1
|
Ozden MF, Sogut O, Az A, Dogan Y. Analysis of Age-Specific Predictors of Mortality in Patients with Coronavirus Disease 2019. Niger J Clin Pract 2024; 27:244-251. [PMID: 38409154 DOI: 10.4103/njcp.njcp_507_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/16/2023] [Indexed: 02/28/2024]
Abstract
AIM We investigated predictors of mortality, including demographic, clinical, and laboratory parameters, in hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia. PATIENTS AND METHODS This retrospective, single-center study included 651 consecutive Turkish adults who had been admitted to the emergency department with a diagnosis of COVID-19. We recorded the demographic, clinical, and laboratory parameters of the patients. The patients were divided into two groups: patients aged ≥65 years and patients aged <65 years. The predictors of mortality for hospitalized COVID-19 patients were evaluated. RESULTS The study included 651 patients (354 [54.4%] men and 297 [45.6%] women; mean age, 56.40 ± 15.70 years). The most common comorbidities were hypertension (37.6%), diabetes mellitus (28.9%), and coronary artery disease (CAD) (16.1%). The overall mortality rate was 10.6% (n = 69); the mortality rate was higher in men than in women. Advanced age; chronic renal failure (CRF); prolonged activated partial thromboplastin time; high serum neutrophil and platelet counts; high C-reactive protein to albumin (CRP/albumin) ratio; and high levels of albumin, lactate dehydrogenase (LDH), and high-sensitivity troponin I (TnI-hs) were independent predictors of mortality in all age groups. CONCLUSION Multivariate logistic regression analysis showed that chronic obstructive pulmonary disease (COPD), high serum platelet count, high CRP/albumin ratio, and high levels of albumin, TnI-hs, and D-dimer were independent predictors of mortality in patients aged <65 years. Conversely, advanced age, CAD, CRF, and high levels of serum CRP and LDH were independent predictors of mortality in patients aged ≥65 years.
Collapse
Affiliation(s)
- M F Ozden
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - O Sogut
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - A Az
- Department of Emergency Medicine, Istanbul Beylikdüzü State Hospital, Istanbul, Turkey
| | - Y Dogan
- Department of Emergency Medicine, Mus State Hospital, Mus, Turkey
| |
Collapse
|
2
|
Lamichhane A, Pokhrel S, Thapa TB, Shrestha O, Kadel A, Joshi G, Khanal S. Associated Biochemical and Hematological Markers in COVID-19 Severity Prediction. Adv Med 2023; 2023:6216528. [PMID: 37900669 PMCID: PMC10602699 DOI: 10.1155/2023/6216528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/03/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023] Open
Abstract
Background The global threat of COVID-19 has created the need for researchers to investigate the disease's progression, especially through the use of biomarkers to inform interventions. This study aims to assess the correlations of laboratory parameters to determine the severity of COVID-19 infection. Methods This study was conducted among 191 COVID-19 patients in Sumeru Hospital, Lalitpur, Nepal. According to their clinical outcomes, these patients were divided into severe and nonsevere groups. Inflammatory markers such as LDH, D-dimer, CRP, ferritin, complete blood cell count, liver function tests, and renal function tests were performed. Binary logistic regression analysis determined relative risk factors associated with severe COVID-19. The area under the curve (AUC) was calculated with ROC curves to assess the potential predictive value of risk factors. Results Out of 191 patients, 38 (19.8%) subjects died due to COVID-19 complications, while 156 (81.7%) survived and were discharged from hospital. The COVID-19 severity was found in patients with older age and comorbidities such as CKD, HTN, DM, COPD, and pneumonia. Parameters such as d-dimer, CRP, LDH, SGPT, neutrophil, lymphocyte count, and LMR were significant independent risk factors for the severity of the disease. The AUC was highest for d-dimer (AUC = 0.874) with a sensitivity of 82.2% and specificity of 81.2%. Similarly, the cut-off values for other factors were age >54.5 years, D-dimer >0.91 ng/ml, CRP >82.4 mg/dl, neutrophil >78.5%, LDH >600 U/L, and SGPT >35.5 U/L, respectively. Conclusion Endorsement of biochemical and hematological parameters with their cut-off values also aids in predicting COVID-19 severity. The biomarkers such as D-dimer, CRP levels, LDH, ALT, and neutrophil count could be used to predict disease severity. So, timely analysis of these markers might allow early prediction of disease progression.
Collapse
Affiliation(s)
- Anit Lamichhane
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- Department of Pathology, Sumeru Hospital Pvt Ltd., Lalitpur, Nepal
| | - Sushant Pokhrel
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | | | - Ojaswee Shrestha
- Department of Pathology, Sumeru Hospital Pvt Ltd., Lalitpur, Nepal
| | - Anuradha Kadel
- Department of Pathology, Sumeru Hospital Pvt Ltd., Lalitpur, Nepal
| | - Govardhan Joshi
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Sudip Khanal
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| |
Collapse
|
3
|
Buttia C, Llanaj E, Raeisi-Dehkordi H, Kastrati L, Amiri M, Meçani R, Taneri PE, Ochoa SAG, Raguindin PF, Wehrli F, Khatami F, Espínola OP, Rojas LZ, de Mortanges AP, Macharia-Nimietz EF, Alijla F, Minder B, Leichtle AB, Lüthi N, Ehrhard S, Que YA, Fernandes LK, Hautz W, Muka T. Prognostic models in COVID-19 infection that predict severity: a systematic review. Eur J Epidemiol 2023; 38:355-372. [PMID: 36840867 PMCID: PMC9958330 DOI: 10.1007/s10654-023-00973-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
Current evidence on COVID-19 prognostic models is inconsistent and clinical applicability remains controversial. We performed a systematic review to summarize and critically appraise the available studies that have developed, assessed and/or validated prognostic models of COVID-19 predicting health outcomes. We searched six bibliographic databases to identify published articles that investigated univariable and multivariable prognostic models predicting adverse outcomes in adult COVID-19 patients, including intensive care unit (ICU) admission, intubation, high-flow nasal therapy (HFNT), extracorporeal membrane oxygenation (ECMO) and mortality. We identified and assessed 314 eligible articles from more than 40 countries, with 152 of these studies presenting mortality, 66 progression to severe or critical illness, 35 mortality and ICU admission combined, 17 ICU admission only, while the remaining 44 studies reported prediction models for mechanical ventilation (MV) or a combination of multiple outcomes. The sample size of included studies varied from 11 to 7,704,171 participants, with a mean age ranging from 18 to 93 years. There were 353 prognostic models investigated, with area under the curve (AUC) ranging from 0.44 to 0.99. A great proportion of studies (61.5%, 193 out of 314) performed internal or external validation or replication. In 312 (99.4%) studies, prognostic models were reported to be at high risk of bias due to uncertainties and challenges surrounding methodological rigor, sampling, handling of missing data, failure to deal with overfitting and heterogeneous definitions of COVID-19 and severity outcomes. While several clinical prognostic models for COVID-19 have been described in the literature, they are limited in generalizability and/or applicability due to deficiencies in addressing fundamental statistical and methodological concerns. Future large, multi-centric and well-designed prognostic prospective studies are needed to clarify remaining uncertainties.
Collapse
Affiliation(s)
- Chepkoech Buttia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Erand Llanaj
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
- ELKH-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Epistudia, Bern, Switzerland
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lum Kastrati
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mojgan Amiri
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Renald Meçani
- Department of Pediatrics, “Mother Teresa” University Hospital Center, Tirana, University of Medicine, Tirana, Albania
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Petek Eylul Taneri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- HRB-Trials Methodology Research Network College of Medicine, Nursing and Health Sciences University of Galway, Galway, Ireland
| | | | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Faina Wehrli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Octavio Pano Espínola
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Preventive Medicine and Public Health, University of Navarre, Pamplona, Spain
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Lyda Z. Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia
| | | | | | - Fadi Alijla
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Alexander B. Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, and Center for Artificial Intelligence in Medicine (CAIM), University of Bern, Bern, Switzerland
| | - Nora Lüthi
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Simone Ehrhard
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurenz Kopp Fernandes
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf Hautz
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| |
Collapse
|
4
|
Sha S, Liu M, Sun M, Xiao L, Chang Q, Chen Y, Huang J. Abnormal myocardial enzymes in the prediction of mortality and hypertension in COVID-19 patients: a retrospective study. Aging (Albany NY) 2022; 14:8585-8594. [DOI: 10.18632/aging.204362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/21/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Shuang Sha
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
| | - Min Liu
- Department of Hospital Infection Control, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai 519000, China
| | - Miaomiao Sun
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
| | - Long Xiao
- Yunmeng County People’s Hospital, Yunmeng 432500, China
| | - Qing Chang
- Clinical Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai 201800, China
- Shanghai General Practice Medical Education and Research Center, Shanghai 201800, China
| | - Ying Chen
- Department of Education and Training Office, Huangshi Central Hospital, Huangshi 435000, China
| | - Jie Huang
- Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
5
|
Maestre-Muñiz MM, Arias Á, Lucendo AJ. Predicting In-Hospital Mortality in Severe COVID-19: A Systematic Review and External Validation of Clinical Prediction Rules. Biomedicines 2022; 10:biomedicines10102414. [PMID: 36289676 PMCID: PMC9599062 DOI: 10.3390/biomedicines10102414] [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: 07/17/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/03/2022] Open
Abstract
Multiple prediction models for risk of in-hospital mortality from COVID-19 have been developed, but not applied, to patient cohorts different to those from which they were derived. The MEDLINE, EMBASE, Scopus, and Web of Science (WOS) databases were searched. Risk of bias and applicability were assessed with PROBAST. Nomograms, whose variables were available in a well-defined cohort of 444 patients from our site, were externally validated. Overall, 71 studies, which derived a clinical prediction rule for mortality outcome from COVID-19, were identified. Predictive variables consisted of combinations of patients′ age, chronic conditions, dyspnea/taquipnea, radiographic chest alteration, and analytical values (LDH, CRP, lymphocytes, D-dimer); and markers of respiratory, renal, liver, and myocardial damage, which were mayor predictors in several nomograms. Twenty-five models could be externally validated. Areas under receiver operator curve (AUROC) in predicting mortality ranged from 0.71 to 1 in derivation cohorts; C-index values ranged from 0.823 to 0.970. Overall, 37/71 models provided very-good-to-outstanding test performance. Externally validated nomograms provided lower predictive performances for mortality in their respective derivation cohorts, with the AUROC being 0.654 to 0.806 (poor to acceptable performance). We can conclude that available nomograms were limited in predicting mortality when applied to different populations from which they were derived.
Collapse
Affiliation(s)
- Modesto M. Maestre-Muñiz
- Department of Internal Medicine, Hospital General de Tomelloso, 13700 Ciudad Real, Spain
- Department of Medicine and Medical Specialties, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - Ángel Arias
- Hospital General La Mancha Centro, Research Unit, Alcázar de San Juan, 13600 Ciudad Real, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28006 Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 13700 Tomelloso, Spain
| | - Alfredo J. Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28006 Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 13700 Tomelloso, Spain
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Ciudad Real, Spain
- Correspondence: ; Tel.: +34-926-525-927
| |
Collapse
|
6
|
Zinellu A, Paliogiannis P, Carru C, Mangoni AA. Serum hydroxybutyrate dehydrogenase and COVID-19 severity and mortality: a systematic review and meta-analysis with meta-regression. Clin Exp Med 2021; 22:499-508. [PMID: 34799779 PMCID: PMC8603904 DOI: 10.1007/s10238-021-00777-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022]
Abstract
Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to investigate serum concentrations of hydroxybutyrate dehydrogenase (HBDH), a combined marker of myocardial and renal injury, in hospitalized COVID-19 patients with different disease severity and survival status. We searched PubMed, Web of Science and Scopus, between December 2019 and April 2021, for studies reporting HBDH in COVID-19. Risk of bias was assessed using the Newcastle–Ottawa scale, publication bias was assessed with the Begg’s and Egger’s tests, and certainty of evidence was assessed using GRADE. In 22 studies in 15,019 COVID-19 patients, serum HBDH concentrations on admission were significantly higher in patients with high disease severity or non-survivor status when compared to patients with low severity or survivor status (standardized mean difference, SMD = 0.90, 95% CI 0.74 to 1.07, p < 0.001; moderate certainty of evidence). Extreme between-study heterogeneity was observed (I2 = 93.5%, p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and the direction of the effect size were not substantially modified. A significant publication bias was observed. In meta-regression, the SMD of HBDH concentrations was significantly associated with markers of inflammation, sepsis, liver damage, non-specific tissue damage, myocardial injury, and renal function. Higher HBDH concentrations were significantly associated with higher COVID-19 severity and mortality. This biomarker of cardiac and renal injury might be useful for risk stratification in COVID-19. (PROSPERO registration number: CRD42021258123).
Collapse
Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Quality Control Unit, University Hospital (AOUSS), Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia.
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
| |
Collapse
|
7
|
Liu X, Zhu L, Lu T, Liu X, Jiao D, Tang X, Chen J, Chen Y, Yu W, Chen Q. Epidemiologic Characteristics of and Prognostic Factors for COVID-19 Among Hospitalized Patients: Updated Implications From Hubei Province, China. Front Public Health 2021; 9:726491. [PMID: 34778170 PMCID: PMC8578829 DOI: 10.3389/fpubh.2021.726491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: The roles of some indicators in the prognosis of patients with coronavirus disease-19 (COVID-19) remain unclear and controversial. This study aimed to explore the epidemiologic characteristics of and prognostic factors for COVID-19 to provide updated recommendations for its prevention, diagnosis, and treatment. Methods: For this retrospective study, demographic, epidemiologic, and clinical data were extracted from the medical records of patients admitted to the Maternal and Child Hospital of Hubei Province (Optical Valley) with COVID-19 between February 19, 2020, and March 19, 2020. The primary outcome was the prognosis that was determined at discharge as mentioned in the medical records. Descriptive statistics, univariate analyses, and stepwise logistic regression analysis were used for data analysis. Results: Of the 1,765 patients included, 93.1% were cured and the mortality was 1.8%. Univariate analyses identified 63 factors significantly associated with COVID-19 prognosis. Logistic regression analysis revealed that a poorer prognosis was associated with undergoing resuscitation, complex disease manifestations, consultation with outside specialists, elevated basophil or lymphocyte counts, an albumin (ALB)/globulin (A/G) ratio > 2.4, and elevated levels of serum aspartate aminotransferase (AST) or creatinine. Patients had a better prognosis if the following conditions were met: dry cough reported as an initial symptom, fatigue as a clinical manifestation, and a diagnosis based on laboratory testing. Conclusion: To prevent clinical deterioration, clinicians should provide special care to patients who underwent resuscitation, with a critical disease, or requiring consultation with outside specialists. Extra attention should be paid to patients with high basophil or lymphocyte counts, a high A/G ratio, and elevated AST or creatinine levels.
Collapse
Affiliation(s)
- Xiang Liu
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Linzhi Zhu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tingjuan Lu
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China.,The Optics Valley Branch of the Maternal and Child Hospital of Hubei Province, Wuhan, China
| | - Xibang Liu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Demin Jiao
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Xiali Tang
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Jun Chen
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Yu Chen
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingyong Chen
- Department of Respiratory Disease, The 903rd Hospital of the People's Liberation Army, Hangzhou, China.,The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
8
|
Stecher SS, Anton S, Fraccaroli A, Götschke J, Stemmler HJ, Barnikel M. Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis. BMC Anesthesiol 2021; 21:178. [PMID: 34182946 PMCID: PMC8236568 DOI: 10.1186/s12871-021-01396-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/14/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. METHODS We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0-12 points) and a high (13-24 points) lung ultrasound score group. RESULTS The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80-130] vs 80 [66-93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3-25] vs 36.5 [9.8-70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). CONCLUSIONS LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.
Collapse
Affiliation(s)
| | - Sofia Anton
- Medical Department II, LMU Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alessia Fraccaroli
- Medical Department III, LMU Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jeremias Götschke
- Medical Department V, LMU Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Hans Joachim Stemmler
- Medical Department III, LMU Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michaela Barnikel
- Medical Department V, LMU Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
9
|
Huang Y, Zhang Z, Liu S, Li X, Yang Y, Ma J, Li Z, Zhou J, Jiang Y, He B. CT-based radiomics combined with signs: a valuable tool to help radiologist discriminate COVID-19 and influenza pneumonia. BMC Med Imaging 2021; 21:31. [PMID: 33596844 PMCID: PMC7887546 DOI: 10.1186/s12880-021-00564-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023] Open
Abstract
Background In this COVID-19 pandemic, the differential diagnosis of viral pneumonia is still challenging. We aimed to assess the classification performance of computed tomography (CT)-based CT signs and radiomics features for discriminating COVID-19 and influenza pneumonia. Methods A total of 154 patients with confirmed viral pneumonia (COVID-19: 89 cases, influenza pneumonia: 65 cases) were collected retrospectively in this study. Pneumonia signs and radiomics features were extracted from the initial unenhanced chest CT images to build independent and combined models. The predictive performance of the radiomics model, CT sign model, the combined model was constructed based on the whole dataset and internally invalidated by using 1000-times bootstrap. Diagnostic performance of the models was assessed via receiver operating characteristic (ROC) analysis. Results The combined models consisted of 4 significant CT signs and 7 selected features and demonstrated better discrimination performance between COVID-19 and influenza pneumonia than the single radiomics model. For the radiomics model, the area under the ROC curve (AUC) was 0.888 (sensitivity, 86.5%; specificity, 78.4%; accuracy, 83.1%), and the AUC was 0.906 (sensitivity, 86.5%; specificity, 81.5%; accuracy, 84.4%) in the CT signs model. After combining CT signs and radiomics features, AUC of the combined model was 0.959 (sensitivity, 89.9%; specificity, 90.7%; accuracy, 90.3%). Conclusions CT-based radiomics combined with signs might be a potential method for distinguishing COVID-19 and influenza pneumonia with satisfactory performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00564-w.
Collapse
Affiliation(s)
- Yilong Huang
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Zhenguang Zhang
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Siyun Liu
- Precision Health Institution, PDx, GE Healthcare (China), Beijing, 100176, China
| | - Xiang Li
- Department of Radiology, The 3rd Peoples' Hospital of Kunming, Kunming, 650000, China
| | - Yunhui Yang
- Department of Medical Imaging, People's Hospital of Xishuangbanna Dai Autonomous Prefecture, Xishuangbanna, 666100, China
| | - Jiyao Ma
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Zhipeng Li
- Medical Imaging Department, Yunnan Provincial Infectious Disease Hospital, Kunming, 650000, China
| | - Jialong Zhou
- MRI Department, The First People's Hospital of Yunnan Province, Kunming, 650000, China
| | - Yuanming Jiang
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Bo He
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China.
| |
Collapse
|
10
|
Xing Y, Yang W, Jin Y, Wang C, Guan X. D-dimer daily continuous tendency predicts the short-term prognosis for COVID-19 independently: A retrospective study from Northeast China. Clin Hemorheol Microcirc 2021; 79:269-277. [PMID: 33554893 DOI: 10.3233/ch-201071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE To study whether D-dimer daily continuous tendency could predict the short-term prognosis of COVID-19. PATIENTS AND METHODES According to the short-term prognosis, 81 COVID-19 patients were divided into two groups, one of worse prognosis (Group W) and the other of better prognosis (Group B). The slope of D-dimer linear regression during hospitalization (SLOPE) was calculated as an indicator of D-dimer daily continuous tendency. The SLOPE difference between Group W and Group B was compared. The difference between the discharge results and the 3-month follow-up results was also compared. COX regression analysis was used to analyze the relationship between SLOPE and short-term prognosis of COVID-19. RESULTS There were 16 patients in Group W and 65 patients in Group B. Group W had more critical proportion (p < 0.0001), indicating that the symptoms of its patients were more severe during hospitalization. ARDS, the most visible cause of worse prognosis, accounted for up to 68.75%, and many symptoms merged and resulted in worse prognosis. The D-dimer levels of Group W not only were significantly higher (p < 0.0001), but also showed an increasing trend. In addition, the D-dimer levels at discharge were significantly higher than those at follow-up (p = 0.0261), and the mean difference was as high as 0.7474. SLOPE significantly correlated with the short-term prognosis of COVID-19 independently (RR: 1.687, 95% CI: 1.345-2.116, P < 0.0001). The worst prognosis occurred most likely during the first month after COVID-19 diagnosis. CONCLUSION Our study found that D-dimer daily continuous tendency independently correlates with worse prognosis and can be used as an independent predictor of the short-term prognosis for COVID-19.
Collapse
Affiliation(s)
- Yinting Xing
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, China
| | - Wei Yang
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, China
| | - Yingyu Jin
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, China
| | - Chao Wang
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, China
| | - Xiuru Guan
- Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, China
| |
Collapse
|
11
|
Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, Bonten MMJ, Dahly DL, Damen JAA, Debray TPA, de Jong VMT, De Vos M, Dhiman P, Haller MC, Harhay MO, Henckaerts L, Heus P, Kammer M, Kreuzberger N, Lohmann A, Luijken K, Ma J, Martin GP, McLernon DJ, Andaur Navarro CL, Reitsma JB, Sergeant JC, Shi C, Skoetz N, Smits LJM, Snell KIE, Sperrin M, Spijker R, Steyerberg EW, Takada T, Tzoulaki I, van Kuijk SMJ, van Bussel B, van der Horst ICC, van Royen FS, Verbakel JY, Wallisch C, Wilkinson J, Wolff R, Hooft L, Moons KGM, van Smeden M. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ 2020; 369:m1328. [PMID: 32265220 PMCID: PMC7222643 DOI: 10.1136/bmj.m1328] [Citation(s) in RCA: 1634] [Impact Index Per Article: 408.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review and appraise the validity and usefulness of published and preprint reports of prediction models for diagnosing coronavirus disease 2019 (covid-19) in patients with suspected infection, for prognosis of patients with covid-19, and for detecting people in the general population at increased risk of covid-19 infection or being admitted to hospital with the disease. DESIGN Living systematic review and critical appraisal by the COVID-PRECISE (Precise Risk Estimation to optimise covid-19 Care for Infected or Suspected patients in diverse sEttings) group. DATA SOURCES PubMed and Embase through Ovid, up to 1 July 2020, supplemented with arXiv, medRxiv, and bioRxiv up to 5 May 2020. STUDY SELECTION Studies that developed or validated a multivariable covid-19 related prediction model. DATA EXTRACTION At least two authors independently extracted data using the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist; risk of bias was assessed using PROBAST (prediction model risk of bias assessment tool). RESULTS 37 421 titles were screened, and 169 studies describing 232 prediction models were included. The review identified seven models for identifying people at risk in the general population; 118 diagnostic models for detecting covid-19 (75 were based on medical imaging, 10 to diagnose disease severity); and 107 prognostic models for predicting mortality risk, progression to severe disease, intensive care unit admission, ventilation, intubation, or length of hospital stay. The most frequent types of predictors included in the covid-19 prediction models are vital signs, age, comorbidities, and image features. Flu-like symptoms are frequently predictive in diagnostic models, while sex, C reactive protein, and lymphocyte counts are frequent prognostic factors. Reported C index estimates from the strongest form of validation available per model ranged from 0.71 to 0.99 in prediction models for the general population, from 0.65 to more than 0.99 in diagnostic models, and from 0.54 to 0.99 in prognostic models. All models were rated at high or unclear risk of bias, mostly because of non-representative selection of control patients, exclusion of patients who had not experienced the event of interest by the end of the study, high risk of model overfitting, and unclear reporting. Many models did not include a description of the target population (n=27, 12%) or care setting (n=75, 32%), and only 11 (5%) were externally validated by a calibration plot. The Jehi diagnostic model and the 4C mortality score were identified as promising models. CONCLUSION Prediction models for covid-19 are quickly entering the academic literature to support medical decision making at a time when they are urgently needed. This review indicates that almost all pubished prediction models are poorly reported, and at high risk of bias such that their reported predictive performance is probably optimistic. However, we have identified two (one diagnostic and one prognostic) promising models that should soon be validated in multiple cohorts, preferably through collaborative efforts and data sharing to also allow an investigation of the stability and heterogeneity in their performance across populations and settings. Details on all reviewed models are publicly available at https://www.covprecise.org/. Methodological guidance as provided in this paper should be followed because unreliable predictions could cause more harm than benefit in guiding clinical decisions. Finally, prediction model authors should adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guideline. SYSTEMATIC REVIEW REGISTRATION Protocol https://osf.io/ehc47/, registration https://osf.io/wy245. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 3 of the original article published on 7 April 2020 (BMJ 2020;369:m1328). Previous updates can be found as data supplements (https://www.bmj.com/content/369/bmj.m1328/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
Collapse
Affiliation(s)
- Laure Wynants
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Georg Heinze
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marc M J Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Darren L Dahly
- HRB Clinical Research Facility, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten De Vos
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Electrical Engineering, ESAT Stadius, KU Leuven, Leuven, Belgium
| | - Paul Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Maria C Haller
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ordensklinikum Linz, Hospital Elisabethinen, Department of Nephrology, Linz, Austria
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Palliative and Advanced Illness Research Center and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liesbet Henckaerts
- Department of Microbiology, Immunology and Transplantation, KU Leuven-University of Leuven, Leuven, Belgium
- Department of General Internal Medicine, KU Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Pauline Heus
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Michael Kammer
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Nina Kreuzberger
- Evidence-Based Oncology, Department I of Internal Medicine and Centre for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Lohmann
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Jie Ma
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Constanza L Andaur Navarro
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jamie C Sergeant
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nicole Skoetz
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Luc J M Smits
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Matthew Sperrin
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Medical Library, Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Bas van Bussel
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht University, Maastricht, Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht University, Maastricht, Netherlands
| | - Florien S van Royen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christine Wallisch
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Jack Wilkinson
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|