An Emerging Marker Predicting The Severity of Covid-19: Neutrophil-Lymphocyte Count Ratio

2021 ◽  
Vol 15 (11) ◽  
pp. 3398-3399
Author(s):  
Ali Hassan ◽  
Zulfiqar Ali ◽  
Hina Iftikhar ◽  
Azhar Graded ◽  
Zulfiqar Haider ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Clinical Symptoms ◽  
Smoking History ◽  
Laboratory Findings ◽  
Count Ratio ◽  
Highly Sensitive ◽  
Severity Prediction ◽  
Severe Group ◽  
The Mean ◽  
Positive Results

Objective: To assess the efficacy of neutrophil-lymphocyte count ratio in predicting the severity of covid-19 Materials and Methods: The patients with positive results for COVID-19 were shifted to COVID ITC, CMH, Multan. The clinical histories of confirmed patients of COVID-19 during February 2020 to May 2021 were reviewed. The patients were divided into 4 classes, mild, common, severe, and fatal, according to guidelines of COVID-19 i.e., trial version 7. Data was collected regarding age, sex, smoking history, temperature, epidemiological history, clinical symptoms, and laboratory findings of all included patients including NLCR. Results: The mean NLCR of Mild and Severe Group was 2.77±1.23 and 20.31±4.45, respectively, (p=0.000). (Table. II). The area under the curves of NLCR was larger than neut, suggesting the optimal performance of NLCR with cut-off value 5.89. The sensitivity and specificity of NLCR was 85% and 95%, respectively. (Table. III). Conclusion: It can be concluded that an increase in NLCR levels can indicate that the covid-19 disease is moving towards exacerbation. NLCR can be recommended as a novel and highly sensitive and specific indicator for severity prediction in Covid-19 patients. Keywords: Emerging, Marker, Severity, Covid-19, Neutrophils, Lymphocytes, Ratio

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.

Evaluation of monomeric prolactin level by TRACE method and precipitation with polyethylene glycol

2021 ◽  
Vol 66 (2) ◽  
pp. 69-74
Author(s):  
S. Yu. Vorotnikova ◽  
L. K. Dzeranova ◽  
N. S. Fedorova ◽  
E. A. Pigarova ◽  
M. G. Vershinina ◽  
...  
Keyword(s):  
Prolactin Level ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Active Form ◽  
Biologically Active ◽  
Mean Values ◽  
Number Of Patients ◽  
Immunoenzyme Method ◽  
The Mean ◽  
Positive Results

Prolactin exists in various forms including the monomeric biologically active form (23kDa) and a higher molecular weight form, bound most commonly to IgG, known as macroprolactin (>100kDa). Macroprolactin lacks biological activity and is one of the causes of false-positive results. In Russian Federation the most common method for macroprolactin determination is PEG precipitation test. We had conducted a retrospective analysis of 37 samples of patients with hyperprolactinemia (3 of them were males). The mean age was 30 [25;35] years. Prolactin level was measured by the immunoenzyme method with manual PEG precipitation and TRACE. The mean values found by the immunoenzyme method with manual PEG precipitation were 461,6 [375,0;821,2] mU/l, by TRACE - 449,9 [357,2;749,2] mU/l. The number of patients with normal prolactin levels was 30% (11) confirmed by two methods, high prolactin level at 46% (17). The prevalence of clinical symptoms of hyperprolactinemia was not differ depend the groups. The phenomenon of macroprolactinemia was registered in 32% (12) of patients. In 8 persons of this group normal prolactin level was revealed and in 4 patients hyperprolactinemia was found by TRACE. Measurements of prolactin levels by the TRACE method is useful for correct diagnosis in patients with equivocal results received by traditional method with PEG precipitation.

scholarly journals The Effects of Succimer and Penicillamine on Acute Lead Poisoning Patients

2021 ◽  
Vol 11 (3) ◽  
pp. 33474-33474
Author(s):  
Gholamali Dorooshi ◽  
◽  
Negar Molavi ◽  
Rokhsareh Meamar ◽  
Akbar Hasanzadeh ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Clinical Symptoms ◽  
Blood Lead ◽  
Study Groups ◽  
Easy Access ◽  
Laboratory Findings ◽  
Treatment Groups ◽  
Significant Difference ◽  
Lead Levels ◽  
The Mean

Background: Lead poisoning was on the rise in recent years. There exists a lack of easy access to some of the main chelator drugs in developing countries. Thus, this study aimed to explore the comparative effects of Succimer and D-Penicillamine on acute lead poisoning patients from 2013 to 2018. Methods: This descriptive study was conducted in the Clinical Toxicology Department of Khorshid Hospital in Isfahan City, Iran. Adult patients with acute lead poisoning were included in the study. Patients in the 3 treatment groups of D-Penicillamine, D-Penicillamine with succimer, and succimer were compared concerning demographic characteristics as well as clinical and laboratory findings at admission time and two weeks later. Results: In total, 163 patients were evaluated in this research. There was no significant difference between the treatment groups respecting improvement in clinical symptoms. The mean blood lead levels during hospitalization and two weeks after the treatment did not significantly differ between the three groups; however, there was a significant reduction in all study groups after two weeks of treatment (P<0.05). The mean white blood cell count was significantly lower only in the D-Penicillamine group two weeks after hospitalization (P<0.05). In the D-Penicillamine group, the mean platelet, hematocrit, and hemoglobin levels were significantly lower two weeks after hospitalization, although within the healthy range. Conclusion: D-Penicillamine may be an acceptable chelator drug for treating patients with acute lead poisoning, especially in communities without access to drugs, like succimer.

Thermography in the Diagnosis of DVT

1981 ◽  
Vol 46 (03) ◽  
pp. 652-654 ◽  
Author(s):  
Dieter Lockner ◽  
Christer Paul ◽  
Birger Hedlund ◽  
Sam Schulman ◽  
Dag Nyman
Keyword(s):  
False Positive ◽  
Screening Method ◽  
Observation Time ◽  
False Positives ◽  
Clinical Suspicion ◽  
Medical Patients ◽  
Highly Sensitive ◽  
The Mean ◽  
Unselected Group ◽  
Positive Results

Summary161 consecutively admitted medical patients with the clinical suspicion of acute deep venous thrombosis (DVT) were thermographed and phlebographed in order to study the congruence of these methods. The sensitivity of thermography in the detection of DVT was found to be 99%, whereas the specificity was only 49%.The low specificity is explained by the fact that all thermographs suggestive of DVT were classified as pathologic to keep the sensitivity of the method as high as possible. Patients with dilated veins which may closely resemble DVT on thermography may in these cases give false positive results.Of 76 patients with phlebographically verified DVT, 22% became thermographically normal within 22 days, whereas 78% did not normalize within the mean observation time of 31 days.In another part of the study all medical patients (101) who were residing in our wards during a period of a week were screened by means of thermography. From this unselected group 17 patients were found to have thermographs suggestive of DVT. In 5 of these patients no reason for pathological thermography could be found.Thermography is a cheap and highly sensitive screening method for DVT, but findings of false positives caused by older thromboses and dilated veins are not unusual. The frequency of such false positives may be minimized by performing thermography after exercise.

scholarly journals Sex Differences in Clinical Characteristics and Risk Factors for Disease Severity of Hospitalized Patients with COVID-19 in Beijing

2020 ◽  
Author(s):  
Jingjing Wang ◽  
Yunjuan Su ◽  
Qi Wang ◽  
Ying Cao ◽  
Aibin Wang ◽  
...  
Keyword(s):  
Sex Differences ◽  
Disease Severity ◽  
Clinical Symptoms ◽  
Imaging Study ◽  
Hospitalized Patients ◽  
Laboratory Findings ◽  
Laboratory Test Results ◽  
Initial Symptoms ◽  
Male Patients ◽  
The Mean

Abstract Background: Recent studies reported that sex differences in patients with coronavirus disease-2019 (COVID-19). However the predictive value of sex differences in disease severity were less studied by previous scholars. Methods: All adults (≥18 years) diagnosed with COVID-19 and admitted to Beijing Ditan Hospital, Capital Medical University (admission date from January 13 to March 19, 2020) were included in samples. Data analyzed in this study included epidemiological, demographic, comorbidities, initial symptoms and signs, laboratory findings, imaging study, disease severity and in-hospital mortality. Results: A total of 185 inpatients were enrolled in the study, among whom 95 patients are males (51.4%). The mean age of all patients was 41 years. Based on the hospital record, the duration from symptoms initiation to hospital admission was longer for men than that for women. Moreover, the mean BMI of males was relatively higher compared to females (25.45vs22.29, p<.001). In addition, the proportion of male patients with CHD, NAFLD, smoking and drinking history was higher than females. During the hospital stay, compared to female patients, male patients were more prone to develop symptoms such as high fever, cough, and chill. Higher levels of AST, CK, CRP and FIB were also observed in male patients. Following this fact, more patients with abnormal CT activities, severe and critical symptoms were developed in male group than females. However, there was no difference in complications and outcome between two groups. By analyzing data comprehensively, we found out that age (analyzed in quartiles, OR: 1.087; 95% CI: 1.038–1.139; p <.001) and BMI (OR: 1.250; 95% CI: 1.046–1.493; p =.014) could be used to help predict disease severity. Conclusions: In this cohort of hospitalized patients in Beijing, male patients developed more clinical symptoms, obtained more abnormal laboratory test results, and showed higher rates in severity of COVID-19. Other than that, the severity of COVID-19 was positively correlated with age and BMI independently.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

scholarly journals Macrolide-Resistant and Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia in Children Treated Using Early Corticosteroids

2021 ◽  
Vol 10 (6) ◽  
pp. 1309
Author(s):  
Hye Young Han ◽  
Ki Cheol Park ◽  
Eun-Ae Yang ◽  
Kyung-Yil Lee
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Serological Test ◽  
Corticosteroid Treatment ◽  
23S Rrna ◽  
Laboratory Parameters ◽  
The Mean ◽  
Domain V ◽  
Positive Results ◽  
Mycoplasma Pneumoniae Pneumonia

We have found that early corticosteroid therapy was effective for reducing morbidity during five Korea-wide epidemics. We evaluated the clinical and laboratory parameters of 56 children who received early corticosteroid treatment for pneumonia that was caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae) or macrolide-sensitive M. pneumoniae between July 2019 and February 2020. All subjects had dual positive results from a PCR assay and serological test, and received corticosteroids within 24–36 h after admission. Point mutation of residues 2063, 2064, and 2067 was identified in domain V of 23S rRNA. The mean age was 6.8 years and the male:female ratio was 1.2:1 (31:25 patients). Most of the subjects had macrolide-resistant M. pneumoniae (73%), and all mutated strains had the A2063G transition. No significant differences in clinical and laboratory parameters were observed between macrolide-resistant and macrolide-sensitive M. pneumoniae groups that were treated with early dose-adjusted corticosteroids. Higher-dose steroid treatment may be needed for patients who have fever that persists for >48 h or increased biomarkers such as lactate dehydrogenase concentration at follow-up despite a usual dose of steroid therapy.

scholarly journals Increased cerebrospinal fluid adenosine 5'-triphosphate in patients with amyotrophic lateral sclerosis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takamasa Nukui ◽  
Atsushi Matsui ◽  
Hideki Niimi ◽  
Tomoyuki Sugimoto ◽  
Tomohiro Hayashi ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Cerebrospinal Fluid ◽  
Serum Creatinine ◽  
Disease Severity ◽  
Assay System ◽  
Atp Levels ◽  
Sum Score ◽  
Highly Sensitive ◽  
Severe Group ◽  
Lateral Sclerosis

Abstract Background Extracellular adenosine 5'-triphosphate (ATP) has been suggested to cause neuroinflammation and motor neuron degeneration by activating microglia and astrocytes in amyotrophic lateral sclerosis (ALS). Since we have developed a highly sensitive ATP assay system, we examined cerebrospinal fluid (CSF) ATP levels in patients with ALS whether it can be a useful biomarker in ALS. Methods Forty-eight CSF samples from 44 patients with ALS were assayed for ATP with a newly established, highly sensitive assay system using luciferase luminous reaction. CSF samples from patients with idiopathic normal pressure hydrocephalus (iNPH) were assayed as a control. Patients were divided into two groups depending on their disease severity, as evaluated using the Medical Research Council (MRC) sum score. Correlations between the CSF ATP levels and other factors, including clinical data and serum creatinine levels, were evaluated. Results CSF ATP levels were significantly higher in patients with ALS than in the iNPH (716 ± 411 vs. 3635 ± 5465 pmol/L, p < 0.01). CSF ATP levels were significantly higher in the more severe group than in the iNPH group (6860 ± 8312 vs. 716 ± 411 pmol/L, p < 0.05) and mild group (6860 ± 8312 vs. 2676 ± 3959 pmol/L, p < 0.05) respectively. ALS functional rating scale-revised (ALSFRS-R) (37.9 ± 5.7 vs. 42.4 ± 2.8, p < 0.01) and serum creatinine levels (0.51 ± 0.13 vs. 0.68 ± 0.23 mg/dL, p < 0.05) were significantly lower in the severe group than in the mild group respectively. A negative correlation of CSF ATP levels with MRC sum score was demonstrated in the correlation analysis adjusted for age and sex (r = -0.3, p = 0.08). Conclusions Extracellular ATP is particularly increased in the CSF of patients with advanced ALS. CSF ATP levels may be a useful biomarker for evaluating disease severity in patients with ALS.

scholarly journals Prediction of COVID-19 severity using laboratory findings on admission: informative values, thresholds, ML model performance

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044500
Author(s):  
Yauhen Statsenko ◽  
Fatmah Al Zahmi ◽  
Tetiana Habuza ◽  
Klaus Neidl-Van Gorkom ◽  
Nazar Zaki
Keyword(s):  
Lymphocyte Count ◽  
Prediction Models ◽  
Model Performance ◽  
Area Under The Curve ◽  
Predictive Biomarkers ◽  
Supervised Machine Learning ◽  
Study Cohort ◽  
Threshold Values ◽  
Laboratory Findings ◽  
Study Results

BackgroundDespite the necessity, there is no reliable biomarker to predict disease severity and prognosis of patients with COVID-19. The currently published prediction models are not fully applicable to clinical use.ObjectivesTo identify predictive biomarkers of COVID-19 severity and to justify their threshold values for the stratification of the risk of deterioration that would require transferring to the intensive care unit (ICU).MethodsThe study cohort (560 subjects) included all consecutive patients admitted to Dubai Mediclinic Parkview Hospital from February to May 2020 with COVID-19 confirmed by the PCR. The challenge of finding the cut-off thresholds was the unbalanced dataset (eg, the disproportion in the number of 72 patients admitted to ICU vs 488 non-severe cases). Therefore, we customised supervised machine learning (ML) algorithm in terms of threshold value used to predict worsening.ResultsWith the default thresholds returned by the ML estimator, the performance of the models was low. It was improved by setting the cut-off level to the 25th percentile for lymphocyte count and the 75th percentile for other features. The study justified the following threshold values of the laboratory tests done on admission: lymphocyte count <2.59×109/L, and the upper levels for total bilirubin 11.9 μmol/L, alanine aminotransferase 43 U/L, aspartate aminotransferase 32 U/L, D-dimer 0.7 mg/L, activated partial thromboplastin time (aPTT) 39.9 s, creatine kinase 247 U/L, C reactive protein (CRP) 14.3 mg/L, lactate dehydrogenase 246 U/L, troponin 0.037 ng/mL, ferritin 498 ng/mL and fibrinogen 446 mg/dL.ConclusionThe performance of the neural network trained with top valuable tests (aPTT, CRP and fibrinogen) is admissible (area under the curve (AUC) 0.86; 95% CI 0.486 to 0.884; p<0.001) and comparable with the model trained with all the tests (AUC 0.90; 95% CI 0.812 to 0.902; p<0.001). Free online tool at https://med-predict.com illustrates the study results.

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