Malnutrition Contributes to Low Lymphocyte Count in Early-Stage Coronavirus Disease-2019

Background and Aim: Lymphocytes play an important role in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). The current explanation for the cause of low TLC is that it is directly related to the invasiveness of SARS-CoV-2, which attacks lymphocytes. We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19.Methods: We prospectively enrolled 101 patients with confirmed COVID-19. On their first day of hospitalization, we collected baseline and laboratory data, including clinical symptoms; the Sequential Organ Failure Assessment, Nutrition Risk Screening 2002 and Subjective Global Assessment were used to assess the malnutrition status of the patients. Multivariable logistic regression was used to identify independent risk factors for low TLC and severe COVID-19.Results: Malnutrition was associated with lower TLC in COVID-19. Fifty-nine (58.4%) of the patients showed low TLC, 41 (40.6%) were at risk for malnutrition, and 18 of them were malnourished. Low TLC was an independent risk factor for severe COVID-19. Compared to patients with normal TLC, those with low TLC more often presented with anorexia, malnutrition, higher SOFA scores (P < 0.05) and comorbidities (diabetes and malignancies). Malnutrition (OR: 3.05, 95% CI: 1.5–6.19, P = 0.006) and SOFA scores (OR: 1.51, 95% CI: 1.04-2.43, P = 0.042) were identified as independent risk factors for low TLC.Conclusions: Malnutrition was common among our patients with early-stage COVID-19, and it contributed to the occurrence of low TLC.

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Risk Factors for Mortality in 220 Patients With COVID-19 in Wuhan, China: A Single-Center, Retrospective Study

Ear Nose & Throat Journal ◽

10.1177/0145561320972608 ◽

2020 ◽

pp. 014556132097260

Author(s):

Shuliang Zhou ◽

Sulin Mi ◽

Shuilian Luo ◽

Ying Wang ◽

Bin Ren ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Respiratory Rate ◽

Sofa Score ◽

Laboratory Data ◽

Older Age ◽

Univariable Analysis ◽

Multivariate Logistic Regression ◽

Failure Assessment ◽

Independent Risk Factors

Background: An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection occurred in Wuhan, China, in December 2019. To date, the analysis of fatal cases and the risk factors for death have rarely been reported. Methods: In this study, 220 adult patients with confirmed and suspected COVID-19 were enrolled. Clinical characteristics, laboratory data, treatments, and complications were compared between 168 survivors and 52 nonsurvivors. Univariable analysis and multivariable logistic regression were used to investigate the risk factors for mortality. Results: A total of 220 patients (168 were discharged and 52 died in the hospital) were enrolled in the study. The median age of all patients was 59.5 (47.0-69.0) years, and the median age of patients who died was significantly older than that of patients who survived (70.5 vs 56.0 years, respectively; P < .001). According to multivariate logistic regression, older age (odds ratio: 1.09, 95% CI: 1.03-1.15; P = .001), initial Sequential Organ Failure Assessment (SOFA) score >2 (37.4, 9.4-148.0; P = .011), and respiratory rate >24 per minute (10.89, 1.47-80.67; P = .019) were independent risk factors for mortality. Conclusion: Clinical and laboratory parameters predicting poor prognosis including older age, baseline SOFA score >2, and respiratory rate >24 per minute were identified.

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A Prediction Model of Mortality in COVID-19 Pneumonia Based on CT Score and Lymphocyte Count

Austin Journal of Pathology & Laboratory Medicine ◽

10.26420/austinjpathollabmed.2021.1030 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Xie Y ◽

◽

Dong H ◽

Liao Y ◽

Zhang J ◽

...

Keyword(s):

Risk Factors ◽

Prediction Model ◽

Lymphocyte Count ◽

Goodness Of Fit ◽

False Positive Rate ◽

Laboratory Data ◽

Absolute Lymphocyte Count ◽

Youden Index ◽

Goodness Of Fit Test ◽

Independent Risk Factors

Background: COVID-19 nucleic acid swab tests have a high false positive rate; therefore, diagnosing COVID-19 pneumonia and predicting prognosis by CT scan are very important. Methods: In this retrospective single-centre study, we included consecutive suspected critical COVID-19 pneumonia cases in the intensive care unit of Wuhan Third Hospital from January 31, 2020, to March 16, 2020. 204 cases were confirmed by real-time RT-PCR, and all patients were evaluated with CT, cut-off values were obtained according to the Youden index and were divided into a high CT score group and a low CT score group. Epidemiological, demographic, clinical, and laboratory data were collected. Finally, Through multi-factor logistic regression model, a prediction model based on multiple prediction indicators was formed, and new joint predictive factors were calculated. The prediction model of mortality in COVID-19 pneumonia based on CT score and lymphocyte count was constructed through data processing analysis. Results: The major imaging feature of COVID-19 pneumonia is Ground Glass Opacities (GGOs). Multivariate regression analysis found that the CT score and absolute lymphocyte count were independent risk factors for death and that the CT score predicted mortality (AUC-ROC =0.7, cut-off=1.45). When the absolute lymphocyte count was lower, the patient’s CT score was also lower. Based on this, a prediction model was established. The prediction model was: In [P/(1-P)]=0.667*gender+0.057*age-0.086CT score-0.831 lymphocyte count-3.91, the goodness of fit test of the model was P=0.041, and the area under the curve of the ROC curve of the model was 0.779. Conclusion: CT score and absolute lymphocyte count are independent risk factors for mortality, and patients with a high CT score may have a worse prognosis. A lower absolute lymphocyte count may indicate that the patient’s CT score is also reduced. The model established by combining CT scores and lymphocyte count showed a good degree of calibration and differentiation.

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The Most Important Risk Factors for Carpal Tunnel Syndrome

Journal of Zabol Medical School ◽

10.18502/jzms.v4i3.7821 ◽

2021 ◽

Author(s):

Ali Asghar Sharifi

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Clinical Symptoms ◽

Normal Subjects ◽

Shape Index ◽

Mean Values ◽

Tunnel Syndrome ◽

Independent Risk Factors ◽

Hand Length

Background: The aim of this study was to determine the risk factors for carpal tunnel syndrome and its relationship with the severity of the disease. Methods: A total of 131 patients with clinical symptoms of CTS and 131 normal subjects were enrolled, of whom 121 were female both in the CTS cases and the controls. All cases were electro diagnostically confirmed and assigned to three severity groups. BMI, wrist ratio, shape index, digit index and hand length/height ratio were measured in all participants. Mean values for each item were compared between cases and controls and severity subgroups. A logistic regression analysis was performed to determine independent CTS risk factors. Results: The mean values of BMI, wrist ratio and shape index were significantly higher in all CTS patients and females compared to controls, whereas in males only BMI and wrist ratio were higher. The patients in the mild severity subgroup had a significantly lower age and wrist ratio. BMI, wrist ratio and shape index were found to be independent risk factors of CTS development in all patients and females. Conclusion: Our study showed BMI, wrist ratio and shape index as independent risk factors for CTS. These findings are important anatomically and clinically and these are the risk factors of anatomical malfunction of the wrist in CTS.

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Mutations in domain V of Mycoplasma pneumoniae 23S rRNA are not associated with clinical characteristics of M. pneumoniae pneumonia in children: a case control study

10.21203/rs.2.23539/v1 ◽

2020 ◽

Author(s):

Huan Deng ◽

Yifan Zhu ◽

Jiamin Zhang ◽

Qiangquan Rong ◽

Yao Quan ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Laboratory Data ◽

Point Mutations ◽

Community Acquired Pneumonia ◽

Pulmonary Complications ◽

23S Rrna ◽

Domain V

Abstract Background Mycoplasma pneumoniae (MP) is a common agent of community-acquired pneumonia in children and young adults that can lead to refractory or persistent Mycoplasma pneumoniae pneumonia (MPP). Macrolide-resistant MP harbors point mutations in domain V of 23S ribosomal Ribonucleic Acid (rRNA) with substitutions detected at positions 2063, 2064, 2067 and 2617. This study’s purpose is to investigate the prevalence and clinical characteristics of mutations in domain V of MP 23S rRNA. Methods We sequenced the 23S rRNA domain V of MP strains collected from children with MPP. Clinical and laboratory data were also obtained, including gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-Deoxyribonucleic Acid (DNA) load at enrollment, leukocyte count, neutrophil count, and lymphocyte count, immunomodulators treatment and pulmonary complications.Results Of 276 strains, 255 (92.39 %) harbored A to G transition at the position 2063 (A2063G), and 21 (7.61 %) were not mutated. There were no significant differences in gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-DNA load at enrollment, hospitalization days, lymphocyte count and pulmonary complications when patients were stratified based on the presence or absence of domain V mutations. We also found that children with refractory MPP experienced higher MP-DNA load than the non-refractory MPP, but the prevalence of domain V mutations was comparable.Conclusions We found that clinical MP strains harbored very high mutation rate in 23S rRNA domain V, especially A2063G mutation. However, these mutations were not associated with clinical symptoms, laboratory results, pulmonary complications and development of refractory pneumonia. Instead, MP-DNA load was significantly different between refractory and non-refractory MPP.

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Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study

10.21203/rs.3.rs-22481/v4 ◽

2020 ◽

Author(s):

Ping Yi ◽

Xiang Yang ◽

Cheng Ding ◽

Yanfei Chen ◽

Kaijin Xu ◽

...

Keyword(s):

Risk Factors ◽

T Lymphocyte ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

B Lymphocyte ◽

Blood Cell Count ◽

Single Centre ◽

Multiple Factors ◽

Independent Risk Factors ◽

Severity Of The Disease

Abstract BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection.MethodsA retrospective analysis was used for PCR-confirmed COVID-19 (coronavirus disease 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration.ResultsOne hundred patients with COVID-19, with a median age of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease. Age ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); Body Mass Index (BMI ) ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease. Age and weight were independent risk factors for disease severity.ConclusionDeterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease. Removing these factors may halt the progression of the disease. In addition, Oxygen support, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.

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Transarterial embolization for postpartum hemorrhage: lessons learned

Acta Radiologica ◽

10.1177/0284185118769691 ◽

2018 ◽

Vol 59 (12) ◽

pp. 1451-1457

Author(s):

Chen-Ju Fu ◽

Wiwan Irama ◽

Yon-Cheong Wong ◽

Hsiao-Jung Tseng ◽

Li-Jen Wang ◽

...

Keyword(s):

Risk Factors ◽

Postpartum Hemorrhage ◽

Transarterial Embolization ◽

Laboratory Data ◽

Vital Signs ◽

International Normalized Ratio ◽

Lessons Learned ◽

Clinical Failure ◽

Shock Index ◽

Independent Risk Factors

Background Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. Purpose To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. Material and Methods We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. Results In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. Conclusion The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.

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Clinical and Epidemiological Features of Acute Zika Virus Infections in León, Nicaragua

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1191 ◽

2021 ◽

Author(s):

Natalie M. Bowman ◽

Filemón Bucardo ◽

Matthew H. Collins ◽

Yaoska Reyes ◽

Edwing Centeno Cuadra ◽

...

Keyword(s):

Risk Factors ◽

Sore Throat ◽

Zika Virus ◽

Clinical Symptoms ◽

Laboratory Data ◽

Maculopapular Rash ◽

Laboratory Diagnosis ◽

Zikv Infection ◽

Serological Tests ◽

Laboratory Findings

The American Zika virus (ZIKV) epidemic has highlighted the need to gain a better understanding of this emerging virus. The goal of this study was to describe the clinical symptoms, laboratory findings, and risk factors for symptomatic ZIKV infection in an area with ongoing transmission of other arboviral infections. We recruited patients at least 2 years of age seeking care at public health centers in León, Nicaragua, between January 2016 and August 2017, for fever, maculopapular rash, and/or nonsuppurative conjunctivitis with a duration of less than 1 week. A laboratory diagnosis of ZIKV was established using a combination of molecular and serological tests. Clinical and laboratory findings and potential risk factors were compared between participants with and without acute ZIKV infection. Fifty-eight (26%) of the 225 participants included in the analysis were found to have acute ZIKV infection. Pregnancy and reports of previous arboviral infection were associated with a higher risk of ZIKV infection. Rash, conjunctivitis, sore throat, and lower absolute neutrophil counts were associated with acute ZIKV infection. The clinical characteristics and risk factors identified were consistent with those identified by previous studies; however, we found sore throat to be a feature of ZIKV infection. We also found that neutrophil counts were lower in ZIKV-infected subjects. These clinical symptoms and laboratory data may help clinicians suspect ZIKV infection during future outbreaks.

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Analysis of Multiple Factors Involved in Pertussis-Like Coughing

Clinical Pediatrics ◽

10.1177/0009922820905871 ◽

2020 ◽

Vol 59 (7) ◽

pp. 641-646

Author(s):

Jiaying Cao ◽

Lu Xu ◽

Jiahua Pan

Keyword(s):

Risk Factors ◽

Bordetella Pertussis ◽

Poor Prognosis ◽

Clinical Symptoms ◽

Lymphocyte Ratio ◽

Study Results ◽

Independent Risk Factors ◽

Wbc Count ◽

Case Data ◽

Inhaled Glucocorticoids

Objectives. To identify risk factors associated with the prognosis of pertussis-like coughing. Methods. A retrospective study on children hospitalized with pertussis-like coughing from 2018 to 2019. We collected all the case data from medical records including age, gender, vaccination, clinical symptoms, complication, pathogens, white blood cell (WBC) count, lymphocyte ratio, application of macrolide antibiotics, usage of sulfamethoxazole, and usage of inhaled glucocorticoids. Logistic regression was used in this study. Results. A total of 213 hospitalized children with pertussis-like coughing were included in this study. About 70 children were cured within 2 weeks. One120 children were cured from 2 weeks to 3 months, including cases of initial attack and relapse. Symptoms lasting longer than 3 months accounts for 10.8%. Bordetella pertussis, WBC count >20 × 109/L and lymphocyte ratio >60% were associated with poor prognosis ( P < .05). Conclusions. Bordetella pertussis, WBC count, and lymphocyte ratio are independent risk factors for poor prognosis.

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Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters

Journal of Neurosurgery ◽

10.3171/jns.2005.102.2.0229 ◽

2005 ◽

Vol 102 (2) ◽

pp. 229-234 ◽

Cited By ~ 81

Author(s):

Rogier P. Schade ◽

Janke Schinkel ◽

Leo G. Visser ◽

J. Marc C. van Dijk ◽

Joan H. C. Voormolen ◽

...

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Clinical Symptoms ◽

External Drainage ◽

Content Type ◽

Ventricular Catheters ◽

Independent Risk Factors ◽

Lumbar Cerebrospinal Fluid ◽

Fine Print

Object. In the present study the authors compared the incidence and risk factors for external drainage—related bacterial meningitis (ED-BM) by using ventricular and lumbar catheters. Methods. A cohort of 230 consecutive patients with ED was evaluated. Cerebrospinal fluid samples were obtained daily for microbiological culture, and ED-BM was defined based on culture results in combination with clinical symptoms. The incidence of ED-BM was 7% in lumbar and 15% in ventricular drains. Independent risk factors included site leakage, drain blockage, and most importantly duration of ED. Despite a higher infection rate, ventricular catheters did not have a significant higher risk of infection after correcting for duration of drainage. Conclusions. Analysis of data in the present study showed that the incidence of ED-associated death is low (0.45%) in patients who do not receive continuous antibiotic prophylaxis during ED.

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The independent risk factors of early diarrhoea in enteral nutrition for ICU patients

Journal of International Medical Research ◽

10.1177/0300060519868340 ◽

2019 ◽

Vol 47 (10) ◽

pp. 4929-4939 ◽

Cited By ~ 1

Author(s):

Weiting Chen ◽

Hehao Wang ◽

Yingzi Chen ◽

Danqin Yuan ◽

Renhui Chen

Keyword(s):

Risk Factors ◽

Enteral Nutrition ◽

Critically Ill ◽

Early Stage ◽

Multivariate Logistic Regression Analysis ◽

Severity Of Illness ◽

Icu Patients ◽

Feeding Method ◽

Prokinetic Agents ◽

Independent Risk Factors

Objective To investigate the prevalence of and factors associated with diarrhoea in the early stage of enteral nutrition in critically ill patients in intensive care units (ICUs). Methods This prospective, multicentre, observational study enrolled consecutive patients who were newly admitted to ICUs and received enteral nutrition treatment. Events were observed continuously for 7 days or until patients were transferred out of the ICU after enteral nutrition. Demographic and clinical data, enteral nutrition data, diarrhoea-related data and outcomes were recorded. A multivariate logistic regression analysis was used to analyse the risk factors for diarrhoea. Results The study included 533 patients, of whom 164 (30.8%) developed diarrhoea. Diarrhoea was most commonly observed on the first to third days after starting enteral nutrition treatment. The median (interquartile range) duration of diarrhoea was 2 (1–3) days. The administration of gastrointestinal prokinetic agents, the increase in acute physiological and chronic health scores and the pyloric posterior feeding method were independent risk factors for diarrhoea. Conclusion The increased severity of illness, the administration of gastrointestinal prokinetic agents and the pyloric posterior feeding method were independent risk factors for diarrhoea in critically ill ICU patients undergoing enteral nutrition treatment.

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