scholarly journals Visual Classification of Three Computed Tomography Lung Patterns to Predict Prognosis of COVID-19: A Retrospective Study

2021 ◽  
Author(s):  
Daisuke Yamada ◽  
Sachiko Ohde ◽  
Kengo Ikejima ◽  
Masaki Matsusako ◽  
Yasuyuki Kurihara
Keyword(s):  
Computed Tomography ◽  
Lactate Dehydrogenase ◽  
Neutrophil Count ◽  
Lymphocyte Count ◽  
Ct Images ◽  
C Reactive Protein ◽  
Clinical Variables ◽  
Reactive Protein ◽  
D Dimer

Abstract Background: Quantitative evaluation of radiographic images has been developed and suggested for the diagnosis of coronavirus disease 2019 (COVID-19). However, there are limited opportunities to use these image-based diagnostic indices in clinical practice. Our aim in this study was to evaluate the utility of a visually-based classification of pulmonary findingsfrom computed tomography (CT) images among COVID-19 patients that we developed, with the following three patterns defined: peripheral, multifocal, and diffuse findings of pneumonia. We also evaluated the prognostic value of this classification to predict the severity of COVID-19. Methods: This was a single-center retrospective cohort study of patients hospitalized with COVID-19 between January and September 2020, who presented with suspicious findings on CT lung images (n=69). We compared the association between the three predefined patterns (peripheral, multifocal, and diffuse) and admission to the intensive care unit, tracheal intubation, and death. The following demographic and clinical variables were compared between the three groups: sex, age, respiratory rate, pulse rate, blood pressure, temperature, oxygen saturation, partial pressure of oxygen, white blood cell count, lymphocyte count, neutrophil count, c-reactive protein, lactate dehydrogenase, Krebs von den Lungen-6 antigen, D-dimer, platelet count, steroid administration, heparin administration, favipiravir administration, Acute Physiology and Chronic Health Evaluation-II score, and sequential organ failure assessment score.Results: Patients with a diffuse pattern were intubated more frequently and for a longer duration than patients with a peripheral or multifocal pattern. The following clinical variables were significantly different between the diffuse pattern and peripheral and multifocal groups: body temperature, lymphocyte count, neutrophil count, c-reactive protein, lactate dehydrogenase, Krebs von den Lungen-6 antigen, D-dimer, and steroid and Avigan administration.Conclusions: Our simple visual assessment of CT images can predict a systemic cytokine storm, a resulting decrease in respiratory function, and the need for supplemental respiratory ventilationamong patientswith COVID-19.

scholarly journals Coagulation Dysfunction and Hematological Changes in 633 Patients with COVID-19

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-23
Author(s):  
Mo Yang ◽  
Huixia Deng ◽  
Liuming Yang ◽  
Liang Li ◽  
Jieyu Ye ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Neutrophil Count ◽  
Lymphocyte Count ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Pulmonary Manifestations ◽  
Hematological Changes ◽  
Coagulation Dysfunction ◽  
Case Data ◽  
D Dimer

Background: A previously unknown beta-coronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. The virus was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the international committee for the classification of viruses (ICTV). The disease caused by this virus was named as coronavirus disease 2019 (COVID-19). In addition to pulmonary manifestations, hematological changes such as lymphocytopenia, thrombocytopenia, and coagulation dysfunction can also be found in COVID-19 patients, and the mechanism is still unclear. Case data and methods: A total of 633 COVID-19 patients from Wuhan hospital of China were retrospectively analyzed. Clinical case data of all patients were collected, including gender, age, chronic underlying diseases, outcome, and blood laboratory test results. The hematological features of COVID-19 patients and the factors affecting their outcome were analyzed. Results: Of 633 patients with COVID-19, the median age was 62 years (interquartile range, IQR, 51.0-70.0) and 330 (52%) were men. Lymphocytopenia (lymphocyte count, 1.0 ×109 / L [IQR, 0.7-1.4]) occurred in 317/607 patients (52%), thrombocytopenia (platelet count <100 × 109/ L) occurred in 14/62 death patients (23%), prolonged prothrombin time (13.8 seconds [IQR, 13.1-15.1]) in 289/486 patients (59%), increased D-Dimer level (0.7 mg/L[IQR, 0.2-2.9]) in 230/411 patients (57%) and increased C-reactive protein levels (10.7 mg/L [IQR, 2.2-49.7]) in 217/426 patients (51%) . Compared with the survival patients, death patients have higher white blood cell count (11.7 × 109/L [IQR, 8.4 to 15.6]), neutrophil count (10.8 × 109/L [IQR, 7.8 to 13.9]), neutrophil count/lymphocyte count (20.5 [IQR, 12.4-34.2]), activated partial thromboplastin time (36.8 seconds [IQR, 31.3-42.3]), prothrombin time (17.1 seconds [IQR, 14.7 to 19.7]), D-Dimer level (4.6 mg/L [IQR, 1.0 to 7.8]), C-reactive protein level (111.8 mg/L (IQR, 53.1 to 196.6), and low lymphocyte count (0.5 × 109/L [IQR, 0.3 to 0.7]). The results of logistic multivariate regression analysis showed that age, neutrophil count, prothrombin time, and C-reactive protein were risk factors for patients with COVID-19. Conclusion: Hematological changes are common in patients with COVID-19. The early stage of the disease is mainly characterized by lymphocytopenia, thrombocytopenia, and the late stage may be characterized by more severe lymphocytopenia, even neutrophils elevation, elevated C-reactive protein, and severe coagulation disorder. The pathogenesis may be mediated by a direct viral infection and/or indirect immunopathology. Disclosures No relevant conflicts of interest to declare.

scholarly journals Elderly Male With Cardiovascular-Related Comorbidities Has a Higher Rate of Fatal Outcomes: A Retrospective Study in 602 Patients With Coronavirus Disease 2019

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiao-Yong Zhan ◽  
Liang Li ◽  
Yuhai Hu ◽  
Qiang Li ◽  
Huimin Kong ◽  
...  
Keyword(s):  
Neutrophil Count ◽  
Lymphocyte Count ◽  
Fatal Outcome ◽  
The Elderly ◽  
C Reactive Protein ◽  
Elderly Male ◽  
Cox Regression Analysis ◽  
Protein Levels ◽  
Reactive Protein ◽  
D Dimer

Elderly with comorbidities have shown a higher rate of fatal outcomes when suffering coronavirus disease 2019 (COVID-19). However, a delineation of clinical significances of hematologic indices and underlying comorbidities in the progression and outcome of COVID-19 remains undefined. Six hundred two COVID-19 patients with established clinical outcomes (discharged or deceased) from Hankou Hospital of Wuhan, China between January 14, 2020 and February 29, 2020 were retrospectively analyzed. Of the 602 patients with COVID-19, 539 were discharged and 63 died in the hospital. The deceased group showed higher leukocyte and neutrophil counts but lower lymphocyte and platelet counts. Longer activated partial thromboplastin time (APTT) and prothrombin time (PT), as well as higher D-dimer and C-reactive protein levels, were found in non-survivors. Our observations suggest that these parameters could serve as potential predictors for the fatal outcome and in the discharged group. A higher neutrophil count and D-dimer level but lower lymphocyte were associated with a longer duration of hospitalization. A multivariable Cox regression analysis showed that higher neutrophil count, prolonged PT, and low lymphocyte count were risk factors for patients with COVID-19. Also, we found an association of lower lymphocyte count and higher C-reactive protein levels with the elderly group and those with cardiovascular-related comorbidities. The significantly different hematologic profiles between survivors and non-survivors support that distinct hematologic signatures in COVID-19 patients will dictate different outcomes as a prognostic marker for recovery or fatality. Lymphopenia and aggressive inflammatory response might be major causes for fatal outcomes in the elderly male and especially those with cardiovascular-related comorbidities.

scholarly journals An emerging marker predicting the severity of COVID-19: Neutrophil-Lymphocyte Count Ratio

2020 ◽  
Author(s):  
Minping Zhang ◽  
Enhua Xiao ◽  
Jiayi Liu ◽  
Yeyu Cai ◽  
Qizhi Yu
Keyword(s):  
Neutrophil Count ◽  
Lymphocyte Count ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
C Reactive Protein ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Count Ratio ◽  
Severe Group ◽  
D Dimer

Abstract Background: To analyze clinical features and laboratory indicators and identify the markers of exacerbation in COVID-19. Methods: We reviewed clinical histories of 177 patients with confirmed COVID-19. The patients were categorized into mild group (153 patients) and severe group (24 patients). The baseline demographic and laboratory indicators of all patients were collected, including the neutrophil-lymphocyte count ratio (NLCR) and C-reactive protein to albumin ratio (CAR). Receiver operating characteristic curve (ROC) analysis was performed to search for indicators predicting exacerbation in COVID-19 patients, and acquiring the area under the curves (AUCs), sensitivity, specificity and cut-off value. Results: The age of the severe group were significantly older than those of the mild group (P <0.01). Fever was the typical symptom in all COVID-19 patients. Cough and fatigue were manifested in mild group, yet severe patients were more prominent in dyspnea. The laboratory indicators showing that the mild group mainly had an elevated C-reactive protein; the severe group had a decreased lymphocyte count and lymphocyte ratio. WBC, neutrophil count, neutrophil ratio, D-dimer, AST, ALT, LDH, BUN, CRP levels increased. Furthermore, compared to mild group, WBC, neutrophil count, neutrophil ratio (Neut%), D-dimer, total bilirubin, albumin, AST, ALT, LDH, BUN, creatine kinase, CRP, CAR, NLCR were significantly higher, the lymphocyte count, lymphocyte ratio, and APTT were significantly lower in severe group (P<0.05). The ROC indicating that NLCR, Neut%, CAR, CRP, and LDH were better at distinguishing mild and severe patients. The AUCs of NLCR was larger than others (NLCR>Neut%>CAR>CRP>LDH: 0.939>0.925>0.908>0.895>0.873), which suggested that NLCR was the optimal maker; a cut-off value for NLCR of 6.15 had 87.5% sensitivity and 97.6% specificity for predicting exacerbation in COVID-19 patients. Conclusions: The different types of COVID-19 had significant differences in age, clinical symptoms and laboratory indicators, and severe patients might be easier to suffer from the multiple organ damage. An elevated NLCR may indicate that the disease was progressing towards exacerbation. It was essential to dynamically monitor the serum NLCR levels which contributed to evaluate the patient's condition and efficacy. NLCR could be used as a novel, highly specific and sensitive marker for predicting severity of COVID-19 patients.

scholarly journals Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study

2020 ◽  
Author(s):  
Dan Wang ◽  
Ruifang Li ◽  
Juan Wang ◽  
Qunqun Jiang ◽  
Chang Gao ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Disease Severity ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Lymphocyte Count ◽  
Serum Amyloid A ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Amyloid A ◽  
D Dimer

Abstract Background: Coronavirus disease 2019 ( COVID-19 ) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan and has quickly spread across the world. The mortality rate in critically ill patients with COVID-19 is high. This study analyzed clinical and biochemical parameters between mild and severe patients, helping to identify severe or critical patients early. Methods: In this single center, cross-sectional study, 143 patients were included and divided to mild/moderate and sever/critical groups. Correlation between the disease criticality and clinical features and peripheral blood biochemical markers was analyzed. Cut-off values for critically ill patients were speculated through the ROC curve. Results: Significantly, disease severity was associated with age (r = 0.458, P < 0.001) , comorbidities (r = 0.445, P < 0.001) , white cell counts (r = 0.229, P = 0.006) , neutrophil count (r = 0.238, P = 0.004) , lymphocyte count (r = -0.295, P < 0.001) , albumin (r = -0.603, P < 0.001) , high-density lipoprotein cholesterol (r= -0.362, P < 0.001) , serum potassium (r = -0.237, P = 0.004) , plasma glucose (r = 0.383, P < 0.001) , total bilirubin (r = 0.340, P < 0.001) , serum amyloid A (r = 0.58, P < 0.001) , procalcitonin (r = 0.345, P < 0.001) , C-reactive protein ( r = 0.477, P < 0.001) , lactate dehydrogenase (r = 0.548, P < 0.001) , aspartate aminotransferase (r = 0.342, P < 0.001) , alanine aminotransferase (r = 0.264, P = 0.001) , erythrocyte sedimentation rate (r = 0.284, P = 0.001) and D-dimer (r = 0.477, P ＜ 0.001) . Conclusion: With following parameters such as age > 52 years, C-reactive protein > 64.79 mg/L, lactate dehydrogenase > 245 U/L, D-dimer > 0.96 ug/mL, serum amyloid A > 100.02 mg/L, or a lbumin ＜ 36 g/L, the progress of COVID-19 to critical stage should be closely observed and possibly prevented. Lymphocyte count, serum potassium and procalcitonin may also be a prognostic indicator .

Abstract 15485: Hematological Changes and Coagulation Dysfunction in 633 Patients With Covid-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mo Yang ◽  
Huixia Deng ◽  
Liang Li ◽  
Yafang Tan ◽  
Jieyu Ye ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Neutrophil Count ◽  
Lymphocyte Count ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Laboratory Test Results ◽  
Pulmonary Manifestations ◽  
Hematological Changes ◽  
Coagulation Dysfunction ◽  
D Dimer

Introduction: A previously unknown coronavirus was discovered from patients with pneumonia. The disease caused by this virus was named as coronavirus disease 2019 (COVID-19). In addition to pulmonary manifestations, hematological changes such as lymphopenia, thrombocytopenia, and coagulation dysfunction can also be found in COVID-19 patients, and the mechanism is still unclear. Methods: A total of 633 COVID-19 patients from Wuhan hospital of China were retrospectively analyzed. Clinical case data of all patients were collected, including gender, age, chronic underlying diseases, outcome, and blood laboratory test results. The hematological features of COVID-19 patients and the factors affecting their outcome were analyzed. Results: The median age was 62 years ( IQR; 51.0-70.0) and 330 (52%) were men. Lymphopenia ( lymphocyte count, 1.0 х10 9 / L [IQR, 0.7-1.4]) occurred in 317/607 patients (52%), prolonged prothrombin time (13.8 seconds [IQR, 13.1-15.1]) in 289/486 patients (59%), increased D-Dimer level (0.7 mg/L[IQR,0.2-2.9]) in 230/411 patients (57%) and increased C-reactive protein levels (10.7 mg/L [IQR, 2.2-49.7]) in 217/426 patients (51%). Compared with the survival patients, death patients have higher white blood cell count (11.7 х 10 9 /L [IQR, 8.4 to 15.6]), neutrophil count (10.8 х 10 9 /L [IQR, 7.8 to 13.9]), neutrophil count/lymphocyte count (20.5 [IQR, 12.4-34.2]), activated partial thromboplastin time (36.8 seconds [IQR, 31.3-42.3]), prothrombin time (17.1 seconds [IQR, 14.7 to 19.7]), D-Dimer level (4.6 mg/L [IQR, 1.0 to 7.8]), C-reactive protein level (111.8 mg/L (IQR, 53.1 to 196.6), and low lymphocyte count (0.5 х 10 9 /L [IQR, 0.3 to 0.7]). The results of logistic multivariate regression analysis showed that age, neutrophil count, prothrombin time, and C-reactive protein were risk factors for patients with COVID-19. Conclusions: Hematological changes are common in patients with COVID-19. The early stage of the disease is mainly characterized by lymphopenia, and the late stage may be characterized by more severe lymphopenia, even neutrophils elevation, elevated C-reactive protein, and severe coagulation disorder. The pathogenesis may be mediated by a direct viral infection and/or indirect immunopathology.

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

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.

scholarly journals 446. Prognostic Value of Absolute Lymphocyte Count for Disease Severity and Clinical Outcomes in Adult COVID-19 Inpatients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S324-S324
Author(s):  
Jianli Niu ◽  
Candice Sareli ◽  
Maria Deane ◽  
Aharon E Sareli
Keyword(s):  
Lactate Dehydrogenase ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Interleukin 6 ◽  
Lymphocyte Count ◽  
Absolute Lymphocyte Count ◽  
Serum Levels ◽  
C Reactive Protein ◽  
Icu Admission ◽  
Reactive Protein

Abstract Background Lymphopenia has been reported as a relatively frequent finding in patients with coronavirus disease 2019 (COVID-19). This study aimed to assess the use of absolute lymphocyte count (ALC) as a prognostic biomarker for disease severity and clinical outcomes. Methods A cohort of adult patients with COVID-19 admitted to Memorial Healthcare System, Hollywood, Florida from March 7, 2020 to January 18, 2021 was retrospectively analyzed. An absolute lymphocyte count (ALC) &lt; 1.1 × 109/L was used as cutoff point to define lymphopenia. Correlations of ALC upon admission with age and serum levels of C-reactive protein, interleukin-6, lactate dehydrogenase, and creatinine were analyzed. Univariate and multivariate regression models were developed to assess the association of lymphopenia with the risk of ICU admission and clinical outcomes. Results 4,485 hospitalized patients were included in the final analyses. Median age was 61 (interquartile range, 47-73) years and 2,311 (51.5%) were men. Lymphopenia was more frequent in patients admitted to the ICU compared to those that were not admitted to the ICU, with an odds ratio of 2.14 (95% confidence interval [CI], 1.78-2.56, p &lt; .0001) (Figure 1). The actual value of the ALC was negatively correlated with age and serum levels of C-reactive protein, interleukin-6, lactate dehydrogenase, and creatinine (all p &lt; 0.005). Patients with lymphopenia (n=2,409) compared to those without lymphopenia (n=2,076) had multivariable-adjusted odds ratios of 1.85 (95% CI, 1.53-2.24) for ICU admission, 2.08 (95% CI, 1.67-2.58) for intubation, 1.98 (95% CI, 1.31-3.00) for development of acute kidney failure, and 2.23 (95% CI, 1.79-2.79) for in-hospital mortality (Table 1). Analyses were adjusted for age, gender, race, hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, malignancy, obesity, and smoking. Conclusion Lymphopenia in adult COVID -19 hospitalized patients was associated with increased risk of disease severity (as evidenced by need for ICU admission) and poor clinical outcomes. Absolute lymphocyte count may help with prognostication in individuals hospitalized with COVID-19. Disclosures All Authors: No reported disclosures

Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma

2018 ◽  
Vol 45 (1) ◽  
pp. 189-194 ◽  
Author(s):  
Yoshiko Nishigaya ◽  
Yoichi Kobayashi ◽  
Yukiko Matsuzawa ◽  
Kiyoshi Hasegawa ◽  
Ichio Fukasawa ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Diagnostic Value ◽  
Uterine Leiomyosarcoma ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Serum Assay ◽  
D Dimer

Association between vitamin D level and prognostic factors among patients infected with SARS-CoV-2

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mehrdad Haghighi ◽  
Seyed Shayan Ebadi ◽  
Hussein Soleimantabar ◽  
Atefe Shadkam ◽  
Seyed Alireza Ebadi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Prognostic Factors ◽  
Medical Records ◽  
Lymphocyte Count ◽  
Cross Sectional Study ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
The Mean ◽  
D Dimer

Abstract Objectives The present study aimed to evaluate the presence of any relationship between vitamin D and prognostic factors among patients infected with SARS-CoV-2. Methods This retrospective cross-sectional study was conducted among patients admitted from March to August 2020 in a referral hospital, Tehran, Iran. All patients aged 18–65 who had not any comorbidity participated in the study. The diagnosis of COVID-19 was established using the rRT-PCR test for SARS-CoV-2 detection. Then the incidence of lung involvement and biochemical markers including vitamin D level, c-reactive protein, D-dimer, lymphocyte count, platelet count, white blood cell count, and lactic acid dehydrogenase, were extracted through medical records. Results Altogether, 84 patients met our study criteria, and the information of 68 (80.9%) participants were collected. Among all 68 patients, 45 (66.2%) were male. The mean (SD) age of all participants was 52.4 (10.4) years old. Among 24 (35.2%) clients who died due to SARS-CoV-2, 20 (83.3%) patients were male (p=0.02). The mean (SD) of vitamin D level was 24.1 (13.6) ng/dL. No association between vitamin D level and prognostic factors, including CRP, lymphocyte count, D-dimer, LDH, and HRCT scan score, was observed. Also, the vitamin D level of the dead patients was not significantly different from that of the treated patients. Conclusions Our findings indicated no significant relationship between vitamin D level and prognostic factors or outcomes of patients infected with SARS-CoV-2.

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