The incremental value of computed tomography of COVID-19 pneumonia in predicting ICU admission

AbstractTriage is crucial for patient’s management and estimation of the required intensive care unit (ICU) beds is fundamental for health systems during the COVID-19 pandemic. We assessed whether chest computed tomography (CT) of COVID-19 pneumonia has an incremental role in predicting patient’s admission to ICU. We performed volumetric and texture analysis of the areas of the affected lung in CT of 115 outpatients with COVID-19 infection presenting to the emergency room with dyspnea and unresponsive hypoxyemia. Admission blood laboratory including lymphocyte count, serum lactate dehydrogenase, D-dimer and C-reactive protein and the ratio between the arterial partial pressure of oxygen and inspired oxygen were collected. By calculating the areas under the receiver-operating characteristic curves (AUC), we compared the performance of blood laboratory-arterial gas analyses features alone and combined with the CT features in two hybrid models (Hybrid radiological and Hybrid radiomics)for predicting ICU admission. Following a machine learning approach, 63 patients were allocated to the training and 52 to the validation set. Twenty-nine (25%) of patients were admitted to ICU. The Hybrid radiological model comprising the lung %consolidation performed significantly (p = 0.04) better in predicting ICU admission in the validation (AUC = 0.82; 95% confidence interval 0.73–0.97) set than the blood laboratory-arterial gas analyses features alone (AUC = 0.71; 95% confidence interval 0.56–0.86). A risk calculator for ICU admission was derived and is available at: https://github.com/cgplab/covidapp. The volume of the consolidated lung in CT of patients with COVID-19 pneumonia has a mild but significant incremental value in predicting ICU admission.

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COVID-19 Coinfection with Mycobacterium abscessus in a Patient with Multiple Myeloma

Case Reports in Infectious Diseases ◽

10.1155/2021/8840536 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Jose A. Rodriguez ◽

Charles Bonnano ◽

Pratik Khatiwada ◽

Alejandra A. Roa ◽

Daniel Mayer ◽

...

Keyword(s):

Multiple Myeloma ◽

Chest Radiograph ◽

Severe Pneumonia ◽

Serum Lactate ◽

Mycobacterium Abscessus ◽

Serum Lactate Dehydrogenase ◽

Reactive Protein ◽

Lower Lung ◽

Repeat Chest ◽

The One

Background. Coronavirus disease (COVID-19) is a worldwide pandemic causing multiple fatalities and morbidities worldwide. We report a case of severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-CoV-2 and Mycobacterium abscessus in an elderly patient with multiple myeloma in Florida, USA. Case Presentation. An 84-year-old male with a medical history significant for multiple myeloma not in remission was sent to the emergency department to rule out COVID-19 infection prior to continuing his chemotherapy sessions. At presentation, he had nonspecific mild symptoms and an unremarkable physical examination. He had significant blood test findings including serum lactate dehydrogenase 373 U/L, high sensitive C-reactive protein 17.40 mg/l, and ferritin 415 ng/ml. Xpert-SARS-CoV-2 was positive. Chest radiograph revealed patchy areas of interstitial infiltrates in mid to lower lung zones. During his hospitalization course, his oxygenation deteriorated, requiring mechanical intubation. Repeat chest radiograph showed worsening bilateral infiltrates. He was started on broad-spectrum antibiotics and eventually weaned off mechanical intubation and extubated. On the 11th day of admission, he was found to be bradycardic and in shock, and he was reintubated. His labs showed worsening inflammatory markers along with kidney dysfunction to the point of requiring renal replacement therapy. He received both convalescent plasma and remdesivir for treatment of COVID-19 pneumonia. Eventually, repeat blood cultures came back positive for the growth of acid-fast beaded bacilli. While awaiting final culture and sensitivity reports, his antibiotics were upgraded to cover possible nocardia infection. Repeat blood and sputum cultures resulted in growth of AFB bacilli Mycobacterium abscessus 1 week after. Conclusions. This case report highlights the importance of keeping a broad differential and considering multiple coinfections, including atypical ones during this COVID-19 pandemic, such as the one that was discussed above, Mycobacterium abscessus, in order to provide goal-directed therapy.

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Orbital plasmacytoma as the presenting feature in multiple myeloma

European Journal of Ophthalmology ◽

10.1177/1120672120929959 ◽

2020 ◽

pp. 112067212092995 ◽

Cited By ~ 1

Author(s):

Malavika Mani ◽

Nirupama Kasturi ◽

Rekha Sravya ◽

Subashini Kaliaperumal ◽

Debasis Gochhait

Keyword(s):

Plasma Cells ◽

Systemic Disease ◽

Elevated Serum ◽

Needle Aspiration ◽

Serum Lactate ◽

Serum Lactate Dehydrogenase ◽

Reactive Protein ◽

Lytic Lesions ◽

Needle Aspiration Cytology

A 50-year-old female patient presented with protrusion of the left eye for 1 month. Examination showed abaxial proptosis, restriction of extraocular movements, and elevated intraocular pressure. Computed tomography of the orbits showed soft tissue enhancing lesion in the superolateral aspect of the left orbit with lytic lesions in calvarium. Fine needle aspiration cytology of the lesion revealed a diagnosis of plasmacytoma with positive CD138 and CD38 immunohistochemical stains. Erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase were elevated. Serum protein electrophoresis revealed hypergammaglobulinemia, and bone marrow biopsy revealed 6% plasma cells. The patient was started on chemotherapy with bortezomib, dexamethasone and lenalidomide by the medical oncologist. Significant improvement in proptosis and extraocular movements noted on follow-up. Orbital myeloma may be the first manifestation of systemic disease.

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Impact of pericardial fluid glucose level and computed tomography attenuation values on diagnosis of malignancy-related pericardial effusion

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02091-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Takashi Nakamura ◽

Mana Okune ◽

Masakazu Yasuda ◽

Heitaro Watanabe ◽

Masafumi Ueno ◽

...

Keyword(s):

Computed Tomography ◽

Pericardial Effusion ◽

Glucose Level ◽

Serum Lactate ◽

Pericardial Fluid ◽

Serum Lactate Dehydrogenase ◽

Predictive Values ◽

Ct Attenuation ◽

Significant Difference ◽

Attenuation Values

Abstract Background We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT). Methods This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups. Results All patients were diagnosed as having exudative PE by Light’s criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light’s criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4–26.0] vs 17.4 [IQR, 13.7–26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012). Conclusions Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.

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Role of Up-Front Primary Tumor Resection and Tumor Sidedness in the Survival of Synchronous Metastatic Colon Cancer Patients

Digestive Surgery ◽

10.1159/000517477 ◽

2021 ◽

pp. 1-7

Author(s):

Dave E.W. van der Kruijssen ◽

Karlijn L. van Rooijen ◽

Sophie A. Kurk ◽

Johannes H.W. de Wilt ◽

Cornelis J.A. Punt ◽

...

Keyword(s):

Colon Cancer ◽

Confidence Interval ◽

Primary Tumor ◽

Cox Regression ◽

Performance Status ◽

Tumor Resection ◽

Serum Lactate ◽

Primary Tumor Resection ◽

Serum Lactate Dehydrogenase ◽

Metastatic Colon Cancer

Introduction: Uncertainty exists about a possible survival benefit of primary tumor resection (PTR) in synchronous metastatic colon cancer (mCC). Since sidedness of the primary tumor is regarded as an important prognostic factor, our objective was to study the interaction between PTR and sidedness in synchronous mCC. Methods: In this retrospective study, we used data from 2 first-line phase 3 randomized controlled trials (RCTs). A mixed Cox regression model was used to study the multiplicative interaction between PTR and sidedness. We adjusted for age, treatment arm, WHO performance status, number of affected organs by metastases, serum lactate dehydrogenase, and year of enrollment. Results: We found that PTR is associated with better survival in both right-sided (hazard ratio [HR] 0.59 [95% confidence interval 0.42–0.8 2]) and left-sided mCC (HR 0.70 [95% confidence interval 0.52–0.93]). The interaction between PTR and sidedness was not significant (p = 0.45). Conclusion: Our data suggest that the prognostic value of PTR is independent of sidedness. Validation of these results will be performed in ongoing RCTs.

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Sex Differences in an Italian Pediatric Population Covid-19 Positive

10.21203/rs.3.rs-44105/v1 ◽

2020 ◽

Author(s):

Elisabetta Straface ◽

Isabella Tarissi De Jacobis ◽

Rosa Vona ◽

Camilla Cittadini ◽

Alessandra Marchesi ◽

...

Keyword(s):

Sex Differences ◽

Pediatric Population ◽

Gastrointestinal Symptoms ◽

Serum Lactate ◽

Serum Lactate Dehydrogenase ◽

C Reactive Protein ◽

Laboratory Findings ◽

Reactive Protein ◽

Males And Females ◽

Multiple Drugs

Abstract Background: Since December 2019 coronavirus disease (COVID-19) emerged in Wuhan and spread rapidly worldwide. Despite the high number of people affected, data on clinical features and prognostic factors in children and adolescents are limited. We propose a retrospective study aimed to identify sex differences in a pediatric population with COVI-19.Methods: A pediatric population admitted with COVID-19 to Bambino Gesù Children's Hospital of Rome (Italy) in the period from March to May 2020 has been studied taking into account sex differences. Medical history, comorbidities, symptoms and laboratory findings were obtained from patients' electronic medical records. Results: In 37 patients (19 males and 18 females) we found that: i) fever and cough were the dominant symptoms, while gastrointestinal symptoms were rare; and ii) all ages of childhood were susceptible to COVID-19. Moreover, we found that females with COVID-19 were older than males (p < 0.01); required more days of hospitalization (p < 0.04); needed of treatment with multiple drugs; and had higher serum lactate dehydrogenase values (p < 0.04) than males. Conversely, males had, although not significant, higher values of C reactive protein and erythrocyte sedimentation rate than females.Conclusions: Based on the data listed above sex differences were detected in an Italian pediatric population. Compared to the adults we found that COVID-19 infection in children is a non-severe inflammatory disease in both males and females. In any case, many detailed studies should be conducted.

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The extent of honeycombing on computed tomography cannot predict the treatment outcome of patients with acute exacerbations of interstitial lung disease (Retrospective cohort study)

10.21203/rs.3.rs-397063/v1 ◽

2021 ◽

Author(s):

Yurika Nishikawa ◽

Yu Hara ◽

Yoichi Tagami ◽

Ryo Nagasawa ◽

Kota Murohashi ◽

...

Keyword(s):

Computed Tomography ◽

Ground Glass Opacity ◽

Pulse Therapy ◽

Serum Lactate ◽

Interstitial Lung Diseases ◽

Charlson Comorbidity Index Score ◽

Serum Lactate Dehydrogenase ◽

Significant Difference ◽

Acute Exacerbations ◽

The Difference

Abstract Background: The purpose of this retrospective study was to clarify whether the presence of honeycombing on computed tomography (CT) can affect the prognosis of patients with acute exacerbations (AEs) of interstitial lung diseases (ILDs).Methods: Clinical parameters including age, sex, Charlson Comorbidity Index score (CCIS), blood biomarkers, and 3-month mortality were retrospectively compared between the CT honeycombing present and absent groups at the diagnosis of AEs of ILDs.Results: Ninety-five patients who were on corticosteroid pulse therapy were assessed. Though log-rank tests showed that Kaplan-Meier survival curves of the high and low ground-glass opacity (GGO) score groups differed significantly in 3-month mortality in patients with AEs of idiopathic ILDs (P = 0.007) and overall patients (P = 0.045), there was no significant difference between the CT honeycombing present and absent groups in patients with AEs of idiopathic ILDs (P = 0.600) and AEs of secondary ILDs (P = 0.472), as well as of overall patients (P = 0.905). In addition, whereas CCIS (OR, 1.436; 95% CI, 1.119-1.938; P = 0.004) and age (OR, 1.097; 95% CI, 1.119-1.212; P = 0.026) were significant predictors of 3-month mortality in the CT honeycombing absent group, serum lactate dehydrogenase (OR, 1.004; 95% CI, 1.002-1.007; P = 0.001) and sex (OR, 6.381; 95% CI, 0.821-49.602; P = 0.023) were significant predictors in the CT honeycombing present groupConclusions: The clinical features of patients with or without honeycombing may differ due to the difference in prognostic factors, but these groups were found to have similar prognoses 3 months after AE onset, and clinicopathological examinations according to these groups are essential.

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Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1361 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Alberto Dolci ◽

Cristina Robbiano ◽

Elena Aloisio ◽

Mariia Chibireva ◽

Ludovica Serafini ◽

...

Keyword(s):

Bacterial Infections ◽

Serum Lactate ◽

Hospitalized Patients ◽

Added Value ◽

Serum Lactate Dehydrogenase ◽

Patient Death ◽

Reactive Protein ◽

Major Application ◽

Attending Physicians

AbstractObjectivesProcalcitonin (PCT) has been proposed for differentiating viral vs. bacterial infections. In COVID-19, some preliminary results have shown that PCT testing could act as a predictor of bacterial co-infection and be a useful marker for assessment of disease severity.MethodsWe studied 83 COVID-19 hospitalized patients in whom PCT was specifically ordered by attending physicians. PCT results were evaluated according to the ability to accurately predict bacterial co-infections and death in comparison with other known biomarkers of infection and with major laboratory predictors of COVID-19 severity.ResultsThirty-three (39.8%) patients suffered an in-hospital bacterial co-infection and 44 (53.0%) patients died. In predicting bacterial co-infection, PCT showed a relatively low accuracy (area under receiver-operating characteristic [ROC] curve [AUC]: 0.757; 95% confidence interval [CI]: 0.651–0.845), with a strength for detecting the outcome not significantly different from that of white blood cell count and C-reactive protein (CRP). In predicting patient death, PCT showed an AUC of 0.815 (CI: 0.714–0.892), not better than those of other more common laboratory tests, such as blood lymphocyte percentage (AUC: 0.874, p=0.19), serum lactate dehydrogenase (AUC: 0.860, p=0.47), blood neutrophil count (AUC: 0.845, p=0.59), and serum albumin (AUC: 0.839, p=0.73).ConclusionsProcalcitonin (PCT) testing, even when appropriately ordered, did not provide a significant added value in COVID-19 patients when compared with more consolidated biomarkers of infection and poor clinical outcome. The major application of PCT in COVID-19 is its ability, associated with a negative predictive value >90%, to exclude a bacterial co-infection when a rule-out cut-off (<0.25 μg/L) is applied.

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Low pericardial fluid glucose concentration combined with computed tomography evaluation as a malignancy-related marker in symptomatic patients undergoing pericardiocentesis: a retrospective study

10.21203/rs.3.rs-275585/v1 ◽

2021 ◽

Author(s):

Takashi Nakamura ◽

Mana Okune ◽

Masakazu Yasuda ◽

Heitaro Watanabe ◽

Masafumi Ueno ◽

...

Keyword(s):

Computed Tomography ◽

Glucose Level ◽

Japanese Patients ◽

Serum Lactate ◽

Pericardial Fluid ◽

Serum Lactate Dehydrogenase ◽

Ct Attenuation ◽

Significant Difference ◽

Attenuation Values ◽

Single Center Observational Study

Abstract Background: We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT).Methods: This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups.Results: All patients were diagnosed as having exudative PE by Light’s criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. A ratio of pericardial to serum lactate dehydrogenase (LDH) >0.6 as one of Light’s criteria, and lower serum brain natriuretic peptide (BNP: 126.9±89.8 pg/ml vs 409.2±97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037) were associated with malignancy (both, p < 0.05). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.25±48.29 mg/dl vs 98.41±44.85, respectively; p < 0.05). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4–26.0] vs 17.4 [IQR, 13.7–26.4], respectively; p = 0.08). Pericardial fluid glucose level ≤70 mg/dl and CT attenuation values >20 HU were strongly associated with malignancy.Conclusions: Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.

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