scholarly journals Comparative evaluation of semi-quantitative CT-severity scoring versus serum lactate dehydrogenase as prognostic biomarkers for disease severity and clinical outcome of COVID-19 patients

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed M. Magdy ◽  
Mohammad A. Saad ◽  
Ahmed F. El Khateeb ◽  
Mona I. Ahmed ◽  
Dina H. Gamal El-Din
Keyword(s):  
Clinical Outcome ◽  
Disease Severity ◽  
Severity Score ◽  
Prognostic Biomarkers ◽  
Short Term ◽  
Quantitative Ct ◽  
Severity Scoring ◽  
Short Term Mortality ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Abstract Background Coronavirus disease 2019 pandemic causes significant strain on healthcare infrastructure and medical resources. So, it becomes crucial to identify reliable predictor biomarkers for COVID-19 disease severity and short term mortality. Many biomarkers are currently investigated for their prognostic role in COVID-19 patients. Our study is retrospective and aims to evaluate role of semi-quantitative CT-severity scoring versus LDH as prognostic biomarkers for COVID-19 disease severity and short-term clinical outcome. Results Two hundred sixty-six patients between April 2020 and November 2020 with positive RT-PCR results underwent non-enhanced CT scan chest in our hospital and were retrospectively evaluated for CT severity scoring and serum LDH level measurement. Data were correlated with clinical disease severity. CT severity score and LDH were significantly higher in severe and critical cases compared to mild cases (P value < 0.001). High predictive significance of CT severity score for COVID-19 disease course noted, with cut-off value ≥ 13 highly predictive of severe disease (96.96% accuracy); cut-off value ≥ 16 highly predictive of critical disease (94.21% accuracy); and cut-off value ≥ 19 highly predictive of short-term mortality (92.56% accuracy). CT severity score has higher sensitivity, specificity, positive, and negative predictive values as well as overall accuracy compared to LDH level in predicting severe, critical cases, and short-term mortality. Conclusion Semi-quantitative CT severity scoring has high predictive significance for COVID-19 disease severity and short-term mortality with higher sensitivity, specificity, and overall accuracy compared to LDH. Our study strongly supports the use of CT severity scoring as a powerful prognostic biomarker for COVID-19 disease severity and short-term clinical outcome to allow triage of need for hospital admission, earlier medical interference, and to effectively prioritize medical resources for cases with high mortality risk for better decision making and clinical outcome.

scholarly journals Modified Sick Neonatal Score (MSNS): A Novel Neonatal Disease Severity Scoring System for Resource-Limited Settings

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
K. P. Mansoor ◽  
S. R. Ravikiran ◽  
Vaman Kulkarni ◽  
Kiran Baliga ◽  
Suchetha Rao ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severity Score ◽  
Scoring Systems ◽  
Cutoff Score ◽  
Disease Severity Score ◽  
Resource Limited Settings ◽  
Convenience Sample ◽  
Severity Scoring ◽  
Neonatal Disease ◽  
Resource Limited

Neonatal disease severity scoring systems are needed to make standardized comparison between performances of different units and to give prognostic information to parents of individual babies admitted. Existing scoring systems are unsuitable for resource-limited settings which lack investigations like pH, pO2/FiO2 ratio, and base excess. This study was planned to evaluate Modified Sick Neonatal Score (MSNS), a novel neonatal disease severity score designed for resource-constrained settings. It was a facility-based cross-sectional analytical study, conducted in the “Special Newborn Care Unit” (SNCU) of government district hospital, attached to Kasturba Medical College, Mangalore, India from November 2016 to October 2017. A convenience sample of 585 neonates was included. Disease severity was assessed immediately at admission using MSNS. MSNS had 8 parameters with 0, 1, and 2 scores for each. 41% of study population was preterm (n=240), and 84.1% had birth weight less than 2500 grams (n=492). The mean (SD) of the total MSNS scores for neonates who expired and discharged was, respectively, 8.22 (2.96) and 13.4 (2.14), a difference being statistically significant at P<0.001. Expired newborns had statistically significant frequency of lower scores across each of the parameters. An optimum cutoff score of ≤10 with 80% sensitivity and 88.8% specificity in predicting mortality was obtained when the ROC curve was generated with the MSNS score as the test variable. Area under the curve was 0.913 (95% CI: 0.879–0.946). In conclusion, MSNS is a practicable disease severity score in resource-restricted settings like district SNCUs. It is for application in both term and preterm neonates. Total score ≤10 has a good sensitivity and specificity in predicting mortality of admitted neonates when used early during the course of hospitalization. MSNS could be used as a tool to compare performance of SNCUs and also enable early referral of individual cases to units with better facilities.

A comparative study to determine the short-term mortality and clinical improvement in hepatic encephalopathy using either rifaximin and or lactulose

2021 ◽  
Vol 12 (3) ◽  
pp. 46-50
Author(s):  
Uttam Biswas ◽  
Shyamal Kanti Pal ◽  
Pallabi Ray Chaudhuri ◽  
Debanjan Roychowdhury ◽  
Abhranil Dhar ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Outcome ◽  
Clinical Improvement ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Precipitating Factors ◽  
Chronic Liver Diseases ◽  
Short Term ◽  
Significant Difference ◽  
Short Term Mortality

Background: Hepatic encephalopathy can be reversed by correcting precipitating factors and efficiently managed by lactulose and or rifaximin. Aims and Objective: The aim of this study to compare the effectiveness of three different modes of treatment in our study populations. Materials and Methods: Ninety patients of decompensated chronic liver diseases were selected and randomised to treat with either lactulose or rifaximin or both lactulose and rifaximin (30 patients in each group) for 7 days. Clinical outcome and short term mortality were noted in each group of treatment. This study was to review the comparison of the effectiveness of Rifaximin (1200mg/day , in 3 divided doses ) alone or in combination with Lactulose (60gram/day ,in divided doses) or Lactulose (60gram/day) alone to reduce the short term mortality and clinical improvement in hepatic encephalopathy of any grade of any cause in adult (>18 years) admitted patients of decompensated chronic liver diseases. Result: Clinical improvement was noted in all three modes of treatment but there is no statistically significant difference in clinical improvement of hepatic encephalopathy when compared amongst each of three modes of treatment. There was obvious reduction of short term mortality or clinical down gradation of hepatic encephalopathy grade after 7 days treatment using lactulose or rifaximin or combined lactulose and rifaximin but there was no statistically significant difference in this regard among these three modes of treatment. Conclusion: All three modes of treatment are equally effective though combination therapy is little better.

Diagnostic and prognostic role of presepsin in patients with cirrhosis and bacterial infection

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Alberto Ferrarese ◽  
Anna Chiara Frigo ◽  
Monica Maria Mion ◽  
Mario Plebani ◽  
Francesco Paolo Russo ◽  
...  
Keyword(s):  
Liver Disease ◽  
Bacterial Infection ◽  
Independent Predictor ◽  
Short Term ◽  
Reactive Protein ◽  
Prognostic Accuracy ◽  
Cox's Regression ◽  
Short Term Mortality ◽  
End Stage ◽  
Sensitivity Specificity

AbstractObjectivesSerum biomarkers have suboptimal accuracy for the early diagnosis of bacterial infection (BI) in cirrhosis.AimTo evaluate the diagnostic and prognostic accuracy of presepsin (PSP) in a cohort of hospitalized patients with cirrhosis.MethodsAll adult cirrhotics admitted between 03.2016 and 06.2019 were consecutively evaluated. PSP was measured using chemiluminescent enzyme immunoassay, and its accuracy was compared with that of common biomarkers.ResultsA total of 278 cirrhotic patients for a total of 448 hospitalizations were prospectively collected. Prevalence of BI at admission was 28.3%. Median (range) Log10PSP in the whole cohort was 2.83 (2.48–3.19) ng/L, significantly higher in patients with BI than in patients without (p<0.001). For a cutoff value of 2.87 ng/L, Log10PSP showed sensitivity, specificity and AUC-ROC of 0.66 (95% CI 0.57–0.74), 0.63 (95% CI 0.57–0.68) and 0.69 (95% CI 0.63–0.73), lower than that of C-reactive protein (p=0.002), but similar to procalcitonin (p=0.18) Patients with BI at hospitalization had higher probability of 28-day mortality (sub-hazard ratio [sHR] 2.65;95% CI 1.49–4.70; p=0.001). At multivariate Cox’s regression analysis, Log10PSP (sHR 2.4; 95% CI 1.22–4.82; p=0.01) together with age and severity of liver disease, was an independent predictor of short-term mortality.ConclusionsPSP shows low diagnostic accuracy for BI in cirrhosis, but it is an independent predictor of short-term mortality. PSP may be a biomarker of systemic inflammation, commonly seen in end-stage liver disease.

scholarly journals RADIOLOGICAL EVALUATION AND CORRELATION OF CT SEVERITY SCORING WITH THE CLINICAL OUTCOME IN RT-PCR CONFIRMED COVID-19 INFECTED PATIENTS

2021 ◽  
pp. 1-3
Author(s):  
Prem Anand E S ◽  
Ealai Athmarao Parthasarathy ◽  
Rajamani Anand
Keyword(s):  
Clinical Outcome ◽  
Severity Score ◽  
Laboratory Data ◽  
Chest Ct ◽  
Treatment Modalities ◽  
P Value ◽  
Radiological Evaluation ◽  
Rt Pcr ◽  
Positive Real ◽  
Severity Scoring

Background Radiological evaluation of the severity of lung inflammation in Covid-19 patients could provide an objective approach to rapidly identify the treatment modalities and to calculate the duration of hospitalization, need for intubation and ICU stay thereby analyzing and managing the clinical outcome of the patient. Purpose To identify the significant relationship between CT severity score and clinical outcome among RT-PCR confirmed Covid-19 infected patients Materials and Methods Inclusion of 40 patients with COVID-19 confirmed by positive real-time reverse transcriptase polymerase chain reaction on throat swabs underwent High resolution chest CT (7 men and 33 women).The CT-SS was defined by summing up individual scores from 20 lung regions; scores of 0, 1, and 2 were respectively assigned for each region if parenchymal opacification involved 0%, less than 50%, or equal or more than 50% of each region (theoretical range of CT-SS from 0 to 40). The clinical and laboratory data were collected and analyzed. Results All patients (n=16) who underwent intubation died invariably. The lung findings in all patients who died consist of co-existence of Consolidation and ground glass opacities in periphery and central region of lungs. Age is a predominant determinant factor for the course and outcome of disease as 17 patients with a mean age of 62 died when compared to 23 patients alive with a mean age of 47. This implies that mortality has a direct relationship with age. Out of 19 patients who had a CT –Severity score of >19 (Severe), 17 were shifted to ICU and 15 patients died. Only 4 patients recovered. Out of 5 patients whose CT-SS score were < 19, 5 patients were shifted to ICU and 2 cases died. 95 % of Covid-19 positive patients had Fever as their predominant complaint. The results are statistically significant with a p value of <0.01 and specificity of 82.6% and sensitivity of 88.2% Conclusion Along with RT-PCR, CT severity scoring is invariably a valuable modality for the management and planning of treatment for the patients by predicting the prognosis. Summary The chest CT severity score could be used to rapidly identify patients with severe forms of COVID-19 and clearly impacts the outcome of the patients.

Disease severity scoring system for acid sphingomyelinase deficiency: Severity score domains and components

2018 ◽  
Vol 123 (2) ◽  
pp. S29
Author(s):  
David Cassiman ◽  
Maria Domenica Cappellini ◽  
Paulina Mabe ◽  
Michael I. Polkey ◽  
Thomas Schiano ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severity Score ◽  
Scoring System ◽  
Acid Sphingomyelinase ◽  
Severity Scoring ◽  
Sphingomyelinase Deficiency

TO STUDY THE EFFECT OF BMV ON P WAVE DISPERSION AND SHORT TERM PROGNOSTIC IMPACT OF P WAVE DISPERSION IN PREDICTION OF CLINICAL OUTCOME AFTER PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY IN PATIENTS WITH MITRAL STENOSIS AND SINUS RHYTHM

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Ashish Kumar Agarwal ◽  
Daulat Singh Meena ◽  
Vijay Pathak ◽  
Anoop Jain ◽  
Rakesh Kumar Ola
Keyword(s):  
Clinical Outcome ◽  
Right Ventricular ◽  
Wave Dispersion ◽  
Tissue Doppler ◽  
P Wave ◽  
Short Term ◽  
P Wave Dispersion ◽  
Mitral Valvuloplasty ◽  
Percutaneous Balloon ◽  
Before And After

Background: The aim of the present study was to study the effect of percutaneous balloon mitral  valvuloplasty (PBMV) on P wave dispersion and to test the correlation between P-maximum and  P-dispersion to right ventricular function and pulmonary artery pressure before and after PMBV. Also to study the impact of P-maximum and P-wave dispersion on the short term clinical outcome after successful PBMV in patients with mitral stenosis (MS) and sinus rhythm. Methods: 75 patients undergoing PMBV were enrolled in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before and one month and one year after PBMV . We studied the changes in pulmonary arterial pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, in addition to the changes in right ventricular function utilizing tissue Doppler assessment both before and after PMBV, in addition the role of the P-wave dispersion in prediction of late cardiac events. Results: There were significant decrease in mean diastolic gradient, PAP, and LA size and significant improvement in right ventricular tissue Doppler indices after PMBV. Accompany these hemodynamic changes after PMBV. P-maximum and P-wave dispersion were found to be decreased (P < 0.001). Conclusion: Successful PBMV was associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV.  The P-maximum and P-wave dispersion changes were correlated with significant impairment of right dysfunction and the degree of pulmonary artery pressure. Keywords: PBMV.PAP,LA

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