Coagulation Dysfunction and Hematological Changes in 633 Patients with COVID-19

Background: A previously unknown beta-coronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. The virus was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the international committee for the classification of viruses (ICTV). The disease caused by this virus was named as coronavirus disease 2019 (COVID-19). In addition to pulmonary manifestations, hematological changes such as lymphocytopenia, thrombocytopenia, and coagulation dysfunction can also be found in COVID-19 patients, and the mechanism is still unclear. Case data and methods: A total of 633 COVID-19 patients from Wuhan hospital of China were retrospectively analyzed. Clinical case data of all patients were collected, including gender, age, chronic underlying diseases, outcome, and blood laboratory test results. The hematological features of COVID-19 patients and the factors affecting their outcome were analyzed. Results: Of 633 patients with COVID-19, the median age was 62 years (interquartile range, IQR, 51.0-70.0) and 330 (52%) were men. Lymphocytopenia (lymphocyte count, 1.0 ×109 / L [IQR, 0.7-1.4]) occurred in 317/607 patients (52%), thrombocytopenia (platelet count <100 × 109/ L) occurred in 14/62 death patients (23%), prolonged prothrombin time (13.8 seconds [IQR, 13.1-15.1]) in 289/486 patients (59%), increased D-Dimer level (0.7 mg/L[IQR, 0.2-2.9]) in 230/411 patients (57%) and increased C-reactive protein levels (10.7 mg/L [IQR, 2.2-49.7]) in 217/426 patients (51%) . Compared with the survival patients, death patients have higher white blood cell count (11.7 × 109/L [IQR, 8.4 to 15.6]), neutrophil count (10.8 × 109/L [IQR, 7.8 to 13.9]), neutrophil count/lymphocyte count (20.5 [IQR, 12.4-34.2]), activated partial thromboplastin time (36.8 seconds [IQR, 31.3-42.3]), prothrombin time (17.1 seconds [IQR, 14.7 to 19.7]), D-Dimer level (4.6 mg/L [IQR, 1.0 to 7.8]), C-reactive protein level (111.8 mg/L (IQR, 53.1 to 196.6), and low lymphocyte count (0.5 × 109/L [IQR, 0.3 to 0.7]). The results of logistic multivariate regression analysis showed that age, neutrophil count, prothrombin time, and C-reactive protein were risk factors for patients with COVID-19. Conclusion: Hematological changes are common in patients with COVID-19. The early stage of the disease is mainly characterized by lymphocytopenia, thrombocytopenia, and the late stage may be characterized by more severe lymphocytopenia, even neutrophils elevation, elevated C-reactive protein, and severe coagulation disorder. The pathogenesis may be mediated by a direct viral infection and/or indirect immunopathology. Disclosures No relevant conflicts of interest to declare.

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Abstract 15485: Hematological Changes and Coagulation Dysfunction in 633 Patients With Covid-19

Circulation ◽

10.1161/circ.142.suppl_3.15485 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mo Yang ◽

Huixia Deng ◽

Liang Li ◽

Yafang Tan ◽

Jieyu Ye ◽

...

Keyword(s):

Prothrombin Time ◽

Neutrophil Count ◽

Lymphocyte Count ◽

C Reactive Protein ◽

Reactive Protein ◽

Laboratory Test Results ◽

Pulmonary Manifestations ◽

Hematological Changes ◽

Coagulation Dysfunction ◽

D Dimer

Introduction: A previously unknown coronavirus was discovered from patients with pneumonia. The disease caused by this virus was named as coronavirus disease 2019 (COVID-19). In addition to pulmonary manifestations, hematological changes such as lymphopenia, thrombocytopenia, and coagulation dysfunction can also be found in COVID-19 patients, and the mechanism is still unclear. Methods: A total of 633 COVID-19 patients from Wuhan hospital of China were retrospectively analyzed. Clinical case data of all patients were collected, including gender, age, chronic underlying diseases, outcome, and blood laboratory test results. The hematological features of COVID-19 patients and the factors affecting their outcome were analyzed. Results: The median age was 62 years ( IQR; 51.0-70.0) and 330 (52%) were men. Lymphopenia ( lymphocyte count, 1.0 х10 9 / L [IQR, 0.7-1.4]) occurred in 317/607 patients (52%), prolonged prothrombin time (13.8 seconds [IQR, 13.1-15.1]) in 289/486 patients (59%), increased D-Dimer level (0.7 mg/L[IQR,0.2-2.9]) in 230/411 patients (57%) and increased C-reactive protein levels (10.7 mg/L [IQR, 2.2-49.7]) in 217/426 patients (51%). Compared with the survival patients, death patients have higher white blood cell count (11.7 х 10 9 /L [IQR, 8.4 to 15.6]), neutrophil count (10.8 х 10 9 /L [IQR, 7.8 to 13.9]), neutrophil count/lymphocyte count (20.5 [IQR, 12.4-34.2]), activated partial thromboplastin time (36.8 seconds [IQR, 31.3-42.3]), prothrombin time (17.1 seconds [IQR, 14.7 to 19.7]), D-Dimer level (4.6 mg/L [IQR, 1.0 to 7.8]), C-reactive protein level (111.8 mg/L (IQR, 53.1 to 196.6), and low lymphocyte count (0.5 х 10 9 /L [IQR, 0.3 to 0.7]). The results of logistic multivariate regression analysis showed that age, neutrophil count, prothrombin time, and C-reactive protein were risk factors for patients with COVID-19. Conclusions: Hematological changes are common in patients with COVID-19. The early stage of the disease is mainly characterized by lymphopenia, and the late stage may be characterized by more severe lymphopenia, even neutrophils elevation, elevated C-reactive protein, and severe coagulation disorder. The pathogenesis may be mediated by a direct viral infection and/or indirect immunopathology.

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Elderly Male With Cardiovascular-Related Comorbidities Has a Higher Rate of Fatal Outcomes: A Retrospective Study in 602 Patients With Coronavirus Disease 2019

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.680604 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiao-Yong Zhan ◽

Liang Li ◽

Yuhai Hu ◽

Qiang Li ◽

Huimin Kong ◽

...

Keyword(s):

Neutrophil Count ◽

Lymphocyte Count ◽

Fatal Outcome ◽

The Elderly ◽

C Reactive Protein ◽

Elderly Male ◽

Cox Regression Analysis ◽

Protein Levels ◽

Reactive Protein ◽

D Dimer

Elderly with comorbidities have shown a higher rate of fatal outcomes when suffering coronavirus disease 2019 (COVID-19). However, a delineation of clinical significances of hematologic indices and underlying comorbidities in the progression and outcome of COVID-19 remains undefined. Six hundred two COVID-19 patients with established clinical outcomes (discharged or deceased) from Hankou Hospital of Wuhan, China between January 14, 2020 and February 29, 2020 were retrospectively analyzed. Of the 602 patients with COVID-19, 539 were discharged and 63 died in the hospital. The deceased group showed higher leukocyte and neutrophil counts but lower lymphocyte and platelet counts. Longer activated partial thromboplastin time (APTT) and prothrombin time (PT), as well as higher D-dimer and C-reactive protein levels, were found in non-survivors. Our observations suggest that these parameters could serve as potential predictors for the fatal outcome and in the discharged group. A higher neutrophil count and D-dimer level but lower lymphocyte were associated with a longer duration of hospitalization. A multivariable Cox regression analysis showed that higher neutrophil count, prolonged PT, and low lymphocyte count were risk factors for patients with COVID-19. Also, we found an association of lower lymphocyte count and higher C-reactive protein levels with the elderly group and those with cardiovascular-related comorbidities. The significantly different hematologic profiles between survivors and non-survivors support that distinct hematologic signatures in COVID-19 patients will dictate different outcomes as a prognostic marker for recovery or fatality. Lymphopenia and aggressive inflammatory response might be major causes for fatal outcomes in the elderly male and especially those with cardiovascular-related comorbidities.

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Visual Classification of Three Computed Tomography Lung Patterns to Predict Prognosis of COVID-19: A Retrospective Study

10.21203/rs.3.rs-820588/v1 ◽

2021 ◽

Author(s):

Daisuke Yamada ◽

Sachiko Ohde ◽

Kengo Ikejima ◽

Masaki Matsusako ◽

Yasuyuki Kurihara

Keyword(s):

Computed Tomography ◽

Lactate Dehydrogenase ◽

Neutrophil Count ◽

Lymphocyte Count ◽

Ct Images ◽

C Reactive Protein ◽

Clinical Variables ◽

Reactive Protein ◽

D Dimer

Abstract Background: Quantitative evaluation of radiographic images has been developed and suggested for the diagnosis of coronavirus disease 2019 (COVID-19). However, there are limited opportunities to use these image-based diagnostic indices in clinical practice. Our aim in this study was to evaluate the utility of a visually-based classification of pulmonary findingsfrom computed tomography (CT) images among COVID-19 patients that we developed, with the following three patterns defined: peripheral, multifocal, and diffuse findings of pneumonia. We also evaluated the prognostic value of this classification to predict the severity of COVID-19. Methods: This was a single-center retrospective cohort study of patients hospitalized with COVID-19 between January and September 2020, who presented with suspicious findings on CT lung images (n=69). We compared the association between the three predefined patterns (peripheral, multifocal, and diffuse) and admission to the intensive care unit, tracheal intubation, and death. The following demographic and clinical variables were compared between the three groups: sex, age, respiratory rate, pulse rate, blood pressure, temperature, oxygen saturation, partial pressure of oxygen, white blood cell count, lymphocyte count, neutrophil count, c-reactive protein, lactate dehydrogenase, Krebs von den Lungen-6 antigen, D-dimer, platelet count, steroid administration, heparin administration, favipiravir administration, Acute Physiology and Chronic Health Evaluation-II score, and sequential organ failure assessment score.Results: Patients with a diffuse pattern were intubated more frequently and for a longer duration than patients with a peripheral or multifocal pattern. The following clinical variables were significantly different between the diffuse pattern and peripheral and multifocal groups: body temperature, lymphocyte count, neutrophil count, c-reactive protein, lactate dehydrogenase, Krebs von den Lungen-6 antigen, D-dimer, and steroid and Avigan administration.Conclusions: Our simple visual assessment of CT images can predict a systemic cytokine storm, a resulting decrease in respiratory function, and the need for supplemental respiratory ventilationamong patientswith COVID-19.

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An emerging marker predicting the severity of COVID-19: Neutrophil-Lymphocyte Count Ratio

10.21203/rs.3.rs-28850/v1 ◽

2020 ◽

Author(s):

Minping Zhang ◽

Enhua Xiao ◽

Jiayi Liu ◽

Yeyu Cai ◽

Qizhi Yu

Keyword(s):

Neutrophil Count ◽

Lymphocyte Count ◽

Clinical Symptoms ◽

Characteristic Curve ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Count Ratio ◽

Severe Group ◽

D Dimer

Abstract Background: To analyze clinical features and laboratory indicators and identify the markers of exacerbation in COVID-19. Methods: We reviewed clinical histories of 177 patients with confirmed COVID-19. The patients were categorized into mild group (153 patients) and severe group (24 patients). The baseline demographic and laboratory indicators of all patients were collected, including the neutrophil-lymphocyte count ratio (NLCR) and C-reactive protein to albumin ratio (CAR). Receiver operating characteristic curve (ROC) analysis was performed to search for indicators predicting exacerbation in COVID-19 patients, and acquiring the area under the curves (AUCs), sensitivity, specificity and cut-off value. Results: The age of the severe group were significantly older than those of the mild group (P <0.01). Fever was the typical symptom in all COVID-19 patients. Cough and fatigue were manifested in mild group, yet severe patients were more prominent in dyspnea. The laboratory indicators showing that the mild group mainly had an elevated C-reactive protein; the severe group had a decreased lymphocyte count and lymphocyte ratio. WBC, neutrophil count, neutrophil ratio, D-dimer, AST, ALT, LDH, BUN, CRP levels increased. Furthermore, compared to mild group, WBC, neutrophil count, neutrophil ratio (Neut%), D-dimer, total bilirubin, albumin, AST, ALT, LDH, BUN, creatine kinase, CRP, CAR, NLCR were significantly higher, the lymphocyte count, lymphocyte ratio, and APTT were significantly lower in severe group (P<0.05). The ROC indicating that NLCR, Neut%, CAR, CRP, and LDH were better at distinguishing mild and severe patients. The AUCs of NLCR was larger than others (NLCR>Neut%>CAR>CRP>LDH: 0.939>0.925>0.908>0.895>0.873), which suggested that NLCR was the optimal maker; a cut-off value for NLCR of 6.15 had 87.5% sensitivity and 97.6% specificity for predicting exacerbation in COVID-19 patients. Conclusions: The different types of COVID-19 had significant differences in age, clinical symptoms and laboratory indicators, and severe patients might be easier to suffer from the multiple organ damage. An elevated NLCR may indicate that the disease was progressing towards exacerbation. It was essential to dynamically monitor the serum NLCR levels which contributed to evaluate the patient's condition and efficacy. NLCR could be used as a novel, highly specific and sensitive marker for predicting severity of COVID-19 patients.

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Association between vitamin D level and prognostic factors among patients infected with SARS-CoV-2

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2021-0008 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Mehrdad Haghighi ◽

Seyed Shayan Ebadi ◽

Hussein Soleimantabar ◽

Atefe Shadkam ◽

Seyed Alireza Ebadi ◽

...

Keyword(s):

Vitamin D ◽

Prognostic Factors ◽

Medical Records ◽

Lymphocyte Count ◽

Cross Sectional Study ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

The Mean ◽

D Dimer

Abstract Objectives The present study aimed to evaluate the presence of any relationship between vitamin D and prognostic factors among patients infected with SARS-CoV-2. Methods This retrospective cross-sectional study was conducted among patients admitted from March to August 2020 in a referral hospital, Tehran, Iran. All patients aged 18–65 who had not any comorbidity participated in the study. The diagnosis of COVID-19 was established using the rRT-PCR test for SARS-CoV-2 detection. Then the incidence of lung involvement and biochemical markers including vitamin D level, c-reactive protein, D-dimer, lymphocyte count, platelet count, white blood cell count, and lactic acid dehydrogenase, were extracted through medical records. Results Altogether, 84 patients met our study criteria, and the information of 68 (80.9%) participants were collected. Among all 68 patients, 45 (66.2%) were male. The mean (SD) age of all participants was 52.4 (10.4) years old. Among 24 (35.2%) clients who died due to SARS-CoV-2, 20 (83.3%) patients were male (p=0.02). The mean (SD) of vitamin D level was 24.1 (13.6) ng/dL. No association between vitamin D level and prognostic factors, including CRP, lymphocyte count, D-dimer, LDH, and HRCT scan score, was observed. Also, the vitamin D level of the dead patients was not significantly different from that of the treated patients. Conclusions Our findings indicated no significant relationship between vitamin D level and prognostic factors or outcomes of patients infected with SARS-CoV-2.

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Efficiency of il-6 inhibitor (olokizumab) in suppressing inflammation in patients with moderate COVID-19 pneumonia

Fundamental and Clinical Medicine ◽

10.23946/2500-0764-2020-5-4-8-13 ◽

2020 ◽

Vol 5 (4) ◽

pp. 8-13

Author(s):

N. G. Ganyukova ◽

M. I. Likstanov ◽

M. V. Kosinova ◽

I. N. Kushnir ◽

V. G. Moses ◽

...

Keyword(s):

Placebo Group ◽

Treatment Group ◽

Blood Cell ◽

Cell Count ◽

Treatment Outcomes ◽

Lymphocyte Count ◽

C Reactive Protein ◽

Blood Cell Count ◽

Reactive Protein ◽

D Dimer

Aim. To study the efficiency of IL-6 inhibitor olokizumab in suppressing the inflammation and improving treatment outcomes in patients with moderate COVID-19 pneumonia. Materials and Methods. We enrolled 48 patients with confirmed COVID-19 pneumonia who had indications for the treatment with olokizumab. Treatment group (n = 29) included patients who received a single subcutaneous injection of olokizumab (0.4 mL, 160 mg/mL) while placebo group (n = 19) included those who did not receive the drug because of contraindications. Inflammatory markers (C-reactive protein, white blood cell count, lymphocyte count, ferritin and D-dimer) have been evaluated on the 1st and the 5th day after the administration of olokizumab. Efficiency of olokizumab was assessed by the treatment outcome and suppression of cytokine storm. Results. At the 5th day, SpO2 was 90% (88; 92-93) in both groups, yet none of the patients in the treatment group required a mechanical ventilation, in contrast to 21.1% patients in the placebo group (p = 0.001). Inflammatory parameters were also reduced in the treatment group according to the measurements of serum C-reactive protein (5.6 (1.8;13.5) and 23 (17;92.5) mg/L in the treatment and placebo group, respectively, p = 0.0002) and white blood cell count (5.9 (4.8;6.2) and 7.6 (6.6;12 )*109 /L in the treatment and placebo group, respectively, p=0.03). No statistically significant differences were registered regarding serum ferritin (325 (200; 700) and 215 (186; 526) ng/mL, p = 0.41), D-dimer (827 (378; 1940) and 1464 (677; 4600) ng FEU/mL, p = 0.16) and lymphocyte count (1.3 (0.8; 2.1) and 1.5 (1; 2.1)*109 /L, p =0.44). Death was registered in 3.5% and 21.1% of patients in the treatment and placebo group, respectively, (p = 0.05). Conclusion. Olokizumab ameliorated the progression of COVID-19 pneumonia, improved treatment outcomes and reduced systemic inflammation.

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Early prediction of mortality risk among patients with severe COVID-19, using machine learning

International Journal of Epidemiology ◽

10.1093/ije/dyaa171 ◽

2020 ◽

Author(s):

Chuanyu Hu ◽

Zhenqiu Liu ◽

Yanfeng Jiang ◽

Oumin Shi ◽

Xin Zhang ◽

...

Keyword(s):

Machine Learning ◽

Predictive Model ◽

Mortality Risk ◽

Protein Level ◽

Lymphocyte Count ◽

External Validation ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

D Dimer

Abstract Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 infection, has been spreading globally. We aimed to develop a clinical model to predict the outcome of patients with severe COVID-19 infection early. Methods Demographic, clinical and first laboratory findings after admission of 183 patients with severe COVID-19 infection (115 survivors and 68 non-survivors from the Sino-French New City Branch of Tongji Hospital, Wuhan) were used to develop the predictive models. Machine learning approaches were used to select the features and predict the patients’ outcomes. The area under the receiver operating characteristic curve (AUROC) was applied to compare the models’ performance. A total of 64 with severe COVID-19 infection from the Optical Valley Branch of Tongji Hospital, Wuhan, were used to externally validate the final predictive model. Results The baseline characteristics and laboratory tests were significantly different between the survivors and non-survivors. Four variables (age, high-sensitivity C-reactive protein level, lymphocyte count and d-dimer level) were selected by all five models. Given the similar performance among the models, the logistic regression model was selected as the final predictive model because of its simplicity and interpretability. The AUROCs of the external validation sets were 0.881. The sensitivity and specificity were 0.839 and 0.794 for the validation set, when using a probability of death of 50% as the cutoff. Risk score based on the selected variables can be used to assess the mortality risk. The predictive model is available at [https://phenomics.fudan.edu.cn/risk_scores/]. Conclusions Age, high-sensitivity C-reactive protein level, lymphocyte count and d-dimer level of COVID-19 patients at admission are informative for the patients’ outcomes.

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Relationship between ECG Findings and Serum Biomarkers in COVID-19 Patients

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2021-0013 ◽

2021 ◽

Vol 7 (3) ◽

pp. 64-69

Author(s):

Gökhan Perincek ◽

Muammer Karakayalı ◽

Sema Avcı

Keyword(s):

Lymphocyte Count ◽

Myocardial Injury ◽

Troponin T ◽

P Wave ◽

Rt Pcr ◽

C Reactive Protein ◽

Premature Ventricular Contractions ◽

Reactive Protein ◽

Fragmented Qrs ◽

D Dimer

Abstract Background and aim: The aim of this study was to evaluate the relationship between ECG findings and blood parameters indicative of inflammation and myocardial injury in COVID-19 patients. Methods: The study included 159 females and 194 males. Demographics, ECG findings (axis, rhythm, branch block, ST- and T-wave changes, premature ventricular contractions, early repolarization, S1Q3T3, fragmented QRS [fQRS], rate, PR, QRS, QT interval, QTc, P-wave dispersion) and albumin, D-dimer, ferritin, pro-BNP, procalcitonin, protein, troponin T, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) were recorded. Results: In the study, 45% of the cases were female and 55% were male. The mean age of the included patients was 45.7 ± 24.4 years. The most frequent comorbidities were chronic obstructive pulmonary disease (COPD) and hypertension (HT) in both groups. The incidence of fQRS on the 1st day was significantly higher in patients with negative COVID-19 test (23% for positive RT-PCR versus 35.6% for negative RT-PCR, p = 0.016). QTc values on the 3rd and 5th day were significantly higher in patients with negative RT-PCR (p = 0.045 and p = 0.042, respectively). Albumin and procalcitonin were significantly higher in patients with positive COVID-19 test results (p = 0.018 and p <0.001, respectively). Patients with fragmented QRS presented significantly lower serum albumin (40.62 ± 4.73 g/L vs. 42.92 ± 3.72 g/L, p = 0.01), and protein levels (p = 0.02), as well as lower lymphocyte count, and significantly higher levels of C-reactive protein (47.01 ± 65.01 mg/L vs. 24.55 ± 44.17 mg/L, p = 0.001), D-dimer (p = 0.009), neutrophil count, pro-BNP (p = 0.004), troponin T (p <0.001), NRL and CAR (1.28 ± 1.83 versus 0.6 ± 1.11, p <0.001). Conclusion: Patients with COVID-19 infection presented significantly higher levels of C-reactive protein, D-dimer, neutrophil, pro-BNP, procalcitonin, troponin T, NLR, and CAR, and significantly lower levels of albumin, lymphocyte count, and serum proteins, indicating the level of inflammation and its relationship with myocardial injury. Further follow-up studies are required, on larger patient sets, for the development of risk prediction tools in COVID-19 patients.

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Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study

10.21203/rs.3.rs-19680/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Dan Wang ◽

Ruifang Li ◽

Juan Wang ◽

Qunqun Jiang ◽

Chang Gao ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Disease Severity ◽

Serum Potassium ◽

Critically Ill Patients ◽

Lymphocyte Count ◽

Serum Amyloid A ◽

C Reactive Protein ◽

Reactive Protein ◽

Amyloid A ◽

D Dimer

Abstract Background: Coronavirus disease 2019 ( COVID-19 ) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan and has quickly spread across the world. The mortality rate in critically ill patients with COVID-19 is high. This study analyzed clinical and biochemical parameters between mild and severe patients, helping to identify severe or critical patients early. Methods: In this single center, cross-sectional study, 143 patients were included and divided to mild/moderate and sever/critical groups. Correlation between the disease criticality and clinical features and peripheral blood biochemical markers was analyzed. Cut-off values for critically ill patients were speculated through the ROC curve. Results: Significantly, disease severity was associated with age (r = 0.458, P < 0.001) , comorbidities (r = 0.445, P < 0.001) , white cell counts (r = 0.229, P = 0.006) , neutrophil count (r = 0.238, P = 0.004) , lymphocyte count (r = -0.295, P < 0.001) , albumin (r = -0.603, P < 0.001) , high-density lipoprotein cholesterol (r= -0.362, P < 0.001) , serum potassium (r = -0.237, P = 0.004) , plasma glucose (r = 0.383, P < 0.001) , total bilirubin (r = 0.340, P < 0.001) , serum amyloid A (r = 0.58, P < 0.001) , procalcitonin (r = 0.345, P < 0.001) , C-reactive protein ( r = 0.477, P < 0.001) , lactate dehydrogenase (r = 0.548, P < 0.001) , aspartate aminotransferase (r = 0.342, P < 0.001) , alanine aminotransferase (r = 0.264, P = 0.001) , erythrocyte sedimentation rate (r = 0.284, P = 0.001) and D-dimer (r = 0.477, P ＜ 0.001) . Conclusion: With following parameters such as age > 52 years, C-reactive protein > 64.79 mg/L, lactate dehydrogenase > 245 U/L, D-dimer > 0.96 ug/mL, serum amyloid A > 100.02 mg/L, or a lbumin ＜ 36 g/L, the progress of COVID-19 to critical stage should be closely observed and possibly prevented. Lymphocyte count, serum potassium and procalcitonin may also be a prognostic indicator .

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Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Viruses ◽

10.3390/v13061067 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1067

Author(s):

Oleksandr Oliynyk ◽

Wojciech Barg ◽

Anna Slifirczyk ◽

Yanina Oliynyk ◽

Vitaliy Gurianov ◽

...

Keyword(s):

Macrophage Activation Syndrome ◽

Macrophage Activation ◽

Cytokine Storm ◽

Cytokine Release ◽

Cytokine Release Syndrome ◽

C Reactive Protein ◽

Treatment Results ◽

Reactive Protein ◽

Median Serum ◽

D Dimer

Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Сonclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.

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