scholarly journals MR-proADM as prognostic factor of outcome in COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emanuela Sozio ◽  
Carlo Tascini ◽  
Martina Fabris ◽  
Federica D’Aurizio ◽  
Chiara De Carlo ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severe Disease ◽  
Scoring Systems ◽  
Orotracheal Intubation ◽  
Outcome Data ◽  
University Hospital ◽  
Data Set ◽  
Discriminative Performance ◽  
Clinical Scoring ◽  
Severity Class

AbstractMid Regional pro-ADM (MR-proADM) is a promising novel biomarker in the evaluation of deteriorating patients and an emergent prognosis factor in patients with sepsis, septic shock and organ failure. It can be induced by bacteria, fungi or viruses. We hypothesized that the assessment of MR-proADM, with or without other inflammatory cytokines, as part of a clinical assessment of COVID-19 patients at hospital admission, may assist in identifying those likely to develop severe disease. A pragmatic retrospective analysis was performed on a complete data set from 111 patients admitted to Udine University Hospital, in northern Italy, from 25th March to 15th May 2020, affected by SARS-CoV-2 pneumonia. Clinical scoring systems (SOFA score, WHO disease severity class, SIMEU clinical phenotype), cytokines (IL-6, IL-1b, IL-8, TNF-α), and MR-proADM were measured. Demographic, clinical and outcome data were collected for analysis. At multivariate analysis, high MR-proADM levels were significantly associated with negative outcome (death or orotracheal intubation, IOT), with an odds ratio of 4.284 [1.893–11.413], together with increased neutrophil count (OR = 1.029 [1.011–1.049]) and WHO disease severity class (OR = 7.632 [5.871–19.496]). AUROC analysis showed a good discriminative performance of MR-proADM (AUROC: 0.849 [95% Cl 0.771–0.730]; p < 0.0001). The optimal value of MR-proADM to discriminate combined event of death or IOT is 0.895 nmol/l, with a sensitivity of 0.857 [95% Cl 0.728–0.987] and a specificity of 0.687 [95% Cl 0.587–0.787]. This study shows an association between MR-proADM levels and the severity of COVID-19. The assessment of MR-proADM combined with clinical scoring systems could be of great value in triaging, evaluating possible escalation of therapies, and admission avoidance or inclusion into trials. Larger prospective and controlled studies are needed to confirm these findings.

scholarly journals Comparison of Various Clinical Scoring Systems in Predicting Progression and Outcome in COVID 19 Infection

2020 ◽  
pp. 9-19
Author(s):  
Hetal Pandya ◽  
Arti Muley ◽  
Roop Gill ◽  
. Jeevana
Keyword(s):  
Disease Severity ◽  
Care Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
General Medicine ◽  
Scoring Systems ◽  
Clinical Disease ◽  
Asian Ethnicity ◽  
Progression Of Disease ◽  
Clinical Scoring

Aim: Comparison of various scoring systems and to find the better one for predicting the progression of disease in COVID-19 infection. Study Design: Observational. Place and Duration: Department of General medicine, Dhiraj hospital, a tertiary care center, located in Gujarat, India over period of 4 month (May-august 2020). Methodology: We included consecutive 300 adult patients of Asian ethnicity with COVID 19 infection, admitted in the hospital in ICU and Ward, who signed for participation. Various clinical scoring systems evaluated and compared for predictability of progression in COVID-19 infection which included two well-established and widely used systems- CURB-65 and qSOFA and two recent models, one being novel scoring model- CALL score used exclusively for COVID19 patients and other, the modified version of NEWS2 system. These scores were calculated for each confirmed COVID-19 positive patient on admission. WHO clinical disease severity grading was used to stratify patients and as reference for comparison with other scores. Results: Of the 300 patients, 197(65.6%) were male and 103(34.3%) were female with mean age of 49.74±15.69 years. 95(31.6%) patients had co-morbidities, hypertension being the most common (21%) followed by diabetes (14.3%). Using WHO clinical disease severity, 160 (53.3%) patients had mild disease, 68(22.6%) had moderate and 72(24%) had severe disease. The four scoring systems were applied and compared for predictability. NEWS2 system had higher discriminative power(AUC,0.69; 95%CI, 45.5 -72.9%) followed by qSOFA (AUC,0.41; 95%CI, 35.3-48.2%), CALL score had lower discrimination (AUC,0.40; 95%CI, 33.5-46.9%) and CURB-65 had the poor values (AUC,0.35; 95%CI, 29.3-42.1%) in predicting the progression of disease in admitted patients. NEWS2 had sensitivity and specificity of 69.7% and 100% respectively. Conclusion: In this study, four clinical scoring systems were compared on admission and NEWS2 system of risk stratification was found more accurate and better in predicting the disease progression in COVID19 positive patients.

scholarly journals Which Clinical Scoring Systems Are Most Useful in Showing Severity in COVID-19 Patients?

2021 ◽  
Author(s):  
Ishak San ◽  
Emin Gemcioglu ◽  
Salih Baser ◽  
Nuray Yilmaz Cakmak ◽  
Abdulsamet Erden ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcomes ◽  
Predictive Value ◽  
Independent Predictor ◽  
Severe Disease ◽  
Scoring Systems ◽  
High Risk Group ◽  
World Health ◽  
Severe Group ◽  
Clinical Scoring

Abstract IntroductionIn this study, we compare the predictive value of clinical scoring systems that are already in use in patients with COVID-19, including the BCRSS, qSOFA, SOFA, MuLBSTA and HScore, for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians.Materials and MethodsWe classified the patients into two groups according to the stage of the disease (severe and non-severe) by using the slightly modified and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 hours.ResultsOf the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR: 6.1, 95% CI: 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR: 4.757, 95% CI: 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively.ConclusionCalculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. With early identification of the high-risk group using BRCSS and qSOFA, early interventions for high-risk patients can improve clinical outcomes in COVID-19.

An algorithm combining VVSYmQ® and VCSS scores may help to predict disease severity in C2 patients

2021 ◽  
pp. 026835552110233
Author(s):  
Mikel Sadek ◽  
Matthew Pergamo ◽  
Jose I Almeida ◽  
Glenn R Jacobowitz ◽  
Lowell S Kabnick
Keyword(s):  
Disease Severity ◽  
Frequency Distribution ◽  
Conservative Therapy ◽  
Severe Disease ◽  
Scoring Systems ◽  
Distribution Analysis ◽  
Concordance Analysis ◽  
Patient Reported ◽  
Pearson's Correlation ◽  
The Relationship

Objectives The purpose was to assess whether combining patient reported scores (VVSymQ®) and physician reported scores (VCSS) stratifies disease severity in C2 patients. Methods Consecutive patients were pooled from the VANISH-1 and VANISH-2 cohorts. VCSS and VVSymQ® were calculated for each patient. The relationship between scoring systems was evaluated using Pearson’s correlation and frequency distribution analysis. Results Two-hundred and ten C2 limbs were included. Scoring systems demonstrated: VVSymQ®: mean = 8.72; VCSS: mean = 6.32; correlation (r = 0.22, p = 0.05). Frequency distribution analysis demonstrated 61.4% of patients had low VVSymQ® and low VCSS; 31.3% had elevated VVSymQ® and increased VCSS; 7.3% were inconsistent with C2 disease. Strict concordance analysis revealed 40.5% had VVSymQ® (< 9)/VCSS (0-6), 18.6% had VVSymQ® (≥ 9)/VCSS (7-9), and 2.9% had VVSymQ® (≥9)/VCSS (≥10). Conclusions For combined elevated VVSymQ® and VCSS, moderate/severe disease is corroborated, and intervention may be indicated. For combined lower scores, the disease severity is mild and conservative therapy is more appropriate.

scholarly journals Low Levels of Vitamin D Are Associated With Markers of Immuno-Inflammatory Response and Clinical Outcome in Covid-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A278-A278
Author(s):  
Luigi di Filippo ◽  
Agnese Allora ◽  
Mauro Doga ◽  
Patrizia Rovere Querini ◽  
Massimo Locatelli ◽  
...  
Keyword(s):  
Vitamin D ◽  
Inflammatory Response ◽  
Disease Severity ◽  
Severe Disease ◽  
University Hospital ◽  
Reactive Protein ◽  
Vitamin D Levels ◽  
High Flow Oxygen ◽  
High Prevalence ◽  
The Relationship

Abstract High prevalence of vitamin D (VD) deficiency in COVID-19 patients was reported by several studies. Since VD is a key regulating factor of both innate and adaptive immunity, it was hypothesized that VD deficiency may predispose to SARS-CoV-2 infection and lower levels of VD could be related to increased COVID-19 severity and worse outcome risks. However, to date, only few studies partially investigated the relationship between VD and inflammatory and immune response and clinical features of COVID-19 patients. The aim of this study is to evaluate the influence of vitamin D levels on COVID-19 inflammatory activity, clinical pattern and disease severity. Patients admitted to San Raffaele University Hospital for COVID-19 from February 2020 were enrolled in this study. We excluded patients with comorbidities and therapies influencing VD metabolism. 25OH-Vitamin D levels were evaluated at admission in hospital and VD insufficiency and deficiency were defined as VD level below 30 ng/mL and 20 ng/mL, respectively. A total of 88 patients were included in the study. Median (IQR) VD levels were 16.3 (11.2–23.9) ng/mL. VD insufficiency and deficiency were found in 88.6% and in 68.2% of patients, respectively. Linear regression analyses showed a positive correlation between VD levels and PaO2/FiO2 ratio (p=0.019; r=0.254), and negative correlations between VD levels and Neutrophil/Lymphocyte (N/L) ratio (p=0.04; r=-0.19), C-reactive protein (CRP) levels (p=0.047; r=-0.18) and Interleukin 6 (IL-6) levels (p=0.04; r=-0.22). Lower VD levels were found in patients affected by severe disease (needs for high-flow oxygen therapy and/or noninvasive mechanical ventilation, admitted to ICU and/or dead) than non-severe patients (13.4 ng/mL [10.37–19.15] vs 18.45 ng/mL [15.15–24.95]; p=0.007). Moreover, patients with VD deficiency had higher levels of CRP, LDH, IL-6, IFN-gamma (p=0.04, p=0.01, p=0.002, p=0.04; respectively), lower PaO2/FiO2 and higher N/L ratios (p=0.008, p=0.004; respectively), and higher rate of severe disease (65% vs 39%, p=0.02), as compared to VD non-deficient ones. In conclusion, low VD levels are widely found in hospitalized COVID-19 and may lead to increased disease severity through an excessive immune-inflammatory response. Our data suggest that reaching adequate vitamin D levels in risky population may contribute to prevention of COVID-19 occurrence and severity.

scholarly journals Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients—Results from the CORONA Germany study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252867
Author(s):  
Nele Gessler ◽  
Melanie A. Gunawardene ◽  
Peter Wohlmuth ◽  
Dirk Arnold ◽  
Juergen Behr ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Respiratory Rate ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Severe Disease ◽  
Temporal Analysis ◽  
Temporal Variations ◽  
Heterogeneous Data ◽  
Primary Objective ◽  
Data Set

Background After one year of the pandemic and hints of seasonal patterns, temporal variations of in-hospital mortality in COVID-19 are widely unknown. Additionally, heterogeneous data regarding clinical indicators predicting disease severity has been published. However, there is a need for a risk stratification model integrating the effects on disease severity and mortality to support clinical decision-making. Methods We conducted a multicenter, observational, prospective, epidemiological cohort study at 45 hospitals in Germany. Until 1 January 2021, all hospitalized SARS CoV-2 positive patients were included. A comprehensive data set was collected in a cohort of seven hospitals. The primary objective was disease severity and prediction of mild, severe, and fatal cases. Ancillary analyses included a temporal analysis of all hospitalized COVID-19 patients for the entire year 2020. Findings A total of 4704 COVID-19 patients were hospitalized with a mortality rate of 19% (890/4704). Rates of mortality, need for ventilation, pneumonia, and respiratory insufficiency showed temporal variations, whereas age had a strong influence on the course of mortality. In cohort conducting analyses, prognostic factors for fatal/severe disease were: age (odds ratio (OR) 1.704, CI:[1.221–2.377]), respiratory rate (OR 1.688, CI:[1.222–2.333]), lactate dehydrogenase (LDH) (OR 1.312, CI:[1.015–1.695]), C-reactive protein (CRP) (OR 2.132, CI:[1.533–2.965]), and creatinine values (OR 2.573, CI:[1.593–4.154]. Conclusions Age, respiratory rate, LDH, CRP, and creatinine at baseline are associated with all cause death, and need for ventilation/ICU treatment in a nationwide series of COVID 19 hospitalized patients. Especially age plays an important prognostic role. In-hospital mortality showed temporal variation during the year 2020, influenced by age. Trial registration number NCT04659187.

Applicability of clinical scoring systems after transarterial chemoembolisation in the bridging to transplant setting

2018 ◽  
Vol 56 (08) ◽  
pp. e312-e313
Author(s):  
I Mohr ◽  
M Vogeler ◽  
J Pfeiffenberger ◽  
D Sprengel ◽  
M Klauss ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Transarterial Chemoembolisation ◽  
Clinical Scoring ◽  
Bridging To Transplant

Epidemiology and Antifungal Susceptibility in Patients with Candidemia in a University Hospital, Thailand

2020 ◽  
Vol 103 (10) ◽  
pp. 1048-1056
Keyword(s):  
Antifungal Susceptibility ◽  
Underlying Disease ◽  
Outcome Data ◽  
Adult Patients ◽  
Antifungal Treatment ◽  
University Hospital ◽  
Fluconazole Resistance ◽  
Fluconazole Therapy ◽  
Fluconazole Resistant ◽  
High Level

Background: Candidemia is the most common nosocomial invasive fungal infection that causes high mortality. Emergence of drug-resistant Candida is reported worldwide but there are few studies in Thailand. Objective: To determine the epidemiology, antifungal susceptibility of Candida, and outcomes among adult patients with candidemia. Materials and Methods: A prospective, observational study in adult patients with candidemia was conducted in 2015 at a university hospital. Demographic, microbiological, and outcome data were recorded. Results: Fifty-two patients with candidemia were identified, of whom 76.9% had an underlying disease and 69.2% had risks for candidemia. Sixty-four percent of candidemia patients contracted non-albicans Candida and 36% had Candida albicans. C. tropicalis was the most common non-albicans Candida species isolated (35%), followed by C. parapsilosis (19%), and C. glabrata (10%). Fluconazole resistance was found in 12.5% of C. albicans and in 11.1% of C. parapsilosis isolates. Reduced fluconazole susceptibility or high-level fluconazole resistance was found in 68.7% of C. tropicalis isolates. All except C. parapsilosis had excellent susceptibility to echinocandins. Seventy-three percent (38/52) of patients received antifungal treatment, of whom, 78.9% received empiric fluconazole therapy, and 89.7% were started on antifungal treatment 24 hours after the isolation of Candida. The overall mortality rate was 51.9%. Conclusion: Fluconazole-resistant Candida became more prevalent particularly in C. tropicalis, which was the predominant species among non-albicans Candida causing candidemia. Empiric treatment with either amphotericin B or echinocandins would be appropriate in high-risk patients with suspected candidemia. Trial registration: Thai Clinical Trials Registry, TCTR20150605001 Keywords: Candida, Fluconazole, Resistant, Thailand

scholarly journals Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

2021 ◽  
Vol 10 (10) ◽  
pp. 2077
Author(s):  
Yi-Min Huang ◽  
Chiao Lo ◽  
Chiao-Feng Cheng ◽  
Cheng-Hsun Lu ◽  
Song-Chou Hsieh ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severe Disease ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Serum Biomarkers ◽  
Healthy Controls ◽  
Granulomatous Mastitis ◽  
C Reactive Protein ◽  
Idiopathic Granulomatous Mastitis ◽  
Reactive Protein

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking breast cancer. Limited research has been conducted on the application of serum biomarkers. This study aims to investigate the association of serum biomarkers with disease severity in patients with IGM. From November 2011 to March 2020, medical records of patients with IGM were reviewed. Serum cytokine levels were measured in patients and healthy controls between July 2018 and March 2020. A total of 41 patients with histologically proven IGM were found. Serum interleukin (IL)-6 level was significantly higher in patients with IGM (n = 11) than healthy controls (n = 7). Serum IL-6 and C-reactive protein (CRP) levels were significantly higher in patients with severe disease than mild and moderate disease. Serum IL-6 (Spearman’s ρ = 0.855; p < 0.001) and CRP (Spearman’s ρ = 0.838; p = 0.001) levels were associated with time to resolution. A higher serum CRP level was associated with a longer time to resolution (B = 0.322; p < 0.001) in multiple linear regression analysis. Serum IL-6 and CRP levels can be used as biomarkers for the evaluation of disease severity in IGM. IL-6 may play a crucial role in the immunopathology of IGM.

scholarly journals Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eunyoung Emily Lee ◽  
Kyoung-Ho Song ◽  
Woochang Hwang ◽  
Sin Young Ham ◽  
Hyeonju Jeong ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune Responses ◽  
Clustering Analysis ◽  
Validation Cohort ◽  
Inflammatory Responses ◽  
Clinical Course ◽  
Severe Disease ◽  
Outcome Data ◽  
Inflammatory Immune Response ◽  
Cluster 2

AbstractThe objective of the study was to identify distinct patterns in inflammatory immune responses of COVID-19 patients and to investigate their association with clinical course and outcome. Data from hospitalized COVID-19 patients were retrieved from electronic medical record. Supervised k-means clustering of serial C-reactive protein levels (CRP), absolute neutrophil counts (ANC), and absolute lymphocyte counts (ALC) was used to assign immune responses to one of three groups. Then, relationships between patterns of inflammatory responses and clinical course and outcome of COVID-19 were assessed in a discovery and validation cohort. Unbiased clustering analysis grouped 105 patients of a discovery cohort into three distinct clusters. Cluster 1 (hyper-inflammatory immune response) was characterized by high CRP levels, high ANC, and low ALC, whereas Cluster 3 (hypo-inflammatory immune response) was associated with low CRP levels and normal ANC and ALC. Cluster 2 showed an intermediate pattern. All patients in Cluster 1 required oxygen support whilst 61% patients in Cluster 2 and no patient in Cluster 3 required supplementary oxygen. Two (13.3%) patients in Cluster 1 died, whereas no patient in Clusters 2 and 3 died. The results were confirmed in an independent validation cohort of 116 patients. We identified three different patterns of inflammatory immune response to COVID-19. Hyper-inflammatory immune responses with elevated CRP, neutrophilia, and lymphopenia are associated with a severe disease and a worse outcome. Therefore, targeting the hyper-inflammatory response might improve the clinical outcome of COVID-19.

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