scholarly journals Laboratory Findings Associated With Severe Illness and Mortality Among Hospitalized Individuals With Coronavirus Disease 2019 in Eastern Massachusetts

2020 ◽  
Vol 3 (10) ◽  
pp. e2023934
Author(s):  
Victor M. Castro ◽  
Thomas H. McCoy ◽  
Roy H. Perlis
Keyword(s):  
Severe Illness ◽  
Laboratory Findings ◽  
Eastern Massachusetts

scholarly journals Laboratory findings associated with severe illness and mortality among hospitalized individuals with coronavirus disease 2019 in Eastern Massachusetts

2020 ◽  
Author(s):  
Victor M. Castro ◽  
Thomas H. McCoy ◽  
Roy H. Perlis
Keyword(s):  
Mechanical Ventilation ◽  
Severe Acute Respiratory Syndrome ◽  
Risk Stratification ◽  
Mortality Risk ◽  
Prediction Models ◽  
Severe Illness ◽  
Laboratory Findings ◽  
Laboratory Values ◽  
Inpatient Settings ◽  
Eastern Massachusetts

AbstractImportanceThe coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented stress on health systems across the world, and reliable estimates of risk for adverse hospital outcomes are needed.ObjectiveTo quantify admission laboratory and comorbidity features associated with critical illness and death and mortality risk across 6 Eastern Massachusetts hospitals.DesignRetrospective cohort study using hospital course, prior diagnoses, and laboratory values through June 5, 2020.SettingEmergency department and inpatient settings from 2 academic medical centers and 4 community hospitals.ParticipantsAll individuals with hospital admission and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing across these 6 hospitals.Main Outcome or Measuresevere illness defined by ICU admission, mechanical ventilation, or death.ResultsAmong 2,511 hospitalized individuals who tested positive for SARS-CoV-2, 215 (8.6%) were eventually admitted to the ICU, 164 (6.5%) required mechanical ventilation, and 292 (11.6%) died. L1-regression models developed in 3 of these hospitals yielded area under ROC curve (AUC) of 0.823 for severe illness and 0.847 for mortality in the 3 held-out hospitals. In total, 78% of deaths occurred in the highest-risk mortality quintile.Conclusions and RelevanceSpecific admission laboratory studies in concert with sociodemographic features and prior diagnosis facilitate risk stratification among individuals hospitalized for COVID-19.Funding1R56MH115187-01Trial RegistrationNoneKey PointsQuestionHow well can sociodemographic features, laboratory values, and comorbiditeis of individuals hospitalized with coronavirus disease 2019 (COVID-19) in Eastern Massachusetts through June 5, 2020 predict severe illness course?FindingsAmong 2,511 hospitalized individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were admitted to one of six hospitals, 215 (8.6%) were eventually admitted to the ICU, 164 (6.5%) required mechanical ventilation, and 292 (11.6%) died. In a risk prediction model, 78% of deaths occurred in the top mortality-risk quintile.MeaningSimple prediction models may assist in risk stratification among hospitalized COVID-19 patients.

scholarly journals Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis

2020 ◽  
Vol 58 (7) ◽  
pp. 1021-1028 ◽  
Author(s):  
Brandon Michael Henry ◽  
Maria Helena Santos de Oliveira ◽  
Stefanie Benoit ◽  
Mario Plebani ◽  
Giuseppe Lippi
Keyword(s):  
Serum Ferritin ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Severe Disease ◽  
Severe Illness ◽  
China National Knowledge Infrastructure ◽  
Discriminative Ability ◽  
Laboratory Findings ◽  
Liver And Kidney ◽  
Wbc Count

AbstractBackgroundAs coronavirus disease 2019 (COVID-19) pandemic rages on, there is urgent need for identification of clinical and laboratory predictors for progression towards severe and fatal forms of this illness. In this study we aimed to evaluate the discriminative ability of hematologic, biochemical and immunologic biomarkers in patients with and without the severe or fatal forms of COVID-19.MethodsAn electronic search in Medline (PubMed interface), Scopus, Web of Science and China National Knowledge Infrastructure (CNKI) was performed, to identify studies reporting on laboratory abnormalities in patients with COVID-19. Studies were divided into two separate cohorts for analysis: severity (severe vs. non-severe and mortality, i.e. non-survivors vs. survivors). Data was pooled into a meta-analysis to estimate weighted mean difference (WMD) with 95% confidence interval (95% CI) for each laboratory parameter.ResultsA total number of 21 studies was included, totaling 3377 patients and 33 laboratory parameters. While 18 studies (n = 2984) compared laboratory findings between patients with severe and non-severe COVID-19, the other three (n = 393) compared survivors and non-survivors of the disease and were thus analyzed separately. Patients with severe and fatal disease had significantly increased white blood cell (WBC) count, and decreased lymphocyte and platelet counts compared to non-severe disease and survivors. Biomarkers of inflammation, cardiac and muscle injury, liver and kidney function and coagulation measures were also significantly elevated in patients with both severe and fatal COVID-19. Interleukins 6 (IL-6) and 10 (IL-10) and serum ferritin were strong discriminators for severe disease.ConclusionsSeveral biomarkers which may potentially aid in risk stratification models for predicting severe and fatal COVID-19 were identified. In hospitalized patients with respiratory distress, we recommend clinicians closely monitor WBC count, lymphocyte count, platelet count, IL-6 and serum ferritin as markers for potential progression to critical illness.

scholarly journals Influence of Cigarettes and Alcohol on the Severity and Death of COVID-19: A Multicenter Retrospective Study in Wuhan, China

2020 ◽  
Vol 11 ◽  
Author(s):  
Mengyuan Dai ◽  
Liyuan Tao ◽  
Zhen Chen ◽  
Zhi Tian ◽  
Xiaofang Guo ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Intake ◽  
Respiratory Infections ◽  
Severe Illness ◽  
Laboratory Findings ◽  
Death Rates ◽  
Recent Emergence ◽  
Global Spread ◽  
History Of ◽  
Multi Center Study

BackgroundThe recent emergence and rapid global spread of coronavirus disease 2019 (COVID-19) is leading to public health crises worldwide. Alcohol consumption and cigarette smoking (CS) are two known risk factors in many diseases including respiratory infections.MethodsWe performed a multi-center study in the four largest hospitals designated for COVID-19 patients in Wuhan. There are totally 1547 patients diagnosed with COVID-19 enrolled in the study, alcohol consumption and CS history were evaluated among these patients. The epidemiology, laboratory findings and outcomes of patients contracted COVID-19 were further studied.ResultsOur findings indicated that COVID-19 patients with a history of CS tend to have more severe outcomes than non-smoking patients. However, alcohol consumption did not reveal significant effects on neither development of severe illness nor death rates in COVID-19 patients.ConclusionCS is a risk factor for developing severe illness and increasing mortality during the SARS-CoV-2 infection. We believe that our findings will provide a better understanding on the effects of alcohol intake and CS exposure in COVID-19 patients.

scholarly journals Hyperglycemia Requiring Insulin Among Pediatric Patients Diagnosed With Hemophagocytic Lymphohistiocytosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A451-A452
Author(s):  
Cintya Schweisberger ◽  
Nila Palaniappan ◽  
Nicole Wood ◽  
Lauren Amos ◽  
Kelsee Halpin
Keyword(s):  
Parenteral Nutrition ◽  
Insulin Therapy ◽  
T Cell Activation ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Cell Activation ◽  
Retrospective Chart Review ◽  
Regular Insulin ◽  
Severe Illness ◽  
Subcutaneous Insulin ◽  
Laboratory Findings

Abstract Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disorder marked by massive cytokine release due to macrophage and T-cell activation. Hallmarks of the diagnosis include fever, splenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogemia, and elevations in ferritin and soluble IL-2 receptor. Given HLH is associated with critical illness, elevation in inflammatory markers, and treated with glucocorticoids, the development of hyperglycemia during its course is not unexpected. However, detailed descriptions of the severity of hyperglycemia and strategies in insulin management among HLH patients are lacking. We describe 10 years’ experience at a single tertiary pediatric health center with HLH patients who developed insulin dependent hyperglycemia. Objectives: To describe the demographics, clinical and laboratory findings, treatment regimens, and outcomes for children with HLH treated with insulin due to hyperglycemia. Study Design: Retrospective chart review from 2010 through 2019 of youth 0 to 21 years of age who required insulin therapy during or shortly after a hospitalization where they were diagnosed with HLH using established criteria. Descriptive statistics were used to characterize the population of interest. Results: Of 30 patients diagnosed with HLH, 33% (n=10) required insulin therapy. Half (n=5) were female and half (n=5) male. The mean age was 8.4 years (7.8 months - 17 years). The majority (80%) were non-Hispanic white. Mean BMI at admission was 53rd percentile (5th - 87th percentile). Max serum glucose ranged from 267 to 725 mg/dL (mean 421 mg/dL). Marked inflammation was present (max CRP 2.6 - 44.9 mg/dL, max ferritin 1,091 - 90,219 ng/mL). All were treated with dexamethasone, doses ranging from 5 to 11 mg/m2/day and duration from 2 to 70 days. Most (90%) received parenteral nutrition (PN) with a mean max GIR of 8 mg/kg/min (SD=2.7). Intravenous infusions of regular insulin were used in 80% of patients, though 2 patients were later transitioned to long and short acting subcutaneous insulin. Mean duration of IV insulin therapy was 9.5 days (2–24 days); however, 2 patients died while on IV insulin therapy. The majority (70%) needed insulin within 5 days of starting steroids. Two patients (20%) were treated with subcutaneous insulin only (no IV). Only 1 patient was discharged home on insulin therapy. Mean hospital stay was 60 days (10–202 days). Mortality was 50% (n=5). Conclusions: One-third of pediatric HLH patients required insulin during their hospitalization for severe hyperglycemia likely secondary to multiple factors including glucocorticoid use, parenteral nutrition, inflammation, and severe illness. Insulin is typically started within 5 days of initiating steroid therapy, limited to IV infusions, and often is not needed by the time of discharge. Risk of mortality is very high.

scholarly journals Inflammatory laboratory findings associated with severe illness among hospitalized individuals with COVID-19 in Medan, Indonesia: a cross-sectional study

F1000Research ◽  
2022 ◽  
Vol 10 ◽  
pp. 1246
Author(s):  
Darmadi Darmadi ◽  
Cennikon Pakpahan ◽  
Riska Habriel Ruslie ◽  
Andri Rezano
Keyword(s):  
Cross Sectional Study ◽  
Tnf Alpha ◽  
Severe Illness ◽  
Cytokine Storm ◽  
Sectional Study ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Ifn Gamma ◽  
Neutrophil Lymphocyte Ratio ◽  
D Dimer

Background: Coronavirus disease (COVID-19) remains a global health problem. COVID-19 patients with severe pneumonia have a higher risk for critical illness, mostly complicated by acute respiratory distress syndrome. The inflammatory response is critical, and the cytokine storm increases the severity of COVID-19. Many factors could be associated with a cytokine storm but they are incompletely understood. This study presents characteristics of COVID-19 patients and explore the clinical and inflammatory parameters of severe and critically ill COVID-19 patients in the intensive care unit (ICU). Method: This cross-sectional study was conducted in all severe COVID-19 patients admitted to the ICU. Peripheral blood was taken for laboratory examination within 24 hours of admission. Haematologic parameters, serum electrolyte, renal function, liver function, pancreas enzyme, D-dimer, inflammatory cytokines interferon (IFN)-gamma, tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), and C-reactive protein (CRP) were assessed in this study. Comparative analyses were done between sex, existing comorbidities, body mass index (BMI), and COVID-19 vaccination status. Results: A total of 80 subjects were included in the study. The most frequent comorbidities found among the subjects were obesity (36.35%) and diabetes (22.5%). Only 13.75% of subjects were vaccinated. Laboratory results indicated leucocytosis and neutrophilia, with a neutrophil-lymphocyte-ratio (NLR) of 7. The mean inflammatory findings (IL-6, IL-10, TNF-alpha, IFN-gamma, MCP-1), D-dimer, CRP, and lipase increased. Lipase levels were higher in men (p = 0.003) and in comorbidity groups. No significant differences were found among different BMI groups. Lipase, IL-6, and MCP-1 levels were significantly higher (p=0.019, <0.0001, and 0.03, respectively) in the non-vaccinated group. Conclusions: Most patients with severe COVID-19 have comorbidities and increased inflammatory markers.

scholarly journals Clinical, laboratory and ultrasonographic findings in 38 calves with type-4 abomasal ulcer

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Ueli Braun ◽  
Christina Widmer ◽  
Karl Nuss ◽  
Monika Hilbe ◽  
Christian Gerspach
Keyword(s):  
Clinical Laboratory ◽  
Clinical Findings ◽  
Pathological Examination ◽  
Severe Illness ◽  
Diffuse Peritonitis ◽  
Laboratory Findings ◽  
Poor General Health ◽  
Abdominal Examination ◽  
The Right ◽  
Tentative Diagnosis

Abstract Background Type-4 abomasal ulcers (U4) are perforated ulcers causing diffuse peritonitis. This retrospective study describes the clinical, laboratory and ultrasonographic findings in 38 calves with U4. The medical records of 38 calves aged three days to 20 weeks with U4 were scrutinised. Results The most common clinical findings were poor general health (95%), reduced skin elasticity (95%), rumen atony (91%), abdominal guarding (76%) and positive percussion auscultation and/or swinging auscultation on the right side of the abdomen (75%). The most frequent laboratory findings were increased numbers of segmented neutrophils (87%), eosinopenia (87%), acidosis (84%), azotaemia (79%) and hyponatraemia (79%). The most frequent abdominal ultrasonographic findings were intestinal atony (68%), fluid (67%) and fibrin deposits (58%) in the abdomen. Thirty-five calves were euthanased and three calves died spontaneously. All calves underwent pathological examination. Diffuse peritonitis caused by a transmural abomasal ulcer was the principal diagnosis in all calves. Conclusions Perforated abomasal ulcers cause severe illness, and a thorough clinical examination combined with ultrasonographic abdominal examination should lead to a tentative diagnosis.

scholarly journals Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users – Ireland, 2000

2005 ◽  
Vol 134 (4) ◽  
pp. 894-901 ◽  
Author(s):  
K. MURRAY-LILLIBRIDGE ◽  
J. BARRY ◽  
S. REAGAN ◽  
D. O'FLANAGAN ◽  
G. SAYERS ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Users ◽  
Methadone Treatment ◽  
Injecting Drug Users ◽  
Clinical Findings ◽  
Severe Illness ◽  
Laboratory Findings ◽  
16S Rdna Pcr ◽  
Public Health Challenges ◽  
Systemic Symptoms

In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.

scholarly journals Anaemia is Associated with Severe Illness in COVID-19: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Zheying Tao ◽  
Mingyu Liu ◽  
Jingyi Wu ◽  
Jing Xu ◽  
Wei Chen ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Virus Disease ◽  
Severe Illness ◽  
C Reactive Protein ◽  
Severe Condition ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Reactive Protein ◽  
The Impact ◽  
The Relationship

Abstract Background and objective:Anaemia commonly aggravates the severity of respiratory diseases, whereas thus far, no study has elucidated the impact of anaemiaonCorona Virus Disease 2019(COVID-19). The aim of this study was to evaluate the clinical characteristics of patients with anaemia, and to further explore the relationship between anaemiaand the severity of COVID-19.METHODS:In this single-center, retrospective, observational study, a total of 222 patients were recruited, including 79 patients with anaemia and 143 patients without anaemia. Clinical characteristics, laboratory findings, disease progression and prognosis were collected and analyzed. Risk factors associated with the severe illness in COVID-19were established by univariable and multivariable logistic regression models.Result：In our cohort, compared to patients without anaemia, patients with anaemia were more likely to experience one or more comorbidities and severe COVID-19 illness, as well as higher mortality. More patients demonstrated elevated levels of C-reactive protein (CRP), procalcitonin(PCT) and creatinine in anaemia group. Levels of erythrocyte sedimentation rate(ESR), D-dimer, myoglobin, T-pro brain natriuretic peptide(T-pro-BNP) and urea nitrogen(BUN)in patients with anaemia were significantly higher than those without. In addition,the proportion of patients with dyspnoea，elevated CRP and PCT was positively associated with the severity of anaemia. The Odd Ratio (OR) of anaemia related to the severe condition of COVID-19 was 5.07 (95% CI:1.82-14.18, P=0.002) and 3.47 (95% CI:1.02-11.75, P=0.046) after adjustment for baseline date and laboratory indices, respectively.Conclusion:Anaemia is an independent risk factor associated with the severe illness of COVID-19, and healthcare professionals should be more sensitive to the haemoglobin levels of COVID-19 patients on admission. To avoid rapid deterioration, more intensive care should be given to patients with anaemia.Trial registration: Ethics committee of Wuhan University People's Hospital (wdry2020-k064)

Intracranial hypotension presenting with severe encephalopathy

1998 ◽  
Vol 89 (3) ◽  
pp. 470-473 ◽  
Author(s):  
Carter E. Beck ◽  
Norman W. Rizk ◽  
Lydia T. Kiger ◽  
David Spencer ◽  
Laureen Hill ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Hypotension ◽  
Neurological Diseases ◽  
Clinical Spectrum ◽  
Severe Illness ◽  
Laboratory Findings ◽  
Postural Headache ◽  
Content Type ◽  
Cerebral Structures ◽  
Fine Print

✓ A patient with severe and protracted symptoms from intracranial hypotension is described. The patient's presentation was marked by diffuse encephalopathy and profound depression of consciousness. This case report expands the presently known clinical spectrum of this uncommon and generally benign illness. The clinical and laboratory findings typically observed in the syndrome of intracranial hypotension are outlined. The pathophysiological mechanisms of the phenomenon are briefly discussed. Intracranial hypotension is a potentially severe illness with specific treatments that are distinct from the treatment of most neurological diseases. Three cardinal features—postural headache, pachymeningitis, and descent of midline cerebral structures—should prompt the diagnosis.

scholarly journals Inflammatory laboratory findings associated with severe illness among hospitalized individuals with COVID-19 in Medan, Indonesia: a cross-sectional study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1246
Author(s):  
Darmadi Darmadi ◽  
Cennikon Pakpahan ◽  
Riska Habriel Ruslie ◽  
Andri Rezano
Keyword(s):  
Cross Sectional Study ◽  
Tnf Alpha ◽  
Severe Illness ◽  
Cytokine Storm ◽  
Sectional Study ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Ifn Gamma ◽  
Neutrophil Lymphocyte Ratio ◽  
D Dimer

Background: Coronavirus disease (COVID-19) is still a global health problem. COVID-19 patients with severe pneumonia have a higher risk for critical illness, mostly complicated by acute respiratory distress syndrome. The inflammatory response is critical, and the cytokine storm increases severity of COVID-19. Many factors could be associated with a cytokine storm but these are incompletely understood. The aim of this study is to present characteristics of patients with COVID-19 and explore the clinical and inflammatory parameters of severe and critically ill COVID-19 patients in the intensive care unit (ICU). Method: The cross-sectional study was conducted in all severe COVID-19 patients admitted to the ICU. Peripheral blood was taken for laboratory examination within 24 hours of admission. Hematologic parameters, serum electrolyte, renal function, liver function, pancreas enzyme, D-dimer, inflammatory cytokines interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), and C-reactive protein (CRP) were assessed in this study. Comparison analyses were done between sex, comorbidity existed, body mass index (BMI), and vaccination status. Results: A total of 80 subjects were included in the study. The most frequent comorbidities found among the subjects were obesity (36.35%) and diabetes (22.5%). Only 13.75% of subjects were vaccinated. Laboratory results indicated leukocytosis and neutrophilia, with neutrophil-lymphocyte-ratio (NLR) of 7. The mean inflammatory findings (IL-6, IL-10, TNF-alpha, IFN-gamma, MCP-1), D-dimer, CRP, and lipase increased. Lipase levels were higher in men (p=0.003) and in comorbidity groups. No significant differences found with different BMI groups. Lipase, IL-6, and MCP-1 levels were significantly higher (p=0.019, <0.0001, and 0.03, respectively) in the non-vaccinated group. Conclusions: Most patients with severe COVID-19 have comorbidities and increased inflammatory markers.

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