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.

Immunoinflammatory Biomarkers in Serum Are Associated with Disease Severity in Atopic Dermatitis

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Jesper Grønlund Holm ◽  
Guillem Hurault ◽  
Tove Agner ◽  
Maja Lisa Clausen ◽  
Sanja Kezic ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Disease Severity ◽  
Predictive Models ◽  
Severe Disease ◽  
Serum Levels ◽  
Disease Characteristics ◽  
Immunological Markers ◽  
Chemokine Ligand ◽  
Serum Total Ige ◽  
The Relationship

Background: A growing body of evidence links various biomarkers to atopic dermatitis (AD). Still, little is known about the association of specific biomarkers to disease characteristics and severity in AD. Objective: To explore the relationship between various immunological markers in the serum and disease severity in a hospital cohort of AD patients. Methods: Outpatients with AD referred to the Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, were divided into groups based on disease severity (SCORAD). Serum levels of a preselected panel of immunoinflammatory biomarkers were tested for association with disease characteristics. Two machine learning models were developed to predict SCORAD from the measured biomarkers. Results: A total of 160 patients with AD were included; 53 (33.1%) with mild, 73 (45.6%) with moderate, and 34 (21.3%) with severe disease. Mean age was 29.2 years (range 6–70 years) and 84 (52.5%) were females. Numerous biomarkers showed a statistically significant correlation with SCORAD, with the strongest correlations seen for CCL17/thymus and activation-regulated chemokine (chemokine ligand-17/TARC) and CCL27/cutaneous T cell-attracting-chemokine (CTACK; Spearman R of 0.50 and 0.43, respectively, p < 0.001). Extrinsic AD patients were more likely to have higher mean SCORAD (p < 0.001), CCL17 (p < 0.001), CCL26/eotaxin-3 (p < 0.001), and eosinophil count (p < 0.001) than intrinsic AD patients. Predictive models for SCORAD identified CCL17, CCL27, serum total IgE, IL-33, and IL-5 as the most important predictors for SCORAD, but with weaker associations than single cytokines. Conclusions: Specific immunoinflammatory biomarkers in the serum, mainly of the Th2 pathway, are correlated with disease severity in patients with AD. Predictive models identified biomarkers associated with disease severity but this finding warrants further investigation.

scholarly journals Disrupted Resolution Mechanisms Favor Altered Phagocyte Responses in Covid-19

2021 ◽  
Author(s):  
Duco Koenis ◽  
Issa Beegun ◽  
Charlotte Jouvene ◽  
Gabriel Amador Aguirre ◽  
Patricia R Souza ◽  
...  
Keyword(s):  
Immune Responses ◽  
Disease Severity ◽  
Clinical Symptoms ◽  
Tissue Injury ◽  
Severe Disease ◽  
Lipid Mediator ◽  
Activation Markers ◽  
And Function ◽  
The Relationship ◽  
Activation Status

Rationale: Resolution mechanisms are central in both the maintenance of homeostasis and the return to catabasis following tissue injury and/or infections. Amongst the pro-resolving mediators, the essential fatty acid-derived specialized pro-resolving lipid mediators (SPM) govern immune responses to limit disease severity. Notably, little is known about the relationship between the expression and activity of SPM pathways, circulating phagocyte function and disease severity in patients infected with novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to coronavirus disease 2019 (COVID-19). Objective: Herein, we investigated the link between circulating SPM concentrations and phagocyte activation status and function in COVID-19 patients (n=39) compared to healthy (n=12) and post-COVID-19 (n=8) volunteers. Methods and Results: Lipid mediator profiling demonstrated that plasma SPM concentrations were upregulated in patients with mild COVID-19 and are downregulated in those with severe disease. SPM concentrations were correlated with both circulating phagocyte activation status and function. Perturbations in plasma SPM concentrations and phagocyte activation were retained after the resolution of COVID-19 clinical symptoms. Treatment of patients with dexamethasone upregulated both the expression of SPM biosynthetic enzymes in circulating phagocytes and plasma concentration of these mediators. Furthermore, incubation of phagocytes from COVID-19 patients with SPM rectified their phenotype and function. This included a downregulation in the expression of activation markers, a decrease in the Tissue Factor and inflammatory cytokine expression, and an upregulation of bacterial phagocytosis. Conclusions: The present findings suggest that downregulation of systemic SPM concentrations is linked with both increased disease severity and dysregulated phagocyte function. They also identify the upregulation of these mediators by dexamethasone as a potential mechanism in host protective activities elicited by this drug in COVID-19 patients. Taken together, our findings elucidate a role for altered resolution mechanisms in the disruption of phagocyte responses and the propagation of systemic inflammation in COVID-19.

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.

Assessing the Relationship Between Disease Severity and Patient-Reported Outcomes in Psoriasis Patients in the US

2018 ◽  
Vol 2 ◽  
pp. S81
Author(s):  
J Lucas ◽  
A Teeple ◽  
J Hetherington ◽  
E Muser
Keyword(s):  
Disease Severity ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
The Us ◽  
The Relationship

Abstract not available. Disclosures: Study sponsored by Janssen. Copyright 2018 SKIN

scholarly journals The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Kirstine Amris ◽  
Eva Ejlersen Wæhrens ◽  
Anders Jespersen ◽  
Anders Stockmarr ◽  
Robert Bennett ◽  
...  
Keyword(s):  
Disease Severity ◽  
Continuum Model ◽  
Chronic Widespread Pain ◽  
Tender Point ◽  
Mechanical Hyperalgesia ◽  
Widespread Pain ◽  
Cross Sectional ◽  
Pressure Pain Thresholds ◽  
Patient Reported ◽  
The Relationship

The clinical utility of tender point (TP) examination in patients reporting chronic widespread pain (CWP) is the subject of contemporary debate. The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity. 271 women with CWP were recruited from a clinical setting. Data collection included patient-reported symptoms, health-related quality of life variables, and observation-based measures of functional ability, muscle strength, 6-minute walk, and pressure pain thresholds measured by cuff algometry. TP examination was conducted according to ACR-guidelines. Relationships between disease variables and TP count (TPC) were analyzed with logistic regression in a continuum model, allowing the TPC to depend on the included disease variables and two regression models carried out for a TPC threshold level, varying between 1 and 17. The threshold analyses indicated a TPC threshold at 8, above which a large number of disease variables became consistently significant explanatory factors, whereas none of the disease variables reached a significance level in the continuum model. These results support the premise that the presence of mechanical hyperalgesia influences symptomatology in CWP and that the severity of clinical expression is related to a threshold of TPs, rather than being part of a continuum.

scholarly journals Patient Reported Outcome Measure in Atopic Dermatitis Patients Treated with Dupilumab: 52-Weeks Results

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 617
Author(s):  
Servando E. Marron ◽  
Lucia Tomas-Aragones ◽  
Carlos A. Moncin-Torres ◽  
Manuel Gomez-Barrera ◽  
Francisco Javier Garcia-Latasa de Aranibar
Keyword(s):  
Quality Of Life ◽  
Atopic Dermatitis ◽  
Clinical Practice ◽  
Disease Severity ◽  
Stressful Life Events ◽  
Severe Disease ◽  
Patient Reported Outcome ◽  
Routine Clinical Practice ◽  
Patient Reported

Dupilumab is used to treat atopic dermatitis (AD) patients who have proven to be refractory to previous treatments. The aim of this study was to assess evolution and patient reported outcome measures in adult patients with moderate-to-severe AD treated with dupilumab in routine clinical practice. The outcomes were evaluated and registered at baseline and weeks 16, 40 and 52. The variables evaluated were: disease severity, pruritus, stressful life events, difficulty to sleep, anxiety and depression, quality of life, satisfaction, adherence to the treatment, efficacy and safety. Eleven patients were recruited between 14 Nov 2017 and 16 Jan 2018. Demographic variables: 90% Caucasian, 82% women. Clinical variables: Mean duration of AD = 17.7 (±12.8), 91% had severe disease severity. At baseline, SCORAD median (range) score = 69.2 (34.8–89.2); itch was reported by 100% of patients; itch visual analogue scale median (range) was 9 (6–10); HADS median (range) total score = 13 (5–21); DLQI mean score = 16 (2–27); EQ-5D-3L median (range) = 57 (30–99). At week-52 there was a significant reduction of SCORAD scores median (range) = 4.3 (0–17.1), HADS total score median (range) = 2 (0–10) and improved quality of life EQ-5D-3L median (range) = 89 (92–60). This study confirms that dupilumab, used for 52-weeks under routine clinical practice, maintains the improved atopic dermatitis signs and symptoms obtained at week 16, with a good safety profile.

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 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 Differential Cytokine Signatures of SARS-CoV-2 and Influenza Infection Highlight Key Differences in Pathobiology

2021 ◽  
Author(s):  
Andrew H. Karaba ◽  
Weiqiang Zhou ◽  
Leon L. Hsieh ◽  
Alexis Figueroa ◽  
Guido Massaccesi ◽  
...  
Keyword(s):  
Random Forest ◽  
Disease Severity ◽  
Influenza Infection ◽  
Severe Disease ◽  
Gm Csf ◽  
Cytokines And Chemokines ◽  
Severe Influenza ◽  
Tnf Α ◽  
Relationship Of ◽  
The Relationship

ABSTRACTBackgroundSeveral inflammatory cytokines are upregulated in severe COVID-19. We compared cytokines in COVID-19 versus influenza in order to define differentiating features of the inflammatory response to these pathogens and their association with severe disease. Because elevated body mass index (BMI) is a known risk factor for severe COVID-19, we examined the relationship of BMI to cytokines associated with severe disease.MethodsThirty-seven cytokines and chemokines were measured in plasma from 145 patients with COVID-19, 57 patients with influenza, and 30 healthy controls. Controlling for BMI, age, and sex, differences in cytokines between groups were determined by linear regression and random forest prediction was utilized to determine the cytokines most important in distinguishing severe COVID-19 and influenza. Mediation analysis was utilized to identify cytokines that mediate the effect of BMI on disease severity.ResultsIL-18, IL-1β, IL-6, and TNF-α were significantly increased in COVID-19 versus influenza patients while GM-CSF, IFN-γ, IFN-λ1, IL-10, IL-15, and MCP-2 were significantly elevated in the influenza group. In subgroup analysis based on disease severity, IL-18, IL-6, and TNF-α were elevated in severe COVID-19, but not severe influenza. Random forest analysis identified high IL-6 and low IFN-λ1 levels as the most distinct between severe COVID-19 and severe influenza. Finally, IL-1RA was identified as a potential mediator of the effects of BMI on COVID-19 severity.ConclusionsThese findings point to activation of fundamentally different innate immune pathways in SARS-CoV-2 and influenza infection, and emphasize drivers of severe COVID-19 to focus both mechanistic and therapeutic investigations.SummarySevere COVID-19 is marked by dysregulated inflammation and is associated with elevated BMI. By comparing cytokines and chemokines in patients with either COVID-19 or influenza, we identified distinct inflammatory pathways and a cytokine mediator of the effect of BMI.

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