The use of laboratory parameters and computed tomography score to determine intensive care unit requirement in COVID-19

Abstract Objectives It is vital to determine the intensive care unit (ICU) requirement at an early stage to reduce the mortality rate in COVID-19 patients. The aim of the study was to find reliable predictive markers to determine the ICU requirement. Methods We retrospectively reviewed the clinical and laboratory records of 151 COVID-19 patients. The predictive abilities of biochemical parameters and computed tomography (CT) score were evaluated to determine of ICU requirement. Results The area under curve (AUC) values for procalcitonin, D-Dimer, C reactive protein (CRP), glucose, lactate dehydrogenase (LDH) and CT score were found higher than those for other parameters in the prediction of ICU requirement. The negative predictive values of these markers were higher than their positive predictive values. CT score was found to be highly correlated with fibrinogen and CRP. The glucose levels [odd ratio (OR): 95% CI; 1.07, p-value: 0.014] and CT score [OR: 95% CI; 1.05, p-value: 0.022] were associated with ICU requirement in COVID-19 patients. Conclusions CT score, procalcitonin, D-Dimer, CRP, glucose, and LDH are potential predictors to rule out ICU requirement on hospital admission. Fibrinogen and CRP can be used to follow up and predict lung damages in patients with COVID-19.

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The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

10.22514/sv.2021.068 ◽

2021 ◽

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lactate Dehydrogenase ◽

Critically Ill ◽

Critically Ill Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Group 2 ◽

D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

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Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group

European Journal of Ophthalmology ◽

10.1177/1120672120976548 ◽

2020 ◽

pp. 112067212097654

Author(s):

Maria Cristina Savastano ◽

Gloria Gambini ◽

Alfonso Savastano ◽

Benedetto Falsini ◽

Umberto De Vico ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Chemistry ◽

Nasopharyngeal Swab ◽

Reactive Protein ◽

Italian Experience ◽

Impairment Score ◽

Pulmonary Impairment ◽

Respiratory Coronavirus ◽

D Dimer

Background: The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated. Methods: Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C−NF−), (2) NPs positive and Cs negative (NFs+Cs−), (3) NPs negative and Cs positive (NFs−Cs+), and (4) NPs and Cs both positive (NFs−Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO2), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP). Results: A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO2 levels are the highest in the NF−C− group (98%) and the lowest (90%) in the group NF+C+ ( p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups ( p = 0.019). Pulmonary impairment score increased from NFs−Cs− group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%). Conclusions: In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity. Trial registration: Clinicaltrials.gov registration. Ethical committee authorization: ID number: 0013008/20

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Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study

JMIR Public Health and Surveillance ◽

10.2196/22471 ◽

2020 ◽

Vol 6 (4) ◽

pp. e22471

Author(s):

Rahila Bhatti ◽

Amar Hassan Khamis ◽

Samara Khatib ◽

Seemin Shiraz ◽

Glenn Matfin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Characteristics ◽

Laboratory Data ◽

Length Of Hospital Stay ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Patients With Diabetes ◽

D Dimer

Background Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). Objective This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. Methods This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. Results Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1c level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (P<.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit. Conclusions Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.

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Possible involvement of Syndecan-1 in the state of COVID-19 related to endothelial injury

Thrombosis Journal ◽

10.1186/s12959-021-00258-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Keiko Suzuki ◽

Hideshi Okada ◽

Hiroyuki Tomita ◽

Kazuyuki Sumi ◽

Yoshinori Kakino ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Disease State ◽

Endothelial Injury ◽

Endothelial Glycocalyx ◽

Case Presentation ◽

Disease Condition ◽

Coronavirus Infection ◽

D Dimer

Abstract Background The coronavirus infection 2019 (COVID-19) is associated with microvascular endothelial injury. Here, we report that syndecan-1, a component of endothelial glycocalyx, may reflect the disease state of COVID-19 related to endothelial injury. Case presentation A patient with COVID-19 was transferred to the intensive care unit of our hospital. Computed tomography of the chest showed bilateral ground glass opacities, which was diagnosed as acute respiratory syndrome. The PaO2/FIO2 ratio gradually increased from 158 on hospitalization to 300 on Day 11, on which day the ventilator was withdrawn. However, serum syndecan-1 (SDC-1) level gradually decreased from 400.5 ng/ml at hospitalization to 165.1 ng/ml on Day 5. On Day 6, serum SDC-1 level increased to 612.9 ng/ml owing to a systemic thrombosis with an increase in D-dimer. Serum SDC-1 level then decreased until 206.0 ng/ml on Day 11 after a decrease in D-dimer. The patient was transferred to another hospital on Day 21 after hospitalization. Conclusions In this case report, changes in serum SDC-1 level closely reflected the change in disease condition in a patient with COVID-19. Serum SDC-1 may be a useful biomarker for monitoring the disease state of critically ill patients with COVID-19.

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Predicting Intensive Care Unit Admissions for COVID-19 Patients in the Emergency Department

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.283 ◽

2021 ◽

pp. 1-5

Author(s):

Suphi Bahadirli ◽

Erdem Kurt

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Chest Ct ◽

C Reactive Protein ◽

Diffuse Infiltration ◽

Reactive Protein ◽

Binary Regression Analysis ◽

D Dimer

Abstract Objective: Determining the parameters that can predict the requirement of intensive care unit (ICU) admissions among the coronavirus disease 2019 (COVID-19) patients presented to the emergency departments (EDs). Methods: In adult consecutive patients admitted (March 15 - April 15, 2020) to the ED of a state hospital for COVID-19, we retrospectively analyzed demographic data, symptoms, laboratory tests, and chest computed tomography (CT) on arrival. Results: We included 458 patients [213 (46.5%) females, median age 48 y]. Body temperature, respiration rate, C-reactive protein (CRP), D-dimer, ferritin values, and the number of comorbidities were significantly higher in patients admitted to the ICU than others. Also, diffuse infiltration in chest CT is more common in patients who need ICU follow-up. As a result of the binary regression analysis, a statistically significant correlation was found between the presence of dyspnea (odds ratio [OR]: 12.55), tachypnea (relative risk [RR] ≥ 18) (OR: 14.54), multiple comorbidities (≥2) (OR: 23.39), diffuse infiltration in CT (OR: 14.52), and CRP (≥45 mg/L) (OR: 4.71); and the need for ICU admission. Conclusion: It has been concluded that the presence of dyspnea and tachypnea, elevated CRP, presence of multiple comorbidities, and diffuse infiltration in CT may predict the need for ICU admissions of the patients, who presented to the EDs.

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Synthetic metrics of early predictive value in patients with COVID-19 pneumonia

Hirurg (Surgeon) ◽

10.33920/med-15-2102-05 ◽

2021 ◽

pp. 36-43

Author(s):

Denis Stanislavovich Baranovsky ◽

Delara Rafaelovna Baranovskaya ◽

Natalya Vadimovna Polekhina ◽

Leonid Aleksandrovich Laberko ◽

Grigory Vladimirovich Rodoman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Disease Onset ◽

Severe Pneumonia ◽

C Reactive Protein ◽

Laboratory Assessment ◽

Reactive Protein ◽

Synthetic Indicators ◽

Thrombotic Complications ◽

D Dimer

Clinical observations have shown that COVID-19-associated pneumonia is often accompanied by coagulopathy, an increase in C-reactive protein and D-dimer. Early laboratory assessment may represent a promising approach for predicting the development of thrombotic complications and the severity of COVID-19. Thrombotic complications often cause a rapid deterioration in the patient’s condition, the development of ARDS and a negative outcome of the disease. In this study, the authors sought to identify synthetic indicators that may be associated with the development of acute respiratory distress syndrome (ARDS) requiring treatment in an intensive care unit in patients with viral pneumonia caused by COVID-19. Differences in D-dimer levels and the ratios of D-dimer and C-reactive protein (CRP) levels to the number of days (Days) elapsed from disease onset to hospitalization were investigated between COVID-19 patients who were transferred to the intensive care unit, within two weeks after admission to the hospital (n = 78), and patients with COVID-19 with a stable course of the disease (n = 70). Multiple comparisons showed statistically significantly higher values of CRP / Days at admission in patients with COVID-19 transferred to the ICU (median 22,57) compared with stable patients (median 7,19), p < 0,0001. D-dimer levels on admission did not have statistically significant differences in these groups, while comparison of D-dimer / days ratios in patients transferred to the ICU and in stable patients revealed statistically significant differences: median 44,57 and 41,27, respectively (p = 0,0048). The authors suggest that these synthetic indicators, which are easily determined in patients with COVID-19 upon admission to the hospital, can be used as early predictive markers of severe pneumonia and a high risk of ARDS, requiring transfer to the intensive care unit.

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Computed tomography features of cerebrovascular complications in intensive care unit patients with severe COVID-19

Radiologia Brasileira ◽

10.1590/0100-3984.2021.0023 ◽

2021 ◽

Vol 54 (5) ◽

pp. 283-288

Author(s):

Vinícius de Padua Vieira Alves ◽

Ananda Altoé ◽

Vanessa Veloso ◽

Clecia Lucia Santos Ferreira ◽

Nina Ventura ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Protein Assay ◽

Reactive Protein ◽

Cerebrovascular Complications ◽

Coagulation Testing ◽

Function Testing ◽

The Brain ◽

Ct Features

Abstract Objective: To report the computed tomography (CT) features of acute cerebrovascular complications in severely ill patients with confirmed coronavirus disease 2019 (COVID-19) in the intensive care unit. Materials and Methods: We conducted a retrospective analysis of 29 intensive care unit patients with confirmed COVID-19 who underwent CT of the brain. We describe the CT features of the cerebrovascular complications of COVID-19, as well the demographic characteristics and clinical features, together with the results of laboratory tests, such as complete blood cell count, coagulation testing, renal function testing, and C-reactive protein assay. Results: Two patients were excluded because of brain death. Among the remaining 27 patients, CT revealed acute cerebrovascular complications in six (three men and three women; 49-81 years of age), whereas no such complications were seen in 21 (15 men and six women; 36-82 years of age). Conclusion: Radiologists should be aware of the risks of cerebrovascular complications of COVID-19 and the potential underlying etiologies. COVID-19-associated coagulopathy is likely multifactorial and may increase the risk of ischemic and hemorrhagic infarction.

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Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study (Preprint)

10.2196/preprints.22471 ◽

2020 ◽

Author(s):

Rahila Bhatti ◽

Amar Hassan Khamis ◽

Samara Khatib ◽

Seemin Shiraz ◽

Glenn Matfin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Characteristics ◽

Laboratory Data ◽

Length Of Hospital Stay ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Patients With Diabetes ◽

D Dimer

BACKGROUND Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). OBJECTIVE This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. METHODS This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. RESULTS Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1<sub>c</sub> level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (<i>P</i><.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit. CONCLUSIONS Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.

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Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin

JAI (Jurnal Anestesiologi Indonesia) ◽

10.14710/jai.v12i3.32905 ◽

2020 ◽

Vol 12 (3) ◽

pp. 17-33

Author(s):

Rohmantuah Trada Purba ◽

Mahendratama Purnama Adhi ◽

Erna Kusumawardhani ◽

Rapto Hardian ◽

Andri Lumban Tobing

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lactate Dehydrogenase ◽

Interleukin 6 ◽

Virus Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Corona Virus ◽

D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.

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Computed Tomography of the Chest in the Intensive Care Unit

Critical Care Clinics ◽

10.1016/s0749-0704(18)30128-3 ◽

1994 ◽

Vol 10 (2) ◽

pp. 267-275 ◽

Cited By ~ 11

Author(s):

Barry H. Gross ◽

David L. Spizarny

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care

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