin Lab Sci 2023; 60:595-624. [PMID: 37439130 DOI: 10.1080/10408363.2023.2232010] [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: 04/10/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global healthcare crisis. While SARS-CoV-2-associated COVID-19 affects primarily the respiratory system, patients with COVID-19 frequently develop extrapulmonary manifestations. Notably, changes in the hematological system, including lymphocytopenia, neutrophilia and significant abnormalities of hemostatic markers, were observed early in the pandemic. Hematological manifestations have since been recognized as important parameters in the pathophysiology of SARS-CoV-2 and in the management of patients with COVID-19. In this narrative review, we summarize the state-of-the-art regarding the hematological and hemostatic abnormalities observed in patients with SARS-CoV-2-associated COVID-19, as well as the current understanding of the hematological system in the pathophysiology of acute and chronic SARS-CoV-2-associated COVID-19.
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Affiliation(s)
- James V Harte
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- School of Biochemistry & Cell Biology, University College Cork, Cork, Ireland
| | | | - Maeve P Crowley
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- Irish Network for Venous Thromboembolism Research (INViTE), Ireland
| | - Vitaliy Mykytiv
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
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7
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Supák D, Mészáros B, Turi B, Herold Z, Kukor Z, Valent S. Predicting Potentially Fatal COVID-19 Disease in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio (NLR). J Clin Med 2023; 12:6896. [PMID: 37959361 PMCID: PMC10649139 DOI: 10.3390/jcm12216896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To evaluate the neutrophil-to-lymphocyte ratio (NLR) values' possible predictive role in fatal and severe cases of COVID-19 disease in pregnant women. Design and data collection: A case-control study was conducted with the inclusion of 45 pregnant COVID-19 patients. All the data were obtained from the hospital information system of Semmelweis University by two of the authors. RESULTS Statistical analyses showed that NLR values were significantly higher in patients with fatal COVID-19 compared to those who survived the disease, with or without mechanical ventilation. The study also assessed whether NLR values measured on the first day of hospitalization or at their peak provided better markers of disease severity. While both the first-day and peak NLR values were evaluated in patients who did not survive the disease, only the peak NLR values had predictive value regarding patient death. CONCLUSION Based on our results, the peak NLR values appear to be useful markers of COVID-19 severity, with a cut-off value of 18.05. However, the authors suggest and hope that larger sample size studies will be conducted to further validate the findings of their research.
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Affiliation(s)
- Dorina Supák
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
| | - Balázs Mészáros
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
| | - Balázs Turi
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
| | - Zoltán Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1082 Budapest, Hungary;
| | - Zoltán Kukor
- Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, 1094 Budapest, Hungary
| | - Sándor Valent
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
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8
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García-Escobar A, Vera-Vera S, Tébar-Márquez D, Rivero-Santana B, Jurado-Román A, Jiménez-Valero S, Galeote G, Cabrera JÁ, Moreno R. Neutrophil-to-lymphocyte ratio an inflammatory biomarker, and prognostic marker in heart failure, cardiovascular disease and chronic inflammatory diseases: New insights for a potential predictor of anti-cytokine therapy responsiveness. Microvasc Res 2023; 150:104598. [PMID: 37633337 DOI: 10.1016/j.mvr.2023.104598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
In the 20th century, research focused on cholesterol and lipoproteins as the key mechanism in establishing atherosclerotic cardiovascular disease (ASCVD). Given that some studies demonstrated subclinical atherosclerosis in subjects without conventional cardiovascular risk factors, the elevated low-density lipoprotein (LDL) levels alone cannot account for the entire burden of atherosclerosis. Hence, large-scale clinical trials demonstrated the operation of immune and inflammatory pathways in ASCVD. In this regard, the evidence establishes that cells of the immune system, both the innate (neutrophils, macrophages) and adaptive (T cell and other lymphocytes) limbs, contribute to atherosclerosis and atherothrombosis. Besides, basic science studies have identified proatherogenic cytokines such as interleukin (IL)-1, IL-12, and IL-18. In this regard, some studies showed that antiinflammatory therapy targeting the immune system by modulating or blocking interleukins, also known as anti-cytokine therapy, can reduce the risk of major cardiovascular adverse events. The neutrophils play a key role in the innate immune system, representing the acute phase of an inflammatory response. In contrast, lymphocytes represent the adaptive immune system and promote the induction of autoimmune inflammation, especially in the chronic inflammatory response. Through the literature review, we will highlight the inflammatory pathway for the physiopathology of ASCVD, HF, and COVID-19. In this regard, the neutrophil-to-lymphocyte ratio (NLR) integrates the innate immune and adaptive immune systems, making the NLR a biomarker of inflammation. In addition, we provided an update on the evidence showing that high NLR is associated with worse prognosis in heart failure (HF), ASCVD, and COVID-19, as well as their clinical applications showing that the normalization of NLR after anti-cytokine therapy is a potential predictor of therapy responsiveness and is associated with reduction of major adverse cardiovascular events.
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Affiliation(s)
- Artemio García-Escobar
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain; Cardiology Department, Quirónsalud University Hospital Madrid, Spain.
| | - Silvio Vera-Vera
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Daniel Tébar-Márquez
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Borja Rivero-Santana
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Alfonso Jurado-Román
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
| | | | - Raúl Moreno
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain; Institute for Health Research La Paz University Hospital (IDIPAZ), Madrid, Spain; Biomedical Research Network Center on Cardiovascular Disease (CIBERCV), Institute of Health Carlos III, Madrid, Spain
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9
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Casas-Rojo JM, Ventura PS, Antón Santos JM, de Latierro AO, Arévalo-Lorido JC, Mauri M, Rubio-Rivas M, González-Vega R, Giner-Galvañ V, Otero Perpiñá B, Fonseca-Aizpuru E, Muiño A, Del Corral-Beamonte E, Gómez-Huelgas R, Arnalich-Fernández F, Llorente Barrio M, Sancha-Lloret A, Rábago Lorite I, Loureiro-Amigo J, Pintos-Martínez S, García-Sardón E, Montaño-Martínez A, Rojano-Rivero MG, Ramos-Rincón JM, López-Escobar A. Improving prediction of COVID-19 mortality using machine learning in the Spanish SEMI-COVID-19 registry. Intern Emerg Med 2023; 18:1711-1722. [PMID: 37349618 DOI: 10.1007/s11739-023-03338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
COVID-19 is responsible for high mortality, but robust machine learning-based predictors of mortality are lacking. To generate a model for predicting mortality in patients hospitalized with COVID-19 using Gradient Boosting Decision Trees (GBDT). The Spanish SEMI-COVID-19 registry includes 24,514 pseudo-anonymized cases of patients hospitalized with COVID-19 from 1 February 2020 to 5 December 2021. This registry was used as a GBDT machine learning model, employing the CatBoost and BorutaShap classifier to select the most relevant indicators and generate a mortality prediction model by risk level, ranging from 0 to 1. The model was validated by separating patients according to admission date, using the period 1 February to 31 December 2020 (first and second waves, pre-vaccination period) for training, and 1 January to 30 November 2021 (vaccination period) for the test group. An ensemble of ten models with different random seeds was constructed, separating 80% of the patients for training and 20% from the end of the training period for cross-validation. The area under the receiver operating characteristics curve (AUC) was used as a performance metric. Clinical and laboratory data from 23,983 patients were analyzed. CatBoost mortality prediction models achieved an AUC performance of 84.76 (standard deviation 0.45) for patients in the test group (potentially vaccinated patients not included in model training) using 16 features. The performance of the 16-parameter GBDT model for predicting COVID-19 hospital mortality, although requiring a relatively large number of predictors, shows a high predictive capacity.
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Affiliation(s)
- José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, 28981, Madrid, Spain
| | - Paula Sol Ventura
- Department of Pediatric Endocrinology, Hospital HM Nens, HM Hospitales, 08009, Barcelona, Spain
| | | | | | | | - Marc Mauri
- Data Scientist, Kaizen AI, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío González-Vega
- Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Vicente Giner-Galvañ
- Internal Medicine Department, Hospital Universitario San Juan. San Juan de Alicante, Alicante, Spain
| | | | - Eva Fonseca-Aizpuru
- Internal Medicine Department, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Antonio Muiño
- Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | | | | | | | - Isabel Rábago Lorite
- Internal Medicine Department, Hospital Universitario Infanta Sofía. San Sebastián de los Reyes, Madrid, Spain
| | - José Loureiro-Amigo
- Internal Medicine Department, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Santiago Pintos-Martínez
- Internal Medicine Department, Hospital Universitario de Sagunto, Puerto de Sagunto, Valencia, Spain
| | - Eva García-Sardón
- Internal Medicine Department, Hospital Universitario de Cáceres, Cáceres, Spain
| | | | | | | | - Alejandro López-Escobar
- Pediatrics Department, Clinical Research Unit, Hospital Universitario Vithas Madrid La Milagrosa, Fundación Vithas, Madrid, Spain.
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10
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Shao S, Zhang Z, Feng L, Liang L, Tong Z. Association of Blood Inflammatory Biomarkers with Clinical Outcomes in Patients with AECOPD: An 8-Year Retrospective Study in Beijing. Int J Chron Obstruct Pulmon Dis 2023; 18:1783-1802. [PMID: 37608836 PMCID: PMC10441637 DOI: 10.2147/copd.s416869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose To discover potential inflammatory biomarkers, which can compare favorably with traditional biomarkers, and their best cut-offs at first admission to predict clinical outcomes (short-term and long-term) and the risk of readmission among acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients. Patients and Methods Novel inflammatory biomarkers (such as the neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], etc.) were compared with traditional biomarkers by Pearson's correlation test. Logistic regression analysis and receiver operating characteristic (ROC) curves were applied to judge the accuracy of these novel biomarkers to predict in-hospital mortality. Results Surviving AECOPD patients had lower NLR, PLR, and lymphocyte-to-monocyte ratios than non-survival patients (all P < 0.001). According to Pearson's correlation test, there was a linear correlation between novel and traditional biomarkers (all P < 0.05). In terms of a single biomarker, the AUC value of NLR was the largest, which was not inferior to C-reactive protein (Z-P = 0.064), and superior to erythrocyte sedimentation rate (Z-P = 0.002) and other novel single inflammatory biomarkers (all Z-P < 0.05). The mortality of patients with NLR ≥ 4.43 was 2.308-fold higher than that of patients with NLR < 4.43. After dividing patients into a higher or lower NLR group, pooled results showed that patients with NLR ≥ 4.43 had a higher rate of treatment failure, intensive care unit admission, longer hospital length of stay, one-year mortality after the index hospitalization, and overall mortality than patients with NLR < 4.43 (all P < 0.001). Patients with NLR ≥ 4.43 were associated with higher and earlier first readmission due to AECOPD than patients with lower NLR. Conclusion NLR was the best to forecast the clinical prognosis and readmission risk among AECOPD patients, which was not inferior to CRP, and the best cut-off value of NLR was 4.43.
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Affiliation(s)
- Shuai Shao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Zhijin Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Lin Feng
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Lirong Liang
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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11
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Bravo E, Maldonado IL, Razo MA, Martinez GV, Lopez S. Association of Neutrophil/Lymphocyte Ratio and Neutrophil/Lymphocyte Platelet Ratio With Acute Kidney Injury in Severe COVID-19. Cureus 2023; 15:e43873. [PMID: 37736444 PMCID: PMC10511298 DOI: 10.7759/cureus.43873] [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] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
Background Severe disease from COVID-19 was the leading cause of admission to the emergency room and hospitalization during the pandemic in Mexico. Acute kidney injury was one of the most prevalent complications in these patients. The neutrophil/lymphocyte (NL) index and the neutrophil/lymphocyte platelet (NLP) index have previously been described as possible markers associated with complications and mortality in this disease. Objective To determine the association of the NL ratio and the NLP ratio in patients with acute kidney injury secondary to severe COVID-19. Materials and methods This is a case-control study, unpaired, of patients diagnosed with severe COVID-19 who presented or did not present acute kidney injury. On admission to the hospital, the hematological ratios were calculated, and Mann-Whitney U tests and multivariate logistic regression were performed. Results A total of 160 patients were included, and a difference in the NLP ratio (4.2 vs. 3.1, p = 0.001) was observed between patients with and without acute kidney injury. Additionally, the NLP ratio was the main risk variable for acute kidney injury in severe COVID-19, with an odds ratio of 2.5 and a 95% confidence interval of 1.108-5.66. Conclusions The NLP ratio has a moderate association and is a risk factor associated with the presence of acute kidney injury in patients with severe COVID-19.
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Affiliation(s)
- Edgar Bravo
- Critical Care Medicine, General Hospital León, León, MEX
| | | | - Marco A Razo
- Critical Care Medicine, General Hospital León, León, MEX
| | | | - Sergio Lopez
- Research Department, University of Guanajuato, León, MEX
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12
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Mancilla-Ceballos R, Milne KM, Guenette JA, Cortes-Telles A. Inflammation associated with lung function abnormalities in COVID-19 survivors. BMC Pulm Med 2023; 23:235. [PMID: 37391742 DOI: 10.1186/s12890-023-02521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Activation of inflammatory pathways promotes organ dysfunction in COVID-19. Currently, there are reports describing lung function abnormalities in COVID-19 survivors; however, the biological mechanisms remain unknown. The aim of this study was to analyze the association between serum biomarkers collected during and following hospitalization and pulmonary function in COVID-19 survivors. METHODS Patients recovering from severe COVID-19 were prospectively evaluated. Serum biomarkers were analyzed from admission to hospital, peak during hospitalization, and at the time of discharge. Pulmonary function was measured approximately 6 weeks after discharge. RESULTS 100 patients (63% male) were included (age 48 years, SD ± 14) with 85% having at least one comorbidity. Patients with a restrictive spirometry pattern (n = 46) had greater inflammatory biomarkers compared to those with normal spirometry (n = 54) including peak Neutrophil-to-Lymphocyte ratio (NLR) value [9.3 (10.1) vs. 6.5 (6.6), median (IQR), p = 0.027] and NLR at hospital discharge [4.6 (2.9) vs. 3.2 (2.9) p = 0.005] and baseline C-reactive protein value [164.0 (147.0) vs. 106.5 (139.0) mg/dL, p = 0.083). Patients with an abnormal diffusing capacity (n = 35) had increased peak NLR [8.9 (5.9) vs. 5.6 (5.7) mg/L, p = 0.029]; baseline NLR [10.0 (19.0) vs. 4.0 (3.0) pg/ml, p = 0.002] and peak Troponin-T [10.0 (20.0) vs. 5.0 (5.0) pg/ml, p = 0.011] compared to patients with normal diffusing capacity (n = 42). Multivariable linear regression analysis identified predictors of restrictive spirometry and low diffusing capacity, but only accounted for a low degree of variance in pulmonary function outcome. CONCLUSION Overexpression of inflammatory biomarkers is associated with subsequent lung function abnormalities in patients recovered from severe COVID-19.
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Affiliation(s)
- Roberto Mancilla-Ceballos
- Internal Medicine Department, Hospital Regional de Alta Especialidad de La Peninsula de Yucatan, Yucatan, Mexico
| | - Kathryn M Milne
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Arturo Cortes-Telles
- Respiratory Diseases Clinic, Hospital Regional de Alta Especialidad de La Peninsula de Yucatan, Yucatan, Mexico.
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13
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Carreto-Binaghi LE, Herrera MT, Guzmán-Beltrán S, Juárez E, Sarabia C, Salgado-Cantú MG, Juarez-Carmona D, Guadarrama-Pérez C, González Y. Reduced IL-8 Secretion by NOD-like and Toll-like Receptors in Blood Cells from COVID-19 Patients. Biomedicines 2023; 11:biomedicines11041078. [PMID: 37189696 DOI: 10.3390/biomedicines11041078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Severe inflammatory responses are associated with the misbalance of innate and adaptive immunity. TLRs, NLRs, and cytokine receptors play an important role in pathogen sensing and intracellular control, which remains unclear in COVID-19. This study aimed to evaluate IL-8 production in blood cells from COVID-19 patients in a two-week follow-up evaluation. Blood samples were taken at admission (t1) and after 14 days of hospitalization (t2). The functionality of TLR2, TLR4, TLR7/8, TLR9, NOD1, and NOD2 innate receptors and IL-12 and IFN-γ cytokine receptors was evaluated by whole blood stimulation with specific synthetic receptor agonists through the quantification of IL-8, TNF-α, or IFN-γ. At admission, ligand-dependent IL-8 secretion was 6.4, 13, and 2.5 times lower for TLR2, TLR4, and endosomal TLR7/8 receptors, respectively, in patients than in healthy controls. Additionally, IL-12 receptor-induced IFN-γ secretion was lower in COVID-19 patients than in healthy subjects. We evaluated the same parameters after 14 days and observed significantly higher responses for TLR2, TLR4, TLR7/8, TLR9, and NOD1, NOD2, and IFN-γ receptors. In conclusion, the low secretion of IL-8 through stimulation with agonists of TLR2, TLR4, TLR7/8, TLR9, and NOD2 at t1 suggests their possible contribution to immunosuppression following hyperinflammation in COVID-19 disease.
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Affiliation(s)
- Laura E. Carreto-Binaghi
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - María Teresa Herrera
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Silvia Guzmán-Beltrán
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Esmeralda Juárez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Carmen Sarabia
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Manuel G. Salgado-Cantú
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Daniel Juarez-Carmona
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla 72000, Mexico
| | - Cristóbal Guadarrama-Pérez
- Servicio de Urgencias, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Yolanda González
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
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Tepebaşı MY, İlhan İ, Temel EN, Sancer O, Öztürk Ö. Investigation of inflammation, oxidative stress, and DNA damage in COVID-19 patients. Cell Stress Chaperones 2023; 28:191-199. [PMID: 36797451 PMCID: PMC9936118 DOI: 10.1007/s12192-023-01330-3] [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: 08/18/2022] [Revised: 01/11/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
COVID-19 disease, which spreads worldwide, is a disease characterized by widespread inflammation and affects many organs, especially the lungs. The resulting inflammation can lead to reactive oxygen radicals, leading to oxidative DNA damage. The pneumonia severity of 95 hospitalized patients with positive RT-PCR test was determined and divided into three groups: mild, moderate, and severe/critical. Inflammation markers (neutrophil-lymphocyte ratio, serum reactive protein, procalcitonin, etc.) were determined, and IL-10 and IFN-γ measurements were analyzed using the enzyme-linked immunosorbent assay method. In evaluating oxidative damage, total thiol, native thiol, disulfide, and ischemia-modified albumin (IMA) levels were determined by measuring spectrophotometrically. The comet assay method's percentage of tail DNA obtained was used to determine oxidative DNA damage. As a result, when the mild and severe/critical groups were compared, we found that total thiol, native thiol, and disulfide levels decreased significantly in the severe/critical group due to the increase in inflammation markers and cytokine levels (p < 0.05). We could not detect any significance in IMA levels between the groups (p > 0.05). At the same time, we determined an increase in the tail DNA percent level, that is, DNA damage, due to the increased oxidative effect. As a result, we determined that inflammation and oxidative stress increased in patients with severe pneumonia, and there was DNA damage in these patients.
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Affiliation(s)
| | - İlter İlhan
- Department of Biochemistry, University of Süleyman Demirel, Isparta, Turkey
| | - Esra Nurlu Temel
- Department of Infectious Diseases, University of Süleyman Demirel, Isparta, Turkey
| | - Okan Sancer
- Department of Medical Biology, University of Süleyman Demirel, Isparta, Turkey
| | - Önder Öztürk
- Department of Chest Diseases, University of Süleyman Demirel, Isparta, Turkey
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15
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Nesterova IV, Atazhakhova MG, Teterin YV, Matushkina VA, Chudilova GA, Mitropanova MN. THE ROLE OF NEUTROPHIL EXTRACELLULAR TRAPS (NETS)
IN THE IMMUNOPATHOGENESIS OF SEVERE COVID-19: POTENTIAL IMMUNOTHERAPEUTIC STRATEGIES REGULATING NET FORMATION AND ACTIVITY. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2023. [DOI: 10.15789/2220-7619-tro-2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The role of neutrophil granulocytes (NG) in the pathogenesis of COVID-19 is associated with the recruitment of NG into inflammatory foci, activation of their functions and enhanced formation of neutrophil extracellular networks (NETs). In this review, we analyzed a fairly large volume of scientific literature devoted to the peculiarities of the formation of NETs, their role in the pathogenesis of COVID-19, participation in the occurrence of immunothrombosis, vasculitis, acute respiratory distress syndrome, cytokine storm syndrome, multi-organ lesions. Convincing data are presented that clearly indicate the significant involvement of NETs in the immunopathogenesis of COVID-19 and the associated severe complications resulting from the intensification of the inflammation process, which is key for the course of infection caused by the SARS-CoV-2 virus. The presented role of NG and NETs, along with the role of other immune system cells and pro-inflammatory cytokines, is extremely important in understanding the development of an overactive immune response in severe COVID-19. The obtained scientific results, available today, allow identifying the possibilities of regulatory effects on hyperactivated NG, on the formation of NETs at various stages and on limiting the negative impact of already formed NETs on various tissues and organs. All of the above should help in the creation of new, specialized immunotherapy strategies designed to increase the chances of survival, reduce the severity of clinical manifestations in patients with COVID-19, as well as significantly reduce mortality rates. Currently, it is possible to use existing drugs and a number of new drugs are being developed, the action of which can regulate the amount of NG, positively affect the functions of NG and limit the intensity of NETs formation. Continuing research on the role of hyperactive NG and netosis, as well as understanding the mechanisms of regulation of the phenomenon of formation and restriction of NETs activity in severe COVID-19, apparently, are a priority, since in the future the new data obtained could become the basis for the development of targeted approaches not only to immunotherapy aimed at limiting education and blocking negative effects already formed NETs in severe COVID-19, but also to immunotherapy, which could be used in the complex treatment of other netopathies, first of all, autoimmune diseases, auto-inflammatory syndromes, severe purulent-inflammatory processes, including bacterial sepsis and hematogenous osteomyelitis.
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16
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Dabrowski W, Gagos M, Siwicka-Gieroba D, Piechota M, Siwiec J, Bielacz M, Kotfis K, Stepulak A, Grzycka-Kowalczyk L, Jaroszynski A, Malbrain MLNG. Humulus lupus extract rich in xanthohumol improves the clinical course in critically ill COVID-19 patients. Biomed Pharmacother 2023; 158:114082. [PMID: 36508996 PMCID: PMC9732508 DOI: 10.1016/j.biopha.2022.114082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The systemic inflammatory response following severe COVID-19 is associated with poor outcomes. Several anti-inflammatory medications have been studied in COVID-19 patients. Xanthohumol (Xn), a natural extract from hop cones, possesses strong anti-inflammatory and antioxidative properties. The aim of this study was to analyze the effect of Xn on the inflammatory response and the clinical outcome of COVID-19 patients. METHODS Adult patients treated for acute respiratory failure (PaO2/FiO2 less than 150) were studied. Patients were randomized into two groups: Xn - patients receiving adjuvant treatment with Xn at a daily dose of 4.5 mg/kg body weight for 7 days, and C - controls. Observations were performed at four time points: immediately after admission to the ICU and on the 3rd, 5th, and 7th days of treatment. The inflammatory response was assessed based on the plasma IL-6 concentration, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and D-dimer levels. The mortality rate was determined 28 days after admission to the ICU. RESULTS Seventy-two patients were eligible for the study, and 50 were included in the final analysis. The mortality rate was significantly lower and the clinical course was shorter in the Xn group than in the control group (20% vs. 48%, p < 0.05, and 9 ± 3 days vs. 22 ± 8 days, p < 0.001). Treatment with Xn decreased the plasma IL-6 concentration (p < 0.01), D-dimer levels (p < 0.05) and NLR (p < 0.01) more significantly than standard treatment alone. CONCLUSION Adjuvant therapy with Xn appears to be a promising anti-inflammatory treatment in COVID-19 patients.
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Affiliation(s)
- Wojciech Dabrowski
- First Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland,.
| | - Mariusz Gagos
- Department of Cell Biology, Institute of Biological Sciences, Maria Curie-Sklodowska University, Lublin, Poland
| | - Dorota Siwicka-Gieroba
- First Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
| | - Mariusz Piechota
- Department of Anesthesiology and Intensive Therapy, Centre for Artificial Extracorporeal Kidney and Liver Support, Dr. W. Bieganski Regional Specialist Hospital, Łódź, Poland
| | - Jan Siwiec
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Poland
| | - Magdalena Bielacz
- First Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Stepulak
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Poland
| | | | | | - Manu LNG Malbrain
- First Department of Anesthesiology and Intensive Therapy Medical University of Lublin, Lublin, Poland
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17
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Ramos-Rincón JM, Ventura PS, Casas-Rojo JM, Mauri M, Bermejo CL, de Latierro AO, Rubio-Rivas M, Mérida-Rodrigo L, Pérez-Casado L, Barrientos-Guerrero M, Giner-Galvañ V, Gallego-Lezaun C, Milián AH, Manzano L, Blázquez-Encinar JC, Solís-Marquínez MN, García MG, Lobo-García J, Valente VAR, Roig-Martí C, León-Téllez M, Tellería-Gómez P, González-Juárez MJ, Gómez-Huelgas R, López-Escobar A, Bermejo CL, Núñez-Cortés JM, Santos JMA, Huelgas RG, Corbella X, Pérez FF, Homs N, Montero A, Mora-Luján JM, Rubio-Rivas M, Bandera VA, Alegría JG, Jiménez-García N, del Pino JL, Escalante MDM, Romero FN, Rodriguez VN, Sierra JO, de Blas PA, Cañas CA, Ayuso B, Morejón JB, Escudero SC, Frías MC, Tejido SC, de Miguel Campo B, Pedroche CD, Simon RD, Reyne AG, Veganzones LI, Huerta LJ, Blanco AL, Gonzalo JL, Lora-Tamayo J, Bermejo CL, de la Calle GM, Godoy RM, Perpiña BO, Ruiz DP, Fernández MS, Montes JT, Suárez AMÁ, Vergés CD, Martínez RFM, Aizpuru EMF, Carrasco AG, Amezua CH, Caleya JFL, Martínez DL, del Mar Martínez López M, Zapico AM, Iscar CO, Casado LP, Martínez MLT, Chamorro LMT, Casas LA, de Oña ÁA, Beato RA, Gonzalo LA, Muñoz JA, Oblitas CMA, García CA, Cebrián MB, Corral JB, Guerrero MB, Estrada ADB, Moreno MC, Fernández PC, Carrillo R, Pérez SC, Muñoz EC, Moreno ADC, Carvajal MCC, de Santos S, Gómez AE, Carracedo EF, Jenaro MMFM, Valle FG, Garcia A, Fernandez-Bravo IG, Leoni MEG, Antúnez MG, Narciso CGS, Gurjian AA, Ibáñez LJ, Olleros CL, Mendo CL, García SL, Jimeno VM, Nohales CM, Núñez-Cortés JM, Ledesma SM, Míguez AM, Delgado CM, Ortega LO, Sánchez SP, Virto AP, Sanz MTP, Llorente BP, Ruiz SP, Fernández-Llamazares GS, Macías MT, Samaniego NT, do Rego AT, Garcia MVV, Villarreal G, Etayo MZ, Lara RA, Fernandez IC, García JCC, García García GM, Granados JG, Sánchez BG, Periáñez FJM, Perez MJP, Pérez JLB, Méndez MLS, Rivera NA, Vieitez AC, del Corral Beamonte E, Manglano JD, Mera IF, del Mar Garcia Andreu M, Aseguinolaza MG, Lezaun CG, Laorden CJ, Murgui RM, Sanz MTM, Ayala-Gutiérrez MM, López RB, Fonseca JB, Buonaiuto VA, Martínez LFC, Palacios LC, Muriel CC, de Windt F, Christophel ATFT, Ocaña PG, Huelgas RG, García JG, Oliver JAH, Jansen-Chaparro S, López-Carmona MD, Quirantes PL, Sampalo AL, Lorenzo-Hernández E, Sevilla JJM, Carmona JM, Pérez-Belmonte LM, de Pedro IP, Pineda-Cantero A, Gómez CR, Ricci M, Cánovas JS, Troncoso JÁ, Fernández FA, Quintana FB, Arenzana CB, Molina SC, Candalija AC, Bengoa GD, de Gea Grela A, de Lorenzo Hernández A, Vidal AD, Capitán CF, Iglesias MFG, Muñoz BG, Gil CRH, Martínez JMH, Hontañón V, Hernández MJJ, Lahoz C, Calvo CM, Gutiérrez JCM, Prieto MM, Robles EM, Saldaña AM, Fernández AM, Prieto JMM, Mozo AN, López CMO, Peláez EP, Pampyn MP, Simón MAQ, Ramos Ramos JC, Ruperto LR, Purificación AS, Bueso TS, Torre RS, Abanedes CIS, Tabares YU, Mayoral MV, Manau JV, del Carmen Beceiro Abad M, Romero MAF, Castro SM, Guillan EMP, Nuñez MP, Fontan PMP, de Larriva APA, Espinal PC, Lista JD, Fuentes-Jiménez F, del Carmen Guerrero Martínez M, Vázquez MJG, Torres JJ, Pérez LL, López-Miranda J, Piedra LM, Orge MM, Vinagre JP, Pérez-Martinez P, Vílchez MER, Martínez AR, Cabrera JLR, Torres-Peña JD, Tomás MA, Balaz D, Tur DB, Navarro RC, Pérez PC, Redondo JC, White ED, Espínola ME, Del Barrio LE, Atiénzar PJE, Cervera CG, Núñez DFG, Navarro FG, Galvañ VG, Uranga AG, Martínez JG, Isasi IH, Villar LL, Sempere VM, Cruz JMN, Fernández SP, García JJP, Pleguezuelos RP, Pérez AR, Ripoll JMS, Mira AS, Wikman-Jorgensen P, Ayllón JAA, Artero A, del Mar Carmona Martín M, Valls MJF, de Mar Fernández Garcés M, Belda ABG, Cruz IL, López MM, Sanchis EM, Gandia JM, Roger LP, Belmonte AMP, García AV, Eisenhofer AA, Milla AA, Pérez IB, Gutiérrez LB, Garay JB, Parra JC, Díaz AC, Da Silva EC, Hernández MC, Díaz RC, Sánchez MJC, Gozalo CC, Martínez VCM, Doblado LD, de la Fuente Moral S, de Santiago AD, Yagüe ID, Velasco ID, Duca AM, del Campo PD, López GE, Palomo EE, Cruz AF, Gómez AG, Prieto SG, Revilla BG, Viejo MÁG, Irusta JG, Merino PG, Abreu EVG, Martín IG, Rojas ÁG, Villanueva AG, Jiménez JH, Estéllez FI, del Estal PL, Sáiz MCM, de Mendoza Fernández C, Urbistondo MM, Vera FM, Seirul-lo MM, Pita SM, Sánchez PAM, Hernández EM, Vargas AM, Concha VMT, De La Torre IM, Rubio EM, de Benito RM, Serrano AM, Palomo PN, Pascual IP, Martín-Vegue AJR, Martínez AR, Olleros CR, Montaud AR, Pizarro YR, García SR, de Domingo DR, Ortiz DS, Chica ES, Almena IS, Martin ES, Chen YT, de Ureta PT, Alijo ÁV, Comendador JMV, Núñez JAV, Yeguas IA, Gómez JA, Cuchillo JB, López IB, Clotet NC, Elías AEC, Manuel EC, de Luque CMC, Benbunan CC, Vilan LD, Hernández CD, Peralta EED, Pérez VE, Fernandez-Castelao S, Saavedra MOF, Klepzig JLG, del Rosario Iguarán Bermúdez M, Ferrer EJ, Rodríguez AM, de Pedro AM, Sánchez RÁM, Bailón MM, Álvarez SM, Orantos MJN, Mata CO, García EO, Mata DO, González CO, Perez-Somarriba J, Mateos PP, Muñoz MER, Regaira XR, Gallardo LMR, Fornie IS, Botrán AS, Robles MS, Urbano ME, González AMV, Martínez MV, Monge Monge D, Pasos EMF, García AV, Comet LS, Giménez LL, Samper UA, Repiso GA, Bruñén JMG, Barrio ML, Martínez MAC, Igual JJG, Fenoll RG, García MA, Monge EA, Rodríguez JÁ, Varela CA, Gòdia MB, Molina MB, Vega MB, Curbelo J, de las Heras Moreno A, Godoy ID, Alvarez ACE, Martín-Caro IF, López-Mosteiro AF, Marquez GG, Blanco MJG, del Álamo Hernández YG, Encina CGR, González NG, Rodríguez CG, Martín NLS, Báez MM, Delgado CM, Caballero PP, Serrano JP, Rodríguez LR, Cortés PR, Franco CR, Roy-Vallejo E, Vega MR, Lloret AS, Moreno BS, Alba MS, Ballesteros JS, Somovilla A, Fernández CS, Tirado MV, Marti AV, Pareja JFP, Fraile IP, Blanco AM, del Castillo Cantero R, López JLV, Lorite IR, Martínez RF, García IS, Rangel LS, Álvarez AA, Juarros OA, López AA, Castiñeira CC, Calviño AC, Sánchez MC, Varela RF, Castro SJF, Trigo AP, Jarel RP, Varea FR, Freán IR, Alonso LR, Pensado FJS, Porto DV, Saavedra CC, Gómez JF, López BG, Garrido MSH, Amorós AIL, Gil SL, de los Reyes Pascual Pérez M, Perea NR, García AT, Lobo JA, Casanovas LF, Amigo JL, Fernández MM, Bermúdez IO, Fernández MP, Rhyman N, Piqueras NV, Pedrajas JNA, García AM, Vargas I, Jiménez IA, González MC, Cobos-Siles M, Corral-Gudino L, Cubero-Morais P, Fernández MG, González JPM, Dehesa MP, Espinosa PS, Blanco SC, Gamboa JOM, Mosteiro CS, Asiain AS, Santos JMA, Barrera ABB, Vela BB, Muiño CB, Fernández CB, Hernáiz RC, López IC, Rojo JMC, Troncoso AC, Romano PC, Deodati F, Santiago AE, Sánchez GGC, Guijarro EG, Sánchez FJG, de la Torre PG, de Guzmán García-Monge M, Luordo D, González MM, Bermejo JAM, Valverde CP, Quero JLP, Rojas FR, García LR, Gonzalo ES, Muñoz FJT, de la Sota JV, Martínez JV, Gómez MG, Sánchez PR, Gonzalez GA, Iraurgi AL, Arostegui AA, Martínez PA, Fernández IMP, Becerro EM, Jiménez AI, Núñez CV, López MA, López EG, Losada MSA, Estévez BR, Muñoz AMA, Fernández MB, Cano V, Moreno RC, Garcia-Tenorio FC, Nájera BDT, González RE, Butenegro MPG, Díez AG, Caverzaschi VG, Pedraza PMG, Moraleja JG, Carvajal RH, Aranda PJ, González RL, Caparachini ÁL, Castañeyra PL, Ancin AL, Garcia JDM, Romero CM, Saiz MJM, Moríñigo HM, Nicolás GM, Platon EM, Oliveri F, Ortiz Ortiz E, Rafael RP, Galán PR, Berrocal MAS, de Ávila VSR, Sierra PT, Aranda YU, Clemente JV, Bergua CY, de la Peña Fernández A, Milián AH, Manrique MA, Erdozain AC, Ruiz ALI, Luque FJB, Carrasco-Sánchez FJ, de-Sousa-Baena M, Leal JD, Rubio AE, Huertas MF, Bravo JAG, Macías AG, Jiménez EG, Jiménez AH, Quintero CL, Reguera CM, Marcos FJM, Beamud FM, Pérez-Aguilar M, Jiménez AP, Castaño VR, dedel AlcazarRío AS, Ruiz LT, González DA, de Zabalza IAP, Hernández SA, Sáenz JC, Dendariena B, del Mazo MG, de Narvajas Urra IM, Hernández SM, Fernández EM, Somovilla JLP, Pejenaute ER, Rodríguez-Solís JB, Osorio LC, del Pilar Fidalgo Montero M, Soriano MIF, Rincón EEL, Hermida AM, Carrilero JM, Santiago JÁP, Robledo MS, Rojas PS, Yebes NJT, Vento V, Vaca LFA, Arnanz AA, García OA, González MB, Sanz PB, Llisto AC, de Pedro Baena S, Del Hoyo Cuenda B, Fabregate-Fuente M, Osorio MAG, Sánchez IG, García AG, Cisneros OAL, Manzano L, Martínez-Lacalzada M, Ortiz BM, Rey-García J, González ER, Díaz CS, Fajardo GS, Carantoña CS, Viteri-Noël A, Zhilina Zhilina S, Claudio GMA, Rodríguez VB, Muñoz CC, Pérez AC, Orbes MVC, Sánchez DE, Revuelta SI, Martín MM, González JIM, Oterino JÁM, Alonso LM, Balbuena SP, García MLP, Prados AR, Rodríguez-Alonso B, Alegría ÁR, Ledesma MS, Pérez RJT, Encinar JCB, Cilleros CM, Martínez IJ, Delange TG, González RF, Noya AG, Ceron CH, Avanzini II, Diez AL, Mato PL, Vizcaya AML, Benítez DP, Zemsch MMP, Expósito LP, Bar MP, González LR, Lara LR, Cabañero D, Ballester MC, Fernández PC, Sánchez RG, Escrig MJ, Amela CM, Gómez LP, Navarro CP, Parra JAT, de Almeida CT, Villarejo MEF, Calvo VP, Otero SP, López BG, Frías CA, Romero VM, Pérez LA, Velado EM, González RA, Boixeda R, Fernández Fernández J, Mármol CL, Navarro MP, Guzmán AR, Fustier AS, Castro JL, Reboiro MLL, González CS, Sala ER, Izuel JMP, Zamrani ZK, Diaz HA, Lopez TD, Pego EM, Pérez CM, Ferro AP, Trigo SS, Sambade DS, Ferrin MT, del Carmen Vázquez Friol M, Maneiro LV, Rodríguez BC, Espartero MEG, Rivas LM, de la Sierra Navas Alcántara M, Tirado-Miranda R, Marquínez MNS, García VA, Suárez DB, Arenas NG, García PM, Copa DC, García AÁ, Álvarez JC, Calderón MJM, Noriega RG, Rubia MC, García JL, Martínez LT, Celeiro JF, Aguilar DEO, Riesco IM, Bécares JV, Mateos AB, García AAT, Casamayor JD, Silvera DG, Díaz AA, Carballo CH, Tejera A, Prieto MJM, Muñoz MBM, Del Arco Delgado JM, Díaz DR, Feria MB, Herrera Herrera FJ, de la Luz Padilla Salazar M, Luis RH, Ledezma EMC, del Mar López Gámez M, Hernández LT, Pérez SC, García SGA, Gainett GC, Hidalgo AG, Daza JM, Peraza MH, Santos RA, Bernabeu-Wittel M, Suárez SR, Nieto M, Miranda LG, Mancera RMG, Torre FE, Quiles CH, Guzmán CC, de la Cuesta JD, Vega JET, del Carmen López Ríos M, Jiménez PD, Franco BB, de Juan CJ, Rivero SG, Tenllado JL, Lara VA, Estrada AG, Ena J, Segado JEG, Ferrer RG, Lorenzo VG, Arroyo RM, García MG, Hernández FJV, González ÁLM, Montes BV, Die RMG, Molinero AM, Regidor MM, Díez RR, Sierra BH, García LFD, Acedo IEA, Cano CMS, García VH, Bernal BR, Jiménez JC, Bazán EC, Reniu AC, Grabalosa JR, Solà JF, De Boulle IC, Xancó CG, Núñez OR, Ripper CJ, Gutiérrez AG, Trallero LER, Novo MFA, Lecumberri JJN, Ruiz NP, Riancho J, García IS, Baena PC, Sevilla JE, Padilla LG, Ronquillo PG, Bustos PG, Botías MN, Taboada JR, Rodríguez MR, Alvarez VA, Suárez NM, Suárez SR, Díaz SS, Pérez LS, Gómez MF, Castaño CM, Rodríguez LM, Vázquez C, Estévanez IC, Gutiérrez CY, Sela MM, Cosío SF, Álvaro CMG, García JL, Piñeiro AP, Viera YC, Rodríguez LC, de Juan Alvarez C, Benitez GF, Escudero LG, Torres JM, Escriche PM, Canteli SP, Pérez MCR, Soler JA, Remolar MB, Álvarez AC, Carlotti DD, Gimeno MJE, Juana SF, López PG, Soler MTG, de la Sota DP, Castellanos GP, Catalán IP, Martí CR, Monzó PR, Padilla JR, Gaya NT, Blasco JU, Pascual MAM, Vidal LJ, Conesa AA, Rivas MCA, Alsina MH, Romero JM, Diez-Canseco AMU, Martínez FA, Vásquez EA, Stablé JCE, Belmonte AH, Peiró AM, Goñi RM, Castellanos MCP, Belda BS, Navarro DV, Lombraña AS, Ugartondo JC, Plaza ABM, Asensio AN, Alves BP, López NV, Téllez ML, Epelde F, Torrente I, Vasco PG, Santacruz AR, Muñoz AV, Giner MJE, Calvo-Sotelo AE, Sardón EG, González JG, Salazar LG, Garcia AA, Días IM, Gomez AS, Matos MC, Gaspar SN, Nieto AG, Méndez RG, Álvarez AR, Hernández OP, Ramírez AP, González MCM, Lorite MNN, Navarrete LG, Negrin JCA, González JFA, Jiménez I, Toledo PO, Ponce EM, Torres XTE, González SG, Fernández CN, Gómez PT, Gisbert OA, Llistosella MB, Casanova PC, Flores AG, Hinojo AG, Martínez AIM, del Carmen Nogales Nieves M, Austrui AR, Cervantes AZ, Castro VA, Lomba AMB, Aparicio RB, Morales MF, Villar JMF, Monteagudo MTL, García CP, Ferreira LR, Llovo DS, Feijoo MBV, Romero JAM, de Albornoz JLSC, Pérez MJS, Martín ES, Astrua TC, Giraldo PTG, Juárez MJG, Fernandez VM, Echevarry AVR, Arche JFV, Rivero MGR, Martínez AM, Bernad RV, Limia C, Fernández CA, Fernández AT, Fajardo LP, de Vega Santos T, Ruiz AL, Míguez HM. Validation of the RIM Score-COVID in the Spanish SEMI-COVID-19 Registry. Intern Emerg Med 2023; 18:907-915. [PMID: 36680737 PMCID: PMC9862219 DOI: 10.1007/s11739-023-03200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
The significant impact of COVID-19 worldwide has made it necessary to develop tools to identify patients at high risk of severe disease and death. This work aims to validate the RIM Score-COVID in the SEMI-COVID-19 Registry. The RIM Score-COVID is a simple nomogram with high predictive capacity for in-hospital death due to COVID-19 designed using clinical and analytical parameters of patients diagnosed in the first wave of the pandemic. The nomogram uses five variables measured on arrival to the emergency department (ED): age, sex, oxygen saturation, C-reactive protein level, and neutrophil-to-platelet ratio. Validation was performed in the Spanish SEMI-COVID-19 Registry, which included consecutive patients hospitalized with confirmed COVID-19 in Spain. The cohort was divided into three time periods: T1 from February 1 to June 10, 2020 (first wave), T2 from June 11 to December 31, 2020 (second wave, pre-vaccination period), and T3 from January 1 to December 5, 2021 (vaccination period). The model's accuracy in predicting in-hospital COVID-19 mortality was assessed using the area under the receiver operating characteristics curve (AUROC). Clinical and laboratory data from 22,566 patients were analyzed: 15,976 (70.7%) from T1, 4,233 (18.7%) from T2, and 2,357 from T3 (10.4%). AUROC of the RIM Score-COVID in the entire SEMI-COVID-19 Registry was 0.823 (95%CI 0.819-0.827) and was 0.834 (95%CI 0.830-0.839) in T1, 0.792 (95%CI 0.781-0.803) in T2, and 0.799 (95%CI 0.785-0.813) in T3. The RIM Score-COVID is a simple, easy-to-use method for predicting in-hospital COVID-19 mortality that uses parameters measured in most EDs. This tool showed good predictive ability in successive disease waves.
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Affiliation(s)
| | - Paula Sol Ventura
- Fundacio Institut d’Investigacio en Ciències de La Salut Germans Trias I Pujol (IGTP), 08916 Badalona, Spain
| | - José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, 28981 Madrid, Spain
| | - Marc Mauri
- Data Scientist, Kaizen AI, Barcelona, Spain
| | | | | | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Vicente Giner-Galvañ
- Internal Medicine Department. Hospital, Clínico Universitario de Sant Joan d’Alacant, Alicante, Spain
| | | | | | - Luis Manzano
- Internal Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | - Alejandro López-Escobar
- Pediatrics Department, Clinical Research Unit, Hospital Universitario Vithas Madrid La Milagrosa, Fundación Vithas. Madrid, Madrid, Spain
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Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France. J Clin Med 2023; 12:jcm12020421. [PMID: 36675351 PMCID: PMC9862383 DOI: 10.3390/jcm12020421] [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: 10/12/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023] Open
Abstract
Describe the characteristics of ventilation-acquired pneumonia (VAP) and potential risk factors in critically ill SARS-CoV-2 patients admitted in three French public hospitals during the first year of the COVID-19 pandemic. We conducted a monocentric retrospective study in seven Marseille intensive care units (ICUs) aiming to describe VAP characteristics and identify their risk factors. VAP patients were compared to a non-VAP control group. From March to November 2020, 161 patients admitted for viral-induced acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV) were included. This cohort was categorized in two groups according to the development or not of a VAP during their stay in ICU. 82 patients (51%) developed ventilation-acquired pneumonia. Most of them were men (77%) and 55% had hypertension. In the VAP population, 31 out of 82 patients (38%) had received dexamethasone and 47% were administered antibiotic course prior to ICU admission. An amount of 88% of respiratory infections were late VAPs with a median delay of 10 days from the onset of IMV. Gram negative bacteria were responsible for 62% of VAPs with Pseudomonas spp. being the most documented bacteria. Less than a third of the ICU-acquired infections were due to multidrug resistant (MDR) bacteria mainly displaying AmpC cephalosporin hyper production resistance phenotype. Multivariate analysis revealed that early Dexamethasone administration in ICU, male sex, older age and ROX score were risk factors for VAP whereas pre-ICU antimicrobial treatment and higher IGS 2 were protective factors. VAP is a frequent ICU-related complication affecting half of patients infected with SARS-CoV-2 and requiring IMV. It was responsible for increased morbidity due to a longer ICU and hospital stay. VAP risk factors included demographic factors such as age and sex. Dexamethasone was associated with a threefold greater risk of developing VAP during ICU stay. These results need to be comforted by large multi-centric studies before questioning the only available and effective treatment against SARS-CoV-2 in ICU patients.
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Pereira PC, de Lima CJ, Fernandes AB, Zângaro RA, Villaverde AB. Cardiopulmonary and hematological effects of infrared LED photobiomodulation in the treatment of SARS-COV2. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 238:112619. [PMID: 36495670 PMCID: PMC9721157 DOI: 10.1016/j.jphotobiol.2022.112619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND COVID-19 disease is caused by SARS-CoV-2 which can trigger acute respiratory syndrome, which presents with dense alveolar and interstitial infiltrates and pulmonary edema, causing severe hypoxemia and significant alteration to pulmonary mechanics with reduced pulmonary compliance. The photobiomodulation technique alters cellular and molecular metabolism, showing promising results regarding the reduction of acute pulmonary inflammation. OBJECTIVE To compare the photomodulation technique using near-infrared LED to conventional respiratory physiotherapy treatment in patients with COVID-19 in reversing acute conditions, reducing hospitalization time, and decreasing the need for oxygen therapy. METHODOLOGY The cohort was comprised of 30 patients undergoing COVID-19 treatment who were divided and allocated into two equal groups randomly: the LED group (LED), treated with infrared LED at 940 nm and conventional therapy, and the control group (CON), who received conventional treatment (antibiotic therapy for preventing superimposed bacterial infections, and physiotherapy) with LED irradiation off. Phototherapy used a vest with an array of 300 LEDs (940 nm) mounted on a 36 cm × 58 cm area and positioned in the patient's anterior thoracic and abdominal regions. The total power was 6 W, with 15 min irradiation time. Cardiopulmonary functions and blood count were monitored before and after treatment. The patients were treated daily for 7 days. Statistical analysis was conducted using a two-tailed unpaired Student's t-test at a significance level of α = 0.05. RESULTS Post-treatment, the LED group showed a reduction in hospital discharge time and a statistically significant improvement for the following cardiopulmonary functions: Partial Oxygen Saturation, Tidal Volume, Maximum Inspiratory, and Expiratory Pressures, Respiratory Frequency, Heart Rate, and Systolic Blood Pressure (p < 0.05). Regarding blood count, it was observed that post-treatment, the LED group presented with significant differences in the count of leukocytes, neutrophils, and lymphocytes. CONCLUSION Photobiomodulation therapy can be used as a complement to conventional treatment of COVID-19, promoting the improvement of cardiopulmonary functions, and minimization of respiratory symptoms.
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Affiliation(s)
- Pâmela Camila Pereira
- Anhembi Morumbi University (UAM), Institute of Biomedical Engineering, Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil,University Center of Itajubá – (FEPI), Rua Dr. Antônio Braga Filho 687, Bairro Varginha, CEP: 37501-002 Itajubá, MG, Brazil
| | - Carlos José de Lima
- Anhembi Morumbi University (UAM), Institute of Biomedical Engineering, Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil,Center of Innovation, Technology and Education – (CITE), Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil
| | - Adriana Barrinha Fernandes
- Anhembi Morumbi University (UAM), Institute of Biomedical Engineering, Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil,Center of Innovation, Technology and Education – (CITE), Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil
| | - Renato Amaro Zângaro
- Anhembi Morumbi University (UAM), Institute of Biomedical Engineering, Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil,Center of Innovation, Technology and Education – (CITE), Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil
| | - Antonio Balbin Villaverde
- Anhembi Morumbi University (UAM), Institute of Biomedical Engineering, Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil,Center of Innovation, Technology and Education – (CITE), Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil,Corresponding author at: Center of Innovation, Technology and Education – CITE, Estrada Dr. Altino Bondensan 500, Distrito de Eugênio de Melo, CEP: 12.247-016 São José dos Campos, SP, Brazil
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20
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Al-Rshaidat MMD, Al-Sharif S, Refaei AA, Shewaikani N, Alsayed AR, Rayyan YM. Evaluating the clinical application of the immune cells' ratios and inflammatory markers in the diagnosis of inflammatory bowel disease. Pharm Pract (Granada) 2023; 21:2755. [PMID: 37090461 PMCID: PMC10117338 DOI: 10.18549/pharmpract.2023.1.2755] [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: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 04/25/2023] Open
Abstract
Objective Inflammatory Bowel Diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract, including Crohn's disease (CD) and ulcerative colitis (UC). Developing methods for effective screening and diagnosis is extremely needed. Accordingly, this study aims to evaluate the potential of immune cells ratios in the diagnosis of IBD. Methods This case-control study includes data from Jordan University Hospital (JUH) medical records for IBD patients with age- and gender-matched healthy controls. Results This study included 46 participants, of which 56.52% had IBD, 54.35% were males, with insignificant differences in sex, age, and body mass index (BMI) between IBD patients and controls (p>0.05). In the CD group, the variables with the highest sensitivity and specificity (HSS) were neutrophil-to-lymphocyte (NLR) (75%, 80%) and platelet-to-lymphocytes (PLR) (75%, 90%), in UC group; mean corpuscular hemoglobin (MCH) (80%, 80%). In CD group, the combinations giving the HSS were PLR+NLR (76%, 90.9%), C-reactive protein (CRP)+PLR (76%, 90.9%), and CRP+NLR (73.07%, 90%). In UC group, the combinations giving the HSS were erythrocyte sedimentation rate (ESR)+PLR (76.9%, 100%), PLR+MCH (74.07%, 100%), PLR+CRP (71.42%, 100%), and PLR+NLR (71.42%, 100%). Regression analysis identified five different combinations of significance in the diagnosis of CD and UC. Higher Youden's index was used and defined the most beneficial clinical combinations as NLR+PLR and CRP+PLR for CD, whereas ESR+PLR for UC. Conclusion Implications to our study include the clinical application of immune cell ratios, inflammatory markers, and their different combinations along with patients' history and physical examination findings for easier, faster, and more cost-effective diagnosis of IBDs.
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Affiliation(s)
- Mamoon M D Al-Rshaidat
- Department of Biological, Sciences, Laboratory for Molecular & Microbial Ecology (LaMME), School of Sciences, The University of Jordan, Amman 11942, Jordan.
| | - Shaima Al-Sharif
- Department of Biological, Sciences, School of Sciences, The University of Jordan, Amman 11942, Jordan.
| | - Assem Al Refaei
- School of Medicine, The University of Jordan, Amman 11942, Jordan.
| | - Nour Shewaikani
- School of Medicine, The University of Jordan, Amman 11942, Jordan.
| | - Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan.
| | - Yaser M Rayyan
- School of Medicine, The University of Jordan, Amman 11942, Jordan.
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21
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Asteris PG, Kokoris S, Gavriilaki E, Tsoukalas MZ, Houpas P, Paneta M, Koutzas A, Argyropoulos T, Alkayem NF, Armaghani DJ, Bardhan A, Cavaleri L, Cao M, Mansouri I, Mohammed AS, Samui P, Gerber G, Boumpas DT, Tsantes A, Terpos E, Dimopoulos MA. Early prediction of COVID-19 outcome using artificial intelligence techniques and only five laboratory indices. Clin Immunol 2023; 246:109218. [PMID: 36586431 PMCID: PMC9797218 DOI: 10.1016/j.clim.2022.109218] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/25/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
We aimed to develop a prediction model for intensive care unit (ICU) hospitalization of Coronavirus disease-19 (COVID-19) patients using artificial neural networks (ANN). We assessed 25 laboratory parameters at first from 248 consecutive adult COVID-19 patients for database creation, training, and development of ANN models. We developed a new alpha-index to assess association of each parameter with outcome. We used 166 records for training of computational simulations (training), 41 for documentation of computational simulations (validation), and 41 for reliability check of computational simulations (testing). The first five laboratory indices ranked by importance were Neutrophil-to-lymphocyte ratio, Lactate Dehydrogenase, Fibrinogen, Albumin, and D-Dimers. The best ANN based on these indices achieved accuracy 95.97%, precision 90.63%, sensitivity 93.55%. and F1-score 92.06%, verified in the validation cohort. Our preliminary findings reveal for the first time an ANN to predict ICU hospitalization accurately and early, using only 5 easily accessible laboratory indices.
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Affiliation(s)
- Panagiotis G. Asteris
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Styliani Kokoris
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Greece.
| | - Eleni Gavriilaki
- Hematology Department – BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Markos Z. Tsoukalas
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Panagiotis Houpas
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | - Maria Paneta
- Fourth Department of Internal Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Greece
| | | | | | - Nizar Faisal Alkayem
- Jiangxi Province Key Laboratory of Environmental Geotechnical Engineering and Hazards Control, Jiangxi University of Science and Technology, Ganzhou 341000, China
| | - Danial J. Armaghani
- Department of Urban Planning, Engineering Networks and Systems, Institute of Architecture and Construction, South Ural State University, 76, Lenin Prospect, Chelyabinsk 454080, Russian Federation
| | - Abidhan Bardhan
- Civil Engineering Department, National Institute of Technology Patna, Bihar, India
| | - Liborio Cavaleri
- Department of Civil, Environmental, Aerospace and Materials Engineering, University of Palermo, Palermo, Italy
| | - Maosen Cao
- Jiangxi Province Key Laboratory of Environmental Geotechnical Engineering and Hazards Control, Jiangxi University of Science and Technology, Ganzhou 341000, China
| | - Iman Mansouri
- Department of Civil and Environmental Engineering, Princeton University Princeton, Princeton, NJ 08544, USA
| | - Ahmed Salih Mohammed
- Engineering Department, American University of Iraq, Sulaimani, Kurdistan-Region, Iraq
| | - Pijush Samui
- Civil Engineering Department, National Institute of Technology Patna, Bihar, India
| | - Gloria Gerber
- Hematology Division, Johns Hopkins University, Baltimore, USA
| | - Dimitrios T. Boumpas
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Argyrios Tsantes
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital "Attikon", National and Kapodistrian University of Athens, Medical School, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Medical School, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, Medical School, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece
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22
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Botoș ID, Pantiș C, Bodolea C, Nemes A, Crișan D, Avram L, Negrău MO, Hirișcău IE, Crăciun R, Puia CI. The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:32. [PMID: 36676656 PMCID: PMC9861709 DOI: 10.3390/medicina59010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay.
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Affiliation(s)
- Ioana Denisa Botoș
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
| | - Carmen Pantiș
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
| | - Constantin Bodolea
- Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrada Nemes
- Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dana Crișan
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Lucreția Avram
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | | | - Ioana Elisabeta Hirișcău
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Rareș Crăciun
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Gastroenterology Clinic, “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Cosmin Ioan Puia
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Surgery, “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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23
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Verma A, Ramayya T, Upadhyaya A, Valenta I, Lyons M, Marschall J, Dehdashti F, Gropler RJ, Woodard PK, Schindler TH. Post COVID-19 syndrome with impairment of flow-mediated epicardial vasodilation and flow reserve. Eur J Clin Invest 2022; 52:e13871. [PMID: 36083297 PMCID: PMC9538977 DOI: 10.1111/eci.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/15/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023]
Abstract
AIMS The aim of this study is to evaluate whether post-acute sequelae of COVID-19 cardiovascular syndrome (PASC-CVS) is associated with alterations in coronary circulatory function. MATERIALS AND METHODS In individuals with PASC-CVS but without known cardiovascular risk factors (n = 23) and in healthy controls (CON, n = 23), myocardial blood flow (MBF) was assessed with 13 N-ammonia and PET/CT in mL/g/min during regadenoson-stimulated hyperemia, at rest, and the global myocardial flow reserve (MFR) was calculated. MBF was also measured in the mid and mid-distal myocardium of the left ventricle (LV). The Δ longitudinal MBF gradient (hyperemia minus rest) as a reflection of an impairment of flow-mediated epicardial vasodilation, was calculated. RESULTS Resting MBF was significantly higher in PASC-CVS than in CON (1.29 ± 0.27 vs. 1.08 ± 0.20 ml/g/min, p ≤ .024), while hyperemic MBFs did not differ significantly among groups (2.46 ± 0.53 and 2.40 ± 0.34 ml/g/min, p = .621). The MFR was significantly less in PASC-CVS than in CON (1.97 ± 0.54 vs. 2.27 ± 0.43, p ≤ .031). In addition, there was a Δ longitudinal MBF gradient in PASC-CVS, not observed in CON (-0.17 ± 0.18 vs. 0.04 ± 0.11 ml/g/min, p < .0001). CONCLUSIONS Post-acute sequelae of COVID-19 cardiovascular syndrome may be associated with an impairment of flow-mediated epicardial vasodilation, while reductions in coronary vasodilator capacity appear predominantly related to increases in resting flow in women deserving further investigations.
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Affiliation(s)
- Amanda Verma
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tarun Ramayya
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anand Upadhyaya
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ines Valenta
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maureen Lyons
- Infectious Disease Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jonas Marschall
- Infectious Disease Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Gropler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pamela K Woodard
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas Hellmut Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Evaluation of emerging inflammatory markers for predicting oxygen support requirement in COVID-19 patients. PLoS One 2022; 17:e0278145. [PMID: 36441688 PMCID: PMC9704613 DOI: 10.1371/journal.pone.0278145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a highly contagious pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly and remains a challenge to global public health. COVID-19 patients manifest various symptoms from mild to severe cases with poor clinical outcomes. Prognostic values of novel markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein to lymphocyte ratio (CLR) calculated from routine laboratory parameters have recently been reported to predict severe cases; however, whether this investigation can guide oxygen therapy in COVID-19 patients remains unclear. In this study, we assessed the ability of these markers in screening and predicting types of oxygen therapy in COVID-19 patients. The retrospective data of 474 COVID-19 patients were categorized into mild and severe cases and grouped according to the types of oxygen therapy requirement, including noninvasive oxygen support, high-flow nasal cannula and invasive mechanical ventilator. Among the novel markers, the ROC curve analysis indicated a screening cutoff of CRP ≥ 30.0 mg/L, NLR ≥ 3.0 and CLR ≥ 25 in predicting the requirement of any type of oxygen support. The NLR and CLR with increasing cut-off values have discriminative power with high accuracy and specificity for more effective oxygen therapy with a high-flow nasal cannula (NLR ≥ 6.0 and CLR ≥ 60) and mechanical ventilator (NLR ≥ 8.0 and CLR ≥ 80). Our study thus identifies potential markers to differentiate the suitable management of oxygen therapy in COVID-19 patients at an earlier time for improving disease outcomes with limited respiratory support resources.
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25
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Metabology: Analysis of metabolomics data using community ecology tools. Anal Chim Acta 2022; 1232:340469. [DOI: 10.1016/j.aca.2022.340469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022]
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Merenstein C, Bushman FD, Collman RG. Alterations in the respiratory tract microbiome in COVID-19: current observations and potential significance. MICROBIOME 2022; 10:165. [PMID: 36195943 PMCID: PMC9532226 DOI: 10.1186/s40168-022-01342-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
SARS-CoV-2 infection causes COVID-19 disease, which can result in consequences ranging from undetectable to fatal, focusing attention on the modulators of outcomes. The respiratory tract microbiome is thought to modulate the outcomes of infections such as influenza as well as acute lung injury, raising the question to what degree does the airway microbiome influence COVID-19? Here, we review the results of 56 studies examining COVID-19 and the respiratory tract microbiome, summarize the main generalizations, and point to useful avenues for further research. Although the results vary among studies, a few consistent findings stand out. The diversity of bacterial communities in the oropharynx typically declined with increasing disease severity. The relative abundance of Haemophilus and Neisseria also declined with severity. Multiple microbiome measures tracked with measures of systemic immune responses and COVID outcomes. For many of the conclusions drawn in these studies, the direction of causality is unknown-did an alteration in the microbiome result in increased COVID severity, did COVID severity alter the microbiome, or was some third factor the primary driver, such as medication use. Follow-up mechanistic studies can help answer these questions. Video Abstract.
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Affiliation(s)
- Carter Merenstein
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Frederic D. Bushman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Ronald G. Collman
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
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27
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Crippa JAS, Pacheco JC, Zuardi AW, Guimarães FS, Campos AC, Osório FDL, Loureiro SR, dos Santos RG, Souza JDS, Ushirohira JM, Ferreira RR, Mancini Costa KC, Scomparin DS, Scarante FF, Pires-Dos-Santos I, Mechoulam R, Kapczinski F, Fonseca BA, Esposito DL, Passos ADC, Dal Fabbro AL, Bellissimo-Rodrigues F, Arruda E, Scarpelini S, Andraus MH, Nather Junior JC, Wada DT, Koenigkam-Santos M, Santos AC, Busatto Filho G, Hallak JE. Cannabidiol for COVID-19 Patients with Mild to Moderate Symptoms (CANDIDATE Study): A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Cannabis Cannabinoid Res 2022; 7:658-669. [PMID: 34619044 PMCID: PMC9587798 DOI: 10.1089/can.2021.0093] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Importance: Owing to its anti-inflammatory properties and antiviral "in vitro" effect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cannabidiol (CBD) has been proposed as a potential treatment for coronavirus disease 2019 (COVID-19). Objective: To investigate the safety and efficacy of CBD for treating patients with mild to moderate COVID-19. Design: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted between July 7 and October 16, 2020, in two sites in Brazil. Setting: Patients were recruited in an emergency room. Participants: Block randomized patients (1:1 allocation ratio-by a researcher not directly involved in data collection) with mild and moderate COVID-19 living in Ribeirão Preto, Brazil, seeking medical consultation, and those who voluntarily agreed to participate in the study. Interventions: Patients received 300 mg of CBD or placebo added to standard symptomatic care during 14 days. Main Outcome and Measure: The primary outcome was reduction or prevention of the deterioration in clinical status from mild/moderate to severe/critical measured with the COVID-19 Scale or the natural course of the resolution of typical clinical symptoms. Primary study outcome was assessed on days 14, 21, and 28 after enrollment. Results: A total of 321 patients were recruited and assessed for eligibility, and 105 were randomly allocated either in CBD (n=49) or in placebo (n=42) group. Ninety-one participants were included in the analysis of efficacy. There were no baseline between-group differences regarding disease severity (χ2=0.025, p=0.988) and median time to symptom resolution (12 days [95% confidence interval, CI, 6.5-17.5] in the CBD group, 9 days [95% CI, 4.8-13.2] in the placebo group [χ2=1.6, p=0.205 by log-rank test]). By day 28, 83.3% in the CBD group and 90.2% in the placebo group had resolved symptoms. There were no between-group differences on secondary measures. CBD was well tolerated, producing mostly mild and transient side effects (e.g., somnolence, fatigue, changes in appetite, lethargy, nausea, diarrhea, and fever), with no significant differences between CBD and placebo treatment groups. Conclusions and Relevance: Daily administration of 300 mg CBD for 14 days failed to alter the clinical evolution of COVID-19. Further trials should explore the therapeutic effect of CBD in patients with severe COVID-19, possibly trying higher doses than the used in our study. Trial Registration: ClinicalTrials.gov identifier NCT04467918 (date of registration: July 13, 2020).
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Affiliation(s)
- José Alexandre S. Crippa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
| | - Julia Cozar Pacheco
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio W. Zuardi
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
| | - Francisco S. Guimarães
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Alline Cristina Campos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Flávia de Lima Osório
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
| | - Sonia Regina Loureiro
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rafael G. dos Santos
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
| | - José Diogo S. Souza
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana Mayumi Ushirohira
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rafael Rinaldi Ferreira
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Davi Silveira Scomparin
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Franciele Franco Scarante
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Isabela Pires-Dos-Santos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Raphael Mechoulam
- Department of Medicinal Chemistry and Natural Products, The Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Flávio Kapczinski
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Benedito A.L. Fonseca
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Danillo L.A. Esposito
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Afonso Dinis Costa Passos
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Amaury Lelis Dal Fabbro
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Eurico Arruda
- Department of Cell and Molecular Biology, and Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Sandro Scarpelini
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Julio Cesar Nather Junior
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Danilo Tadao Wada
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcel Koenigkam-Santos
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Carlos Santos
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jaime E.C. Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Science and Technology—Translational Medicine, São Paulo, Brazil
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DİREK T, İNAN K, ŞENGÜL İNAN M, ŞAHİN MF, AYTEKİN ÇELİK İ, KARAOGLANOGLU N. Analysis of the factors that affect survival among patients who developed subcutaneous emphysema monitored on COVID-19 diagnosis: single-centred research. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1146541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The COVID-19 patients with pulmonary involvement frequently develop pneumothorax, pneumomediastinum and subcutaneous emphysema due to barotrauma. Reviewing the literature, pneumothorax, pneumomediastinum and subcutaneous emphysema it can be observed among ICU patients due to the pulmonary involvement of the COVID-19 disease, and therefore, can cause mortality and morbidity. This study aims to analyse the factors that affect mortality in COVID-19 patients in ICUs who develop subcutaneous emphysema.
Material and Method: A total of 854 COVID-19 patients who were consulted from all branches in the Chest Surgery Clinic of Ankara City Hospital between September 1, 2020 - March 1, 2021 were retrospectively analyzed. Demographic characteristics, comorbid diseases and COVID-related tests (LDH, D-dimer, procalcitonin, ferritin, CRP, IL-6, lymphocyte percentage and neutrophil and lymphocyte ratio) imaging results and survival of 66 patients with subcutaneous emphysema were analyzed.
Results: Of the patients, 41 (62%) were male and 25 (38%) were female. The mean age was 63 years. 55 (83%) of these patients were followed up with invasive ventilation support due to general health impairment, increased oxygen demand and heart problems. Age, intubation and NLR were found to be statistically significant in terms of survival and death, on survival. It was discovered that age and intubation variables could be risk factors. The mortality rates were 1.01 times higher for the elderly compared to the younger patients and 13.8 times higher for the intubated compared to the non-intubated patients.
Conclusion: Age of patient and intubation can be regarded as risk factors for mortality in COVID-19 patients with subcutaneous emphysema, monitored in ICUs. Furthermore, comorbid diseases increase mortality rates.
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SARS-CoV-2 pneumonia and bacterial pneumonia patients differ in a second hit immune response model. Sci Rep 2022; 12:15485. [PMID: 36109525 PMCID: PMC9476429 DOI: 10.1038/s41598-022-17368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Secondary infections have been shown to complicate the clinical course and worsen the outcome of critically ill patients. Severe Coronavirus Disease 2019 (COVID-19) may be accompanied by a pronounced cytokine release, and immune competence of these patients towards most pathogenic antigens remains uncompromised early in the disease. Patients with bacterial sepsis also exhibit excessive cytokine release with systemic hyper-inflammation, however, typically followed by an anti-inflammatory phase, causing immune paralysis. In a second hit immune response model, leukocyte activation capacity of severely ill patients with pneumonia caused by SARS-CoV-2 or by bacteria were compared upon ICU admission and at days 4 and 7 of the ICU stay. Blood cell count and release of the pro-inflammatory cytokines IL-2, IFNγ and TNF were assessed after whole-blood incubation with the potent immune stimulus pokeweed mitogen (PWM). For comparison, patients with bacterial sepsis not originating from pneumonia, and healthy volunteers were included. Lymphopenia and granulocytosis were less pronounced in COVID-19 patients compared to bacterial sepsis patients. After PWM stimulation, COVID-19 patients showed a reduced release of IFNγ, while IL-2 levels were found similar and TNF levels were increased compared to healthy controls. Interestingly, concentrations of all three cytokines were significantly higher in samples from COVID-19 patients compared to samples from patients with bacterial infection. This fundamental difference in immune competence during a second hit between COVID-19 and sepsis patients may have implications for the selection of immune suppressive or enhancing therapies in personalized medicine.
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Supák D, Mészáros B, Nagy M, Gáspár D, Wagner LJ, Kukor Z, Valent S. Case report: COVID-19 infection in a pregnant 33-year-old kidney transplant recipient. Front Med (Lausanne) 2022; 9:948025. [PMID: 36111115 PMCID: PMC9468219 DOI: 10.3389/fmed.2022.948025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/21/2022] [Indexed: 01/08/2023] Open
Abstract
Patients facing severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infections with comorbidities, especially patients whose immune system is weakened have higher chances to face severe outcomes. One of the main reasons behind the suppression of the immune system is iatrogenic, in patients who have autoimmune diseases and/or had an organ transplant. Although there are studies that are examining immunocompromised and/or transplanted patients with COVID-19 infection, furthermore there is a limited number of studies available which are dealing with COVID-19 in pregnant women; however, it is unique and is worth reporting when these factors are coexisting. In this study, we present the case of a 33-year-old Caucasian pregnant woman, who had a kidney transplant in 2009 and contracted the SARS-CoV-2 virus on the 26th gestational week, in 2021. After her infection, superimposed preeclampsia was diagnosed and due to the worsening flowmetric parameters, she gave birth to a premature male newborn with cesarean section. Our kidney transplant patient’s case highlights how COVID-19 disease can lead to preeclampsia and artificial termination of gestation.
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Affiliation(s)
- Dorina Supák
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Balázs Mészáros
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Márta Nagy
- Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | - Dániel Gáspár
- Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | - László J. Wagner
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Zoltán Kukor
- Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
- *Correspondence: Zoltán Kukor,
| | - Sándor Valent
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Marques P, Fernandez-Presa L, Carretero A, Gómez-Cabrera MC, Viña J, Signes-Costa J, Sanz MJ. The radiographic assessment of lung edema score of lung edema severity correlates with inflammatory parameters in patients with coronavirus disease 2019—Potential new admission biomarkers to predict coronavirus disease 2019 worsening. Front Med (Lausanne) 2022; 9:871714. [PMID: 36035415 PMCID: PMC9402930 DOI: 10.3389/fmed.2022.871714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoronavirus disease 2019 (COVID-19) has placed enormous pressure on intensive care units (ICUs) and on healthcare systems in general. A deeper understanding of the pathophysiology of the most severe forms of COVID-19 would help guide the development of more effective interventions. Herein, we characterized the inflammatory state of patients with COVID-19 of varying degrees of severity to identify admission biomarkers for predicting COVID-19 worsening.DesignAdmission blood samples were obtained from 78 patients with COVID-19. Radiographic assessment of lung edema (RALE) scoring was calculated by imaging. Platelet and leukocyte counts were measured by flow cytometry, and plasma levels of C-reactive protein were assessed by immunoturbidimetry, and interleukin (IL)-8/CXCL8, IL-10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and monocyte chemoattractant protein-1 (MCP-1/CCL2) levels by enzyme-linked immunosorbent assay (ELISA).ResultsThe RALE score correlated with several admission hemogram (platelets, neutrophils, and lymphocytes) and inflammatory (IL-8/CXCL8, MCP-1/CCL2, IL-10, and C-reactive protein) parameters. COVID-19 worsening, based on the need for oxygen (Δoxygen supply) during hospitalization, correlated negatively with admission lymphocyte counts but positively with neutrophil-to-lymphocyte ratio and with plasma levels of the inflammatory parameters correlating with RALE score.ConclusionOur data indicate a correlation between the RALE score and Δoxygen supply and admission inflammatory status. The identification of a panel of biomarkers that reflect COVID severity might be useful to predict disease worsening during hospitalization and to guide clinical management of COVID-19-related complications. Finally, therapies targeting IL-8/CXCL8- or IL-10 activity may offer therapeutic approaches in COVID-19 treatment.
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Affiliation(s)
- Patrice Marques
- Department of Pharmacology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
| | - Lucia Fernandez-Presa
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
- Pneumology Unit, University Clinic Hospital of Valencia, Valencia, Spain
| | - Aitor Carretero
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Maria-Carmen Gómez-Cabrera
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - José Viña
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
- *Correspondence: José Viña,
| | - Jaime Signes-Costa
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
- Pneumology Unit, University Clinic Hospital of Valencia, Valencia, Spain
- Jaime Signes-Costa,
| | - Maria-Jesus Sanz
- Department of Pharmacology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
- CIBERDEM-Spanish Biomedical Research Center in Diabetes and Associated Metabolic Disorders, ISCIII, Madrid, Spain
- Maria-Jesus Sanz,
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Higaki A, Okayama H, Homma Y, Sano T, Kitai T, Yonetsu T, Torii S, Kohsaka S, Kuroda S, Node K, Matsue Y, Matsumoto S. Predictive value of neutrophil-to-lymphocyte ratio for the fatality of COVID-19 patients complicated with cardiovascular diseases and/or risk factors. Sci Rep 2022; 12:13606. [PMID: 35948607 PMCID: PMC9364304 DOI: 10.1038/s41598-022-17567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2022] [Indexed: 12/15/2022] Open
Abstract
Previous studies have reported that a high neutrophil-to-lymphocyte ratio (NLR) is associated with disease severity and poor prognosis in COVID-19 patients. We aimed to investigate the clinical implications of NLR in patients with COVID-19 complicated with cardiovascular diseases and/or its risk factors (CVDRF). In total, 601 patients with known NLR values were selected from the CLAVIS-COVID registry for analysis. Patients were categorized into quartiles (Q1, Q2, Q3, and Q4) according to baseline NLR values, and demographic and clinical parameters were compared between the groups. Survival analysis was conducted using the Kaplan-Meier method. The diagnostic performance of the baseline and follow-up NLR values was tested using receiver operating characteristic (ROC) curve analysis. Finally, two-dimensional mapping of patient characteristics was conducted using t-stochastic neighborhood embedding (t-SNE). In-hospital mortality significantly increased with an increase in the baseline NLR quartile (Q1 6.3%, Q2 11.0%, Q3 20.5%; and Q4, 26.6%; p < 0.001). The cumulative mortality increased as the quartile of the baseline NLR increased. The paired log-rank test revealed significant differences in survival for Q1 vs. Q3 (p = 0.017), Q1 vs. Q4 (p < 0.001), Q2 vs. Q3 (p = 0.034), and Q2 vs. Q4 (p < 0.001). However, baseline NLR was not identified as an independent prognostic factor using a multivariate Cox proportional hazards regression model. The area under the curve for predicting in-hospital death based on baseline NLR was only 0.682, whereas that of follow-up NLR was 0.893. The two-dimensional patient map with t-SNE showed a cluster characterized by high mortality with high NLR at follow-up, but these did not necessarily overlap with the population with high NLR at baseline. NLR may have prognostic implications in hospitalized COVID-19 patients with CVDRF, but its significance depends on the timing of data collection.
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Affiliation(s)
- Akinori Higaki
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yoshito Homma
- Department of Infectious Diseases, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Takahide Sano
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Kuroda
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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Tufa A, Gebremariam TH, Manyazewal T, Getinet T, Webb DL, Hellström PM, Genet S. Inflammatory mediators profile in patients hospitalized with COVID-19: A comparative study. Front Immunol 2022; 13:964179. [PMID: 35958594 PMCID: PMC9359079 DOI: 10.3389/fimmu.2022.964179] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/01/2022] [Indexed: 01/08/2023] Open
Abstract
Abnormal inflammatory mediator concentrations during SARS-CoV-2 infection may represent disease severity. We aimed to assess plasma inflammatory mediator concentrations in patients with SARS-CoV-2 in Addis Ababa, Ethiopia. In this study, 260 adults: 126 hospitalized patients with confirmed COVID-19 sorted into severity groups: severe (n=68) and mild or moderate (n=58), and 134 healthy controls were enrolled. We quantified 39 plasma inflammatory mediators using multiplex ELISA. Spearman rank correlation and Mann-Whitney U test were used to identify mechanistically coupled inflammatory mediators and compare disease severity. Compared to healthy controls, patients with COVID-19 had significantly higher levels of interleukins 1α, 2, 6, 7, 8, 10 and 15, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion protein 1 (VCAM-1), IFN-γ-inducible protein-10 (IP-10, CXCL10), macrophage inflammatory protein-1 alpha (MIP-1α, CCL3), eotaxin-3 (CCL26), interferon-gamma (IFN-γ), tumor necrosis factor-α (TNF-α), basic fibroblast growth factor (bFGF), placental growth factor (PlGF), and fms-like tyrosine kinase 1 (Flt-1). Patients with severe COVID-19 had higher IL-10 and lower macrophage-derived chemokine (MDC, CCL22) compared to the mild or moderate group (P<0.05). In the receiver operating characteristic curve, SAA, IL-6 and CRP showed strong sensitivity and specificity in predicting the severity and prognosis of COVID-19. Greater age and higher CRP had a significant association with disease severity (P<0.05). Our findings reveal that CRP, SAA, VCAM-1, CXCL10, CCL22 and IL-10 levels are promising biomarkers for COVID-19 disease severity, suggesting that plasma inflammatory mediators could be used as warning indicators of COVID-19 severity, aid in COVID-19 prognosis and treatment.
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Affiliation(s)
- Abdisa Tufa
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Haile Gebremariam
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Getinet
- School of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dominic-Luc Webb
- Gastroenterology and Hepatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per M. Hellström
- Gastroenterology and Hepatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Solomon Genet
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lengerich BJ, Nunnally ME, Aphinyanaphongs Y, Ellington C, Caruana R. Automated interpretable discovery of heterogeneous treatment effectiveness: A COVID-19 case study. J Biomed Inform 2022; 130:104086. [PMID: 35504543 PMCID: PMC9055753 DOI: 10.1016/j.jbi.2022.104086] [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: 10/23/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 01/25/2023]
Abstract
Testing multiple treatments for heterogeneous (varying) effectiveness with respect to many underlying risk factors requires many pairwise tests; we would like to instead automatically discover and visualize patient archetypes and predictors of treatment effectiveness using multitask machine learning. In this paper, we present a method to estimate these heterogeneous treatment effects with an interpretable hierarchical framework that uses additive models to visualize expected treatment benefits as a function of patient factors (identifying personalized treatment benefits) and concurrent treatments (identifying combinatorial treatment benefits). This method achieves state-of-the-art predictive power for COVID-19 in-hospital mortality and interpretable identification of heterogeneous treatment benefits. We first validate this method on the large public MIMIC-IV dataset of ICU patients to test recovery of heterogeneous treatment effects. Next we apply this method to a proprietary dataset of over 3000 patients hospitalized for COVID-19, and find evidence of heterogeneous treatment effectiveness predicted largely by indicators of inflammation and thrombosis risk: patients with few indicators of thrombosis risk benefit most from treatments against inflammation, while patients with few indicators of inflammation risk benefit most from treatments against thrombosis. This approach provides an automated methodology to discover heterogeneous and individualized effectiveness of treatments.
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Affiliation(s)
- Benjamin J. Lengerich
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, 32 Vassar Street, Cambridge 02139, MA, USA,Corresponding author
| | - Mark E. Nunnally
- Departments of Anesthesiology, Perioperative Care and Pain Medicine, Neurology, Surgery and Medicine, NYU Langone Health, 560 1st Avenue, New York 10016, NY, USA
| | - Yin Aphinyanaphongs
- Department of Population Health, NYU Langone Health, 227 East 30th Street, New York 10016, NY, USA
| | - Caleb Ellington
- Computational Biology Department, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh 15213, PA, USA
| | - Rich Caruana
- Microsoft Research, 14820 NE 36th Street, Redmond 02139, WA, USA
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ASADUZZAMAN MD, BHUIA MOHAMMADROMEL, ALAM ZHMNAZMUL, BARI MOHAMMADZABEDJILLUL, FERDOUSI TASNIM. Role of hemogram-derived ratios in predicting intensive care unit admission in COVID-19 patients: a multicenter study. IJID REGIONS 2022; 3:234-241. [PMID: 35720134 PMCID: PMC9050181 DOI: 10.1016/j.ijregi.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 02/07/2023]
Abstract
Purpose As hyperinflammation is recognized as a driver of severe COVID-19 disease, checking markers of inflammation is gaining more attention. Our study aimed to evaluate the utility of cost-effective hemogram-derived ratios in predicting intensive care unit (ICU) admission in COVID-19 patients. Methods This multicenter retrospective study included hospitalized COVID-19 patients from four dedicated COVID-19 hospitals in Sylhet, Bangladesh. Data on demographics, clinical characteristics, laboratory parameters and survival outcomes were analyzed. Logistic regression analysis was used to identify the significance of each hemogram-derived ratio in predicting ICU admission. Results Of 442 included patients, 98 (22.17%) required ICU admission. At the time of admission, patients requiring ICU had a higher neutrophil count and lower lymphocyte and platelet counts than patients not requiring ICU. Peripheral capillary oxygen saturation at admission was significantly lower in those who subsequently required ICU admission. Neutrophil-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, neutrophil-to-platelet ratio, and systemic immune-inflammation index were significant predictors of ICU admission. Conclusion Hemogram-derived ratios can be an effective tool in facilitating the early categorization of at-risk patients, enabling timely measures to be taken early in the disease course.
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Affiliation(s)
- MD ASADUZZAMAN
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet-3100, Bangladesh
| | - MOHAMMAD ROMEL BHUIA
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet-3114, Bangladesh
| | - ZHM NAZMUL ALAM
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet-3100, Bangladesh
| | | | - TASNIM FERDOUSI
- Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Zhang Y, Wang Q, Mackay CR, Ng LG, Kwok I. Neutrophil subsets and their differential roles in viral respiratory diseases. J Leukoc Biol 2022; 111:1159-1173. [PMID: 35040189 PMCID: PMC9015493 DOI: 10.1002/jlb.1mr1221-345r] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/19/2022] Open
Abstract
Neutrophils play significant roles in immune homeostasis and as neutralizers of microbial infections. Recent evidence further suggests heterogeneity of neutrophil developmental and activation states that exert specialized effector functions during inflammatory disease conditions. Neutrophils can play multiple roles during viral infections, secreting inflammatory mediators and cytokines that contribute significantly to host defense and pathogenicity. However, their roles in viral immunity are not well understood. In this review, we present an overview of neutrophil heterogeneity and its impact on the course and severity of viral respiratory infectious diseases. We focus on the evidence demonstrating the crucial roles neutrophils play in the immune response toward respiratory infections, using influenza as a model. We further extend the understanding of neutrophil function with the studies pertaining to COVID-19 disease and its neutrophil-associated pathologies. Finally, we discuss the relevance of these results for future therapeutic options through targeting and regulating neutrophil-specific responses.
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Affiliation(s)
- Yuning Zhang
- Department of ResearchNational Skin CentreSingaporeSingapore
| | - Quanbo Wang
- School of Pharmaceutical Sciences, Shandong Analysis and Test CenterQilu University of Technology (Shandong Academy of Sciences)JinanChina
| | - Charles R Mackay
- School of Pharmaceutical Sciences, Shandong Analysis and Test CenterQilu University of Technology (Shandong Academy of Sciences)JinanChina
- Department of Microbiology, Infection and Immunity ProgramBiomedicine Discovery Institute, Monash UniversityMelbourneAustralia
| | - Lai Guan Ng
- Singapore Immunology Network (SIgN)A*STAR (Agency for Science, Technology and Research)BiopolisSingapore
- State Key Laboratory of Experimental HematologyInstitute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical CollegeTianjinChina
- School of Biological SciencesNanyang Technological UniversitySingaporeSingapore
- Department of Microbiology and ImmunologyImmunology Translational Research Program, Yong Loo Lin School of Medicine, Immunology Program, Life Sciences Institute, National University of SingaporeSingaporeSingapore
- National Cancer Centre SingaporeSingaporeSingapore
| | - Immanuel Kwok
- Singapore Immunology Network (SIgN)A*STAR (Agency for Science, Technology and Research)BiopolisSingapore
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Cocoş R, Mahler B, Turcu-Stiolica A, Stoichiță A, Ghinet A, Shelby ES, Bohîlțea LC. Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study. Viruses 2022; 14:v14061201. [PMID: 35746672 PMCID: PMC9228480 DOI: 10.3390/v14061201] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/21/2022] Open
Abstract
Our study objective was to construct models using 20 routine laboratory parameters on admission to predict disease severity and mortality risk in a group of 254 hospitalized COVID-19 patients. Considering the influence of confounding factors in this single-center study, we also retrospectively assessed the correlations between the risk of death and the routine laboratory parameters within individual comorbidity subgroups. In multivariate regression models and by ROC curve analysis, a model of three routine laboratory parameters (AUC 0.85; 95% CI: 0.79–0.91) and a model of six laboratory factors (AUC 0.86; 95% CI: 0.81–0.91) were able to predict severity and mortality of COVID-19, respectively, compared with any other individual parameter. Hierarchical cluster analysis showed that inflammatory laboratory markers grouped together in three distinct clusters including positive correlations: WBC with NEU, NEU with neutrophil-to-lymphocyte ratio (NLR), NEU with systemic immune-inflammation index (SII), NLR with SII and platelet-to-lymphocyte ratio (PLR) with SII. When analyzing the routine laboratory parameters in the subgroups of comorbidities, the risk of death was associated with a common set of laboratory markers of systemic inflammation. Our results have shown that a panel of several routine laboratory parameters recorded on admission could be helpful for early evaluation of the risk of disease severity and mortality in COVID-19 patients. Inflammatory markers for mortality risk were similar in the subgroups of comorbidities, suggesting the limited effect of confounding factors in predicting COVID-19 mortality at admission.
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Affiliation(s)
- Relu Cocoş
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
- Department of Medical Genetics, University of Medicine and Pharmacy “Carol Davila”, 020032 Bucharest, Romania;
- Correspondence: (R.C.); (A.T.-S.)
| | - Beatrice Mahler
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
- Pneumology Department (II), University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (R.C.); (A.T.-S.)
| | - Alexandru Stoichiță
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Andreea Ghinet
- Institute of Pneumophtisiology “Marius Nasta”, 050159 Bucharest, Romania; (B.M.); (A.S.); (A.G.)
| | - Elena-Silvia Shelby
- Scientific Research Nucleus, Dr. Nicolae Robanescu National Clinical Centre for Children’s Neurorecovery, 041408 Bucharest, Romania;
| | - Laurențiu Camil Bohîlțea
- Department of Medical Genetics, University of Medicine and Pharmacy “Carol Davila”, 020032 Bucharest, Romania;
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [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: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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D’Amato M, Vertui V, Pandolfi L, Bozzini S, Fossali T, Colombo R, Aliberti A, Fumagalli M, Iadarola P, Didò C, Viglio S, Meloni F. Investigating the Link between Alpha-1 Antitrypsin and Human Neutrophil Elastase in Bronchoalveolar Lavage Fluid of COVID-19 Patients. Curr Issues Mol Biol 2022; 44:2122-2138. [PMID: 35678672 PMCID: PMC9164061 DOI: 10.3390/cimb44050143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022] Open
Abstract
Neutrophils play a pathogenic role in COVID-19 by releasing Neutrophils Extracellular Traps (NETs) or human neutrophil elastase (HNE). Given that HNE is inhibited by α1-antitrypsin (AAT), we aimed to assess the content of HNE, α1-antitrypsin (AAT) and HNE-AAT complexes (the AAT/HNE balance) in 33 bronchoalveolar lavage fluid (BALf) samples from COVID-19 patients. These samples were submitted for Gel-Electrophoresis, Western Blot and ELISA, and proteins (bound to AAT or HNE) were identified by Liquid Chromatography-Mass Spectrometry. NETs' release was analyzed by confocal microscopy. Both HNE and AAT were clearly detectable in BALf at high levels. Contrary to what was previously observed in other settings, the formation of HNE-AAT complex was not detected in COVID-19. Rather, HNE was found to be bound to acute phase proteins, histones and C3. Due to the relevant role of NETs, we assessed the ability of free AAT to bind to histones. While confirming this binding, AAT was not able to inhibit NET formation. In conclusion, despite the finding of a high burden of free and bound HNE, the lack of the HNE-AAT inhibitory complex in COVID-19 BALf demonstrates that AAT is not able to block HNE activity. Furthermore, while binding to histones, AAT does not prevent NET formation nor their noxious activity.
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Affiliation(s)
- Maura D’Amato
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Vertui
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy; (V.V.); (L.P.); (C.D.); (F.M.)
| | - Laura Pandolfi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy; (V.V.); (L.P.); (C.D.); (F.M.)
| | - Sara Bozzini
- Laboratory of Respiratory Disease, Cell Biology Section, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, 20121 Milan, Italy; (T.F.); (R.C.)
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, 20121 Milan, Italy; (T.F.); (R.C.)
| | - Anna Aliberti
- Division of Anesthesiology and Intensive Care 1, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marco Fumagalli
- Department of Biology and Biotechnologies “L. Spallanzani”, University of Pavia, 27100 Pavia, Italy; (M.F.); (P.I.)
| | - Paolo Iadarola
- Department of Biology and Biotechnologies “L. Spallanzani”, University of Pavia, 27100 Pavia, Italy; (M.F.); (P.I.)
| | - Camilla Didò
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy; (V.V.); (L.P.); (C.D.); (F.M.)
| | - Simona Viglio
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Federica Meloni
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy; (V.V.); (L.P.); (C.D.); (F.M.)
- Transplant Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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A targetable ‘rogue’ neutrophil-subset, [CD11b+DEspR+] immunotype, is associated with severity and mortality in acute respiratory distress syndrome (ARDS) and COVID-19-ARDS. Sci Rep 2022; 12:5583. [PMID: 35379853 PMCID: PMC8977568 DOI: 10.1038/s41598-022-09343-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Neutrophil-mediated secondary tissue injury underlies acute respiratory distress syndrome (ARDS) and progression to multi-organ-failure (MOF) and death, processes linked to COVID-19-ARDS. This secondary tissue injury arises from dysregulated neutrophils and neutrophil extracellular traps (NETs) intended to kill pathogens, but instead cause cell-injury. Insufficiency of pleiotropic therapeutic approaches delineate the need for inhibitors of dysregulated neutrophil-subset(s) that induce subset-specific apoptosis critical for neutrophil function-shutdown. We hypothesized that neutrophils expressing the pro-survival dual endothelin-1/VEGF-signal peptide receptor, DEspR, are apoptosis-resistant like DEspR+ cancer-cells, hence comprise a consequential pathogenic neutrophil-subset in ARDS and COVID-19-ARDS. Here, we report the significant association of increased peripheral DEspR+CD11b+ neutrophil-counts with severity and mortality in ARDS and COVID-19-ARDS, and intravascular NET-formation, in contrast to DEspR[-] neutrophils. We detect DEspR+ neutrophils and monocytes in lung tissue patients in ARDS and COVID-19-ARDS, and increased neutrophil RNA-levels of DEspR ligands and modulators in COVID-19-ARDS scRNA-seq data-files. Unlike DEspR[-] neutrophils, DEspR+CD11b+ neutrophils exhibit delayed apoptosis, which is blocked by humanized anti-DEspR-IgG4S228P antibody, hu6g8, in ex vivo assays. Ex vivo live-cell imaging of Rhesus-derived DEspR+CD11b+ neutrophils showed hu6g8 target-engagement, internalization, and induction of apoptosis. Altogether, data identify DEspR+CD11b+ neutrophils as a targetable ‘rogue’ neutrophil-subset associated with severity and mortality in ARDS and COVID-19-ARDS.
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Karimpour-razkenari E, Naderi-Behdani F, Salahshoor A, Heydari F, Alipour A, Baradari AG. Melatonin as adjunctive therapy in patients admitted to the Covid-19. Ann Med Surg (Lond) 2022; 76:103492. [PMID: 35287296 PMCID: PMC8908573 DOI: 10.1016/j.amsu.2022.103492] [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: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Coronavirus has disrupted the natural order of the world since September 2019 with no specific medication. The beneficial effects of melatonin on sepsis and viral influenza were demonstrated previously, but its effects on covid-19, especially COVID -19 ICU, is unclear. Therefore, our aim was to determine the effects of melatonin in COVID-19 ICU patients. Methods This is a retrospective cohort study in which the records of patients admitted to COVID -19 ICU of (XXX) during March to June 2020 were reviewed. According to inclusion criteria, patients who received 15 mg of melatonin daily were called MRG and the rest were called NMRG. Results Thirty-one patients were included and analyzed, of which twelve patients were in MRG. Demographic and clinical characteristics, and laboratory data were similar between two groups at ICU admission. Melatonin had no significant effect on ICU duration, CRP and ESR, also the trend of changes was in favor of melatonin. Nevertheless, melatonin significantly reduced the NLR (OR = −9.81, p = 0.003), and also declined mortality marginally (p = 0.09). Melatonin was well tolerated with no major adverse effects, moreover the thrombocytopenia occurrence was significantly lower in MRG (p = 0.005). In MRG, survival increased and mortality risk decreased, although the difference between groups wasn't significant (p = 0.37), which might be related to the small sample-size. Conclusion Our study showed that melatonin is unlikely to reduce mortality among COVID19 patients and with no significant effect on disease-specific biochemical parameters. Coronavirus has disrupted the natural order of the world since September 2019 with no specific medication. The beneficial effects of melatonin on sepsis and viral influenza were demonstrated previously. Our survey showed melatonin had a beneficial effect on survival and mortality risk. As well as platelets and lymphocytes without life-threatening complications. Melatonin was an essential adjuvant therapy in patients admitted to covid-19 ICU.
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Mortezaee K, Majidpoor J. CD8 + T Cells in SARS-CoV-2 Induced Disease and Cancer-Clinical Perspectives. Front Immunol 2022; 13:864298. [PMID: 35432340 PMCID: PMC9010719 DOI: 10.3389/fimmu.2022.864298] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022] Open
Abstract
Dysregulated innate and adaptive immunity is a sign of SARS-CoV-2-induced disease and cancer. CD8+ T cells are important cells of the immune system. The cells belong to the adaptive immunity and take a front-line defense against viral infections and cancer. Extreme CD8+ T-cell activities in the lung of patients with a SARS-CoV-2-induced disease and within the tumor microenvironment (TME) will change their functionality into exhausted state and undergo apoptosis. Such diminished immunity will put cancer cases at a high-risk group for SARS-CoV-2-induced disease, rendering viral sepsis and a more severe condition which will finally cause a higher rate of mortality. Recovering responses from CD8+ T cells is a purpose of vaccination against SARS-CoV-2. The aim of this review is to discuss the CD8+ T cellular state in SARS-CoV-2-induced disease and in cancer and to present some strategies for recovering the functionality of these critical cells.
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Affiliation(s)
- Keywan Mortezaee
- Department of Anatomy, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Jamal Majidpoor
- Department of Anatomy, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Rathod BD, Amle D, Khot RS, Prathipati KK, Joshi PP. Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India. Cureus 2022; 14:e23696. [PMID: 35519791 PMCID: PMC9064266 DOI: 10.7759/cureus.23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Clinical presentation of coronavirus disease 2019 (COVID-19) varies from an asymptomatic state to severe disease characterized by acute respiratory distress syndrome, respiratory failure, thrombosis, and multi-organ dysfunction syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been reviewed as one of the laboratory factors that have been proposed to predict the severity of disease and mortality in COVID-19 pandemic. Aim and objectives: To evaluate the association between NLR and the disease severity and mortality in COVID-19. Materials and methods: After approval from Institutional Ethics Committee, this prospective cohort study was carried out in a tertiary-care teaching medical institute of Central India. COVID-19 patients of the age group 18 years and above admitted during the study period were included. Cases were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. NLR was calculated by doing a complete blood count at the time of hospitalization by the Mindray BC-6000 auto hematology analyzer. The outcome of the disease was classified as recovery and death during hospitalization. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of NLR at admission to predict severe COVID-19 or mortality. Ordinal regression analysis was used to assess the impact of NLR on disease severity and mortality. Results: Mean NLR was significantly higher in the severe COVID-19 group as compared to the mild/moderate group and in deceased as compared to discharged cases. ROC curve analysis revealed NLR to be an excellent predictor of disease severity as well as a prognostic parameter for risk of death. NLR was found to be a significant independent positive predictor for contracting the severe disease (Odd’s ratio 1.396, 95% CI=1.112-1.753, p=0.004) and mortality (Odd’s ratio 1.276, 95% CI=1.085-1.499, p=0.003). Conclusion: High NLR was significantly associated with the disease severity and mortality in COVID-19.
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Shahid MF, Malik A, Siddiqi FA, Fazal I, Hammad M, Saeed A, Abbas N. Neutrophil-to-Lymphocyte Ratio and Absolute Lymphocyte Count as Early Diagnostic Tools for Corona Virus Disease 2019. Cureus 2022; 14:e22863. [PMID: 35399415 PMCID: PMC8982500 DOI: 10.7759/cureus.22863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background and objectives In comparison to real-time polymerase chain reaction (RT-PCR) testing, blood-related parameters including absolute lymphocyte count (ALC) and neutrophil-to-lymphocyte ratio (NLR) carry an indeterminate potential in the assessment of corona virus disease 2019 (COVID-19). Our main objective was to assess their efficacy in timely identification of COVID-19 patients and to determine whether these biomarkers can be employed as an early diagnostic tool in patients presenting with symptoms suggestive of COVID-19. Methodology This cross-sectional study was conducted at the Emergency Department of a Tertiary Care Hospital in Rawalpindi, Pakistan from November 2020 to March 2021. Patients suspected to have COVID-19 on a clinical basis (fever, cough or shortness of breath) were selected by using convenience non-probability sampling. RT-PCR was used to diagnose COVID-19 after evaluating NLR and ALC of the sample population. An NLR = 3.5 and ALC < 1 x 103 cells/mm3 was considered as the cut-off value. Statistical analysis was conducted via SPSS 23.0 (IBM Corp., Armonk, NY). Chi-square and independent t-tests were used to correlate various data variables, while p-value <0.05 was considered significant. Results Out of the 172 subjects included in the study, the mean age was 40.6 ± 10.0 years, while 51% of individuals were males. Fever was found to be the most prevalent complaint (94%). Double RT-PCR testing showed that 51.2% of the population was RT-PCR positive, having a mean ALC of 1.4 ± 0.9 x 103/mm3, significantly lower than RT-PCR negative cases (p < 0.001). In addition, NLR was drastically elevated for RT-PCR-positive individuals (p < 0.001) while it also had a distinctly high specificity of 91.7% among COVID-19 patients. Additionally, NLR did not correlate with any of the baseline patient-related parameters (presenting complaint, age, and gender). Conclusion NLR and ALC are potentially efficacious measures for an early diagnosis of COVID-19, and can be possibly utilized for an early diagnosis of COVID-19 suspects.
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Terra POC, Donadel CD, Oliveira LC, Menegueti MG, Auxiliadora‐Martins M, Calado RT, De Santis GC. Neutrophil-to-lymphocyte ratio and D-dimer are biomarkers of death risk in severe COVID-19: A retrospective observational study. Health Sci Rep 2022; 5:e514. [PMID: 35155834 PMCID: PMC8827272 DOI: 10.1002/hsr2.514] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIMS Over 4 million deaths from coronavirus disease (COVID)-19 have been reported in the world. Several biomarkers have been identified that predict disease severity, but there is still a need to identify biomarkers for death risk in severe COVID-19. We aim to define amongst the biomarkers already identified those which are mostly associated with increased death rate in patients with severe COVID-19. METHODS In this retrospective study conducted in three public hospitals linked to the Medical School of Ribeirão Preto, Brazil, patients with severe COVID-19 were evaluated regarding biomarkers (neutrophil-to-lymphocyte ratio-NLR, D-dimer, fibrinogen) of death risk, obtained before administration of corticosteroids. RESULTS Thirty-nine (32.8%) of the 119 patients included (104 [87.4%] on mechanical ventilation) died during hospitalization. Non-survivor group had higher median (range) NLR (12.63 [2.6-115] vs 7.43 [0.43-31.8]; P = .001), D-dimer (2.17 [0.27-20.00] vs 1.57 [0.28-20.00]; P = .03), but lower fibrinogen (631 [353-1078] vs 705 [407-1200]; P = .02). The group with NLR ≥ 10 and D-dimer ≥ 2 μg/mL had a higher death risk than the group with NLR < 10 and D-dimer < 2 μg/mL (OR: 5.39; CI 95%: 1.5-19.42; P = .01). CONCLUSION High NLR and D-dimer, especially when combined, are predictors of death risk for patients with severe COVID-19 and should be incorporated into their evaluation.
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Affiliation(s)
- Patrícia Oliveira Cunha Terra
- Department of Medical Imaging, Hematology, and OncologyRibeirão Preto Medical School, University of São PauloSão PauloBrazil
| | - Camila Dermínio Donadel
- Department of Medical Imaging, Hematology, and OncologyRibeirão Preto Medical School, University of São PauloSão PauloBrazil
| | - Luciana Correa Oliveira
- Department of Medical Imaging, Hematology, and OncologyRibeirão Preto Medical School, University of São PauloSão PauloBrazil
- Regional Blood Center of Ribeirão PretoRibeirão Preto Medical School, University of São PauloSão PauloBrazil
| | | | | | - Rodrigo Tocantins Calado
- Department of Medical Imaging, Hematology, and OncologyRibeirão Preto Medical School, University of São PauloSão PauloBrazil
- Regional Blood Center of Ribeirão PretoRibeirão Preto Medical School, University of São PauloSão PauloBrazil
| | - Gil Cunha De Santis
- Department of Medical Imaging, Hematology, and OncologyRibeirão Preto Medical School, University of São PauloSão PauloBrazil
- Regional Blood Center of Ribeirão PretoRibeirão Preto Medical School, University of São PauloSão PauloBrazil
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Pourdowlat G, Saghafi F, Mozafari A, Sahebnasagh A, Abedini A, Nabi Meybodi M, Salehi Nezamabadi A, Mousavinasab SR, Kiani A, Raji H, Soltani N, Gholmzadeh Baeis M, Eidani E, Sadeghi Yakhdani A, Movaseghi F, Habtemariam S, Akhoundi Meybodi Z, Gholinataj Jelodar M. Efficacy and safety of colchicine treatment in patients with COVID-19: A prospective, multicenter, randomized clinical trial. Phytother Res 2022; 36:891-898. [PMID: 35107188 DOI: 10.1002/ptr.7319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 12/21/2022]
Abstract
Colchicine has shown clinical benefits in the management of COVID-19 via its anti-inflammatory effect. However, the exact role of colchicine in COVID-19 patients is unknown. The current clinical trial was performed on 202 patients with moderate to severe COVID-19. Patients were randomly assigned in a 1:1 ratio to receive up to a 3-day course of 0.5 mg colchicine followed by a 12-day course of 1 mg colchicine in combination with standard care or a 15-day course of standard care. Among 202 randomized patients, 153 completed the study and received colchicine/standard care or continued standard care (M age, 54.72 [SD, 15.03] years; 93 [63.1%] men). On day 14, patients in the colchicine/standard care group had significantly higher odds of a better clinical status distribution on chest CT evaluation (p = .048). Based on NYHA classification, the percentage change of dyspnea on day 14 between groups was statistically significant (p = .026), indicating a mean of 31.94% change in the intervention group when compared with 19.95% in the control group. According to this study, colchicine can improve clinical outcomes and reduce pulmonary infiltration in COVID-19 patients if contraindications and precautions are considered and it is prescribed at the right time and in appropriate cases.
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Affiliation(s)
- Guitti Pourdowlat
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abolfazl Mozafari
- Department of Medical Sciences, Qom Branch, Islamic Azad University, Qom, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Nabi Meybodi
- Department of Pharmaceutics, School of Pharmacy, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | | | - Seyed Ruhollah Mousavinasab
- Infectious Diseases Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Raji
- Department of Internal Medicine, Air pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nadia Soltani
- Pharmaceutical Sciences Research Center, School of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehdi Gholmzadeh Baeis
- Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Eidani
- NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Movaseghi
- Department of Medical Sciences, Qom Branch, Islamic Azad University, Qom, Iran
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services UK, University of Greenwich, Kent, UK
| | - Zohreh Akhoundi Meybodi
- Infectious Disease Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohsen Gholinataj Jelodar
- Department of Internal Medicine, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Palaiodimos L, Ali R, Teo HO, Parthasarathy S, Karamanis D, Chamorro-Pareja N, Kokkinidis DG, Kaur S, Kladas M, Sperling J, Chang M, Hupart K, Cha-Fong C, Srinivasan S, Kishore P, Davis N, Faillace RT. Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City. J Clin Med 2022; 11:jcm11030622. [PMID: 35160073 PMCID: PMC8836690 DOI: 10.3390/jcm11030622] [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: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals’ ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m2. Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.
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Affiliation(s)
- Leonidas Palaiodimos
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: (L.P.); (S.P.)
| | - Ryad Ali
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA; (R.A.); (D.K.); (S.S.)
| | - Hugo O. Teo
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Sahana Parthasarathy
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: (L.P.); (S.P.)
| | - Dimitrios Karamanis
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA; (R.A.); (D.K.); (S.S.)
| | - Natalia Chamorro-Pareja
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damianos G. Kokkinidis
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Sharanjit Kaur
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Michail Kladas
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jeremy Sperling
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Michael Chang
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Kenneth Hupart
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Colin Cha-Fong
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Shankar Srinivasan
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA; (R.A.); (D.K.); (S.S.)
| | - Preeti Kishore
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nichola Davis
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Robert T. Faillace
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Jachymek M, Cader A, Ptak M, Witkiewicz W, Szymański AG, Kotfis K, Kaźmierczak J, Szylińska A. The Value of Clinical Frailty Scale (CFS) as a Prognostic Tool in Predicting Mortality in COVID-19-A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1104. [PMID: 35162123 PMCID: PMC8834053 DOI: 10.3390/ijerph19031104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Due to the unpredictable nature of COVID-19, there is a need to identify patients at high risk of severe course of the disease and a higher mortality rate. OBJECTIVE This study aims to find the correlation between frailty and mortality in adult, hospitalized patients with COVID-19. METHODS Clinical records of 201 patients who suffered from COVID-19 and were hospitalized between October 2020 and February 2021 were retrospectively analyzed. Demographic, clinical, and biochemical data were collected. Patients were assessed using Clinical Frailty Scale (CFS) and were divided into three groups: CFS 1-3 fit; CFS 4-6 vulnerable and with mild to moderate frailty; CSF 7-9, severe frailty. The association between frailty and in-hospital mortality was the primary outcome. RESULTS Severe frailty or terminal illness was observed in 26 patients (12.94%) from a cohort of 201 patients. Those patients were older (median age 80.73, p < 0.001) and had more comorbidities. Frailty was also associated with higher requirement for oxygen supplementation, greater risk of in-hospital complications and worse biochemical laboratory results. An increase in CFS score also correlated with higher mortality (OR = 1.89, p < 0.001). The Conclusions: Clinical Frailty Scale (CFS) can be used as a potentially useful tool in predicting mortality in patients with COVID-19.
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Affiliation(s)
- Magdalena Jachymek
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Aleksandra Cader
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Powskańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.C.); (M.P.)
| | - Michał Ptak
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Powskańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.C.); (M.P.)
| | - Wojciech Witkiewicz
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Adam Grzegorz Szymański
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Katarzyna Kotfis
- Department Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Jarosław Kaźmierczak
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Żołnierska 54, 71-210 Szczecin, Poland
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Perera N, de Silva A, Kumbukage M, Rambukwella R, Indrakumar J. Neutrophil Lymphocyte Ratio as a Marker of In-Hospital Deterioration in COVID-19: Observations From a Resource Constraint Setting. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2022; 15:2632010X221090898. [PMID: 35450133 PMCID: PMC9016554 DOI: 10.1177/2632010x221090898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
Introduction and Objectives: The study was conducted to assess the association of neutrophil lymphocyte
ratio (NLR) in COVID-19 and to identify the cut-off value that predicts
mortality, need of respiratory support and admission to high-dependency or
intensive care. Methods: A retrospective observational study was conducted to collect demographic
data, clinical variables, the neutrophil-lymphocyte ratio on-admission and
the outcome of confirmed COVID-19 patients admitted to a tertiary care
center in Sri Lanka. Results: There were 208 patients with a median age of 56 years (IQR 43-67) and 98
(47.1%) males. The median neutrophil count was 4.07 × 103/µL (IQR
2.97-6.79) and the median lymphocyte count was 1.74 × 103/µL (IQR
1.36-4.75). The calculated NLR ranged from 0.12 to 48.28 with a median value
of 2.32 (IQR 1.37-4.76). A NLR value >3.6 predicted development of severe
disease requiring respiratory support, transfer to a high-dependency or an
intensive care unit and/or succumbing to the illness with a sensitivity 80%
and specificity 80% (area under the curve 0.8, 95% CI 0.72-0.88,
P < .0001). The adjusted odds ratio of NLR > 3.6
on predicting severe disease was 11.1, 95% CI 4.5- 27.0,
P < .0001. Conclusions: A NLR > 3.6 is a useful variable to be included in risk prediction scores
in Sri Lanka.
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Affiliation(s)
- Nilanka Perera
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Western Province, Sri Lanka
| | - Ashani de Silva
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Western Province, Sri Lanka
| | - Mahesh Kumbukage
- Research unit, Family Health Bureau, Colombo, Western Province, Sri Lanka
| | - Roshan Rambukwella
- Research unit, Family Health Bureau, Colombo, Western Province, Sri Lanka
| | - Jegarajah Indrakumar
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Western Province, Sri Lanka
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Ayurvedic management through telemedicine of covid hypoxia non-dependent of oxygen support in a patient with chest CT score of 18/25- A case report. J Ayurveda Integr Med 2022; 13:100660. [PMID: 36473403 PMCID: PMC9723920 DOI: 10.1016/j.jaim.2022.100660] [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: 08/23/2021] [Revised: 08/27/2022] [Accepted: 10/07/2022] [Indexed: 12/07/2022] Open
Abstract
This paper is the first known documentation of a covid patient in ARDS and MODS who recovered from home through Ayurveda telemedicine and when not completely dependent on oxygen. The covid patient suffered from fever, body ache, breathlessness, fatigue, and was admitted to the hospital when his SpO2 was at 56, his CT scores at 18/25, Corads 6 and his NL ratio was at 9. The patient was shifted to another hospital as he refused treatment in the first hospital; in the second hospital also he refused treatment and got himself discharged against medical advice when his SpO2 was at 65, RR 40. The patient sought Ayurvedic treatment through phone voluntarily when in MODS. He showed clinical improvement within a day and the SpO2 steadily raised to reach 94 in 27 days. He may have required invasive mechanical ventilation for COVID-19 ARDS reflected by his raised covid biomarkers (Malik et al., 2021) [1]. But this was not necessitated; also other risk factors for poor outcomes were his old age, comorbidities as diabetes, kidney injury and liver injury. This paper records that oral and ophthalmic administration of Ayurveda medicines can immediately increase SpO2 levels. This case study also opens up possibilities of emergency care in Ayurveda with respect to hypoxia.
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