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Kokkoris S, Kanavou A, Katsaros D, Karageorgiou S, Kremmydas P, Gkoufa A, Ntaidou T, Giannopoulos C, Kardamitsi MA, Dimopoulou G, Theodorou E, Georgakopoulou VE, Spandidos DA, Orfanos S, Kotanidou A, Routsi C. Temporal trends in laboratory parameters in survivors and non‑survivors of critical COVID‑19 illness and the effect of dexamethasone treatment. Biomed Rep 2024; 20:12. [PMID: 38124763 PMCID: PMC10731161 DOI: 10.3892/br.2023.1700] [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: 09/19/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Although coronavirus disease 2019 (COVID-19)-induced changes in laboratory parameters in patients upon admission have been well-documented, information on their temporal changes is limited. The present study describes the laboratory trends and the effect of dexamethasone treatment on these parameters, in patients with COVID-19 in the intensive care unit (ICU). Routine laboratory parameters, namely white blood cell (WBC), neutrophil, lymphocyte and platelet (PLT) counts, fibrinogen, C-reactive protein (CRP), lactate dehydrogenase (LDH) and albumin concentrations, were recorded upon admission to the ICU and, thereafter, on days 3, 5, 10, 15 and 21; these values were compared between survivors and non-survivors, as well as between those who were treated with dexamethasone and those who were not. Among the 733 patients in the ICU, (mean age, 65±13 years; 68% males; ICU mortality rate 45%; 76% of patients treated with dexamethasone), the WBC and neutrophil counts were persistently high in all patients, without significant differences over the first 15 days. Initially, low lymphocyte counts exhibited increasing trends, but remained higher in survivors compared to non-survivors (P=0.01). The neutrophil-to-lymphocyte ratio (NLR) was persistently elevated in all patients, although it was significantly higher in non-survivors compared to survivors (P<0.001). The PLT count was initially increased in all patients, although it was significantly decreased in non-survivors over time. The fibrinogen and LDH values remained similarly elevated in all patients. However, the increased levels of CRP, which did not differ between patients upon admission, further increased in non-survivors compared to survivors after day 10 (P=0.001). Declining trends in albumin levels over time, overall, with a significant decrease in non-survivors compared to survivors, were observed. Dexamethasone treatment significantly affected the temporal progression of fibrinogen and CRP in survivors and that of NLR in non-survivors. On the whole, the present study demonstrates that patients in the ICU with COVID-19 present persistently abnormal laboratory findings and significant differences in laboratory trends of NLR, CRP, PLT and albumin, but not in WBC and neutrophil count, and fibrinogen and LDH levels, between survivors and non-survivors. The temporal progression of fibrinogen, CRP and NLR is affected by dexamethasone treatment.
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Affiliation(s)
- Stelios Kokkoris
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Angeliki Kanavou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Dimitrios Katsaros
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Stavros Karageorgiou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Panagiotis Kremmydas
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
- Department of Infectious Diseases, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Theodora Ntaidou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Charalampos Giannopoulos
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Marina-Areti Kardamitsi
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Georgia Dimopoulou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Evangelia Theodorou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Stylianos Orfanos
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Anastasia Kotanidou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Christina Routsi
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
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Bailey M, Linden D, Earley O, Guo Parke H, McAuley DF, Peto T, Taggart C, Kidney J. Inhibition of bradykinin in SARS-CoV-2 infection: a randomised, double-blind trial of icatibant compared with placebo (ICASARS). BMJ Open 2023; 13:e074726. [PMID: 38035747 PMCID: PMC10689398 DOI: 10.1136/bmjopen-2023-074726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 12/02/2023] Open
Abstract
SARS-CoV-2 binds to ACE2 receptors and enters cells. The symptoms are cough, breathlessness, loss of taste/smell and X-ray evidence of infiltrates on chest imaging initially caused by oedema, and subsequently by a lymphocytic pneumonitis. Coagulopathy, thrombosis and hypotension occur. Worse disease occurs with age, obesity, ischaemic heart disease, hypertension and diabetes.These features may be due to abnormal activation of the contact system. This triggers coagulation and the kallikrein-kinin system, leading to accumulation of bradykinin and its derivatives, which act on receptors B1R and B2R. Receptor activation causes cough, hypotension, oedema and release of the cytokine interleukin-6 (IL-6) which recruits lymphocytes. These effects are core features seen in early SARS CoV-2 infection. METHODS AND ANALYSIS In this study, hypoxic patients with COVID-19 with symptom onset ≤7 days will be randomised to either a bradykinin inhibitor (icatibant) or placebo. Patients and investigators will be blinded. The primary outcome will be blood oxygenation, measured by arterial blood sampling. The secondary outcome will be cardiovascular status. Retinal imaging will be performed to assess vessel size. Blood samples will be taken for measurement of inflammatory analyses including IL-6. As a separate substudy, we will also take comparator blood inflammatory samples from a COVID-19-negative cohort. ETHICS AND DISSEMINATION The study has received the following approvals: West Midlands-Edgbaston Research Ethics Committee. Medicines and Healthcare products Regulatory Agency has issued a clinical trial authorisation. Belfast Health and Social Care Trust is the study sponsor. Results will be made available to participants upon request and findings will be presented and published. TRIAL REGISTRATION NUMBER NCT05407597.
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Affiliation(s)
- Melanie Bailey
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Dermot Linden
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Olivia Earley
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Hong Guo Parke
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - Tunde Peto
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
- Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - Cliff Taggart
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Joe Kidney
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
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Kokkoris S, Kanavou A, Kremmydas P, Katsaros D, Karageorgiou S, Gkoufa A, Georgakopoulou VE, Spandidos DA, Giannopoulos C, Kardamitsi M, Routsi C. Temporal evolution of laboratory characteristics in patients critically ill with COVID‑19 admitted to the intensive care unit (Review). MEDICINE INTERNATIONAL 2023; 3:52. [PMID: 37810906 PMCID: PMC10557099 DOI: 10.3892/mi.2023.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
In the context of coronavirus disease 2019 (COVID-19), laboratory medicine has played a crucial role in both diagnosis and severity assessment. Although the importance of baseline laboratory findings has been extensively reported, data regarding their evolution over the clinical course are limited. The aim of the present narrative review was to provide the dynamic changes of the routine laboratory variables reported in patients with severe COVID-19 over the course of their critical illness. A search was made of the literature for articles providing data on the time-course of routine laboratory tests in patients with severe COVID-19 during their stay in the intensive care unit (ICU). White blood cell, neutrophil and lymphocyte counts, neutrophil to lymphocyte ratio, platelet counts, as well as D-dimer, fibrinogen, C-reactive protein, lactate dehydrogenase and serum albumin levels were selected as disease characteristics and routine laboratory parameters. A total of 25 research articles reporting dynamic trends in the aforementioned laboratory parameters over the clinical course of severe COVID-19 were identified. During the follow-up period provided by each study, the majority of the laboratory values remained persistently abnormal in both survivors and non-survivors. Furthermore, in the majority of studies, the temporal trends of laboratory values distinctly differentiated patients between survivors and non-survivors. In conclusion, there are distinct temporal trends in selected routine laboratory parameters between survivors and non-survivors with severe COVID-19 admitted to the ICU, indicating their importance in the prognosis of clinical outcome.
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Affiliation(s)
- Stelios Kokkoris
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Angeliki Kanavou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Panagiotis Kremmydas
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Dimitrios Katsaros
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Stavros Karageorgiou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
- Department of Infectious Diseases, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Charalampos Giannopoulos
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Marina Kardamitsi
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Christina Routsi
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
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Bailey M, Linden D, Guo-Parke H, Earley O, Peto T, McAuley DF, Taggart C, Kidney J. Vascular risk factors for COVID-19 ARDS: endothelium, contact-kinin system. Front Med (Lausanne) 2023; 10:1208866. [PMID: 37448794 PMCID: PMC10336249 DOI: 10.3389/fmed.2023.1208866] [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: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
SARS-CoV-2 binds to ACE2 receptors, expressed within the lungs. Risk factors for hospitalization include hypertension, diabetes, ischaemic heart disease and obesity-conditions linked by the presence of endothelial pathology. Viral infection in this setting causes increased conversion of circulating Factor XII to its active form (FXIIa). This is the first step in the contact-kinin pathway, leading to synchronous activation of the intrinsic coagulation cascade and the plasma Kallikrein-Kinin system, resulting in clotting and inflammatory lung disease. Temporal trends are evident from blood results of hospitalized patients. In the first week of symptoms the activated partial thromboplastin time (APTT) is prolonged. This can occur when clotting factors are consumed as part of the contact (intrinsic) pathway. Platelet counts initially fall, reflecting their consumption in coagulation. Lymphopenia occurs after approximately 1 week, reflecting the emergence of a lymphocytic pneumonitis [COVID-19 acute respiratory distress syndrome (ARDS)]. Intrinsic coagulation also induces the contact-kinin pathway of inflammation. A major product of this pathway, bradykinin causes oedema with ground glass opacities (GGO) on imaging in early COVID-19. Bradykinin also causes release of the pleiotrophic cytokine IL-6, which causes lymphocyte recruitment. Thromobosis and lymphocytic pneumonitis are hallmark features of COVID-19 ARDS. In this review we examine the literature with particular reference to the contact-kinin pathway. Measurements of platelets, lymphocytes and APTT should be undertaken in severe infections to stratify for risk of developing ARDS.
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Affiliation(s)
- Melanie Bailey
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dermot Linden
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Hong Guo-Parke
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Olivia Earley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tunde Peto
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Danny F. McAuley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Clifford Taggart
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Joseph Kidney
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Charvet B, Brunel J, Pierquin J, Iampietro M, Decimo D, Queruel N, Lucas A, Encabo-Berzosa MDM, Arenaz I, Marmolejo TP, Gonzalez AI, Maldonado AC, Mathieu C, Küry P, Flores-Rivera J, Torres-Ruiz F, Avila-Rios S, Salgado Montes de Oca G, Schoorlemmer J, Perron H, Horvat B. SARS-CoV-2 awakens ancient retroviral genes and the expression of proinflammatory HERV-W envelope protein in COVID-19 patients. iScience 2023; 26:106604. [PMID: 37091988 PMCID: PMC10079620 DOI: 10.1016/j.isci.2023.106604] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/29/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Patients with COVID-19 may develop abnormal inflammatory response, followed in some cases by severe disease and long-lasting syndromes. We show here that in vitro exposure to SARS-CoV-2 activates the expression of the human endogenous retrovirus (HERV) HERV-W proinflammatory envelope protein (ENV) in peripheral blood mononuclear cells from a subset of healthy donors, in ACE2 receptor and infection-independent manner. Plasma and/or sera of 221 COVID-19 patients from different cohorts, infected with successive SARS-CoV-2 variants including the Omicron, had detectable HERV-W ENV, which correlated with ENV expression in T lymphocytes and peaked with the disease severity. HERV-W ENV was also found in postmortem tissues of lungs, heart, gastrointestinal tract, brain olfactory bulb, and nasal mucosa from COVID-19 patients. Altogether, these results demonstrate that SARS-CoV-2 could induce HERV-W envelope protein expression and suggest its involvement in the immunopathogenesis of certain COVID-19-associated syndromes and thereby its relevance in the development of personalized treatment of patients.
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Affiliation(s)
| | | | | | - Mathieu Iampietro
- CIRI, International Center for Infectiology Research, INSERM U1111, CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Didier Decimo
- CIRI, International Center for Infectiology Research, INSERM U1111, CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France
| | | | - Alexandre Lucas
- We-Met platform, I2MC/Inserm/Université Paul Sabatier UMR1297, Toulouse, France
| | | | - Izaskun Arenaz
- Biobanco del Sistema de Salud de Aragón, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Tania Perez Marmolejo
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, México Ciudad, México
| | - Arturo Ivan Gonzalez
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, México Ciudad, México
| | | | - Cyrille Mathieu
- CIRI, International Center for Infectiology Research, INSERM U1111, CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Patrick Küry
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Jose Flores-Rivera
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Fernanda Torres-Ruiz
- Centro de investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México Ciudad, México
| | - Santiago Avila-Rios
- Centro de investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México Ciudad, México
| | - Gonzalo Salgado Montes de Oca
- Centro de investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México Ciudad, México
| | - Jon Schoorlemmer
- ARAID Fundación; Instituto Aragonés de Ciencias de la Salud (IACS); Grupo B46_20R de la DGA and GIIS-028 del IISA; all Zaragoza, Spain
| | - Hervé Perron
- GeNeuro Innovation, Lyon, France
- GeNeuro, Plan les Ouates, Geneva, Switzerland
| | - Branka Horvat
- CIRI, International Center for Infectiology Research, INSERM U1111, CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France
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Semiz S. COVID19 biomarkers: What did we learn from systematic reviews? Front Cell Infect Microbiol 2022; 12:1038908. [PMID: 36583110 PMCID: PMC9792992 DOI: 10.3389/fcimb.2022.1038908] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID19) pandemic continues to represent a substantial public health concern. It can rapidly progress to severe disease, with poor prognosis and a high mortality risk. An early diagnosis and specific prognostic tools can help healthcare providers to start interventions promptly, understand the likely prognosis and to identify and treat timely individuals likely to develop severe disease with enhanced mortality risk. Here we focused on an impressive set of systematic reviews and meta-analyses that were performed since the start of the COVID19 pandemic and summarized their results related to the levels of hematologic, inflammatory, immunologic biomarkers as well as markers of cardiac, respiratory, hepatic, gastrointestinal and renal systems and their association with the disease progression, severity and mortality. The evidence outlines the significance of specific biomarkers, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, interleukin-6), hematological (lymphocytes count, neutrophil-to-lymphocyte ratio, D-dimer, ferritin, red blood cell distribution width), cardiac (troponin, CK-MB, myoglobin), liver (AST, ALT, total bilirubin, albumin) and lung injury (Krebs von den Lungen-6) that can be used as prognostic biomarkers to aid the identification of high-risk patients and the prediction of serious outcomes, including mortality, in COVID19. Thus, these parameters should be used as essential tools for an early risk stratification and adequate intervention in improving disease outcomes in COVID19 patients.
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HOŞGÜN D, AYDEMİR S. Evaluation of the correlation of serum calcium, phosphorus levels and calcium phosphorus product with disease severity and ICU mortality in SARS-COV-2 pneumonia patients followed up in ICU. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1120563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Calcium and phosphorus are important elements in the body that have been shown to decrease in critical inflammatory diseases. The aim of this study was to evaluate serum levels of calcium and phosphorus and the calcium phosphate product (CPP) in patients followed up in intensive care unit (ICU) due to hypoxemic respiratory failure caused by coronavirus disease 2019 (COVID-19) pneumonia. The secondary endpoint of the study were respiratory support therapies used in the evaluation of independent mortality and disease severity in ICU that were divided into four groups depending on the time of administration: (i) first 24 hours, (ii) 48-72 hours, (iii) 72 hours, and (iv) 72 hours-28 days.
Material and Method: The retrospective study included patients with critical and severe COVID-19 pneumonia followed up in ICU.
Results: The study included 369 patients with a mean age of 64.3±14.8 years. ICU mortality was observed in 142 (38.5%) patients, among whom 17 (4.6%) patients died within 24 hours, 28 (7.6%) died between 48-72 hours, 50 (12.7%) died within 72 hours, and 47 (12.7%) died between 72 hours and 28 days. Serum calcium level established a significant relationship with ICU mortality at 28 days and 72 hours (p0.05).
Conclusion: Serial assessment of serum calcium may be a new criterion in the prediction of independent mortality in critical and severe COVID-19 pneumonia, which has been recently identified and has numerous unknown features.
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Affiliation(s)
- Derya HOŞGÜN
- Atatürk Sanatoryum Education and Research Hospital
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8
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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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Quantitative inspiratory-expiratory chest CT findings in COVID-19 survivors at the 6-month follow-up. Sci Rep 2022; 12:7402. [PMID: 35513692 PMCID: PMC9070972 DOI: 10.1038/s41598-022-11237-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
We evaluated pulmonary sequelae in COVID-19 survivors by quantitative inspiratory-expiratory chest CT (QCT) and explored abnormal pulmonary diffusion risk factors at the 6-month follow-up. This retrospective study enrolled 205 COVID-19 survivors with baseline CT data and QCT scans at 6-month follow-up. Patients without follow-up pulmonary function tests were excluded. All subjects were divided into group 1 (carbon monoxide diffusion capacity [DLCO] < 80% predicted, n = 88) and group 2 (DLCO ≥ 80% predicted, n = 117). Clinical characteristics and lung radiological changes were recorded. Semiquantitative total CT score (0-25) was calculated by adding five lobes scores (0-5) according to the range of lesion involvement (0: no involvement; 1: < 5%; 2: 5-25%; 3: 26-50%; 4: 51-75%; 5: > 75%). Data was analyzed by two-sample t-test, Spearman test, etc. 29% survivors showed air trapping by follow-up QCT. Semiquantitative CT score and QCT parameter of air trapping in group 1 were significantly greater than group 2 (p < 0.001). Decreased DLCO was negatively correlated with the follow-up CT score for ground-glass opacity (r = - 0.246, p = 0.003), reticulation (r = - 0.206, p = 0.002), air trapping (r = - 0.220, p = 0.002) and relative lung volume changes (r = - 0.265, p = 0.001). COVID-19 survivors with lung diffusion deficits at 6-month follow-up tended to develop air trapping, possibly due to small-airway impairment.
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Temporal Changes in the Oxyhemoglobin Dissociation Curve of Critically Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11030788. [PMID: 35160240 PMCID: PMC8836951 DOI: 10.3390/jcm11030788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023] Open
Abstract
Critical COVID-19 is a life-threatening disease characterized by severe hypoxemia with complex pathophysiological mechanisms that are not yet completely understood. A pathological shift in the oxyhemoglobin curve (ODC) was previously described through the analysis of p50, intended as the oxygen tension at which hemoglobin is saturated by oxygen at 50%. The aim of this study was to analyze Hb-O2 affinity features over time in a cohort of critically ill COVID-19 patients, through the analysis of ODC p50 behavior. A retrospective analysis was performed; through multiple arterial blood gas (ABG) analyses, each p50 was calculated and normalized according to PaCO2, pH and temperature; patients' p50 evolution over time was reported, comparing the first 3 days (early p50s) with the last 3 days (late p50s) of ICU stay. A total of 3514 ABG analyses of 32 consecutive patients were analyzed. The majority of patients presented a left shift over time (p = 0.03). A difference between early p50s and late p50s was found (20.63 ± 2.1 vs. 18.68 ± 3.3 mmHg, p = 0.03); median p50 of deceased patients showed more right shifts than those of alive patients (24.1 vs. 18.45 mmHg, p = 0.01). One-way ANOVA revealed a p50 variance greater in the early p50s (σ2 = 8.6) than in the late p50s (σ2 = 3.84), associated with a reduction over time (p < 0.001). Comparing the Hb-O2 affinity in critically ill COVID-19 patients between ICU admission and ICU discharge, a temporal shift in the ODC was observed.
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Birhanu A, Merga BT, Ayana GM, Alemu A, Negash B, Dessie Y. Factors associated with prolonged length of hospital stay among COVID-19 cases admitted to the largest treatment center in Eastern Ethiopia. SAGE Open Med 2022; 10:20503121211070366. [PMID: 35070311 PMCID: PMC8777367 DOI: 10.1177/20503121211070366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The hospital admissions load and how long each patient will stay in the hospital should be known to prevent the overwhelming of the health system during coronavirus disease 2019 era. Even though the length of hospital stay could vary due to different factors, the factors that affect the stay are not well characterized yet, particularly in the resource-limited settings. Knowing the time spent by the coronavirus disease 2019 patients in the hospital and its associated factors are important to prioritize mobilizing resources, such as beds, pharmacological and non-pharmacological supplies, and health personnel. Therefore, this study was intended to determine the median and identify factors associated with the length of hospital stay among coronavirus disease 2019 cases. METHODS A facility-based cross-sectional study design was implemented on 394 randomly selected hospitalized patients. Epidata Version 3.1 software was used for data entry, and further analysis was done using Stata version 14.2 software. Frequencies, median with interquartile range, and chi-square test were performed. A logistic regression model was used to identify the association between outcome and explanatory variables. The statistical significance was declared at p-value of less than 0.05 at 95% confidence interval. RESULTS The analysis was done for a total of 394 cases admitted for coronavirus disease 2019. The median age of the study participants was 40 years with interquartile range of 28-60 years. The median length of hospital stay was 12 days with the interquartile range of 8-17 days. The patients presented with shortness of breathing (AOR = 2.74, 95% confidence interval: 1.33-5.66), incident organ failure (AOR = 3.65, 95% confidence interval: 1.15-11.58), increased leukocyte count (AOR = 0.95; 95% confidence interval: 0.91-0.99), and blood urea nitrogen (AOR = 0.98, 95% confidence interval: 0.97-0.99) had a significant association with prolonged hospital stay. CONCLUSION This study demonstrated that the proportion of patients stayed above the median hospital stay of the total patients was 185 (46.9%) with the median length of 12 (interquartile range = 8-17) days. Patients presented with difficulty of breathing, had incident organ failure, had decreased leukocyte, and blood urea nitrogen level should be estimated to stay longer in the hospital. Hence, patients with prolonged hospital length of stay associating factors should be expected to consume more pharmacological and non-pharmacological resources during hospital care receiving.
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Affiliation(s)
- Abdi Birhanu
- School of Medicine, College of Health
and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of
Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of
Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of
Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of
Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of
Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Suryawanshi SY, Priya S, Sinha SS, Soni S, Haidry N, Verma S, Singh S. Dynamic profile and clinical implications of hematological and immunological parameters in COVID-19 patients. A retrospective study. J Family Med Prim Care 2021; 10:2518-2523. [PMID: 34568129 PMCID: PMC8415668 DOI: 10.4103/jfmpc.jfmpc_2400_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ever since the World Health Organization (WHO) announced the SARS-CoV-2 or nCOVID-19 infection (a pandemic), continuous spread of the virus has been observed which has continuously seen to affect and kill multitudes of individuals all over the world. An understanding of the pathophysiology of this disease is necessary for an effective treatment. Laboratory investigations play an important role in the diagnosis as well as treatment of this infectious disease. Hematological parameters demonstrate alterations during the progression of nCOVID-19 infection. Of these, many are indicative of extremely poor clinical outcome. Hematological findings like leukopenia, lymphopenia, thrombocytopenia and coagulation-related abnormalities are the most common manifestations. The aim of this study was to assess the dynamic profile and clinical implications of hematological and immunological parameters among nCOVID-19 infections. MATERIALS AND METHODS This retrospective study was designed after categorizing patients suffering from COVID-19 into three groups: (a) Group I; (b) Group II and (c) Group III or severe critical patients. Hematological and immunological parameters of neutrophilic and white blood cell counts, d-dimer levels, hemoglobin levels, immunoglobulin G (IgG) and M (IgM) levels and interleukin-6 (IL-6) levels were assessed. Statistical analysis using Kruskal-Wallis test was used. RESULTS Normal white blood cell and neutrophil count among COVID-19 patients was seen. However, median values in Group II (P < 0.01) and Group III (P < 0.0001) were found to show significantly higher values when compared to Group I. A significant (P < 0.01) decrease in lymphocytic counts was found among severe and critical patients. Hemoglobin level was found to demonstrate higher decrease (P < 0.01) among severe and critical patients. Platelet count was found in normal range in all COVID-19 patients. Routine coagulation tests revealed increased fibrinogen (P < 0.01) and d-dimer levels (P < 0.0001) in severe and critical patients. Normal proportions of total CD3+ and CD4 + T lymphocytes were observed in COVID-19. However, CD8 + T lymphocytes proportion was found to be decreased (P-value < 0.05). Immunoglobulin G levels among Groups II and III patients were found to be lower when compared with Group I (P < 0.001). No statistical significance was observed between the groups in IgM levels. Plasma IL-6 levels were found to show progressive rise among Groups II and III patients (P < 0.05). CONCLUSION Analysis of hematological and immunological parameters profiles in COVID-19 patients may help in deciphering the clinical progression of patients suffering from COVID-19 disease. Thus, regular monitoring of the hospitalized patients may help in planning the management of these cases.
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Affiliation(s)
| | - Shrishtee Priya
- Department of Conservative Dentistry and Endodontics, Hazaribag College of Dental Sciences, Hazaribagh, Demotand, Jharkhand, India
| | - Sandarbh Saumya Sinha
- Department of Oral and Maxillofacial Surgery, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
| | - Srinath Soni
- Department of Prosthodontics, Crown and Bridge and Implantology, Patna Dental College and Hospital, Patna, India
| | - Naqoosh Haidry
- Department of Oral and Maxillofacial Surgery, Patna Dental College and Hospital, Patna, India
| | - Shilpi Verma
- MDS Prosthodontics Crown and Bridge, Private Practitioner, Dental Clinic FF13 Luv Kush Tower, Patna, India
| | - Supriya Singh
- Senior Resident Department of Community Medicine, Private Practitioner, New Delhi, India
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