scholarly journals D Dimer – Prognostic indicator for disease severity in patients hospitalised with COVID 19

2021 ◽  
Vol 8 (4) ◽  
pp. 461-464
Author(s):  
Vineet Banga ◽  
Stuti Jain
Keyword(s):  
Retrospective Study ◽  
Disease Severity ◽  
Severe Disease ◽  
Prognostic Indicator ◽  
Clinical Severity ◽  
Care Hospital ◽  
Severity Of Disease ◽  
Management Protocol ◽  
Severity Levels ◽  
D Dimer

Patients of Covid 19 infections present with different severity. Levels of D Dimer in these patients can be correlated with disease severity for management and prognosis. To evaluate the usefulness of D-Dimer levels in blood to correlate with disease severity in COVID 19 patients. Retrospective study was done in Department of Pathology of Secondary Care hospital that became designated covid hospital from May 2021 to June 2021 on 60 COVID 19 positive admitted patients. D dimer levels were analysed and correlated with clinical severity of disease. Out of total 60 patients, 33 were in mild, 23 in moderate and 4 were in severe category. In mild cases D Dimer varies from 43 ng/ml to 183 ng/ml. In moderate cases D Dimer varies from 270 ng/ml to 991 ng/ml. In severe cases D Dimer varies from 1043 ng/ml to 2463 ng/ml. The study suggests cut off levels for D Dimer as up to 200 ng/ml for mild, 200-1000 ng/ml for moderate and more than 1000 ng/ml for severe category in COVID 19 patients. D dimer helps in identifying severe disease and can be used as an essential biomarker in developing the management protocol for COVID 19 patients.

scholarly journals Rotational Thromboelastometry Reveals Distinct Coagulation Profiles for Patients With COVID-19 Depending on Disease Severity

2021 ◽  
Vol 27 ◽  
pp. 107602962110276
Author(s):  
Mehmet Gökhan Gönenli ◽  
Zeynep Komesli ◽  
Said İncir ◽  
Özlem Yalçın ◽  
Olga Meltem Akay
Keyword(s):  
Disease Severity ◽  
Complete Blood Count ◽  
Severe Disease ◽  
Clinical Severity ◽  
Therapeutic Approaches ◽  
Thrombotic Risk ◽  
Rotational Thromboelastometry ◽  
Coagulation Parameters ◽  
Positive Correlations ◽  
D Dimer

Identifying a hypercoagulable state in patients with COVID-19 may help identify those at risk for virus–induced thromboembolic events and improve clinical outcomes using personalized therapeutic approaches. Herein, we aimed to perform a global assessment of the patients’ hemostatic system with COVID-19 using rotational thromboelastometry (ROTEM) and to describe whether patients with different disease severities present different coagulation profiles. Together with 37 healthy volunteers, a total of 65 patients were included and then classified as having mild, moderate, and severe disease depending on clinical severity. Peripheral blood samples were collected and analyzed using a ROTEM Coagulation Analyzer. Also, complete blood count and coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen levels, and D-dimer levels were measured at admission. EXTEM and INTEM MCF ( P < 0.001) values were significantly higher and the EXTEM CFT ( P = 0.002) value was significantly lower in patients with COVID-19 when compared with controls. In particular, patients with the severe disease showed a significant decrease in CFT ( P < 0.001) and an increase in MCF ( P < 0.001) in both INTEM and EXTEM assays compared with patients with the non-severe disease. Correlation analysis revealed significant correlations between ROTEM parameters and other coagulation parameters. There were significant positive correlations between fibrinogen, D-dimer, platelet count, and MCF in both EXTEM and INTEM assays. Our data demonstrate thromboelastographic signs of hypercoagulability in patients with COVID-19, which is more pronounced in patients with increased disease severity. Therefore, ROTEM analysis can classify subsets of patients with COVID-19 at significant thrombotic risk and assist in clinical decisions.

scholarly journals Differential Association of Viral Dynamics With Disease Severity Depending on Patients’ Age Group in COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Yuri Kim ◽  
Shinhyea Cheon ◽  
Hyeongseok Jeong ◽  
Uni Park ◽  
Na-Young Ha ◽  
...  
Keyword(s):  
Viral Load ◽  
Elderly Patients ◽  
Disease Severity ◽  
Acute Phase ◽  
Inflammatory Responses ◽  
Severe Disease ◽  
Neutralizing Antibody ◽  
The Elderly ◽  
Clinical Severity ◽  
Younger Patients

Despite a clear association of patient’s age with COVID-19 severity, there has been conflicting data on the association of viral load with disease severity. Here, we investigated the association of viral load dynamics with patient’s age and severity of COVID-19 using a set of respiratory specimens longitudinally collected (mean: 4.8 times/patient) from 64 patients with broad distribution of clinical severity and age during acute phase. Higher viral burden was positively associated with inflammatory responses, as assessed by IL-6, C-reactive protein, and lactate dehydrogenase levels in patients’ plasma collected on the same day, primarily in the younger cohort (≤59 years old) and in mild cases of all ages, whereas these were barely detectable in elderly patients (≥60 years old) with critical disease. In addition, viral load dynamics in elderly patients were not significantly different between mild and critical cases, even though more enhanced inflammation was consistently observed in the elderly group when compared to the younger group during the acute phase of infection. The positive correlation of viral load with disease severity in younger patients may explain the increased therapeutic responsiveness to current antiviral drugs and neutralizing antibody therapies in younger patients compared to elderly patients. More careful intervention against aging-associated inflammation might be required to mitigate severe disease progression and reduce fatality in COVID-19 patients more than 60 years old.

scholarly journals Clinical Characteristic of Thoracic Malignancy Patients with Coronavirus Disease 2019 Related to Mitigation Strategy in Dharmais National Cancer Center Hospital, Indonesia

2021 ◽  
Vol 9 (B) ◽  
pp. 692-697
Author(s):  
Arif Hanafi ◽  
Noorwati Soetandyo ◽  
Achmad Mulawarman Jayusman ◽  
Leovinna Widjaja ◽  
Fifi Dwijayanti ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Disease Severity ◽  
Poor Prognosis ◽  
Severe Disease ◽  
Mitigation Strategy ◽  
Cancer Center ◽  
P Value ◽  
Lymphocyte Ratio ◽  
Thoracic Malignancy ◽  
D Dimer

Aim: To describe the clinical data and disease severity of thoracic malignancy patients with COVID-19 and its relation to the mitigation process at the Dharmais National Cancer Center, Indonesia. Methods: Total 5256 cancer patients registered from May 2020 to March 2021. There were 681 cancer patients diagnosed with COVID-19. Forty-five thoracic malignancy patients were enrolled. Data from medical records were obtained at the Dharmais Cancer Hospital, then analyzed using SPSS version 25. Comparative result was considered significant, as p-value < 0.05. Results: There were 12.9% of total patients registered infected by COVID-19, which 6% with thoracic malignancy dominated by Non-small cell lung carcinoma (57.8%). Patients who have asymptomatic (31.1%), mild (13.3%), and moderate COVID-19 disease (8.9%) were alive. Patient with severe disease (46.7%) tend to deteriorate. Neutrophilia (mean 78.0%), lymphopenia (mean 13.0%), high neutrophil to lymphocyte ratio (mean 13.1), hyperuricemia (mean 31.6 mg/dL), high fibrinogen (mean 521.7 mg/dL), and high d-dimer (mean 3821.6 ng/mL) were significantly associated with disease severity (p-value < 0.05). Conclusions: Only small number of cancer patients affected by COVID-19 and mostly do not progress to severe disease, showing the strict mitigation strategy was successful. Severe disease patients have a poor prognosis, with neutrophilia, lymphopenia, high neutrophil to lymphocyte ratio, hyperuricemia, high fibrinogen, and high d-dimer may be valuable for predicting poor prognosis.

scholarly journals Combined Indexes of Serum NLR, CRP, LDH, IL-6 and D-Dimer Levels are a Biomarker of Disease Severity and Prognostic Predictor in Patients with Coronavirus Disease 2019

2021 ◽  
Author(s):  
Jing Li ◽  
Mingyang Tang ◽  
Didi Liu ◽  
Fengchao Wang ◽  
Yanqing Yang
Keyword(s):  
Disease Progression ◽  
Disease Severity ◽  
Severe Disease ◽  
Composite Endpoint ◽  
Serum Markers ◽  
Inflammatory Factors ◽  
Rna Detection ◽  
Host Immune Responses ◽  
Positive Rate ◽  
D Dimer

Abstract Background: Coronavirus disease-2019 (COVID-19) has become a worldwide emergency and has had a severe impact on human health. Inflammatory factors have the potential to either enhance the efficiency of host immune responses or damage the host organs with immune overreaction in COVID-19. Therefore, there is an urgent need to investigate the functions of inflammatory factors and serum markers that participate in disease progression. Methods: In total, 54 COVID-19 patients were enrolled in this study. Disease severity was evaluated by clinical evaluation, laboratory tests, and computed tomography (CT) scans. Data were collected at: admission, 3–5 days after admission, when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection became negative, and composite endpoint. Results: We found that the positive rate in sputum was three times higher than that in throat swabs. Higher levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (D-D), interleukin-6 (IL-6) and neutrophil-to-lymphocyte (NLR) or lower lymphocyte counts suggested more severe disease, and the levels of cytokines and serum markers were intrinsically correlated with disease progression. When SARS-CoV-2 RNA detection became negative, the receiver operating characteristic (ROC) curve demonstrated that LDH had the highest sensitivity independently, and four indicators (NLR, CRP, LDH, and D-D) when combined had the highest sensitivity in distinguishing critically ill patients from mild ones. Conclusions: Monitoring dynamic changes in NLR, CRP, LDH, IL-6, and D-D levels, combined with CT imaging and viral RNA detection in sputum, could aid in severity evaluation and prognosis prediction and facilitate COVID-19 treatment.

scholarly journals Complement C5a and Clinical Markers to predict COVID-19 Disease Severity and Mortality in a Multi-ethnic Population

2021 ◽  
Author(s):  
Farhan S Cyprian ◽  
Muhammad Suleman ◽  
Ibrahim Abdelhafez ◽  
Asmma Doudin ◽  
Ibn Mohammed Masud Danjuma ◽  
...  
Keyword(s):  
Disease Severity ◽  
Complete Blood Count ◽  
Severe Disease ◽  
Clinical Severity ◽  
Classification Model ◽  
Clinical Markers ◽  
Hepatocellular Injury ◽  
Risk Of Death ◽  
Markers Of Inflammation ◽  
Wide Range

Abstract Coronavirus disease-2019 (COVID-19) was declared as a pandemic by WHO in March 2020. SARS-CoV-2 causes a wide range of illness from asymptomatic to life-threatening. There is an essential need to identify biomarkers to predict disease severity and mortality during the earlier stages of the disease, aiding treatment and allocation of resources to improve survival. The aim of this study was to identify at the time of SARS-COV-2 infection patients at high risk of developing severe disease associated with low survival using blood parameters, including inflammation and coagulation mediators, vital signs, and pre-existing comorbidities. This cohort included 89 multi-ethnic COVID-19 patients recruited between July 14th and October 20th 2020 in Doha, Qatar. According to clinical severity, patients were grouped into severe (n = 33), mild (n = 33) and asymptomatic (n = 23). Common routine tests such as complete blood count (CBC), glucose, electrolytes, liver and kidney function parameters and markers of inflammation, thrombosis and endothelial dysfunction including complement component split product C5a, Interleukin-6, ferritin and C-reactive protein were measured at the time COVID-19 infection was confirmed. Correlation tests suggest that C5a is a novel predictive marker of disease severity and mortality, in addition to 40 biological and physiological parameters that were found statistically significant between survivors and non-survivors. Survival analysis showed that. high C5a levels, hypoalbuminemia, lymphopenia, elevated procalcitonin, neutrophilic leukocytosis, acute anemia along with increased acute kidney and hepatocellular injury markers were associated with a higher risk of death in COVID-19 patients. Altogether, we created a prognostic classification model, the CAL model (C5a, Albumin, and Lymphocyte count) to predict severity with significant accuracy. Stratification of patients using the CAL model could help the identification of patients likely to develop severe symptoms in advance so that treatments can be targeted accordingly.

scholarly journals Gut microbiota diversity and C-Reactive Protein are predictors of disease severity in COVID-19 patients

2021 ◽  
Author(s):  
André Moreira-Rosário ◽  
Cláudia Marques ◽  
Hélder Pinheiro ◽  
João Ricardo Araújo ◽  
Pedro Ribeiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gut Microbiota ◽  
Disease Severity ◽  
Severe Disease ◽  
Clinical Severity ◽  
Rrna Gene ◽  
C Reactive Protein ◽  
Clinical Progression ◽  
Reactive Protein ◽  
Microbiota Diversity

AbstractRisk factors for COVID-19 disease severity are still poorly understood. Considering the pivotal role of gut microbiota on host immune and inflammatory functions, we investigated the association between changes in gut microbiota composition and the clinical severity of COVID-19. We conducted a multicentre cross-sectional study prospectively enrolling 115 COVID-19 patients categorized according to: 1) WHO Clinical Progression Scale - mild 19 (16.5%), moderate 37 (32.2%) or severe 59 (51.3%); and 2) location of recovery from COVID-19 - ambulatory 14 (household isolation; 12.2%), hospitalized in ward 40 (34.8%) or intensive care unit 61 (53.0%). Gut microbiota analysis was performed through 16S rRNA gene sequencing and data obtained was further related with clinical parameters of COVID-19 patients. Risk factors for COVID-19 severity were identified by univariate and multivariable logistic regression models.In comparison with mild COVID-19 patients, the gut microbiota of moderate and severe patients has: a) lower Firmicutes/Bacteroidetes ratio, b) higher abundance of Proteobacteria; and c) lower abundance of beneficial butyrate-producing bacteria such as Roseburia and Lachnospira genera. Multivariable regression analysis showed that Shannon index diversity (odds ratio [OR] 2.85 [95% CI 1.09-7.41]; p=0.032) and C-Reactive Protein (OR 3.45 [95% CI 1.33-8.91]; p=0.011) were risk factors for COVID-19 severe disease (a score of 6 or higher in WHO clinical progression scale).In conclusion, our results demonstrated that hospitalised moderate and severe COVID-19 patients have microbial signatures of gut dysbiosis and for the first time, the gut microbiota diversity is pointed out as a prognostic biomarker for COVID-19 disease severity.

scholarly journals Development and validation of a diagrammatic scale for quantifying maize leaf spots caused by Diplodia macrospora

2019 ◽  
Vol 40 (6) ◽  
pp. 2475
Author(s):  
Eloisa Lorenzetti ◽  
Juliano Tartaro ◽  
Alfredo José Alves Neto ◽  
Anderson Luis Heling ◽  
Jeferson Carlos Carvalho ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Disease Severity ◽  
Maize Leaf ◽  
Stimulus Response ◽  
Severity Of Disease ◽  
Leaf Spots ◽  
Maize Leaves ◽  
Severity Levels ◽  
Development And Validation ◽  
Diagrammatic Scale

The objective of this study was to develop and validate a diagrammatic scale to evaluate the severity of spots on maize leaves caused by the fungus Diplodia macrospora. Severity ranged between the minimal (0.5%) and maximal (55%) limits of disease severity, and intermediate severity levels were defined according to the "Weber-Fechner stimulus response law". The proposed scale describes six levels of severity based on how much of the leaf is affected: 0.5%, 3%, 8%, 23%, 36%, and 55%. Validation was carried out by eight evaluators, four inexperienced and four experienced. They estimated the severity of disease in 60 maize leaves, with and without the proposed diagrammatic scale. A relationship was shown by regression analysis between estimated and actual severity, with and without the use of the scale. When both inexperienced and experienced evaluators used the scale, they were able to estimate disease severity more accurately and precisely.

scholarly journals Analysis of D-Dimer Levels among Covid -19 Positive Patients in a Tertiary Care Hospital in Bangalore

2021 ◽  
Vol 9 (2) ◽  
pp. 80-84
Author(s):  
Dr. Manasa. S ◽  
◽  
Dr. Venkatesh Vikram H. C ◽  
Keyword(s):  
Retrospective Study ◽  
Tertiary Care Hospital ◽  
Early Stage ◽  
Tertiary Care ◽  
Fibrin Clot ◽  
Coagulation Disorder ◽  
Care Hospital ◽  
Coagulation Disorders ◽  
Lab Test ◽  
D Dimer

Introduction: Pro-thrombotic changes are stimulated by Corona Virus as it has an affinity forendothelium and lung structures and this may explain its association with thrombotic events,reduction of pulmonary gas exchange, respiratory distress, and death. D-dimer is a specific markerof the breakdown of a fibrin clot and has been used as a diagnostic and prognostic marker in VTEand other coagulation disorders. Objectives: The objective of this study was to assess thecorrelation of the D-Dimer levels and disease severity among COVID-19 patients. Materials andmethods: This is a retrospective study done over 6 months from July 2020 to December 2020 in atertiary care hospital in Bangalore. All the COVID- 19 positive cases who were admitted to ourhospital were audited regarding the D-dimer levels during admission and the course of thetreatment. Results: Coagulation disorder occurred at the early stage of COVID-19 infection, with1066 (57.7%) patients having increased D-dimer levels. Out of 1846 COVID 19 patients 106(5.7%)patients died due to complications. 106 patients who deceased, all the patients had anincreased D dimer value either in the first lab test or in the consecutive tests. Among 106 patients56(52.8%) patients had increased D-dimer at the first lab test, 32 (30.1%) had D-dimer increasedat the second and 18(16.98%) in third lab tests. The increased D-dimer levels were closelyassociated with the progression of the disease and also the changes in the CT imaging. Conclusion:The increase in D-Dimer levels also increased the complications in the COVID-19 patient. So it isnecessary to continuously monitor D-dimer levels and labelled anticoagulation as management toolsfor COVID-19 disease to prevent complications and reduce interventions.

scholarly journals Utility of Neutrophil-Lymphocyte Ratio (NLR) as an Indicator of Disease Severity and Prognostic Marker among Patients with Covid-19 Infection in a Tertiary Care Centre in Bangalore – A Retrospective Study

2021 ◽  
Vol 8 (16) ◽  
pp. 1020-1024
Author(s):  
Ashwin Kulkarni ◽  
Divya Prabhu ◽  
Likitesh A.B. ◽  
Anil Kumar T ◽  
Varun Vinayak P. Rao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Resolution ◽  
Disease Severity ◽  
Severity Score ◽  
Computerised Tomography ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Mild Disease ◽  
Markers Of Inflammation ◽  
D Dimer

BACKGROUND The infection caused due to novel coronavirus 2 can cause wide spectrum of disease from asymptomatic mild disease to life threatening disease. The widespread inflammation is most likely the cause of the adverse outcomes. There are numerous markers of the inflammation which are used to identify the severity and prognosis of the disease. Neutrophil lymphocyte ratio (NLR) is one such marker which is easily available and feasible in all the hospital settings. This study intended to evaluate the NLR as a marker of disease severity and prognosis, in those with Covid-19. METHODS This was a retrospective study to determine the utility of NLR as a marker of severity and prognosis among patients with Covid disease. Medical records of 60 patients admitted with mild to moderate Covid-19 disease were reviewed and relevant data was retrieved. The NLR at admission and 72 hours later was noted. High resolution computerised tomography was done and computerised tomography severity score (CT-SS) was calculated. The outcomes of these patients were noted. RESULTS Mean NLR at admission in mild disease was 5.6 and in moderate disease was 9.2. This difference was found to be statistically significant. It was also seen that NLR had a positive co-relation with CT severity score, duration of hospital stay, Creactive protein (CRP) and D-dimer. For predicting mortality, NLR with cut off of 6.6 had a sensitivity of 100 % and a specificity of 66.07 %. CRP with cut off of 6.8 had sensitivity of 100 %, specificity of 76.79 %. D-dimer with cut off of 1.6 had specificity of 78.58 %. For predicting severity, NLR with cut off of 6.6 had sensitivity of 75 % and specificity of 80 %. CRP with cut off of 7.9 had sensitivity of 65 % and specificity of 100 %. D-dimer with cut off of 1.3, had sensitivity of 90 % and specificity of 97.5 %. CONCLUSIONS The study shows that neutrophil–lymphocyte ratio is a good indicator of disease severity and has prognostic significance in Covid-19. There is a positive correlation with high-resolution computed tomography (HRCT) chest score and other markers of inflammation among patients with Covid-19. Serial monitoring of NLR can be utilised as a surrogate to HRCT chest to determine disease severity whenever the latter is not available. This can ensure early intervention and help prevent mortality. KEYWORDS Neutrophil-Lymphocyte Ratio, Severity of Covid

scholarly journals Using secondary cases to characterize the severity of an emerging or re-emerging infection

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Tim K. Tsang ◽  
Can Wang ◽  
Bingyi Yang ◽  
Simon Cauchemez ◽  
Benjamin J. Cowling
Keyword(s):  
Infectious Disease ◽  
Systematic Review ◽  
Statistical Model ◽  
Disease Severity ◽  
Severe Disease ◽  
Clinical Severity ◽  
Contact Tracing ◽  
Emerging Infection ◽  
Index Cases ◽  
Extract Information

AbstractThe methods to ascertain cases of an emerging infectious disease are typically biased toward cases with more severe disease, which can bias the average infection-severity profile. Here, we conducted a systematic review to extract information on disease severity among index cases and secondary cases identified by contact tracing of index cases for COVID-19. We identified 38 studies to extract information on measures of clinical severity. The proportion of index cases with fever was 43% higher than for secondary cases. The proportion of symptomatic, hospitalized, and fatal illnesses among index cases were 12%, 126%, and 179% higher than for secondary cases, respectively. We developed a statistical model to utilize the severity difference, and estimate 55% of index cases were missed in Wuhan, China. Information on disease severity in secondary cases should be less susceptible to ascertainment bias and could inform estimates of disease severity and the proportion of missed index cases.

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