Emergency room comprehensive assessment of demographic, radiological, laboratory and clinical data of patients with COVID-19: determination of its prognostic value for in-hospital mortality

AbstractMortality risk in COVID-19 patients is determined by several factors. The aim of our study was to adopt an integrated approach based on clinical, laboratory and chest x-ray (CXR) findings collected at the patient’s admission to Emergency Room (ER) to identify prognostic factors. Retrospective study on 346 consecutive patients admitted to the ER of two North-Western Italy hospitals between March 9 and April 10, 2020 with clinical suspicion of COVID-19 confirmed by reverse transcriptase-polymerase reaction chain test (RT-PCR), CXR performed within 24 h (analyzed with two different scores) and recorded prognosis. Clinical and laboratory data were collected. Statistical analysis on the features of 83 in-hospital dead vs 263 recovered patients was performed with univariate (uBLR), multivariate binary logistic regression (mBLR) and ROC curve analysis. uBLR identified significant differences for several variables, most of them intertwined by multiple correlations. mBLR recognized as significant independent predictors for in-hospital mortality age > 75 years, C-reactive protein (CRP) > 60 mg/L, PaO2/FiO2 ratio (P/F) < 250 and CXR “Brixia score” > 7. Among the patients with at least two predictors, the in-hospital mortality rate was 58% against 6% for others [p < 0.0001; RR = 7.6 (4.4–13)]. Patients over 75 years had three other predictors in 35% cases against 10% for others [p < 0.0001, RR = 3.5 (1.9–6.4)]. The greatest risk of death from COVID-19 was age above 75 years, worsened by elevated CRP and CXR score and reduced P/F. Prompt determination of these data at admission to the emergency department could improve COVID-19 pretreatment risk stratification.

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Baseline chest X-ray in coronavirus disease 19 (COVID-19) patients: association with clinical and laboratory data

La radiologia medica ◽

10.1007/s11547-020-01272-1 ◽

2020 ◽

Vol 125 (12) ◽

pp. 1271-1279

Author(s):

Marco Gatti ◽

Marco Calandri ◽

Matteo Barba ◽

Andrea Biondo ◽

Carlotta Geninatti ◽

...

Keyword(s):

Roc Curve ◽

Univariate Analysis ◽

Laboratory Data ◽

Binary Logistic Regression ◽

Nonparametric Tests ◽

Roc Curve Analysis ◽

Reactive Protein ◽

Chest X Ray ◽

Low Sensitivity ◽

North Western

Abstract Purpose To assess the reliability of CXR and to describe CXR findings and clinical and laboratory characteristics associated with positive and negative CXR. Methods Retrospective two-center study on consecutive patients admitted to the emergency department of two north-western Italian hospitals in March 2020 with clinical suspicion of COVID-19 confirmed by RT-PCR and who underwent CXR within 24 h of the swab execution. 260 patients (61% male, 62.8 ± 15.8 year) were enrolled. CXRs were rated as positive (CXR+) or negative (CXR−), and features reported included presence and distribution of airspace opacities, pleural effusion and reduction in lung volumes. Clinical and laboratory data were collected. Statistical analysis was performed with nonparametric tests, binary logistic regression (BLR) and ROC curve analysis. Results Sensitivity of CXR was 61.1% (95%CI 55–67%) with a typical presence of bilateral (62.3%) airspace opacification, more often with a lower zone (88.7%) and peripheral (43.4%) distribution. At univariate analysis, several factors were found to differ significantly between CXR+ and CXR−. The BLR confirmed as significant predictors only lactate dehydrogenase (LDH), C-reactive protein (CRP) and interval between the onset of symptoms and the execution of CXR. The ROC curve procedure determined that CRX+ was associated with LDH > 500 UI/L (AUC = 0.878), CRP > 30 mg/L (AUC = 0.830) and interval between the onset of symptoms and the execution of CXR > 4 days (AUC = 0.75). The presence of two out of three of the above-mentioned predictors resulted in CXR+ in 92.5% of cases, whereas their absence in 7.4%. Conclusion CXR has a low sensitivity. LDH, CRP and interval between the onset of symptoms and the execution of CXR are major predictors for a positive CXR.

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Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa170 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1338-1411 ◽

Cited By ~ 3

Author(s):

Nicolas Keller ◽

François Chantrel ◽

Thierry Krummel ◽

Dorothée Bazin-Kara ◽

Anne Laure Faller ◽

...

Keyword(s):

Laboratory Data ◽

Case Fatality ◽

Patient Characteristics ◽

Complete Recovery ◽

High Rate ◽

Atypical Symptoms ◽

Reactive Protein ◽

Risk Of Death ◽

Included Patient

Abstract Background There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. Methods All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. Results Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66–83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0–5), 7 (4–11) and 32 (26.5–35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25–106) and 690 Ly/µL (IQR 450–960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11–3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005–1.017); P < 0.0001]. Conclusions HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.

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C-Reactive Protein and Lymphocyte are important indicators of severe coronavirus disease and poor prognosis in elderly patients

10.21203/rs.3.rs-21426/v3 ◽

2020 ◽

Author(s):

Qinglin He ◽

Xiafen Hu ◽

Xiaochen Xiang ◽

Siyang Chen ◽

Wanxin Liu ◽

...

Keyword(s):

Elderly Patients ◽

Disease Severity ◽

Area Under The Curve ◽

Reference Interval ◽

The Elderly ◽

C Reactive Protein ◽

Roc Curve Analysis ◽

Dynamic Changes ◽

Reactive Protein ◽

Risk Of Death

Abstract Objective：To explore the value of C-reactive protein (CRP) and lymphocyte (L) in the assessment of disease severity and prognosis of elderly COVID-19 patients.Methods: A total of 194 positive COVID-19 patients were collected from Tianyou Hospital and Puren Hospital, affiliated hospital of Wuhan University of Science and Technology. Their demographic characteristics were analyzed. The dynamic changes of CRP and L in peripheral blood were retrospectively studied.Results: (1) There were significant statistical differences in CRP, L in clinical typing and clinical outcome in patients over 60 years old compared with those under 60 years old. Survival analysis showed that the risk of death was greater in patients over 60 than in those under 60.（2）In 125 patients over 60 years old, the hospitalized patients with severe or critical types of disease had significantly higher CRP than those with moderate type (p<0.01). In the outcome of the elderly patients, the CRP of the patients with the outcomes of discharge, improvement, aggravation and death increased successively (p<0.01). According to the analysis of Logistic regression model, the increase of CRP constitutes a risk factor for death in elderly patients. (3) In the ROC curve analysis to distinguish the death outcome and non-death outcome of COVID-19 patients, the area under the curve (AUC) of CRP and L was 0.751 and 0.720 respectively. CRP and L had good diagnostic accuracy for the death outcome of patients. (4) Changes in CRP were correlated with changes in CT imaging and were consistent with changes in the course of the disease.Conclusions: (1) The data collected in this research showed that the cumulative survival rate of patients over 60 years old was lower than that of patients under 60 years old. With the increase of age, the CRP of patients showed an increasing trend, and the L of patients showed a characteristic lower than the normal reference interval. (2) CRP and L are important monitoring indicators of COVID-19 in elderly patients. Combined with CT examination and observation of their dynamic changes, CRP and L are of important clinical guiding value for the judgment of disease severity and the evaluation of prognosis.

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Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

PLoS ONE ◽

10.1371/journal.pone.0247422 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247422

Author(s):

Jesús Díez-Manglano ◽

Marta Nataya Solís-Marquínez ◽

Andrea Álvarez García ◽

Nicolás Alcalá-Rivera ◽

Irene Maderuelo Riesco ◽

...

Keyword(s):

Hospital Mortality ◽

Healthcare Workers ◽

Clinical Laboratory ◽

Population Data ◽

Clinical Severity ◽

Multivariate Logistic Regression Model ◽

Risk Of Death ◽

Professional Exposure ◽

Treatment Data ◽

Observational Cohort

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20–65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067–0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality.

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Bacteriological Characteristics of COVID-19 Patients Nosocomially Co-infected at a Designated Hospital: A Retrospective Study

10.21203/rs.3.rs-65356/v1 ◽

2020 ◽

Author(s):

Jing Yu ◽

Lei Nie ◽

Xia Zhou ◽

Dongde Wu ◽

Jian Chen ◽

...

Keyword(s):

Clinical Laboratory ◽

White Blood Cells ◽

Laboratory Data ◽

Critical Factor ◽

Severe Pneumonia ◽

C Reactive Protein ◽

Reactive Protein ◽

Extensive Drug Resistance ◽

Causative Agents ◽

Secondary Bacterial Pneumonia

Abstract Background: Bacterial co-infection in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a critical factor that increases the complexity and treatment of coronavirus disease 2019 (COVID-19). Methods: We collected the clinical laboratory data of 1799 patients with confirmed COVID-19 who were admitted to Jinyintan Hospital in Wuhan, China, between January 1 to April 26, 2020. The bacterial co-infection along with disease progression was analyzed. Other inflammatory markers, including C-reactive protein (CRP), white blood cells (WBC), lymphocytes (L), neutrocytes (N), interleukin-6 (IL-6), and procalcitonin (PCT), were assessed to estimate the progression of COVID-19. Results: We found that 191 of the 1799 (10.62%) patients had bacterial co-infection. The most prevalent causative agents for bacterial co-infection were Klebsiella pneumoniae (91 cases, 5.06%) and Acinetobacter baumannii (66 cases, 3.67%). The most patients with bacterial co-infection showed extensive drug-resistance. The outcomes of patients with bacterial co-infection were worse than those of patients without bacterial co-infection.Conclusions: Secondary bacterial pneumonia during virus infection is a major risk factor for high mortality resulting from severe pneumonia caused by COVID-19.

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Clinical and Epidemiological Characteristics of the First Month of the Covid-19 Pandemic in Chile

10.1101/2020.08.11.20171975 ◽

2020 ◽

Author(s):

Macarena R Vial ◽

Anne Peters ◽

Inia Perez ◽

Maria Spencer ◽

Mario Barbe ◽

...

Keyword(s):

Latin America ◽

Hospital Mortality ◽

Clinical Characteristics ◽

Clinical Course ◽

Laboratory Data ◽

Molecular Testing ◽

Protein Levels ◽

Reactive Protein ◽

Single Center Study ◽

Epidemiological Characteristics

Introduction: Understanding the clinical course and outcomes of patients with Covid-19 in underrepresented populations like Latin America is paramount. In this study, we report the clinical characteristics of Covid-19 in Chile, with a focus on subjects requiring hospitalization during the initial phases of the SARS-CoV-2 pandemic. Methods: This is a single center study including all consecutive patients diagnosed with Covid-19 during the first month of the pandemic. Demographics, clinical characteristics and laboratory data were collected within 24 hours of admission. The primary outcome was a composite of ICU admission or all-cause, in-hospital mortality. Results: During the first month of the pandemic, 381 patients were confirmed as positive for SARS- CoV-2 by molecular testing; 88 (23.1%) of them eventually required hospitalization. Median age of the cohort was 39 years (IQR 31-49). Overall mortality was 0.7% and 18 (3.7%) out of the 88 subjects who required hospitalization either died and/or required ICU. Increased body mass index (BMI), C-reactive protein levels (CRP) and the SaTO2/FiO2 index on admission were independently associated with a higher risk of ICU care or death. Discussion: The lower mortality observed in our prospective cohort during the first month of SARS-Cov-2 pandemic was lower than previously reported. This finding could be due to a lower threshold for admission, a healthcare system not yet overburdened and a younger population, among other factors. BMI, CRP on admission were strong predictors for ICU care or all-cause, in- hospital mortality. Our data provide important information regarding the clinical course of Covid- 19 in Latin America.

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C-Reactive Protein and Lymphocyte are important indicators of severe coronavirus disease and poor prognosis in elderly patients

10.21203/rs.3.rs-67738/v1 ◽

2020 ◽

Author(s):

Qinglin He ◽

Xiafen Hu ◽

Xiaochen Xiang ◽

Siyang Chen ◽

Wanxin Liu ◽

...

Keyword(s):

Elderly Patients ◽

Disease Severity ◽

Area Under The Curve ◽

Reference Interval ◽

The Elderly ◽

C Reactive Protein ◽

Roc Curve Analysis ◽

Dynamic Changes ◽

Reactive Protein ◽

Risk Of Death

Abstract Objective：To explore the value of C-reactive protein (CRP) and lymphocyte (L) in the assessment of disease severity and prognosis of elderly COVID-19 patients.Methods: A total of 194 positive COVID-19 patients were collected from Tianyou Hospital and Puren Hospital, affiliated hospital of Wuhan University of Science and Technology. Their demographic characteristics were analyzed. The dynamic changes of CRP and L in peripheral blood were retrospectively studied.Results: (1) There were significant statistical differences in CRP, L in clinical typing and clinical outcome in patients over 60 years old compared with those under 60 years old. Survival analysis showed that the risk of death was greater in patients over 60 than in those under 60.（2）In 125 patients over 60 years old, the hospitalized patients with severe or critical types of disease had significantly higher CRP than those with moderate type (p<0.01). In the outcome of the elderly patients, the CRP of the patients with the outcomes of discharge, improvement, aggravation and death increased successively (p<0.01). According to the analysis of Logistic regression model, the increase of CRP constitutes a risk factor for death in elderly patients. (3) In the ROC curve analysis to distinguish the death outcome and non-death outcome of COVID-19 patients, the area under the curve (AUC) of CRP and L was 0.751 and 0.720 respectively. CRP and L had good diagnostic accuracy for the death outcome of patients. (4) Changes in CRP were correlated with changes in CT imaging and were consistent with changes in the course of the disease.Conclusions: (1) The cumulative survival rate of patients over 60 years old was lower than that of patients under 60 years old. With the increase of age, the CRP of patients showed an increasing trend, and the L of patients showed a characteristic lower than the normal reference interval. (2) CRP and L are important monitoring indicators of COVID-19 in elderly patients. Combined with CT examination and observation of their dynamic changes, CRP and L are of important clinical guiding value for the judgment of disease severity and the evaluation of prognosis.

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CURB-65 plus Hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

10.21203/rs.3.rs-74812/v1 ◽

2020 ◽

Author(s):

Alessandra Oliva ◽

Cristian Borrazzo ◽

Francesca Cancelli ◽

Cristiana Franchi ◽

Martina Carnevalini ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admission ◽

Clinical Laboratory ◽

Albumin Level ◽

Score System ◽

Reactive Protein ◽

Risk Of Mortality ◽

Radiological Data ◽

Single Center Study ◽

Icu Transfer

Abstract Introduction: There is the need of a simple but highly reliable score system for stratifying the risk of mortality and Intensive Care Unit (ICU) transfer in patients with SARS-CoV-2 pneumonia at the Emergency Room. Purpose: In this study, the ability of CURB-65, extended CURB-65, PSI and CALL scores and C-Reactive Protein (CRP) to predict intra-hospital mortality and ICU admission in patients with SARS-CoV-2 infection were evaluated.Methods: During March-May 2020, a retrospective, single-center study including all consecutive adults patients with diagnosis of SARS-CoV-2 pneumonia was conducted. Clinical, laboratory and radiological data as well as CURB-65, expanded CURB-65, PSI and CALL scores were calculated based on data recorded at hospital admission. Results: Overall, 224 patients with documented SARS-CoV-2 infection were included in the study. As for intra-hospital mortality (24/224, 11%), PSI performed better than all the other tested scores, which showed lower AUC values (AUC=0.890 for PSI versus AUC=0.885, AUC=0.858 and AUC=0.743 for expanded CURB-65, CURB-65 and CALL scores, respectively). Of note, the addition of hypoalbuminemia to the CURB-65 score increased the prediction value of intra-hospital mortality (AUC=0.905). All the tested scores performed worse in predicting the need of ICU transfer (26/224, 12%), with the best AUC for extended CURB-65 score (AUC= 0.708).Conclusion: The addition of albumin level to the easy-to-calculate CURB-65 score at hospital admission is able to improve the quality of prediction of intra-hospital mortality in patients with SARS-CoV-2 pneumonia.

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Serum adipokine profiles in patients with microscopic polyangiitis and granulomatosis with polyangiitis: An exploratory analysis

PLoS ONE ◽

10.1371/journal.pone.0254226 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254226

Author(s):

Sung Soo Ahn ◽

Taejun Yoon ◽

Jason Jungsik Song ◽

Yong-Beom Park ◽

Sang-Won Lee

Keyword(s):

Disease Activity ◽

Granulomatosis With Polyangiitis ◽

Clinical Laboratory ◽

Microscopic Polyangiitis ◽

Laboratory Data ◽

Serum Levels ◽

Enzyme Linked Immunosorbent Assay ◽

Laboratory Findings ◽

Reactive Protein ◽

Potential Biomarker

Objectives Previous studies have shown that adipokines may serve as potential biomarkers reflecting disease activity in various autoimmune diseases. Here, we investigated the relationship between four adipokines and clinical/laboratory findings in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). Methods Sera from 63 patients with MPA and GPA who were registered in a prospective cohort were used to detect serum levels of adiponectin, chemerin, resistin, and vaspin using commercial enzyme-linked immunosorbent assay kits. Associations between adipokines and clinical and laboratory data was assessed using Pearson’s correlation analysis. Results The median age was 65.0 years, 24 patients were male, and 42 patients were diagnosed with MPA. The median levels of adiponectin, chemerin, resistin, and vaspin in patient sera were 13.9 ng/mL, 9.2 ng/mL, 23.7 ng/mL, and 0.1 ng/mL, respectively. A significant correlation between chemerin level and five-factor score (FFS) was found (r = 0.320, p = 0.011), and resistin was correlated with both Birmingham vasculitis activity score and FFS (r = 0.256, p = 0.043 and r = 0.320, p = 0.011). Regarding laboratory data, adiponectin level was associated with creatinine, and chemerin level was associated with creatinine, albumin, and erythrocyte sedimentation rate (ESR). On the other hand, resistin was found to be associated with white blood cell count, creatinine, ESR, and C-reactive protein. Age did not have a significant impact on the levels of adipokines. Conclusions The expression of adipokines in the sera of patients with MPA and GPA differs depending on clinical and laboratory features, and serum resistin may be suggested as a potential biomarker reflecting disease activity.

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Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease

BMC Pediatrics ◽

10.1186/s12887-021-02876-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yaheng Lu ◽

Tingting Chen ◽

Yizhou Wen ◽

Feifei Si ◽

Xindan Wu ◽

...

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

Multiple Logistic Regression Analysis ◽

Laboratory Data ◽

Ivig Treatment ◽

Roc Curve Analysis ◽

Reactive Protein ◽

Ivig Resistance ◽

Intravenous Immunoglobulin Resistance ◽

Resistant Group

Abstract Background Repeated intravenous immunoglobulin (IVIG) resistance prediction is one of the pivotal topics in Kawasaki disease (KD). Those non-responders of repeated IVIG treatment might be improved by an early-intensified therapy to reduce coronary artery lesion and medical costs. This study investigated predictors of resistance to repeated IVIG treatment in KD. Methods A total of 94 children with IVIG-resistant KD treated at our hospital between January 2016 and August 2020 were retrospectively analyzed. According to the therapeutic effect of a second dose IVIG treatment, the children were divided into repeated IVIG-responsive group and repeated IVIG-resistant group, and the clinical and laboratory data were compared. Predictors of repeated IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results The Pre-IVIG laboratory data showed the percentage of neutrophils (N%) and levels of serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in repeated IVIG-resistant group compared with repeated IVIG-responsive group, while levels of serum sodium and albumin (ALB) were significantly lower (P < 0.05). The post-IVIG laboratory values of N% and C-reactive protein (CRP) were significantly higher in the repeated IVIG-resistant group compared with repeated IVIG-responsive group, while hemoglobin and ALB were lower (P < 0.05). Pre-IVIG PCT and post-IVIG CRP exhibited AUC of 0.751 and 0.778 respectively in predicting repeated IVIG resistance in KD. Pre-IVIG PCT > 1.81ng/ml (OR 4.1, 95 % CI 1.4 ~ 12.0, P < 0.05) and post-IVIG CRP > 45 mg/L (OR 4.6, 95 % CI 1.3 ~ 16.2, P < 0.05) were independent predictors of repeated IVIG resistance in KD. Conclusions Our study illustrates the serum PCT level before initial IVIG treatment and CRP after initial IVIG could be used to predict repeated IVIG resistance in KD.

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