scholarly journals A Comprehensive Evaluation of Early Predictors of Disease Progression in Patients with COVID-19: A Case Control Study

2020 ◽  
Author(s):  
Qiang Tang ◽  
Yanwei Liu ◽  
Yingfeng Fu ◽  
Ziyang Di ◽  
Kailiang Xu ◽  
...  
Keyword(s):  
Disease Progression ◽  
Serum Ferritin ◽  
Elevated Level ◽  
Clinical Laboratory ◽  
Comprehensive Evaluation ◽  
Clinical Information ◽  
Organ Damage ◽  
Advanced Age ◽  
Health Crisis ◽  
Kaplan Meier

Abstract Background: The 2019 coronavirus disease (COVID-19) has become an unprecedented public health crisis with nearly 16 million confirmed cases and 630,000 deaths worldwide. Methods: We retrospectively investigated the demographic, clinical, laboratory, radiological and treatment data of COVID-19 patients consecutively enrolled from January 18 to May 15, 2020, in Taihe and Jinzhou central hospital. Results: Of all 197 patients, the median age was 66.5 years (IQR 7-76), and 120 (60.9%) patients were males. We identified 88 (44.7%) of 197 COVID-19 patients as the disease progression (aggravation) cases. The aggravation cases tend to have more medical comorbidity: hypertension (34.1%), diabetes (30.7%), and presented with dyspnea (34.1%), neutrophilia (60.2%), and lymphocytopenia (73.9%), compared with those without. And the patients with disease progression showed significantly higher level of Fibrinogen (Fbg), D-dimer, IL-6, C-reactive protein (CRP), procalcitonin (PCT), and serum ferritin, and were more prone to develop organ damage in the liver, kidney, and heart (P<0.05). Multivariable regression showed that advanced age, comorbidities, lymphopenia, and elevated level of Fbg, lactate dehydrogenase (LDH), Cardiac troponin (CTnI), IL-6, serum ferritin were the significant predictors of disease progression. Further, we investigated antibody responses to SARS-CoV-2 and found that the levels of IgM and IgG were significantly higher in the disease progression cases compared to non-progression cases from 3 weeks after symptom onset. In addition, the disease progression group tended to peak later and has a more vigorous IgM/IgG response against SARS-CoV-2. Further, we performed Kaplan-Meier analysis and found that 61.6% of patients had not experienced ICU transfer or survival from hospital within 25 days from admission.Conclusions: Investigating the potential factors of advanced age, comorbidities and elevated level of IL-6, serum ferritin and Kaplan-Meier analysis enables early identification and management of patients with poor prognosis. Detection of the dynamic antibody may offer vital clinical information during the course of SARS-CoV-2 and provide prognostic value for patients infection.

scholarly journals A comprehensive evaluation of early potential risk factors for disease aggravation in patients with COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Qiang Tang ◽  
Yanwei Liu ◽  
Yingfeng Fu ◽  
Ziyang Di ◽  
Kailiang Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Serum Ferritin ◽  
Potential Risk ◽  
Comprehensive Evaluation ◽  
Organ Damage ◽  
Kaplan Meier ◽  
Public Crisis ◽  
Potential Risk Factors ◽  
Multivariable Regression

AbstractThe 2019 Coronavirus Disease (COVID-19) has become an unprecedented public crisis. We retrospectively investigated the clinical data of 197 COVID-19 patients and identified 88 patients as disease aggravation cases. Compared with patients without disease aggravation, the aggravation cases had more comorbidities, including hypertension (25.9%) and diabetes (20.8%), and presented with dyspnoea (23.4%), neutrophilia (31.5%), and lymphocytopenia (46.7%). These patients were more prone to develop organ damage in liver, kidney, and heart (P < 0.05). A multivariable regression analysis showed that advanced age, comorbidities, dyspnea, lymphopenia, and elevated levels of Fbg, CTnI, IL-6, and serum ferritin were significant predictors of disease aggravation. Further, we performed a Kaplan–Meier analysis to evaluate the prognosis of COVID-19 patients, which suggested that 64.9% of the patients had not experienced ICU transfers and survival from the hospital.

Assessing the utility of monitoring IgA multiple myeloma patients with quantitative serum IgA levels.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20515-e20515
Author(s):  
Alissa Visram ◽  
Abdullah S. Al Saleh ◽  
Harsh V Parmar ◽  
David L Murray ◽  
David Dingli ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Disease Progression ◽  
Median Time ◽  
Treatment Initiation ◽  
Progression Free Survival ◽  
Organ Damage ◽  
Bone Lesions ◽  
Disease Response ◽  
Kaplan Meier ◽  
Monoclonal Proteins

e20515 Background: IgA monoclonal proteins (MCPs), unlike IgG MCPs, often migrate in the beta region on serum protein electrophoresis (SPEP) which can lead to underestimation of their size due to the co-migration with physiologic proteins. In IgA multiple myeloma (MM), the utility of quantitative IgA levels in assessing disease response in comparison to SPEP is not well studied. Methods: We retrospectively analyzed 304 IgA MM patients, diagnosed between 2004 and 2018, with available serial MCP and quantitative IgA levels. Kaplan Meier analysis was used to estimate the median progression free survival (mPFS) using the IMWG criteria and our study definition of IgA progression (2 consecutive IgA values that are > 25% above the nadir IgA value and above upper limit of normal (ULN) of 356 mg/dL, and a detectable IgA MCP on serum immunofixation). The mPFS was defined as the time from treatment initiation until disease progression or death. Results: IgA MCP migrated in the beta region in 134 (44%) patients, and in the gamma region in 150 (56%) patients. At diagnosis the median MCP was 3 (IQR 1.9-4) g/dL and the median IgA was 3240 (IQR 2008-4420) mg/dL. The median time from treatment initiation to MCP nadir was 80 (IQR 42-144) days and median time to IgA nadir was 154 (IQR 90-238) days. At MCP nadir 40% of patients had an IgA above the ULN. All complete responders (n = 104) had normal IgA levels, with a median IgA of 54 (IQR 27-88) g/dL. A ≥90% decrease in IgA between treatment initiation and IgA nadir, compared to a < 90% decrease, was associated with a longer mPFS (34 vs. 20 months, p = 0.006) and overall survival (97 vs. 33 months, p = 0.003). Patients with serial MCP and IgA levels available prior to progression (n = 195) were used to compare the mPFS using the IMWG and IgA progression criteria. The mPFS using the IgA criteria was 32 (95% CI 29-39) months, versus 39 (95% CI 33-45) months using IMWG criteria. Overall, 92 (47%) patients progressed by both IMWG and IgA criteria. At the time of progression using the IgA criteria compared to at IMWG progression, the median hemoglobin was higher (13.3 vs. 11.6 g/dL, respectively, p < 0.001) and fewer patients had new symptomatic bone lesions (2% vs. 33%, respectively, p < 0.001). Conclusions: In IgA MM patients, monitoring quantitative IgA levels predicts disease response and allows for earlier detection of disease progression, prior to the development of end organ damage.

scholarly journals Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: a retrospective study from Wuhan, China

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jianwei Xiao ◽  
Xiang Li ◽  
Yuanliang Xie ◽  
Zengfa Huang ◽  
Yi Ding ◽  
...  
Keyword(s):  
Disease Progression ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Radiological Feature ◽  
Severe Illness ◽  
Chronic Obstructive ◽  
Limited Information ◽  
Obstructive Pulmonary Disease ◽  
Health Crisis

Abstract Background The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms. Methods This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID­19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression. Results Patients with severe/critical symptoms were older (p < 0.001) and more often male (p = 0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (> 11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811–0.902). Conclusions Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (> 11) was associated with severe illness.

scholarly journals Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: A retrospective study from Wuhan, China

2020 ◽  
Author(s):  
Jianwei Xiao ◽  
Xiang Li ◽  
Yuanliang Xie ◽  
Zengfa Huang ◽  
Yi Ding ◽  
...  
Keyword(s):  
Disease Progression ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Radiological Feature ◽  
Severe Illness ◽  
Chronic Obstructive ◽  
Limited Information ◽  
Obstructive Pulmonary Disease ◽  
Health Crisis

Abstract Background: The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms. Methods: This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID­19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression.Results: Patients with severe/critical symptoms were older (p<0.001) and more often male (p=0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (>11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811-0.902).Conclusions: Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (>11) was associated with severe illness.

scholarly journals Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: A retrospective study from Wuhan, China

2020 ◽  
Author(s):  
Jianwei Xiao ◽  
Xiang Li ◽  
Yuanliang Xie ◽  
Zengfa Huang ◽  
Yi Ding ◽  
...  
Keyword(s):  
Disease Progression ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Radiological Feature ◽  
Severe Illness ◽  
Chronic Obstructive ◽  
Limited Information ◽  
Obstructive Pulmonary Disease ◽  
Health Crisis

Abstract Background: The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms.Methods: This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID­19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression.Results: Patients with severe/critical symptoms were older (p<0.001) and more often male (p=0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (>11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811-0.902).Conclusions: Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (>11) was associated with severe illness.

scholarly journals P0741CHRONIC KIDNEY DISEASE PROGRESSION IN A LARGE PREVENTION COHORT IN COLOMBIA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Angela Rivera ◽  
Angelito Bernardo ◽  
Jasmin Vesga ◽  
Izcay Ronderos ◽  
Mauricio Sanabria
Keyword(s):  
Kidney Disease ◽  
Disease Progression ◽  
Prevention Program ◽  
Reduction Rate ◽  
Progression Rate ◽  
Ckd Progression ◽  
Care Services ◽  
Kaplan Meier ◽  
Observational Cohort ◽  
Kidney Disease Progression

Abstract Background and Aims Chronic kidney disease (CKD) is a syndrome that today has important implications for the health of populations and the economic sustainability of health systems around the world, therefore strategies to slow disease progression are necessary. Aims: To estimate the incidence of renal replacement therapy (RRT) in a cohort of patients included in a CKD secondary prevention program and to describe the decrease of the estimated glomerular filtration rate (eGFR). Method This is a historical, multicenter, observational cohort study in a prevention program between January 1, 2010, and December 31, 2017, with follow-up until December 31, 2018, at the Renal Care Services (RCS) network. Socio-demographic and clinical characteristics of all patients were summarized descriptively. We estimated the incidence of RRT rate with Kaplan Meier analysis. Progression rate to RRT was analyzed by mixed-effects model adjusted for the eGFR reduction rate at 180 days; the model considered the diagnosis of diabetes. Results 7131 patients met the inclusion criteria for data analysis. The mean age was 65 years, 50.5% were female, (Table 1). There were 577 events of RRT with a rate of 2.02 events of RRT per 100 patients-year [95% CI,1.86 to 2.19], characteristics at the RRT initiation are presented in Table 2. At the beginning of the program the eGFR was 45.3 ml / min / 1.73m2 in non-diabetics, and 40.9 3 ml / min / 1.73m2 in diabetics. The CKD progression was - 0.48 ml / min / 1.73m2 per 180 days in diabetics and - 0.20 ml / min / 1.73m2 per 180 days in non-diabetics. The final events of the cohort are presented in Figure 1; the mortality rate was 0.89 events per 100 patients-year [95% CI, 0,79 to 1,01]. Conclusion This population of patients in a CKD prevention program presented a low rate of initiation of dialysis therapy and a slight decrease of eGFR; the diabetic status influences the CKD progression.

scholarly journals The association between clinical laboratory data and chest CT findings explains disease severity in a large Italian cohort of COVID-19 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simone Canovi ◽  
◽  
Giulia Besutti ◽  
Efrem Bonelli ◽  
Valentina Iotti ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Organ Damage ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Arterial Oxygen ◽  
Emergency Rooms ◽  
Cross Sectional ◽  
Ct Findings ◽  
Patient Prognosis

Abstract Background Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. Methods This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. Results Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. Conclusions Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.

scholarly journals COVID-19 infection: epidemiological, clinical, and radiological expression among adult population

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Eman Ragab ◽  
Asrar Helal Mahrous ◽  
Ghadeer Maher El Sheikh
Keyword(s):  
Serum Ferritin ◽  
Clinical Laboratory ◽  
Adult Population ◽  
Significant Risk ◽  
High Serum ◽  
Male Gender ◽  
Lower Sensitivity ◽  
Significant Difference ◽  
D Dimer

Abstract Background High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases. Results Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature. Conclusion Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.

scholarly journals 2019 novel coronavirus disease with secondary ischemic stroke: two case reports

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Fu ◽  
Yun Chen ◽  
Ping Li
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Small Vessel ◽  
Vessel Occlusion ◽  
Aged Patients ◽  
Health Crisis ◽  
Physical Examinations ◽  
Novel Coronavirus

Abstract Background The COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported. Case presentation We here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin. Conclusions These cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.

Lightbulb technique for the treatment of osteonecrosis of the femoral head

2017 ◽  
Vol 28 (3) ◽  
pp. 272-277 ◽  
Author(s):  
Cemil Yildiz ◽  
Yusuf Erdem ◽  
Kenan Koca
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Bone Grafting ◽  
Treatment Effectiveness ◽  
Treatment Success ◽  
Total Hip ◽  
Kaplan Meier ◽  
Grafting Technique ◽  
Stage 4 ◽  
Stage 1

Introduction: The aim of this study was to report the clinical and radiological outcomes for 21 patients (28 hips) treated for osteonecrosis of the femoral head using the lightbulb technique, a nonvascularised bone grafting technique. Methods: The study group included 14 men and 7 women, with a mean age of 33.2 (range 22-50) years, presenting with avascular necrosis of the femoral head of stage 4a or earlier, according to the Steinberg classification. Patients were treated using the nonvascularised lightbulb bone grafting technique. The primary clinical outcome was the Harris Hip Scores (HHS), while primary outcomes of treatment effectiveness and disease progression were based on radiographic evidence of disease progression and the need for total hip replacement. The rate of treatment success and failure was evaluated using the Kaplan-Meier survival analysis. Results: The mean HHS increased from 52.66 to 74.33 after treatment, with excellent-to-good outcomes obtained in 21 (75%) of the cases. Fair-to-poor results were obtained in 7 (25%) of the cases, with total hip arthroplasty subsequently required in 5 of these cases. The radiological failure rate was 50% among cases treated in Steinberg stage 1 (1/2), 42% in stage 3 (5/12), and 100% in stage 4 (2/2). Conclusions: The lightbulb technique can provide a clinically acceptable rate of successful treatment of osteonecrosis of the femoral head when used in the early stages of the disease, prior to collapse of the femoral head.

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