scholarly journals Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study

2020 ◽  
Author(s):  
Anna Maria Cattelan ◽  
Eugenia Di Meco ◽  
Marco Trevenzoli ◽  
Alessia Frater ◽  
Anna Ferrari ◽  
...  

Abstract Background Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study aims to offer a comparative description of the COVID-19 patients, admitted to a general ward for a non-critical clinical picture, who required or not to be transferred to the intensive (ICU) and/or sub-intensive care (SICU) units. Methods This observational retrospective study included all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined Group 1; patients who were transferred to the ICU and/or SICU are defined Group 2. Demographic and clinical characteristics were compared between the two groups. Results 303 patients were included. Median age was 62 years. 69 patients (22,8%) met the primary outcome and were defined Group 2. The overall mortality rate was 6.8%. Group 2 were more likely to be men, had a higher mortality (14,5% vs. 3,8%, p<0,01), had more hypertension (72,4% vs. 44%, p<0,01) and diabetes (31,9% vs. 21%, p=0,04) and were more likely to present dry cough (49,3% vs. 25,2%, p<0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63,2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72,7%vs. 17,2%, p<0,01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-reactive-protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, liver function tests and C-reactive-protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p<0,01). Conclusions The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anna Maria Cattelan ◽  
Eugenia Di Meco ◽  
Marco Trevenzoli ◽  
Alessia Frater ◽  
Anna Ferrari ◽  
...  

Abstract Background Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not. Methods This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups. Results 303 were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p < 0.01), had a higher fatality rate (14.5% vs. 3.8%, p < 0,01), had more hypertension (72.4% vs. 44%, p < 0,01) and diabetes (31.9% vs. 21%, p = 0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p < 0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p = 0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-Reactive-Protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-Reactive-Protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p < 0.01). Conclusions The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.


2020 ◽  
Author(s):  
Anna Maria Cattelan ◽  
Eugenia Di Meco ◽  
Marco Trevenzoli ◽  
Alessia Frater ◽  
Anna Ferrari ◽  
...  

Abstract Background Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not.Methods This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups. Results 303 patients were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p<0.01), had a higher fatality rate (14.5% vs. 3.8%, p<0,01), had more hypertension (72.4% vs. 44%, p<0,01) and diabetes (31.9% vs. 21%, p=0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p<0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p=0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-reactive-protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-reactive-protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p<0.01). Conclusions The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.


2020 ◽  
Author(s):  
Anna Maria Cattelan ◽  
Eugenia Di Meco ◽  
Marco Trevenzoli ◽  
Alessia Frater ◽  
Anna Ferrari ◽  
...  

Abstract BackgroundIdentifying risk factors for severe novel-coronavirus disease (COVID-19) is essential to ascertain which patients may benefit from advanced supportive care. The study aims to give a comparative description of COVID-19 patients who were admitted or not to the intensive (ICU) or sub-intensive cares units (SICU). MethodsThis observational study of prospectively collected data included all COVID-19 patients primarily admitted to the Infectious Diseases department of Padua between February 22 and May 20, 2020. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of ICU and/or SICU admission. Results 303 patients were included. Median age was 62 years (IQR:50-74), 60.1% were male. 234 patients were managed in the Infectious Diseases ward (Group 1) and 69 patients (22,8%) met the primary outcome (Group 2). The mortality rate was 6.8%. Group 2 were more likely to be men, had a higher mortality (14,5%vs3,8%, p<0,01) and had more hypertension (72,4vs 44%,p<0,01) and diabetes (31,9vs21%,p=0,04). Chest X-ray at admission was positive in 63,2% and Group 2 were more likely to develop pathological findings during the hospitalization (72,7%vs17,2%,p<0,01). Group 2 presented at admission a higher neutrophil count, aspartate-transaminase and C-reactive-protein. At the 3° measurement, differences were found for white blood cell and neutrophil count, liver function tests and C-reactive-protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20vs35days,p<0,01). ConclusionsThe presence of comorbidities and the persistent observation of slightly abnormal laboratory findings should be regarded as predisposing factors for disease severity and clinical worsening.


2020 ◽  
Vol 66 (suppl 2) ◽  
pp. 77-81 ◽  
Author(s):  
Ceyhun Varim ◽  
Selcuk Yaylaci ◽  
Taner Demirci ◽  
Tezcan Kaya ◽  
Ahmet Nalbant ◽  
...  

SUMMARY BACKGROUND Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001) CONCLUSION The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.


QJM ◽  
2021 ◽  
Author(s):  
N W Chew ◽  
J N Ngiam ◽  
S M Tham ◽  
Z Y Lim ◽  
T Y W Li ◽  
...  

Summary Background/Introduction There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. Aim We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. Design and Methods Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever—Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. Results There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P&lt;0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P&lt;0.001). The presence of fever (OR 4.096, 95% CI 1.737–9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. Discussion/Conclusion In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.


MedAlliance ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 8-14

SummaryIntroduction. With the ongoing COVID-19 pandemic, finding new treatments is an extremely important issue. The effectiveness of heliox was previously demonstrated in the complex treatment of patients with various bron-chopulmonary pathologies. Therefore, this method has been recommended for the treatment of pneumonia associated with COVID-19. Purpose. To study the safety and efficacy of inhaled heliox therapy in the treatment of pneumonia in COVID-19. Materials and methods. A sing-le-center prospective study was carried out for the period from 01.12.2020 to 15.02.2021. The study included 91 pa-tients. The patients were divided into two groups: group 1 (using heliox) included 46 people, and group 2 (con-trol) — 45. Inhalations of a heated oxygen-helium mixture heliox (70% helium, 30% oxygen) were carried out using “Ingalit-B2-01” inhaler. Objective (saturation, O2 flow) and laboratory parameters (lactate dehydrogenase, C-reactive protein), as well as chest organs CT data were studied. Differences between groups were determined using the χ2 test, as well as the Mann–Whitney U-test. The p value <0.05 was considered significant. Results. In group 1, side effects developed in 5 (11.3%) patients. These patients refused to further participate in the study. Final number of patients in group 1 — 41. Among patients of group 1, there was a tendency towards a more rapid normalization of lactate dehydrogenase and C-reactive protein, as well as a decrease in oxygen dependence. In group 1, according to CT data, no progression of pneumonia was recorded. In group 2, progression was observed in 6 (13.3%) patients. The overall effectiveness of treatment among patients in group 1 was 100%, among patients in group 2 — 86.7%. The differences between the groups are statistically sig-nificant (p=0.02). Conclusion. The use of inhalations with a heated oxygen-helium mixture heliox (30% oxygen, 70% helium) has shown its effectiveness and safety in the treatment of viral pneumonia (CT1- 2) associated with COVID-19.


Author(s):  
Abdullah Alshukry ◽  
Mohammad Bu Abbas ◽  
Yaseen Ali ◽  
Barrak Alahmad ◽  
Abdullah A. Al-Shammari ◽  
...  

AbstractBackgroundCOVID-19 has a highly variable clinical presentation, ranging from asymptomatic to severe respiratory symptoms and death. Diabetes seems to be one of the main comorbidities contributing to a worse COVID-19 outcome.ObjectiveIn here we analyze the clinical characteristics and outcomes of diabetic COVID-19 patients.MethodsIn this single-center, retrospective study of 417 consecutive COVID-19 patients, we analyze and compare disease severity, outcome, associated complications, and clinical laboratory findings between diabetic and non-diabetic COVID-19 patients.ResultsCOVID-19 patients with diabetes had more severe outcomes and higher mortality than non-diabetic COVID-19 patients. Diabetic COVID-19 patients had significantly higher prevalence of comorbidities, such as hypertension. Laboratory investigations also highlighted notably higher levels of C-reactive protein in diabetic COVID019 patients and lower estimated glomerular filtration rate. They also showed a higher incidence of complications.ConclusionDiabetes could be a major contributor to worsening outcomes in COVID-19 patients. Understanding the pathophysiology underlining these findings could provide insight into better management and improved outcome of such cases.Highlights of the StudyA significantly higher proportion of Diabetic COVID-19 patients required admission to the ICU.Higher fasting blood glucose was associated with higher risk of COVID-19 associated mortality.Diabetic COVID-19 patients had significantly higher incidence of complications including sepsis, ARDS, cardiac failure and renal failure.


2021 ◽  

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.


Author(s):  
A. A. Zvyagin ◽  
V. S. Demidova ◽  
G. V. Smirnov

The article presents the results of a prospective, single-center observational clinical trial, in which biomarker levels were compared in patients with sepsis.Objective: to evaluate the dynamics of the level of presepsin, procalciotonin and C-reactive protein in two groups - the dead and the surviving patients with sepsis.Materials and methods. The study consistently included 41 patients with a diagnosis of sepsis (based on the concept of "Sepsis-3"), divided into two groups: group 1 (21 people) – survivors, group 2 (20 people) – dead. Patients in both groups received conventional intensive therapy for sepsis. In addition to the standard laboratory and instrumental examination, patients in the dynamics were monitored for the level of presepsin, procalcitonin, C-reactive protein.Results. The average level of presepsin in group 1 and group 2 was 1718.00 and 3266.50 pg/ml, respectively, with half of the values being within (Me (25.75) 1021.00–3231.00 and 1618.50–7469.00 pg/ml. The average level of procalcitonin in group 1 and group – 0.995 and 4.465 ng/ml, respectively, while Me (25.75) 0.49–4.44 and 1.625–19.30 ng/ml. The average level of C-reactive protein in group No. 1 and group No. 2 is 95.5 and 215.0 mg/l, respectively, with Me (25.75) 64.00–155.00 and 155.00–264.00 mg/l. When comparing the values of biomarkers in the two groups of patients, significant differences were found (p-value for presepsin, procalсitonina and C-reactive protein are, respectively 0.000008, 0.000242, 0.0000001).


2016 ◽  
Vol 19 (5) ◽  
pp. 383-387 ◽  
Author(s):  
Irina Alexandrovna Khripun ◽  
Sergey Vladislavovich Vorobyev ◽  
Maxim Nikolaevich Morgunov ◽  
Michail Iosifovich Kogan

Type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease that is based on endothelial dysfunction (ED). Currently, conventional diagnostic methods are unreliable, especially at early stages of disease.Aims. The aim of this work was to assess endothelial function in men with T2DM without clinical signs of cardiovascular disease.Materials and methods. The study included 100 patients (mean age, 54.3 ± 5.3 years) with a T2DM duration of less than 10 years and without signs of cardiovascular disease. The patients were divided into two groups: group 1 consisted of 60 patients with a T2DM duration of less than five years. Group 2 included 40 men with a history of diabetes between 5 and 10 years. Endothelial function was assessed by the levels of nitric oxide (NO), endothelial NO synthase type 3 (eNOS3), ICAM-1, VCAM-1, E-selectin, P-selectin, resistin and C-reactive protein and the arterial vasoreactivity of the brachial artery (BA) using the D. Celermajer method.Results. Results revealed decreases in levels of both eNOS3 by 2.5 fold (P = 0.0005) and NO by 1.9 fold (P = 0.043) in group 2 patients, compared to those in group 1 patients. When the duration of diabetes was greater than five years, levels of VCAM-1, resistin and C-reactive protein increased by 12.1% (P = 0.048), 62% (P = 0.01) and 45.6%, respectively. Additionally, the time until maximal BA vasodilatation during reactive hyperemia was observed to be higher in group 2 [105 (90; 180) seconds] than those in group 1 [90 (60; 120) seconds].Conclusions. Biochemical and imaging signs of ED begin to appear in the first five years of T2DM, long before clinical manifestations. The earliest symptoms are decreases in eNOS3 and NO levels, increases in VCAM-1 and resistin concentrations and increased time until maximal BA vasodilatation during reactive hyperemia.


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