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Gandhi R, Kalsariya V, Katara R, Murugan Y. Sarcopenia, Eosinophil-to-Platelet Ratio, and C-reactive Protein as Predictors of Adverse Events in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study. Cureus 2024; 16:e56651. [PMID: 38646255 PMCID: PMC11032177 DOI: 10.7759/cureus.56651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Biomarkers such as sarcopenia, eosinopenia, and C-reactive protein (CRP) may predict adverse events in chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to determine their prognostic utility and accuracy versus conventional measures. METHODS This was a prospective analysis of COPD patients hospitalized for acute exacerbations for more than one year. Patients with primary diagnoses other than COPD were excluded. A total of 200 participants were screened, and 50 experienced adverse events, including mortality, rehospitalization, prolonged stay, hypoxemia, or hypercapnia. Data on demographics, lung function, symptoms, nutrition, frailty, sarcopenia, the eosinophil-to-platelet ratio (EPR), and CRP were extracted. Differences between groups were analyzed using t-tests and regression modeling. RESULTS Elevated CRP and a low EPR were significant predictors of adverse events after adjustment, with CRP having an area under the curve (AUC) of 0.71 (0.64-0.80) and EPR having an AUC of 0.76 (0.61-0.79) for composite outcomes. According to the multivariate logistic regression analysis, sarcopenia (adjusted Or (aOR)-1.97 (1.87-4.44)), EPR (aOR-2.33 (1.02-5.32)), and CRP (aOR-2.09 (1.01-3.18)) remained significant. CONCLUSION The EPR and CRP levels are useful prognostic markers of in-hospital morbidity and mortality during COPD exacerbations. However, multidimensional assessments incorporating other treatable traits may further optimize risk prediction and reduce adverse outcomes.
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Affiliation(s)
- Rohankumar Gandhi
- Community and Family Medicine, Guru Gobindsingh Government Hospital, Jamnagar, IND
| | - Vijay Kalsariya
- Pulmonary Medicine, Guru Gobindsingh Government Hospital, Jamnagar, IND
| | - Roshan Katara
- Pulmonary Medicine, Guru Gobindsingh Government Hospital, Jamnagar, IND
| | - Yogesh Murugan
- Family Medicine, Guru Gobindsingh Government Hospital, Jamnagar, IND
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2
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Sarı E, Erdede Ö. Comparison of Eosinophil Counts in Inflammatory Conditions: Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Infectious Mononucleosis. Children (Basel) 2024; 11:204. [PMID: 38397316 PMCID: PMC10887273 DOI: 10.3390/children11020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
This study examined the distinctions between multisystem inflammatory syndrome associated with coronavirus disease 2019, Kawasaki disease, and infectious mononucleosis. These three inflammatory disorders have commonalities according to clinical and laboratory results, particularly in relation to eosinophil levels. In this retrospective, single-center study, we documented the examination records (acute phase reactants and complete blood count) and clinical and cardiological findings of 130 patients diagnosed with multisystem inflammatory syndrome, Kawasaki disease, and infectious mononucleosis. These patients were treated and received follow-up care in our hospital from March 12, 2020, to September 13, 2022, as per the hospital records. Statistical analyses were performed using NCSS 2007, version 1 software. Eosinopenia was more prevalent in children with multisystem inflammatory syndrome than in those with Kawasaki disease, who showed normal or elevated eosinophil counts. The eosinophil counts in patients with infectious mononucleosis typically fell within the normal range. Our study found no correlation between the eosinophil counts and cardiac involvement in pediatric patients with either condition. These findings indicate a higher prevalence of eosinopenia in patients with multisystem inflammatory syndrome, irrespective of cardiac involvement, than in those with Kawasaki disease. Despite similarities in clinical findings, Kawasaki disease and multisystem inflammatory syndrome in children necessitate further studies for distinct characteristic elucidation.
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Affiliation(s)
- Erdal Sarı
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, Istanbul 34668, Turkey;
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3
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Wang X, Dian Y, Zhou Q, Deng G, Wei R, Zeng F. Association of eosinopenia with worsening prognosis in hospitalized Azvudine-treated COVID-19 patients: a retrospective cohort study. Front Immunol 2023; 14:1320973. [PMID: 38162638 PMCID: PMC10754985 DOI: 10.3389/fimmu.2023.1320973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background Current guidelines prioritize the use of Azvudine in Coronavirus Disease 2019 (COVID-19) patients, while biomarkers for prognosis in Azvudine-treated COVID-19 patients are still lacking. Here, we aim to assess the prognostic value of eosinopenia in Azvudine-treated COVID-19 patients. Methods We retrospectively reviewed 290 consecutive Azvudine-treated hospitalized COVID-19 patients. Clinical characteristics and prognosis data were analyzed between patients with eosinopenia and with normal eosinophil levels. Results A total of 290 patients were enrolled in this study, with a median age of 69 years. Among them, 40.69% presented with eosinopenia and 59.31% had normal eosinophil levels. Common symptoms included cough (87.6%), expectoration (76.2%), fever (67.9%), poor appetite (47.2%), and polypnea (46.6%). Compared to patients with normal eosinophil levels, those with eosinopenia were older and less likely to experience fatigue (25.4% vs. 39.0%, P=0.016). Significant differences in laboratory parameters, particularly in blood routine and blood biochemical indicators, were observed between the two groups. Patients with eosinopenia were also less likely to develop severe illness subtypes, requiring more medication and oxygen support. The Cox proportional hazard model showed that eosinopenia was associated with worsening progression in Azvudine-treated COVID-19 patients (adjusted hazard ratio=2.79, 95% confidence interval: 1.04, 7.50), adjusting for potential confounders. Conclusion Eosinopenia is associated with worsening prognosis in Azvudine-treated COVID-19 patients.
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Affiliation(s)
- Xiaomin Wang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yating Dian
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Qian Zhou
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Guangtong Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- Furong Laboratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Furong Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
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Gambichler T, Schuleit N, Susok L, Becker JC, Scheel CH, Torres-Reyes C, Overheu O, Reinacher-Schick A, Schmidt W. Prognostic Performance of Inflammatory Biomarkers Based on Complete Blood Counts in COVID-19 Patients. Viruses 2023; 15:1920. [PMID: 37766326 PMCID: PMC10536301 DOI: 10.3390/v15091920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
With the end of the pandemic, COVID-19 has entered an endemic phase with expected seasonal spikes. Consequently, the implementation of easily accessible prognostic biomarkers for patients with COVID-19 remains an important area of research. In this monocentric study at a German tertiary care hospital, we determined the prognostic performance of different clinical and blood-based parameters in 412 COVID-19 patients. We evaluated the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and absolute eosinopenia (AEP, 0/µL) of COVID-19 patients (n = 412). The Siddiqui and Mehra staging proposal, the WHO clinical progression scale, and COVID-19-associated death were used as COVID-19 outcome measures. With respect to Siddiqi and Mehra staging, patient age of older than 75 years, high C-reactive protein (CRP), absolute eosinopenia (AEP), cardiovascular comorbidities, and high ferritin were significant independent predictors for severe COVID-19. When outcome was determined according to the WHO clinical progression scale, patient age of older than 75 years, high CRP, high LDH, AEP, high neutrophil-to-lymphocyte ratio (NLR), and the presence of pulmonal comorbidities were significant independent predictors for severe COVID-19. Finally, COVID-19-associated death was predicted independently by patient age of older than 75 years, high LDH, high NLR, and AEP. Eosinopenia (< 40/µL) was observed in 74.5% of patients, and AEP in almost 45%. In conclusion, the present real-world data indicate that the NLR is superior to more complex systemic immune-inflammation biomarkers (e.g., SII and PIV) in COVID-19 prognostication. A decreased eosinophil count emerged as a potential hallmark of COVID-19 infection, whereas AEP turned out to be an accessible independent biomarker for COVID-19 severity and mortality.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University, 44791 Bochum, Germany
- Department of Dermatology, Christian Hospital Unna, 59423 Unna, Germany
| | - Nadine Schuleit
- Department of Dermatology, Ruhr-University, 44791 Bochum, Germany
| | - Laura Susok
- Department of Dermatology, Ruhr-University, 44791 Bochum, Germany
- Department of Dermatology, Klinikum Dortmund gGmbH, 44137 Dortmund, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, 45122 Essen, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | | | - Oliver Overheu
- Department of Internal Medicine, Ruhr-University Bochum, 44791 Bochum, Germany
- Department of Hematology and Oncology with Palliative Care, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Wolfgang Schmidt
- Department of Internal Medicine, Ruhr-University Bochum, 44791 Bochum, Germany
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Ito A, Ishida T, Nakanishi Y, Kobe H, Tokioka F. Eosinopenia is associated with adverse outcomes after COVID-19 infection: A perspective from Japan. Respirology 2023; 28:677-680. [PMID: 37105899 DOI: 10.1111/resp.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yosuke Nakanishi
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiroshi Kobe
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Chen H, Zhang H, Wen S, Xiu X, You D, Zhao H, Wang D, Yang Y, Shu Y. Mendelian randomization suggests a potential causal effect of eosinophil count on influenza vaccination responsiveness. J Med Virol 2023; 95:e28394. [PMID: 36495182 DOI: 10.1002/jmv.28394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/21/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Currently, the clinical factors affecting immune responses to influenza vaccines have not been systematically explored. The mechanism of low responsiveness to influenza vaccination (LRIV) is complicated and not thoroughly elucidated. Thus, we integrate our in-house genome-wide association studies (GWAS) analysis result of LRIV (N = 111, Ncase [Low Responders] = 34, Ncontrol [Responders] = 77) with the GWAS summary of 10 blood-based biomarkers (sample size ranging from 62 076-108 794) deposited in BioBank Japan (BBJ) to comprehensively explore the shared genetics between LRIV and blood-based biomarkers to investigate the causal relationships between blood-based biomarkers and LRIV by Mendelian randomization (MR). The applications of four MR approaches (inverse-variance-weighted [IVW], weighted median, weighted mode, and generalized summary-data-based MR [GSMR]) suggested that the genetically instrumented LRIV was associated with decreased eosinophil count (β = -5.517 to -4.422, p = 0.004-0.039). Finally, we conclude that the low level of eosinophil count is a suggestive risk factor for LRIV.
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Affiliation(s)
- Hongwei Chen
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Haoyang Zhang
- Department of Pediatric laboratory, Wuxi Children's Hospital Affiliated to Jiangnan University, Wuxi, Jiangsu, People's Republic of China.,School of Data and Computer Science, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Simin Wen
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, People's Republic of China.,Guangzhou First People's Hospital, Guangzhou, People's Republic of China
| | - Xuehao Xiu
- Department of Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Danming You
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huiying Zhao
- Department of Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Dayan Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yuedong Yang
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuelong Shu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, People's Republic of China.,Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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Cauchois R, Pietri L, Dalmas JB, Koubi M, Capron T, Cassir N, Potere N, Polidoro I, Jean R, Jarrot PA, Andre B, Veit V, Carvelli J, Pauly V, Chanez P, Papazian L, Kaplanski G. Eosinopenia as Predictor of Poor Outcome in Hospitalized COVID-19 Adult Patients from Waves 1 and 2 of 2020 Pandemic. Microorganisms 2022; 10. [PMID: 36557676 DOI: 10.3390/microorganisms10122423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
During SARS-CoV-2 infection, eosinopenia may reflect a hyperactive immune response. In this study of hospitalized COVID-19 patients, we aimed to better understand the prognostic value of severe eosinopenia (absolute eosinophil count = 0 G/L) and decipher its underlying mechanisms. We retrospectively analyzed the records of COVID-19 patients hospitalized from March to June 2020 in three university hospitals in Marseille, France. We assessed the association between severe eosinopenia and a composite poor outcome in these patients, including the need for oxygen supplementation at >6 L/min, ICU admission, and in-hospital death. Among the 551 COVID-19 patients included in this study, severe eosinopenia was found in 228 (51%) of them on admission to hospital and was associated with a composite poor outcome using multivariate analysis (OR = 2.58; CI95 [1.77−3.75]; p < 0.0001). We found a significant association between the presence of severe eosinopenia on admission and the elevation in C-reactive protein, ferritin, IP-10, and suPAR. The histological findings in a series of 37 autopsies from patients who died from severe COVID-19 and presented with severe eosinopenia showed no pulmonary eosinophil trapping. Severe eosinopenia can be a reliable biomarker associated with a composite poor outcome in hospitalized COVID-19 adult patients. It may reflect the magnitude of immune hyperactivation during severe-to-critical COVID-19.
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de Vries MP, Mohammadnia N, Simsek S, Schoorl M. Eosinopenia and increased markers of endothelial damage are characteristic of COVID-19 infection at time of hospital admission. Scand J Clin Lab Invest 2022; 82:290-295. [PMID: 35621384 DOI: 10.1080/00365513.2022.2079095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In December 2019, a new virus has been discovered, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to coronavirus disease 2019 (COVID-19). COVID-19 has been defined as an evolving disease with different phases. It starts with a mild or asymptomatic phase in which there is minimal disease. Thereafter, most patients recover, however, in 20% of the cases the infection worsens. It is hypothesized that eosinopenia, endothelial injury and the presence of smooth muscle autoantibodies are associated with the severity of the COVID-19. In a subset of 75 blood samples of patients with a SARS-CoV-2 infection at time of hospitalization and 30 healthy control samples concentrations of eosinophils, VEGF, VCAM, endothelin and smooth muscle autoantibodies were determined with hemocytometry, ELISA and immunofluorescence assays. In the group of patients with COVID-19 eosinophils (IQR = 0.0-0.01*109/L) were significantly decreased (p < .001), whereas markers of endothelial damage VCAM (IQR = 740-1120 ng/mL) and endothelin (IQR = 2.0-3.4 pg/mL) were significantly increased (p < .001) compared to the group of healthy controls (eosinophils IQR = 0.09-0.19*109/L, VCAM IQR = 362-561 ng/mL, endothelin IQR = 0.5-1.0 pg/mL). From the multivariate analysis, it is concluded that at time of hospitalization a combination of eosinopenia and increased markers of endothelial damage VCAM and endothelin are characteristic of COVID-19.
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Affiliation(s)
- Marouscha P de Vries
- Department of Clinical Chemistry, Haematology and Immunology, Northwest Clinics, Alkmaar, Netherlands
| | - Nieky Mohammadnia
- Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands
| | - Marianne Schoorl
- Department of Clinical Chemistry, Haematology and Immunology, Northwest Clinics, Alkmaar, Netherlands
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Mao Y, Qian Y, Sun X, Li N, Huang H. Eosinopenia Predicting Long-term Mortality in Hospitalized Acute Exacerbation of COPD Patients with Community-acquired Pneumonia-A Retrospective Analysis. Int J Chron Obstruct Pulmon Dis 2022; 16:3551-3559. [PMID: 35002227 PMCID: PMC8722564 DOI: 10.2147/copd.s347948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) could be triggered by community-acquired pneumonia (CAP). Peripheral blood eosinopenia are strongly associated with increased mortality. In hospitalized AECOPD patients with CAP, eosinopenia may be used to identify patients with high risk of death on admission. Methods We conducted a retrospective cohort study in 82 hospitalized AECOPD patients with CAP. Patients who had received systemic corticosteroids preadmission were excluded. The patients were identified by individual case file review. According to blood eosinophil count, patients were grouped as eosinopenia (<50/μL) and non-eosinopenia (≥50/μL). Association of eosinopenia with infection and 18-month survival were analyzed using appropriate statistical methods. Results Baseline demographic, comorbidity, CURB65 and Pneumonia Severity Index scores were similar between two groups. The eosinopenia group had significantly higher pro-brain natriuretic peptide, D-dimer, neutrophil percentage, and lower lymphocyte count and lymphocyte percentage. The eosinopenia group had significantly higher C-reactive protein (median 77.30 vs 16.55, p=0.008) and procalcitonin (median 0.32 vs 0.12, p=0.001). Survival at 18 months after hospital discharge was significantly lower in the eosinopenia group vs non-eosinopenia group (log rank, p=0.002). Conclusion Eosinopenia (<50/μL) was a strong predictor of 18-month mortality and associated with more severe infection in hospitalized AECOPD patients with CAP. Eosinophil count at admission can be used as a prognosis marker of mortality in those population.
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Affiliation(s)
- Yanxiong Mao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yuanyuan Qian
- Department of Respiratory and Critical Care Medicine, Haining People's Hospital, Haining Branch, The First Affiliated Hospital, Zhejiang University, Haining, Zhejiang, People's Republic of China
| | - Xiaoyan Sun
- Department of Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Na Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Huaqiong Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
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De Filippo M, Magri P, Bossi G, Brambilla I, Castagnoli R, Mascolo A, Votto M, Licari A, Marseglia GL. Clinical and Epidemiological Features of Pediatric Patients with COVID-19 in a Tertiary Pediatric Hospital. Acta Biomed 2022; 93:e2022039. [PMID: 35666116 PMCID: PMC9494185 DOI: 10.23750/abm.v93is3.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) affects people of any age with high mortality and morbidity in adults older than 65 years. Reports on pediatric cases highlighted those children generally develop milder symptoms than adults or are asymptomatic. We aimed to assess the epidemiological and clinical data of children and adolescents with SARS-CoV-2 infection to improve pediatric COVID-19. METHODS We retrospectively analyzed clinical and epidemiological features of patients with SARS-CoV-2 infection hospitalized at the Pediatric Hospital of Pavia, Italy, between February 1, 2020, to April 30, 2021. RESULTS 71 patients aged 0-16 years were included; 33 (46%) females and 38 (54 %) males. Thirty-three (46%) patients had comorbidities, such as obesity and hematological diseases. Thirty-one children (44%) were exposed to COVID-19-positive household members. Nine (12.7 %) patients were asymptomatic, whereas 57 (80.3%) had a mild-moderate disease. Only five (7%) showed a severe or critical disease, and two patients required ICU admission. The most frequent symptoms were fever (76%), loss of appetite (26%), gastrointestinal symptoms (19%), and cough (19%). Chest X-ray was performed in 42 patients showing lung abnormalities in more than half of symptomatic patients. The most common laboratory features were lymphopenia and eosinopenia associated with high levels of inflammation markers. CONCLUSIONS This study confirmed that COVID-19 has a mild course in children compared to adults. Most of the enrolled children were asymptomatic or had a mild-moderate disease. Patients with comorbidities were more prone to develop clinical complications.
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Affiliation(s)
- Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Paola Magri
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Grazia Bossi
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Mascolo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Valverde-Monge M, Cañas JA, Barroso B, Betancor D, Ortega-Martin L, Gómez-López A, Rodríguez-Nieto MJ, Mahíllo-Fernández I, Sastre J, Del Pozo V. Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients. Front Immunol 2021; 12:668074. [PMID: 34149705 PMCID: PMC8208034 DOI: 10.3389/fimmu.2021.668074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Studies on the role of eosinophils in coronavirus disease 2019 (COVID-19) are scarce, though available findings suggest a possible association with disease severity. Our study analyzes the relationship between eosinophils and COVID-19, with a focus on disease severity and patients with underlying chronic respiratory diseases. METHODS We performed a retrospective analysis of 3018 subjects attended at two public hospitals in Madrid (Spain) with PCR-confirmed SARS-CoV-2 infection from January 31 to April 17, 2020. Patients with eosinophil counts less than 0.02×109/L were considered to have eosinopenia. Individuals with chronic respiratory diseases (n=384) were classified according to their particular underlying condition, i.e., asthma, chronic pulmonary obstructive disease, or obstructive sleep apnea. RESULTS Of the 3018 patients enrolled, 479 were excluded because of lack of information at the time of admission. Of 2539 subjects assessed, 1396 patients presented an eosinophil count performed on admission, revealing eosinopenia in 376 cases (26.93%). Eosinopenia on admission was associated with a higher risk of intensive care unit (ICU) or respiratory intensive care unit (RICU) admission (OR:2.21; 95%CI:1.42-3.45; p<0.001) but no increased risk of mortality (p>0.05). CONCLUSIONS Eosinopenia on admission conferred a higher risk of severe disease (requiring ICU/RICU care), but was not associated with increased mortality. In patients with chronic respiratory diseases who develop COVID-19, age seems to be the main risk factor for progression to severe disease or death.
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Affiliation(s)
| | - José A. Cañas
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Blanca Barroso
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Diana Betancor
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Alicia Gómez-López
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Jesús Rodríguez-Nieto
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pulmonology Unit, Hospital Universitario Fundación Jiménez Díaz and Hospital General de Villalba, Madrid, Spain
| | - Ignacio Mahíllo-Fernández
- Epidemiology and Biostatistics Unit, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Joaquín Sastre
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria Del Pozo
- Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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van Duijnhoven HLP, Leuvenink J, Keuren JFW. Original article: Soni M. Evaluation of eosinopenia as a diagnostic and prognostic indicator in COVID-19 infection. Int J Lab Hematol. 2020;00:1-5. https://doi.org/10.1111/ijlh.13425. Int J Lab Hematol 2021; 43:e287-e289. [PMID: 33973723 PMCID: PMC8239607 DOI: 10.1111/ijlh.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Hans L P van Duijnhoven
- Department of Clinical Chemistry and Hematology, Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - Jacqueline Leuvenink
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Jeffrey F W Keuren
- Department of Clinical Chemistry and Hematology, Sint Jans Gasthuis, Weert, The Netherlands.,Department of Clinical Chemistry and Hematology, Diagnostiek voor U, Eindhoven, The Netherlands
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Soni M. Original Article: Evaluation of eosinopenia as a diagnostic and prognostic indicator in COVID-19 infection. Int J Lab Hematol 2021; 43:e303. [PMID: 33973726 PMCID: PMC8239698 DOI: 10.1111/ijlh.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 12/03/2022]
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14
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Al Duhailib Z, Farooqi M, Piticaru J, Alhazzani W, Nair P. The role of eosinophils in sepsis and acute respiratory distress syndrome: a scoping review. Can J Anaesth 2021; 68:715-726. [PMID: 33495945 PMCID: PMC7833890 DOI: 10.1007/s12630-021-01920-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Septic shock and acute respiratory distress syndrome (ARDS) are characterized by a dysregulated immune host response that may respond to steroid therapy. Eosinophils contribute to type 2 inflammation that often responds to steroid therapy; their role in immune dysregulation and outcomes in sepsis and ARDS is unclear. SOURCE A systematic search of Cochrane Library, MEDLINE, and EMBASE was performed from inception to 9 September 2020. The search comprised the following terms: eosinophils, sepsis, septic shock, and ARDS. Two reviewers independently screened abstracts and texts and extracted data on disease severity and clinical outcomes. PRINCIPAL FINDINGS Thirty-nine studies were identified: 30 evaluated serum eosinophil count in sepsis, one evaluated eosinophil activity in sepsis, three assessed bronchoalveolar lavage (BAL) eosinophil count in ARDS, four assessed eosinophil activity in ARDS, and one assessed peripheral eosinophil count in ARDS. Eleven studies showed an association between eosinopenia and sepsis, and eight studies found persistent eosinopenia at > 48 hr of intensive care unit admission to predict mortality and readmission in septic patients. Three studies found BAL eosinophil count to be low in ARDS, although one found that levels rose in late-phase ARDS. Three studies found eosinophil activity markers in BAL to be high in ARDS and correlate with ARDS severity. CONCLUSION Persistent peripheral eosinopenia is a marker of bacterial sepsis and is independently associated with poor outcomes. Bronchoalveolar lavage eosinophil counts are low in early-phase ARDS, but increase in late-phase ARDS, while elevated markers of eosinophil activity correlate with ARDS severity. Further studies understanding the mechanisms leading to eosinopenia in sepsis and increased eosinophil activity in ARDS are needed.
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Affiliation(s)
- Zainab Al Duhailib
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
| | - Malik Farooqi
- Department of Medicine, Division of Respirology, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
| | - Joshua Piticaru
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Parameswaran Nair
- Department of Medicine, Division of Respirology, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
- Corresponding Author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37134 Verona, Italy, Tel. +39-045-8124308, Fax. +39-045-8122970,
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Brandon M Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Ohio, USA
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Affiliation(s)
- Elena Roca
- COVID-19 Unit, Departmental Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
- Corresponding Author: Elena Roca MD, Covid-19 Unit, Head and Neck Department, Poliambulanza Fundation Hospital, Via Leonida Bissolati, 57, 25124 Brescia, Brescia (Italy), Phone: +39 3393667949, e-mail:
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Costanza M Zattra
- COVID-19 Unit, Departmental Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Carlo Lombardi
- COVID-19 Unit & Departmental Unit of Pneumology & Allergology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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Le Borgne P, Abensur Vuillaume L, Alamé K, Lefebvre F, Chabrier S, Bérard L, Haessler P, Gennai S, Bilbault P, Lavoignet CE. Do Blood Eosinophils Predict in-Hospital Mortality or Severity of Disease in SARS-CoV-2 Infection? A Retrospective Multicenter Study. Microorganisms 2021; 9:334. [PMID: 33567583 DOI: 10.3390/microorganisms9020334] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Healthcare systems worldwide have been battling the ongoing COVID-19 pandemic. Eosinophils are multifunctional leukocytes implicated in the pathogenesis of several inflammatory processes including viral infections. We focus our study on the prognostic value of eosinopenia as a marker of disease severity and mortality in COVID-19 patients. Methods: Between 1 March and 30 April 2020, we conducted a multicenter and retrospective study on a cohort of COVID-19 patients (moderate or severe disease) who were hospitalized after presenting to the emergency department (ED). We led our study in six major hospitals of northeast France, one of the outbreak’s epicenters in Europe. Results: We have collected data from 1035 patients, with a confirmed diagnosis of COVID-19. More than three quarters of them (76.2%) presented a moderate form of the disease, while the remaining quarter (23.8%) presented a severe form requiring admission to the intensive care unit (ICU). Mean circulating eosinophils rate, at admission, varied according to disease severity (p < 0.001), yet it did not differ between survivors and non-survivors (p = 0.306). Extreme eosinopenia (=0/mm3) was predictive of severity (aOR = 1.77, p = 0.009); however, it was not predictive of mortality (aOR = 0.892, p = 0.696). The areas under the Receiver operating characteristics (ROC) curve were, respectively, 58.5% (CI95%: 55.3–61.7%) and 51.4% (CI95%: 46.8–56.1%) for the ability of circulating eosinophil rates to predict disease severity and mortality. Conclusion: Eosinopenia is very common and often profound in cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Eosinopenia was not a useful predictor of mortality; however, undetectable eosinophils (=0/mm3) were predictive of disease severity during the initial ED management.
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Behera JR, Rup AR, Dash AK, Sahu SK, Gaurav A, Gupta A. Clinical and Laboratory Profile of Enteric Fever in Children From a Tertiary Care Centre in Odisha, Eastern India. Cureus 2021; 13:e12826. [PMID: 33633872 PMCID: PMC7899128 DOI: 10.7759/cureus.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Enteric fever is a major health problem in developing countries. Varied clinical presentation leads to diagnostic dilemmas resulting in fatal complications. Objective: To determine the socio-demographic, clinical manifestations, complications, antibiotic sensitivity pattern, treatment, and outcome in hospitalized enteric fever patients. Methods: A retrospective case record analysis of hospitalized patients in the age group one to 14 years with a discharge diagnosis of enteric fever was done in a tertiary care centre of Odisha over a period of three years (January 2017 to December 2019). Results: Of 112 patients, 75% of children belonged to the six to 14 years age group with a mean age of 7.6 +/- 3.6 years and a male to female ratio of 1.66:1. The peak of cases was seen during the month of January to June with 94% of cases occurring in low and middle socioeconomic status. The commonest presentation was fever in 98.21%; other features were vomiting (39.29%), pain in abdomen (21.43%), diarrhoea (26.79%), and anorexia (14.29%). Eosinopenia was found in 58.93%, transaminitis in 30.36%, and raised CRP in 73.21%. In 30 children blood culture was positive with sensitivity to third-generation cephalosporin. All isolates were nalidixic acid-resistant Salmonella Typhi (NARST). Complications were seen in 21.42%. All recovered and two left against medical advice. Conclusion: Enteric fever is a major threat in the paediatric age group. Early clinical diagnosis with rational use of antibiotics according to sensitivity pattern is important. Improved hygiene, vaccination, and awareness among people is necessary for prevention.
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Affiliation(s)
| | - Amit R Rup
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Arun K Dash
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Abhinav Gaurav
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Abhas Gupta
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Soni M. Evaluation of eosinopenia as a diagnostic and prognostic indicator in COVID-19 infection. Int J Lab Hematol 2020; 43 Suppl 1:137-141. [PMID: 33289964 DOI: 10.1111/ijlh.13425] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Eosinopenia has been observed during infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. This study evaluated the role of eosinopenia as a diagnostic and prognostic indicator in COVID-19 infection. METHODS Information on 429 patients with confirmed COVID-19, admitted to Apollo Hospitals, Chennai, India between 04 June 2020 to 15 August 2020, was retrospectively collected through electronic records and analysed. RESULTS 79.25% of the patients included in the study had eosinopenia on admission. The median eosinophil count in COVID-19-positive patients was 0.015 × 109 /L, and in negative patients, it was 0.249 × 109 /L. Eighteen per cent of the positive patients presented with 0 eosinophil count. Eosinopenia for early diagnosis of COVID-19 had a sensitivity of 80.68% and specificity of 100% with an accuracy of 85.24. Role of eosinopenia in prognostication of COVID-19 was found to be insignificant. There was no statistically significant difference between the median eosinophil counts in survivors and nonsurvivors. Eosinophil trends during the course of disease were found to be similar between survivors and nonsurvivors. CONCLUSIONS Eosinopenia on admission is a reliable and convenient early diagnostic marker for COVID-19 infection, helping in early identification, triaging and isolation of the patients till nucleic acid test results are available. Role of eosinopenia as a prognostic indicator is insignificant.
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Affiliation(s)
- Mamta Soni
- Department of Hematology & Clinical Pathology, Apollo Hospital, Chennai, India
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Silva JM, Costa AM, Tuna C, Gonçalves R, Ferreira S, Belém F, Evangelista MC, Ascensão M. Eosinopenia as predictor of infection in patients admitted to an internal medicine ward: a cross-sectional study. Porto Biomed J 2020; 5:e084. [PMID: 33204891 DOI: 10.1097/j.pbj.0000000000000084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/15/2020] [Indexed: 01/21/2023] Open
Abstract
Supplemental Digital Content is available in the text Background: The identification of infection in an internal medicine ward is crucial but not always straightforward. Eosinopenia has been proposed as a marker of infection, but specific cutoffs for prediction are not established yet. We aim to assess whether there is difference in eosinophil count between infected and noninfected patients and, if so, the best cutoffs to differentiate them. Methods: Cross-sectional, observational study with analysis of all patients admitted to an Internal Medicine Department during 2 consecutive months. Clinical, laboratory and imaging data were analyzed. Infection at hospital admission was defined in the presence of either a microbiological isolation or suggestive clinical, laboratory, and/or imaging findings. Use of antibiotics in the 8 days before hospital admission, presence of immunosuppression, hematologic neoplasms, parasite, or fungal infections were exclusion criteria. In case of multiple hospital admissions, only the first admission was considered. Sensitivity and specificity values for eosinophils, leukocytes, neutrophils, and C-reactive protein were determined by receiver operating characteristic curve. Statistical analysis was performed with IBM SPSS Statistics® v25 and MedCalc Statistical Software® v19.2.3. Results: A total of 323 hospitalization episodes were evaluated, each corresponding to a different patient. One hundred fifteen patients were excluded. A total of 208 patients were included, 62.0% (n = 129) of them infected at admission. Ten patients had multiple infections. Infected patients had fewer eosinophils than uninfected patients (15.8 ± 42 vs 71.1 ± 159 cell/mm3; P < .001). An eosinophil count at admission ≤69 cell/mm3 had a sensitivity of 89.1% and specificity of 54.4% (area under the curve 0.752; 95% confidence interval 0.682–0.822) for the presence of infection. Eosinophil count of >77 cells/mm3 had a negative likelihood ratio of 0.16. Conclusions: Eosinophil count was significantly lower in infected than in uninfected patients. The cutoff 69 cells/mm3 was the most accurate in predicting infection. Eosinophil count >77 cells/mm3 was a good predictor of absence of infection.
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Abstract
Background and objectives Salmonella typhi is involved in one of the most prevalent infectious diseases of South East Asia, typhoid fever, but diagnostic tests cannot be performed regularly in developing countries. The objective of the study is to determine the association of eosinopenia with culture or serology-proven typhoid fever in patients, to determine the association of leukopenia with culture or serology-proven typhoid fever in patients and to determine independent predictors of eosinopenia. Methods This case-control study, done at Fauji Foundation Hospital, Pakistan, included patients with symptoms suggestive of typhoid fever, culture, or serology positive for typhoid fever and excluded patients who had been previously diagnosed with malaria and dengue hemorrhagic fever. After flagging cultures and serology, the records were viewed for leukocyte counts. Data, including age, gender, and clinical symptoms, were also recorded for analysis. Results Out of 200 participants, 59 participants with diagnosed typhoid fever had eosinopenia. There were 29 participants who had been diagnosed with typhoid fever via culture or serology and had leukopenia. Eosinopenia and leukopenia were more likely to be present in patients with a diagnosis of typhoid (OR: 9.60, 20.00). The independent predictors for eosinopenia were DOT enzyme immunoassay (DOT EIA) positive for Salmonella typhi, culture positive for Salmonella typhi and leukopenia (p<0.05). Conclusion The presence of eosinopenia and features or serology suggestive of typhoid would most likely be associated with cultures being positive and, therefore, might provide an efficient means to begin treatment.
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Affiliation(s)
- Uzma Ishaq
- Hematology and Medical Oncology, Fauji Foundation Hospital, Rawalpindi, PAK
| | - Jahanzeb Malik
- Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK
| | - Maliha Asif
- Pathology, Rahber Medical and Dental College, Lahore, PAK
| | - Hina Zaib
- Hematology, Ali Medical Center, Rawalpindi, PAK
| | - Iqbal Haider
- Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK
| | - Tayyaba Zahid
- Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK
| | | | - Umar Ikram
- Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
- Corresponding Author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37134 Verona, Italy, Tel. +39-045-8124308, Fax. +39-045-8122970,
| | - Brandon M Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Ohio, USA
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Jesenak M, Brndiarova M, Urbancikova I, Rennerova Z, Vojtkova J, Bobcakova A, Ostro R, Banovcin P. Immune Parameters and COVID-19 Infection - Associations With Clinical Severity and Disease Prognosis. Front Cell Infect Microbiol 2020; 10:364. [PMID: 32695683 PMCID: PMC7338601 DOI: 10.3389/fcimb.2020.00364] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/23/2022] Open
Abstract
Severe acute respiratory syndrome caused by a novel 2019 coronavirus (SARS-CoV2) represents one of the most studied infectious diseases of today. The number of scientific reports and publications increases exponentially day by day. While the majority of infected subjects are asymptomatic or show mild symptoms, there is an important proportion of patients who requires hospitalization and, sometimes, intensive care. Immune response to novel coronavirus is complex, involves both innate and adaptive immunity, and is biphasic. Significant differences were observed when comparing severe and non-severe patients. Analysis of the reported results from clinical trials clearly show an involvement of specific cellular immunity (predominantly leucopenia, decreased counts of CD3+, CD4+, and CD8+ T lymphocytes, changes of T cell compartment) and the so-called cytokine storm, which is associated with worsening of symptoms and the promotion of lung damage. An interesting finding regarding eosinopenia that can have both diagnostic and prognostic value is reported by some authors. Examination of selected immune parameters could help to identify severe patients with the risk of unfavorable course of the disease, predict the prognosis and recognize improvement in the clinical status. Moreover, detailed analysis of the immune changes could help to select novel prospective therapeutic strategies.
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Affiliation(s)
- Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
- Department of Clinical Immunology and Allergology, University Hospital in Martin, Martin, Slovakia
| | - Miroslava Brndiarova
- Department of Pediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Ingrid Urbancikova
- Department of Pediatrics, Faculty of Medicine, Children Faculty Hospital, P. J. Safarik University, Kosice, Slovakia
- Department of Pediatric Infectology, Faculty of Medicine, Children Faculty Hospital, P. J. Safarik University, Kosice, Slovakia
| | - Zuzana Rennerova
- Pneumo-Alergo Centre Ltd., Falck Healthcare Group, Bratislava, Slovakia
- Department of Pediatric Pulmonology and Phthisiology, Faculty of Medicine, National Institute of Children Diseases, Slovak Medical University, Bratislava, Slovakia
| | - Jarmila Vojtkova
- Department of Pediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Anna Bobcakova
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Robert Ostro
- Department of Pediatrics, Faculty of Medicine, Children Faculty Hospital, P. J. Safarik University, Kosice, Slovakia
| | - Peter Banovcin
- Department of Pediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
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Abstract
Previous data have revealed an association between eosinopenia and mortality of acute ischemic stroke. However, the relationship of eosinopenia with infarct volume, infection rate, and poor outcome of acute ischemic stroke is still unknown. The retrospective study included 421 patients (273 males, 65%; mean age, 68.0 ± 13.0 years) with first acute ischemic stroke who were hospitalized in the Second Affiliated Hospital of Soochow University, China, from January 2017 to February 2018. Laboratory data, neuroimaging results, and modified Rankin Scale scores were collected. Patients were divided into four groups according to their eosinophil percentage level (< 0.4%, 0.4–1.1%, 1.1–2.3%, ≥ 2.3%). Spearman’s correlation analysis showed that the percentage of eosinophils was negatively correlated with infarct volume (rs = −0.514, P < 0.001). Receiver operating characteristic analysis demonstrated that eosinopenia predicted a large infarct volume more accurately than neutrophilia; the area under curve was 0.906 and 0.876, respectively; a large infarct was considered as that with a diameter larger than 3 cm and involving more than two major arterial blood supply areas. Logistic regression analysis revealed that eosinophil percentage was an independent risk factor for acute ischemic stroke (P = 0.002). Moreover, eosinophil percentage was significantly associated with large infarct volume, high infection rate (pulmonary and urinary tract infections), and poor outcome (modified Rankin Scale score > 3) after adjusting for potential confounding factors (P-trend < 0.001). These findings suggest that eosinopenia has the potential to predict the severity of acute ischemic stroke. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University, China (approval number: K10) on November 10, 2015.
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Affiliation(s)
- Hui-Min Zhao
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wen-Qian Qin
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Pei-Ji Wang
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhong-Min Wen
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Suwarto S, Adlani H, Nainggolan L, Rumende CM, Soebandrio A. Laboratory parameters for predicting Salmonella bacteraemia: a prospective cohort study. Trop Doct 2017; 48:124-127. [PMID: 28959915 DOI: 10.1177/0049475517734118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood cultures for a definitive diagnosis of typhoid fever takes time and are not routinely available. We thus investigated laboratory parameters to predict Salmonella bacteraemia. We conducted a prospective cohort study in Jakarta, Indonesia. Patients with suspected typhoid fever admitted to hospital from October 2014 to December 2016 were included. Out of 187 individuals, 27 had Salmonella typhi and 12 had S. paratyphi in blood cultures. Absolute eosinopenia, elevated aspartate aminotransferase and elevated C-reactive protein > 40 mg/L were positive predictors.
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Affiliation(s)
- Suhendro Suwarto
- 1 Senior Lecturer, Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Hadianti Adlani
- 2 Associate Lecturer, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Leonard Nainggolan
- 3 Lecturer, Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Cleopas Martin Rumende
- 4 Senior Lecturer, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Amin Soebandrio
- 5 Professor, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.,5 Professor, Department of Microbiology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Hori YS, Kodera S, Sato Y, Shiojiri T. Eosinopenia as a Predictive Factor of the Short-Term Risk of Mortality and Infection after Acute Cerebral Infarction. J Stroke Cerebrovasc Dis 2016; 25:1307-12. [PMID: 26971036 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Eosinopenia has been shown to be a prognostic factor in bacteremia, chronic obstructive pulmonary disease, and myocardial infarction, but studies focusing on cerebral infarction are lacking. METHODS We conducted a retrospective study of 405 patients admitted to the Asahi General Hospital from June 2011 to September 2014 with a diagnosis of cerebral infarction within 24 hours after symptom onset. Differences in mortality, mortality associated with infection, and the prevalence of infection within 2 months of hospital admission were assessed between patients with and without eosinopenia at presentation. RESULTS Patients with eosinopenia had a significantly higher mortality rate (hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.17-5.21, P = .01), mortality associated with infection (HR 28.7, 95% CI 4.9-542.2, P <.0001), and an increased prevalence of infection (HR 1.83, 95% CI 1.12-2.89, P = .01) than patients without eosinopenia. Patients with neutrophilia and eosinopenia showed a significantly higher mortality rate than patients without neutrophilia (HR 3.15, 95% CI 1.40-6.92, P = .007), whereas patients with neutrophilia without eosinopenia showed no significant difference in mortality compared with patients without neutrophilia (HR 1.57, 95% CI .56-3.93, P = .37). Eosinopenia was a significant risk factor in 2-month mortality rate in multivariate analyses (HR 2.34, 95% CI 1.05-4.95, P = .04). CONCLUSIONS Eosinopenia is a novel predictive factor for complications after acute cerebral infarction. Stroke patients with eosinopenia should be monitored carefully for infection.
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Affiliation(s)
- Yusuke S Hori
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan.
| | - Satoshi Kodera
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Yasunori Sato
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Toshiaki Shiojiri
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
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