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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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Pérez-Tanoira R, Lledó García L, Torralba González de Suso M, Rodríguez Zapata M, Arroyo Serrano T, Giménez Pardo C, Rodríguez Pedrosa MI, Romero Badía MN, Pérez-García F, González López P, Villaescusa García C, Cuadros González J. High Seroprevalence Against SARS-CoV-2 Among Faculty of Medicine and Health Sciences Personnel and Students of the University of Alcalá, Spain: Contributing Factors. Int J Gen Med 2021; 14:7017-7024. [PMID: 34707393 PMCID: PMC8544125 DOI: 10.2147/ijgm.s332803] [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: 08/05/2021] [Accepted: 09/28/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose Seroprevalence against SARS-CoV-2 within university systems is poorly studied, making evidence-based discussions of educational system reopening difficult. Moreover, few studies evaluate how antibodies against SARS-CoV-2 are maintained over time. We assessed serological response against the SARS-CoV-2 virus among our university students and staff. Patients and Methods In this prospective cohort study, seroprevalence was determined in 705 randomly selected volunteers, members of the Faculty of Medicine and Health Sciences of the University of Alcalá, using a chemiluminescent Siemens' SARS-CoV-2 immunoassay for total antibodies. Positive samples were tested for IgG and IgM/IgA using VIRCLIA® MONOTEST (Vircell). A first analysis took place during June 2020, and in those testing positive, a determination of secondary outcomes was performed in November 2020. Results A total of 130 subjects showed anti-SARS-CoV-2 antibodies (18.5%, 95% CI, 15.8-21.5%). Of these, IgM/IgA was positive in 27 and indeterminate in 19; IgG was positive in 118, indeterminate in 1. After 23 weeks, among 102 volunteers remeasured, IgG became undetectable in 6. Presence of antibodies was associated, in multivariable logistic regression, with exposure to infected patients (31.3%) [OR 1.84, 95% CI, 1.14-2.96; P = 0.012], presence of COVID-19 symptoms (52.4%) [OR 6.88, 95% CI, 4.28-11.06; P < 0.001], and confirmed earlier infection (82.9%) [OR 11.87, 95% CI, 4.26-33.07; P < 0.001]. Conclusions The faculty of medicine and health sciences personnel and students of our university showed a high infection rate for SARS-CoV-2 during 2020 associated with providing clinical care to infected patients. This emphasizes the importance of the performance of continuous surveillance methods of the most exposed health personnel, including health science students.
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Affiliation(s)
- Ramón Pérez-Tanoira
- Department of Biomedicine and Biotechnology, Alcalá University, Alcalá de Henares, Madrid, Spain.,Department of Clinical Microbiology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Lourdes Lledó García
- Department of Biomedicine and Biotechnology, Alcalá University, Alcalá de Henares, Madrid, Spain
| | - Miguel Torralba González de Suso
- Unidad de Apoyo a Investigación de la Gerencia Integrada de Guadalajara, Guadalajara, Castilla-La Mancha, Spain.,Department of Medicine and Medical Specialties, Alcalá University, Guadalajara, Castilla-La Mancha, Spain
| | - Manuel Rodríguez Zapata
- Department of Medicine and Medical Specialties, Alcalá University, Guadalajara, Castilla-La Mancha, Spain
| | - Teresa Arroyo Serrano
- Department of Clinical Microbiology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Consuelo Giménez Pardo
- Department of Biomedicine and Biotechnology, Alcalá University, Alcalá de Henares, Madrid, Spain
| | | | | | - Felipe Pérez-García
- Department of Biomedicine and Biotechnology, Alcalá University, Alcalá de Henares, Madrid, Spain.,Department of Clinical Microbiology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - Juan Cuadros González
- Department of Biomedicine and Biotechnology, Alcalá University, Alcalá de Henares, Madrid, Spain.,Department of Clinical Microbiology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Feng YF, Wang KP, Mo JG, Xu YH, Wang LZ, Jin C, Chen X, Yi B. The spatiotemporal trend of renal involvement in COVID-19: A pooled analysis of 17 134 patients. Int J Infect Dis 2021; 106:281-288. [PMID: 33823283 PMCID: PMC8019246 DOI: 10.1016/j.ijid.2021.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The spatiotemporal trend of renal involvement in coronavirus disease 2019 (COVID-19) patients is still unclear. Therefore, the aim of this study was to reveal the dynamics of renal involvement superimposed COVID-19 according to time and space. METHODS COVID-19 patients reporting renal involvement were included in this study. The following information was collected from relevant articles: first author, patient demographics, patient enrollment period, location, definition of acute kidney injury (AKI), prevalence of AKI, and use of renal replacement therapy (RRT). RESULTS A total of 17 134 patients were finally included. The overall prevalence of AKI in COVID-19 patients was 19%, with 7% of them undergoing RRT. The overall risk of AKI in patients enrolled before March 1, 2020 (9%) was significantly lower than that after March 1, 2020 (36%) (P < 0.00001). Moreover, the overall risk of AKI outside Asia (35%) was significantly higher than that in Asia (10%) (P < 0.00001). Additionally, similar to patients requiring RRT, AKI patients were more likely to become seriously ill or even to die (P < 0.00001). CONCLUSIONS This study found that renal involvement superimposed COVID-19, a comorbidity portending a poor prognosis, has become an increasingly serious problem over time and is more common outside Asia. Thus, more attention should be paid to the management of this specific group of patients.
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Affiliation(s)
- Yi-Fu Feng
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Kun-Peng Wang
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Jing-Gang Mo
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Ying-He Xu
- Department of Intensive Care Unit, Taizhou Central Hospital, Taizhou 318000, China
| | - Lie-Zhi Wang
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital, Taizhou 318000, China
| | - Xiang Chen
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China; Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Hepatobiliary and Pancreatic Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Bin Yi
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Cardiothoracic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
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Toloui A, Moshrefiaraghi D, Madani Neishaboori A, Yousefifard M, Haji Aghajani M. Cardiac Complications and Pertaining Mortality Rate in COVID-19 Patients; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e18. [PMID: 33870205 PMCID: PMC8035700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Raising knowledge over cardiac complications and managing them can play a key role in their recovery. In this study, we aim to investigate the evidence regarding the prevalence of cardiac complications and the resulting mortality rate in COVID-19 patients. METHOD Search was conducted in electronic databases of Medline (using PubMed), Embase, Scopus, and Web of Science, in addition to the manual search in preprint databases, and Google and Google scholar search engines, for articles published from 2019 until April 30th, 2020. Inclusion criterion was reviewing and reporting cardiac complications in patients with confirmed COVID-19. RESULTS The initial search resulted in 853 records, out of which 40 articles were included. Overall analysis showed that the prevalence of acute cardiac injury, heart failure and cardiac arrest were 19.46% (95% CI: 18.23-20.72), 19.07% (95% CI: 15.38-23.04) and 3.44% (95% CI: 3.08-3.82), respectively. Moreover, abnormal serum troponin level was observed in 22.86% (95% CI: 21.19-24.56) of the COVID-19 patients. Further analysis revealed that the overall odds of mortality is 14.24 (95% CI: 8.67-23.38) times higher when patients develop acute cardiac injury. The pooled odds ratio of mortality when the analysis was limited to abnormal serum troponin level was 19.03 (95% CI: 11.85-30.56). CONCLUSION Acute cardiac injury and abnormal serum troponin level were the most prevalent cardiac complications/abnormalities in COVID-19 patients. The importance of cardiac complications is emphasized due to the higher mortality rate among patients with these complications. Thus, troponin screenings and cardiac evaluations are recommended to be performed in routine patient assessments.
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Affiliation(s)
- Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haji Aghajani
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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