Predictive Modeling of Poor Outcome in Severe COVID-19: A Single-Center Observational Study Based on Clinical, Cytokine and Laboratory Profiles

Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients. Methods: A prospective and consecutive study involving 108 COVID-19 patients was conducted between March and April 2020 at Hospital Clínico Universitario de Valladolid (Spain). Plasma samples from each patient were collected after emergency room admission. Forty-five serum cytokines were measured in duplicate, and clinical data were analyzed using SPPS version 25.0. Results: A multivariate predictive model showed high hepatocyte growth factor (HGF) plasma levels as the only cytokine related to intubation or death risk at hospital admission (OR = 7.38, 95%CI—(1.28–42.4), p = 0.025). There were no comorbidities included in the model except for the ABO blood group, in which the O blood group was associated with a 14-fold lower risk of a poor outcome. Other clinical variables were also included in the predictive model. The predictive model was internally validated by the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.94, a sensitivity of 91.7% and a specificity of 95%. The use of a bootstrapping method confirmed these results. Conclusions: A simple, robust, and quick predictive model, based on the ABO blood group, four common laboratory values, and one specific cytokine (HGF), could be used in order to predict poor outcomes in COVID-19 patients.

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Clinical risk scores for the early prediction of severe outcomes in patients hospitalized for COVID-19

Internal and Emergency Medicine ◽

10.1007/s11739-020-02617-4 ◽

2021 ◽

Author(s):

Walter Ageno ◽

◽

Chiara Cogliati ◽

Martina Perego ◽

Domenico Girelli ◽

...

Keyword(s):

Hospital Admission ◽

Predictive Value ◽

Clinical Laboratory ◽

Area Under The Curve ◽

Orotracheal Intubation ◽

Risk Scores ◽

Algorithm Selection ◽

Derivation Cohort ◽

Neutrophil Lymphocyte Ratio ◽

Predictive Risk

AbstractCoronavirus disease of 2019 (COVID-19) is associated with severe acute respiratory failure. Early identification of high-risk COVID-19 patients is crucial. We aimed to derive and validate a simple score for the prediction of severe outcomes. A retrospective cohort study of patients hospitalized for COVID-19 was carried out by the Italian Society of Internal Medicine. Epidemiological, clinical, laboratory, and treatment variables were collected at hospital admission at five hospitals. Three algorithm selection models were used to construct a predictive risk score: backward Selection, Least Absolute Shrinkage and Selection Operator (LASSO), and Random Forest. Severe outcome was defined as the composite of need for non-invasive ventilation, need for orotracheal intubation, or death. A total of 610 patients were included in the analysis, 313 had a severe outcome. The subset for the derivation analysis included 335 patients, the subset for the validation analysis 275 patients. The LASSO selection identified 6 variables (age, history of coronary heart disease, CRP, AST, D-dimer, and neutrophil/lymphocyte ratio) and resulted in the best performing score with an area under the curve of 0.79 in the derivation cohort and 0.80 in the validation cohort. Using a cut-off of 7 out of 13 points, sensitivity was 0.93, specificity 0.34, positive predictive value 0.59, and negative predictive value 0.82. The proposed score can identify patients at low risk for severe outcome who can be safely managed in a low-intensity setting after hospital admission for COVID-19.

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Prognostic value of diffusion-weighted MRI for post-cardiac arrest coma

Neurology ◽

10.1212/wnl.0000000000009289 ◽

2020 ◽

Vol 94 (16) ◽

pp. e1684-e1692 ◽

Cited By ~ 4

Author(s):

Karen G. Hirsch ◽

Nancy Fischbein ◽

Michael Mlynash ◽

Stephanie Kemp ◽

Roland Bammer ◽

...

Keyword(s):

Cardiac Arrest ◽

Brain Tissue ◽

Characteristic Curve ◽

Area Under The Curve ◽

Poor Outcome ◽

Diffusion Weighted ◽

Blinded Study ◽

Apparent Diffusion ◽

Adc Values ◽

Poor Outcomes

ObjectiveTo validate quantitative diffusion-weighted imaging (DWI) MRI thresholds that correlate with poor outcome in comatose cardiac arrest survivors, we conducted a clinician-blinded study and prospectively obtained MRIs from comatose patients after cardiac arrest.MethodsConsecutive comatose post-cardiac arrest adult patients were prospectively enrolled. MRIs obtained within 7 days after arrest were evaluated. The clinical team was blinded to the DWI MRI results and followed a prescribed prognostication algorithm. Apparent diffusion coefficient (ADC) values and thresholds differentiating good and poor outcome were analyzed. Poor outcome was defined as a Glasgow Outcome Scale score of ≤2 at 6 months after arrest.ResultsNinety-seven patients were included, and 75 patients (77%) had MRIs. In 51 patients with MRI completed by postarrest day 7, the prespecified threshold of >10% of brain tissue with an ADC <650 ×10−6 mm2/s was highly predictive for poor outcome with a sensitivity of 0.63 (95% confidence interval [CI] 0.42–0.80), a specificity of 0.96 (95% CI 0.77–0.998), and a positive predictive value (PPV) of 0.94 (95% CI 0.71–0.997). The mean whole-brain ADC was higher among patients with good outcomes. Receiver operating characteristic curve analysis showed that ADC <650 ×10−6 mm2/s had an area under the curve of 0.79 (95% CI 0.65–0.93, p < 0.001). Quantitative DWI MRI data improved prognostication of both good and poor outcomes.ConclusionsThis prospective, clinician-blinded study validates previous research showing that an ADC <650 ×10−6 mm2/s in >10% of brain tissue in an MRI obtained by postarrest day 7 is highly specific for poor outcome in comatose patients after cardiac arrest.

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Prothrombotic State Induced by Middle-Distance Endurance Exercise in Middle-Aged Athletes

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0038-1667115 ◽

2018 ◽

Vol 44 (08) ◽

pp. 747-755 ◽

Cited By ~ 2

Author(s):

Gian Salvagno ◽

Cantor Tarperi ◽

Matteo Gelati ◽

Martina Montagnana ◽

Elisa Danese ◽

...

Keyword(s):

Blood Coagulation ◽

Blood Group ◽

Thrombin Generation ◽

Area Under The Curve ◽

Abo Blood Group ◽

Middle Aged ◽

Endurance Running ◽

Von Willebrand ◽

The Impact ◽

D Dimer

AbstractSince the impact of possible prothrombotic factors on blood coagulation resulting from exercise remains elusive, this study investigated the acute effects of middle-distance endurance running on blood coagulation parameters in middle-aged athletes. The study population consisted of 33 male endurance runners who were engaged in a 21.1 km run under competitive conditions. Blood samples were collected before the run, immediately after the run, and 3 hours after run completion. Samples were assessed for activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, D-dimer, factor VIII (FVIII), von Willebrand factor antigen (VWF:Ag), endogenous thrombin potential (area under the curve of thrombin generation [TGA-AUC]), and peak thrombin generation (TGA-PK). Post-run variations were expressed as delta (Δ). At baseline, APTT was found to be significantly associated with ABO blood group, VWF:Ag, and FVIII; fibrinogen with age; VWF:Ag with BMI, training regimen, and ABO blood group; APTT with FVIII; FVIII with VWF:Ag and ABO blood group; APTT with VWF:Ag; and TGA-PK with ABO blood group, PT, and TGA-AUC. Immediately after the run, statistically significant increases were observed for PT, D-dimer, VWF:Ag, and FVIII, while statistically significant reductions could be observed for APTT, TGA-AUC, and TGA-PK. Fibrinogen values remained unchanged. Significant correlations were observed between Δ VWF:Ag and Δ FVIII, Δ APTT and Δ VWF:Ag, Δ APTT and Δ FVIII, Δ TGA-AUC and Δ TGA-PK, and between Δ D-dimer and Δ TGA-AUC and Δ TGA-PK. No Δ variation was associated with running time. The results of this study seemingly suggest that middle-distance competitive running may evoke several prothrombotic changes in blood coagulation.

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Neutrophil to Lymphocyte Ratio Predicts Outcome of Stroke by Cervicocranial Arterial Dissection

Frontiers in Medicine ◽

10.3389/fmed.2020.598055 ◽

2020 ◽

Vol 7 ◽

Author(s):

Guangbi Sun ◽

Yi Yang ◽

Zhiguo Chen ◽

Le Yang ◽

Shanshan Diao ◽

...

Keyword(s):

Predictive Value ◽

Inflammatory Marker ◽

Area Under The Curve ◽

Neutrophil To Lymphocyte Ratio ◽

Arterial Dissection ◽

Lymphocyte Ratio ◽

Poor Outcome ◽

The Poor ◽

Multivariable Analyses ◽

Poor Outcomes

Background and Purpose: Neutrophil to lymphocyte ratio (NLR) is positively associated with poor prognosis in patients with cerebral infarction. The goal of this prospective study is to explore the predictive value of NLR in patients with acute ischemic stroke (AIS) caused by cervicocranial arterial dissection (CCAD).Methods: Ninety-nine patients with AIS caused by CCAD met criteria for inclusion and exclusion were selected for this study. We collected baseline data on the admission including NLR. The primary poor outcome was major disability (modified Rankin Scale score ≥ 3) or death at 3 months after AIS.Results: A total of 20 (20.2%) patients had a poor outcome at 3 months after AIS. According to the 3-month outcome, the patients were divided into two groups and univariate and multivariable analyses were conducted. Among the risk factors, elevated NLR levels were independently associated with 3-month poor outcomes. Further, we made the ROC curve to evaluate the predictive value of NLR level on prognosis. The area under the curve was 0.79 and a cut-off value of NLR was 2.97 for differentiating the poor outcome. We divided patients into groups according to the cut-off value. Patients with high NLR have a higher risk of poor outcome than those with low NLR (P < 0.05).Conclusion: As an inflammatory marker, elevated NLR levels were associated with 3-month poor outcome in AIS caused by CCAD.

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Molecular characterization of the human ABO blood group orthologus system in pigs

Animal Genetics ◽

10.1111/j.1365-2052.2010.02152.x ◽

2011 ◽

Vol 42 (3) ◽

pp. 325-328 ◽

Cited By ~ 11

Author(s):

D. T. Nguyen ◽

H. Choi ◽

H. Jo ◽

J.-H. Kim ◽

V. R. Dirisala ◽

...

Keyword(s):

Molecular Characterization ◽

Blood Group ◽

Abo Blood Group

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Characterization of a novel B(A) allele with BBBA type at the ABO blood group

Journal of Human Genetics ◽

10.1007/s10038-006-0013-5 ◽

2006 ◽

Vol 51 (8) ◽

pp. 732-736 ◽

Cited By ~ 5

Author(s):

Zhi-Hui Deng ◽

Qiong Yu ◽

Yan-Lian Liang ◽

Da-Ming Wang ◽

Yu-Qing Su ◽

...

Keyword(s):

Blood Group ◽

Abo Blood Group

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Characterization of a novel O 1 variant allele at the ABO blood group locus

Tissue Antigens ◽

10.1034/j.1399-0039.2001.580613.x ◽

2001 ◽

Vol 58 (6) ◽

pp. 422-424 ◽

Cited By ~ 3

Author(s):

P. Bugert ◽

L. Rütten ◽

S. Goerg ◽

H. Klüter

Keyword(s):

Blood Group ◽

Variant Allele ◽

Abo Blood Group ◽

Group Locus

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A rheo-optical method for the study of aggregated particles: application to the characterization of ABO blood group monoclonal antibodies

Rheologica Acta ◽

10.1007/s003970000109 ◽

2000 ◽

Vol 39 (6) ◽

pp. 595-600

Author(s):

Jean-François Stoltz ◽

Rodolphos Jose Rasia ◽

Juana Rosa Valverde ◽

L. Pla ◽

Danielle Sontag ◽

...

Keyword(s):

Monoclonal Antibodies ◽

Blood Group ◽

Optical Method ◽

Abo Blood Group

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Levels of caspase-1 in cerebrospinal fluid of patients with traumatic brain injury: correlation with intracranial pressure and outcome

Journal of Neurosurgery ◽

10.3171/2020.2.jns193079 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Jon Pérez-Bárcena ◽

Catalina Crespí ◽

Guillem Frontera ◽

Juan Antonio Llompart-Pou ◽

Osman Salazar ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

External Ventricular Drain ◽

Area Under The Curve ◽

Protein Levels ◽

Poor Outcome ◽

Caspase 1 ◽

Auc Value ◽

Poor Outcomes

OBJECTIVEThe objectives of this study were to evaluate levels of inflammasome-signaling proteins in serum and CSF of patients with traumatic brain injury (TBI), and to correlate these protein levels with intracranial pressure (ICP) and clinical outcomes at 6 months after injury.METHODSThis is a prospective and observational study in patients with moderate and severe TBI who required an external ventricular drain as part of their treatment. Serum and CSF samples were collected 3 times a day for the first 5 days after TBI. The authors have determined the protein concentration of caspase-1 in the CSF and serum of patients with TBI by using commercially available enzyme-linked immunosorbent assays. The ICP value was recorded hourly. The 6-month outcome was assessed using the Glasgow Outcome Scale–Extended.RESULTSA total of 21 patients were included in this study, and a total of 234 paired serum-CSF samples were analyzed. The area under the curve (AUC) value of caspase-1 in CSF during the 5-day period was 2452.9 pg/mL·hr in the group of patients with high ICP vs 617.6 pg/mL·hr in the patients with low ICP. The differences were mainly on day 2 (19.7 pg/mL vs 1.8 pg/mL; p = 0.06) and day 3 (13.9 pg/mL vs 1 pg/mL; p = 0.05). The AUC value of caspase in CSF during the 5-day period was 1918.9 pg/mL·hr in the group of patients with poor outcome versus 924.5 pg/mL·hr in the patients with good outcome. The protein levels of caspase-1 in CSF were higher in patients with unfavorable outcomes during the first 96 hours after TBI.CONCLUSIONSIn this cohort of patients with TBI who were admitted to the neurosurgical ICU, the inflammasome protein caspase-1 is increased in the CSF of patients with high ICP, especially on days 2 and 3 after TBI. Also the protein levels of caspase-1 in CSF were higher in patients with poor outcome during the first 96 hours after TBI. Moreover, not only the absolute value of caspase-1 in CSF but also its trend is associated with poor outcomes.

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Abstract 10: Early Neuroprognostication After Refractory VF/VT Cardiac Arrest Requiring ECPR

Circulation ◽

10.1161/circ.140.suppl_2.10 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Jason A Bartos ◽

Lindsay Nutting ◽

Claire Carlson ◽

Ganesh Raveendran ◽

Tom P Aufderheide ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Near Infrared ◽

Neuron Specific Enolase ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Head Ct ◽

Poor Outcome ◽

Anoxic Injury ◽

Continuous Eeg ◽

Poor Outcomes

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival for refractory ventricular fibrillation (VF) cardiac arrest. Early prognostication will be critical to focus this resource-intensive care to patients likely to benefit. Objectives: The aim of this study is to examine the efficacy of current neuroprognostication tools early in the setting of ECPR for refractory VF. Methods: Consecutive patients transported for the University of Minnesota ECPR program and surviving to hospital admission between December 2015 and May 2019 were assessed. All patients received neurologic assessment with head CT, continuous EEG, cerebral near-infrared spectroscopy (NIRS), biomarkers including S100B and neuron specific enolase (NSE), and neurologic exam. All patients were considered viable unless they developed refractory shock, devastating brain injury, or family requested cessation of efforts. For this analysis, patients were divided into two groups: 1) neurologically favorable survival (CPC 1-2) and 2) those who died or had CPC 3-4. Data from the first 24 hours of hospital admission were used. Results: Of 168 patients, 130 patients survived to hospital admission. Of these, 42% (54/130) survived neurologically favorable. Abnormalities on admission head CT were predictive of poor outcomes; cerebral edema was 100% specific and 30% sensitive for poor outcomes while anoxic injury provided 98% specificity and 39% sensitivity. Admission NSE levels greater than three times the upper limit of normal were predictive with 98% specificity and 26% sensitivity for poor outcome. Admission S100B was highly variable failing to discriminate patient outcome. Absence of brainstem reflexes at 24 hours had 100% specificity and 32% sensitivity. An isoelectric EEG at 24 hours had 100% specificity and 20% sensitivity. NIRS did not predict poor outcomes. When combined, ≥ 1 of the following: anoxic injury on CT, edema on CT, NSE, absence of brainstem reflexes, isoelectric EEG have a specificity of 96% and sensitivity of 67% for poor outcome. Conclusions: Neuroprognostication after 24 hours of hospital admission may be possible in the refractory VF population requiring ECPR. High specificity is possible but sensitivity is limited. Further study is needed.

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