Increased Serum Inflammatory Markers have worsened Clinical Outcomes and Mortality in Sars-Cov-2 Infection Irrespective of High or Low Serum Viral Load

Aim: To determine the viral load in the patients admitted in Covid-19 isolation and its correlation with the inflammatory markers and the following clinical outcome. Methodology: A retrospective study was conducted in the Pathology Department of Doctors Hospital and Medical Centre in Lahore, Pakistan from November 2020 to January 2021. IRB approval was granted. A total of 86 patients met the inclusion criteria for the study. Data was analyzed using research tool SPSS 24. Results: Increased serum viral load in SARS-CoV-2 infection showed positive correlation with inflammatory markers IL-6 (P =0.04) and D-dimer (P =0.029). Inflammatory markers LDH, Ferritin, Procalcitonin, D-Dimers and viral load itself (CT) all correlated with higher mortality while IL-6 did not. Conclusion: Serum viral load in patients infected with SARS-CoV-2 correlates with higher mortality rates itself and also raises certain inflammatory markers (IL-6, D-Dimers), which are independently accountable for causing higher mortality as well. Hence, increased inflammatory markers resulted in poor prognosis regardless of high or low viral load. Their correlation with mortality can still serve as prognostic indicators. Keywords: viral load, inflammatory markers, Covid-19, mortality

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Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

10.21203/rs.3.rs-105205/v2 ◽

2021 ◽

Author(s):

Ahmet Murt ◽

Mevlut Tamer Dincer ◽

Cebrail Karaca ◽

Sinan Trabulus ◽

Ridvan Karaali ◽

...

Keyword(s):

Acute Kidney Injury ◽

Inflammatory Markers ◽

Kidney Injury ◽

Final Analysis ◽

Disease Stage ◽

Inclusion Criteria ◽

Acid Base ◽

Acid Base Status ◽

Worse Prognosis ◽

D Dimer

Abstract Aim Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. This study aimed to analyze AKI among hospitalized COVID-19 patients in relation to the time and etiologies of AKI. Methods 1056 patients who were hospitalized with COVID-19 diagnosis in our institution were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed.Results AKI had 24% mortality in COVID-19 patients who had eGFRs of over 60 ml/min/1,73 m2. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Conclusions AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has a worse prognosis.

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Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

10.21203/rs.3.rs-105205/v1 ◽

2020 ◽

Author(s):

Ahmet Murt ◽

Mevlut Tamer Dincer ◽

Cebrail Karaca ◽

Sinan Trabulus ◽

Ridvan Karaali ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Admission ◽

Inflammatory Markers ◽

Inflammatory Marker ◽

Kidney Injury ◽

Final Analysis ◽

Disease Stage ◽

Immunologic Response ◽

Inclusion Criteria ◽

D Dimer

Abstract Introduction Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. This study aimed to analyze AKI among hospitalized COVID-19 patients in relation to the time and etiologies of AKI.Materials & Methods 1056 patients who were hospitalized with COVID-19 diagnosis in our institution were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI were involved in the final analysis. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels and inflammatory markers as well as changes in these parameters were compared between the groups.Results AKI was seen in 23% of the patients and 23% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day.Conclusion Early AKI was more related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Findings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies.

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The Effectiveness of High-dose N-acetylcysteine in Severe COVID-19 Patients

KELUWIH: Jurnal Kesehatan dan Kedokteran ◽

10.24123/kesdok.v3i1.4707 ◽

2021 ◽

Vol 3 (1) ◽

pp. 22-34

Author(s):

Puri Safitri Hanum ◽

Qory’ Hanifa

Keyword(s):

Length Of Stay ◽

Medical Records ◽

Inflammatory Markers ◽

Laboratory Data ◽

High Dose ◽

Inclusion Criteria ◽

X Ray ◽

Laboratory Results ◽

High Doses ◽

D Dimer

The study's objective was to describe the effect of using high doses of N-acetylcysteine on severe COVID-19 patients. It was evaluated from the length of stay and by monitoring the drug use data, laboratory data, and clinical data at Bhayangkara H.S Samsoeri Mertojoso Hospital Surabaya. The data was collected retrospectively from patients' Health Medical Records who got high dose N-acetylcysteine in October 2020 – February 2021, with standard therapy: antivirus (Remdesivir), antibiotics, vitamins, symptomatic and comorbid therapy, anticoagulant, and corticosteroids (Dexamethasone) as inclusion criteria, then described descriptively. The observation result confirmed that the use of a high dose of N-acetylcysteine (NAC) [1 x 1200 – 5000 mg] po/iv had effective results as seen from the patients' length of stay, which was 12 days for patients without comorbid and 14 days for patients with comorbid like diabetes and/or hypertension. The use of high dose NAC showed improvement in the patients' clinical condition that is evaluated from improved oxygen saturation by 37%. In addition, the laboratory results are shown an improvement in thorax X-ray by 69% and inflammatory markers like CRP and d-dimer by 100%. Further research that uses a prospective method is needed to get a better result on the use of high-dose NAC in patients with severe COVID-19.

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Clinical and angiographic characteristics of patients with STEMI and confirmed diagnosis of COVID-19: an experience of Tanta University Hospital

The Egyptian Heart Journal ◽

10.1186/s43044-020-00103-y ◽

2020 ◽

Vol 72 (1) ◽

Cited By ~ 2

Author(s):

Ahmed Alaarag ◽

Timoor Hassan ◽

Sameh Samir ◽

Mohamed Naseem

Keyword(s):

Poor Prognosis ◽

Management Strategy ◽

Clinical Presentation ◽

Underlying Mechanism ◽

Fibrinolytic Therapy ◽

University Hospital ◽

Total Occlusion ◽

St Elevation ◽

Primary Management ◽

D Dimer

Abstract Background Patients with established cardiovascular diseases have a poor prognosis when affected by the coronavirus disease 2019 (COVID-19). Also, the cardiovascular system, especially the heart, is affected by COVID-19. So we aimed to evaluate the angiographic and clinical characteristics of COVID-19 patients presented by ST-elevation myocardial infarction (STEMI). Results Our retrospective study showed that STEMI patients with COVID-19 had elevated inflammatory markers with mean of their CRP (89.69 ± 30.42 mg/dl) and increased laboratory parameters of thrombosis with mean D-dimer (660.15 ± 360.11 ng/ml). In 69.2% of patients, STEMI was the first clinical presentation and symptoms suggestive of COVID-19 developed during the hospital stay; about one third of patients had a non-obstructive CAD, while patients with total occlusion had a high thrombus burden. Conclusion STEMI may be the initial presentation of COVID-19. A non-obstructive CAD was found in about one third of patients; on the other hand, in patients who had a total occlusion of their culprit artery, the thrombus burden was high. Identification of the underlying mechanism responsible for the high thrombus burden in these patients is important as it may result in changes in their primary management strategy, either primary PCI, fibrinolytic therapy, or a pharmaco-invasive strategy. Furthermore, adjunctive anticoagulation and antiplatelet therapy may need to be revised.

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Comment on Sigmund et al. “Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections”

International Orthopaedics ◽

10.1007/s00264-020-04920-3 ◽

2021 ◽

Author(s):

Nan Jiang ◽

Bin Yu

Keyword(s):

Inflammatory Markers ◽

Joint Infections ◽

Serum Inflammatory Markers

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Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽

10.3390/diagnostics11020355 ◽

2021 ◽

Vol 11 (2) ◽

pp. 355

Author(s):

Matteo Ferro ◽

Gennaro Musi ◽

Deliu Victor Matei ◽

Alessandro Francesco Mistretta ◽

Stefano Luzzago ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Inflammatory Markers ◽

Low Risk ◽

Inclusion Criteria ◽

Robotic Radical Prostatectomy ◽

Lymphocyte Ratio ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

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Pancreatic Cancer Exposome Profile to Aid Early Detection and Inform Prevention Strategies

Journal of Clinical Medicine ◽

10.3390/jcm10081665 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1665

Author(s):

Maria J. Monroy-Iglesias ◽

Saoirse Dolly ◽

Debashis Sarker ◽

Kiruthikah Thillai ◽

Mieke Van Hemelrijck ◽

...

Keyword(s):

Pancreatic Cancer ◽

Early Detection ◽

Immune Responses ◽

Inflammatory Markers ◽

Poor Prognosis ◽

Associated Factors ◽

Review Of The Literature ◽

Prevention Strategies ◽

Factors Influencing ◽

Detection Strategies

Pancreatic cancer (PCa) is associated with a poor prognosis and high mortality rate. The causes of PCa are not fully elucidated yet, although certain exposome factors have been identified. The exposome is defined as the sum of all environmental factors influencing the occurrence of a disease during a life span. The development of an exposome approach for PCa has the potential to discover new disease-associated factors to better understand the carcinogenesis of PCa and help with early detection strategies. Our systematic review of the literature identified several exposome factors that have been associated with PCa alone and in combination with other exposures. A potential inflammatory signature has been observed among the interaction of several exposures (i.e., smoking, alcohol consumption, diabetes mellitus, obesity, and inflammatory markers) that further increases the incidence and progression of PCa. A large number of exposures have been identified such as genetic, hormonal, microorganism infections and immune responses that warrant further investigation. Future early detection strategies should utilize this information to assess individuals’ risk for PCa.

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Prognostic significance of bone marrow and spleen 18F-FDG uptake in patients with colorectal cancer

Scientific Reports ◽

10.1038/s41598-021-91608-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jae-Hoon Lee ◽

Hye Sun Lee ◽

Soyoung Kim ◽

Eun Jung Park ◽

Seung Hyuk Baik ◽

...

Keyword(s):

Colorectal Cancer ◽

Bone Marrow ◽

Inflammatory Markers ◽

Univariate Analysis ◽

Prognostic Significance ◽

Uptake Ratio ◽

Liver Uptake ◽

Fdg Uptake ◽

Standardized Uptake Values ◽

Serum Inflammatory Markers

AbstractSerum inflammatory markers are used in the prognostication of colorectal cancer (CRC); however, the corresponding role of positron emission tomography (PET)-derived inflammatory markers remains unclear. This study aimed to investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) uptake in the bone marrow and spleen of patients with CRC and evaluate the relationship between FDG uptake estimates in these organs and serum inflammatory markers. In total, 411 patients who underwent preoperative FDG PET/computed tomography (CT) within 1 month of surgery were enrolled. The mean standardized uptake values of the bone marrow and spleen were normalized to the value of the liver, thereby generating bone marrow-to-liver uptake ratio (BLR) and spleen-to-liver uptake ratio (SLR) estimates. The value of BLR and SLR in predicting overall survival (OS) was assessed using the Cox proportional hazards model. The correlation between BLR or SLR and neutrophil-to-lymphocyte ratio (NLR) was evaluated. The predictive accuracy of BLR alone and in combination with SLR was compared using the integrated area under the receiver operating characteristic curves (iAUC). In the univariate analysis, BLR (> 1.06) and SLR (> 0.93) were significant predictors of OS. In the multivariate analysis, BLR was an independent predictor of OS (hazard ratio = 5.279; p < 0.001). Both BLR and SLR were correlated with NLR (p < 0.001). A combination of BLR and SLR was better than BLR alone at CRC prognostication (iAUC, 0.561 vs. 0.542). FDG uptake estimates in the bone marrow and spleen may be useful imaging-derived biomarkers of systemic inflammation, supporting CRC prognostication.

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