scholarly journals A Comprehensive Appraisal of Laboratory Biochemistry Tests as Major Predictors of COVID-19 Severity

2020 ◽  
Vol 144 (12) ◽  
pp. 1457-1464 ◽  
Author(s):  
Elena Aloisio ◽  
Mariia Chibireva ◽  
Ludovica Serafini ◽  
Sara Pasqualetti ◽  
Felicia S. Falvella ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Troponin T ◽  
Severe Disease ◽  
Negative Likelihood Ratio ◽  
Likelihood Ratios ◽  
Lactate Dehydrogenase Activity ◽  
Reactive Protein ◽  
Low Concentrations ◽  
High Concentrations

Context.— A relevant portion of coronavirus disease 2019 (COVID-19) patients develop severe disease with negative outcomes. Several biomarkers have been proposed to predict COVID-19 severity, but no definite interpretative criteria have been established to date for stratifying risk. Objective.— To evaluate 6 serum biomarkers (C-reactive protein, lactate dehydrogenase, D-dimer, albumin, ferritin, and cardiac troponin T) for predicting COVID-19 severity and to define related cutoffs able to aid clinicians in risk stratification of hospitalized patients. Design.— A retrospective study of 427 COVID-19 patients was performed. Patients were divided into groups based on their clinical outcome: nonsurvivors versus survivors and patients admitted to an intensive care unit versus others. Receiver operating characteristic curves and likelihood ratios were employed to define predictive cutoffs for evaluated markers. Results.— Marker concentrations at peak were significantly different between groups for both selected outcomes. At univariate logistic regression analysis, all parameters were significantly associated with higher odds of death and intensive care. At the multivariate analysis, high concentrations of lactate dehydrogenase and low concentrations of albumin in serum remained significantly associated with higher odds of death, whereas only low lactate dehydrogenase activities remained associated with lower odds of intensive care admission. The best cutoffs for death prediction were greater than 731 U/L for lactate dehydrogenase and 18 g/L or lower for albumin, whereas a lactate dehydrogenase activity lower than 425 U/L was associated with a negative likelihood ratio of 0.10 for intensive treatment. Conclusions.— Our study identifies which biochemistry tests represent major predictors of COVID-19 severity and defines the best cutoffs for their use.

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.

A comparison of five methods of temperature measurement in febrile intensive care patients

1995 ◽  
Vol 4 (4) ◽  
pp. 286-292 ◽  
Author(s):  
T Schmitz ◽  
N Bair ◽  
M Falk ◽  
C Levine
Keyword(s):  
Intensive Care ◽  
Pulmonary Artery ◽  
Temperature Measurement ◽  
Core Temperature ◽  
Rectal Temperature ◽  
False Negative ◽  
Negative Likelihood Ratio ◽  
Likelihood Ratios ◽  
Axillary Temperature ◽  
Intensive Care Patients

BACKGROUND: A clinically useful temperature measurement method should correlate well with the body's core temperature. Although previous investigators have studied temperature readings from different sites in hypothermic and normothermic patients, none have compared methods specifically in febrile patients. OBJECTIVE: To compare temperature measurement methods in febrile intensive care patients. METHODS: Temperature readings were obtained in rapid sequence from an electronic thermometer for oral and axillary temperature, rectal probe, infrared ear thermometer on "core" setting, and pulmonary artery catheter, approximately every hour during the day and every 4 hours at night. The sample consisted of 13 patients with pulmonary artery catheters and with temperatures of at least 37.8 degrees C. RESULTS: Rectal temperature correlated most closely with pulmonary artery temperature. Rectal temperature showed closest agreement with pulmonary artery temperature, followed by oral, ear-based, and axillary temperatures. Rectal and ear-based temperatures were most sensitive in detecting temperatures greater than 38.3 degrees C. Likelihood ratios for detecting hyperthermia were 5.32 for oral, 2.46 for rectal, and 1.97 for ear-based temperature. Rectal and ear-based temperatures had the lowest negative likelihood ratios, indicating the least chance of a false negative reading. Axillary temperature had a negative likelihood ratio of 0.86. CONCLUSIONS: Rectal temperature measurement correlates most closely with core temperature. If the rectal site is contraindicated, oral or ear-based temperatures are acceptable. Axillary temperature does not correlate well with pulmonary artery temperature. These results underscore the importance of consistency in method when establishing temperature trends, and of awareness of method when interpreting clinical data.

scholarly journals Effects of a Polyoxyethylene Detergent on Platelet Function

1977 ◽  
Author(s):  
P.G. Barton
Keyword(s):  
Lactate Dehydrogenase ◽  
Platelet Rich Plasma ◽  
Secondary Phase ◽  
Human Platelets ◽  
Brij 58 ◽  
Low Concentrations ◽  
High Concentrations ◽  
Glass Surfaces ◽  
Induced Aggregation ◽  
Membrane Destabilization

Low concentrations of a polyoxyethylene detergent, Brij 58, inhibited the secondary phase of platelet aggregation induced by ADP in human citrated platelet rich plasma but had no effect on primary aggregation.Thrombin-induced aggregation of washed human platelets suspended in Tyrode’s buffer was inhibited after incubation of cells with 4.5 × 10-6M detergent. Development of prothrombin-converting activity and efflux of [14C]-serotonin, 45Ca2+ ions and labile endoperoxides were abolished concomitantly. Aggregation of washed platelets by collagen or sodium arachidonate and the attachment of cells to clean glass surfaces were also inhibited by the same concentration of Brij 58 that inhibited thrombin aggregation. This concentration of Brij 58 did not itself produce any release of a cytoplasmic marker, lactate dehydrogenase, from platelets. Higher concentrations of Brij 58, exceeding 10-4 M, lysed the cells liberating all of their serotonin, Ca2+ and lactate dehydrogenase. These results suggest that low concentrations of Brij 58 stabilize a membrane conformation against the action of platelet stimulatory agents while high concentrations produce membrane destabilization and cell lysis. The presence of albumin (BSA) in the suspending fluid increased by tenfold the concentrations of detergent required to “elicit these effects and this could be attributed to competitive binding of the detergent to albumin, demonstrated with [14C]-acetylated Brij 58.

scholarly journals Association of glyceraldehyde 3-phosphate dehydrogenase with the membrane of the intact human erythrocyte

1980 ◽  
Vol 187 (3) ◽  
pp. 837-841 ◽  
Author(s):  
S Keokitichai ◽  
J M Wrigglesworth
Keyword(s):  
Lactate Dehydrogenase ◽  
Dehydrogenase Activity ◽  
Human Erythrocyte ◽  
Membrane Fraction ◽  
Human Erythrocytes ◽  
Supernatant Fraction ◽  
Salt Treatment ◽  
Intact Cells ◽  
Lactate Dehydrogenase Activity ◽  
Low Concentrations

Intact human erythrocytes were exposed to low concentrations of glutaraldehyde. After washing and subsequent lysis of the cells, glyceraldehyde 3-phosphate dehydrogenase activity is found to be associated with a membrane fraction and cannot be eluted by salt treatment. Lactate dehydrogenase activity is associated with a supernatant fraction under the same conditions. Preincubation of the intact cells under conditions designed to increase internal NADH concentrations, leads to a lower membrane-associated activity of glyceraldehyde 3-phosphate dehydrogenase after lysis.

New Instrument for Rapid Determination of Activities of Lactate Dehydrogenase Isoenzymes

1975 ◽  
Vol 21 (9) ◽  
pp. 1277-1281 ◽  
Author(s):  
Johannes Everse ◽  
Richard M Reich ◽  
Nathan O Kaplan ◽  
W Donald Finn
Keyword(s):  
Lactate Dehydrogenase ◽  
Dehydrogenase Activity ◽  
Electronic Device ◽  
Rapid Determination ◽  
Total Activity ◽  
Myocardial Infarctions ◽  
Lactate Dehydrogenase Activity ◽  
New Instrument ◽  
High Concentrations ◽  
Lactate Dehydrogenase Isoenzymes

Abstract Lactate dehydrogenase isoenzymes can be distinguished kinetically by the fact that isoenzyme H is strongly inhibited a few seconds after the reaction is started if high concentrations of pyruvate are present, in contrast to the M isoenzyme. A new instrument that exploits this fact can measure both the total activity and the proportion of H isoenzyme in serum or plasma in 8 to 10 s. The instrument consists of a simplified stoppedflow apparatus in which the plasma is assayed for lactate dehydrogenase activity, and an electronic device that measures the rate of the reaction at two pre-set time intervals. The first rate is taken between 0.2 and 0.4 s after the reaction is started, a time at which both isoenzymes are fully active, and at which the rate obtained thus reflects total lactate dehydrogenase activity in the plasma sample. The second rate is measured 4 to 6 s after the start of the reaction, at which time the H isoenzyme has become inhibited and the observed rate compared to the initial rate is therefore proportional to the percentage of H isoenzyme activity in the serum. These two rates are electronically displayed on two three-digit voltmeters, the first display being the total activity, the second a number proportional to the inhibited slope. The percentage of M isoenzyme can then be calculated from the initial and final rate. A total of five to six repeat assays may be done within a minute on 1 ml of plasma or serum. This instrument may be of significant value in following the progress of myocardial infarctions and other diseases.

scholarly journals Intermediates of peroxisomal β-oxidation. A study of the fatty acyl-CoA esters which accumulate during peroxisomal β-oxidation of [U-14C]hexadecanoate

1990 ◽  
Vol 270 (1) ◽  
pp. 175-180 ◽  
Author(s):  
K Bartlett ◽  
R Hovik ◽  
S Eaton ◽  
N J Watmough ◽  
H Osmundsen
Keyword(s):  
Lactate Dehydrogenase ◽  
Chain Length ◽  
Full Range ◽  
Fatty Acyl ◽  
Acetyl Coa ◽  
Low Concentrations ◽  
High Concentrations ◽  
Rate Limiting

1. 14C-labelled fatty acyl-CoA esters resulting from β-oxidation of [U-14C]hexadecanoate by peroxisomal fractions isolated from rats treated with clofibrate showed the presence of the full range of saturated intermediates down to acetyl-CoA. 2. The pattern of intermediates generated was fairly constant. At low concentrations of [U-14C]hexadecanoate (50 microM), decanoyl-CoA was present in lowest amounts. At higher concentrations of [U-14C]hexadecanoate (greater than 100 microM), all intermediates of chain length shorter than 12 carbon atoms (except acetyl-CoA) were present at similar low concentrations; the process of β-oxidation now resembling chain-shortening of hexadecanoate by two cycles of β-oxidation. 3. In the absence of an NAD(+)-regenerating system [pyruvate and lactate dehydrogenase (EC 1.1.1.28)] 2-enoyl- and 3-hydroxyacyl-CoA esters were generated, suggesting that re-oxidation of NADH is essential for optimal rates of peroxisomal β-oxidation in vitro. 4. At high concentrations of [U-14C]hexadecanoate (greater than 100 microM), 3-oxohexadecanoyl-CoA was produced, suggesting that thiolase (acetyl-CoA acetyltransferase; EC 2.3.1.9) can become rate-limiting for peroxisomal β-oxidation.

TNF-α, iNOS Augmentation Due to Macrophages and Neutrophils Activity in Samples from Patients in Intensive Care Unit with COVID-19 Infection

2021 ◽  
Author(s):  
Zivar Zangeneh ◽  
Alireza Andalib ◽  
Gholamreza Khamisipour ◽  
Hamid Saadabadimotlagh ◽  
Sareh Zangeneh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Inflammatory Cytokines ◽  
White Blood Cells ◽  
Cell Activity ◽  
C Reactive Protein ◽  
Therapeutic Goals ◽  
Reactive Protein ◽  
Inflammatory Macrophages

Background and Aims: Cells and secreted molecules by the innate immune system are the essential factors in the pathogenesis and determining the severity of inflammation in COVID-19 patients. Severe inflammation results from increased activity of neutrophils, macrophages, and other cells with their products. Inflammatory cytokines such as tumor necrosis factor-a (TNF-a)  increases the severity and pathogenesis of the disease caused by the virus. Phagocytes are armed with inducible nitric oxide synthase (iNOS), that upon stimulation by proinflammatory cytokines augment an immune response against pathogens. Materials and Methods: Two groups of patients were included with COVID-19 infection from the intensive care unit (ICU, n=52) and (non-ICU-care, n=54). Blood samples were collected to measure cells and serum parameters, including lymphocytes, neutrophils, platelet counts, accompanied with C-reactive protein, lactate dehydrogenase, TNF-a and iNOS levels. Results: In the ICU group, increased white blood cells (p=0.048), decreased lymphocytes (p=0.0007), increased neutrophils (p=0.001), decreased platelets, increase serum levels for lactate dehydrogenase (p =0.0001), c-reactive protein (p=0.003), TNF-a (p=0.018), and iNOS (p=0.008) were statistically obtained. Positive correlations were calculated between TNF-a and iNOS (r=0.65, p=0.0002) and with c-reactive protein (r=0.52, p=0.003) and with lactate dehydrogenase (r=0.68, p=0.0001). Conclusion: Inflammation due to macrophages and neutrophils activity in COVID-19 patients and increased mediators correlate with disease progression. It seems that control of the cell activity and their inflammatory cytokines would be considered for therapeutic goals. Changing the polarization of inflammatory macrophages to anti-inflammatory macrophages with therapeutic applications could prevent the severity of the provocative course of the disease.

scholarly journals SARS-CoV-2 in Urine May Predict a Severe Evolution of COVID-19

2021 ◽  
Vol 10 (18) ◽  
pp. 4061
Author(s):  
Alessandro Perrella ◽  
Mario Brita ◽  
Francesco Coletta ◽  
Simona Cotena ◽  
GiamPaola De Marco ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Intensive Care Units ◽  
Disease Severity ◽  
Death Rate ◽  
Severe Disease ◽  
Serum Levels ◽  
C Reactive Protein ◽  
Disease Evolution ◽  
Reactive Protein

We hypothesized that the spread of SARS-CoV-2 in urine during a severe COVID-19 infection may be the expression of the worsening disease evolution. Therefore, the aim of this study was to verify if the COVID-19 disease severity is related to the viral presence in urine samples. We evaluated the clinical evolution in acute COVID-19 patients admitted in the sub-intensive care and intensive care units between 28 of December 2020 and 15th of February 2021 and being positive for SARS-CoV-2 RNA in the respiratory tract, including repeated endotracheal aspirates (ETA), sputum, nasopharyngeal swabs (NPS) and urine. We found that those subjects with SARS-COV-2 in the urine at admittance (8 out of 60 eligible patients) had a more severe disease than those with negative SARS-CoV-2 in urine. Further, they showed an increase in fibrinogen and (C-reactive Protein) CRP serum levels, requiring mechanic ventilation. Of those with positive SARS-CoV-2 in the urine, 50% died. According to our preliminary results, it seems that the presence of SARS-CoV-2 in the urine characterizes patients with a more severe disease and is also related to a higher death rate.

scholarly journals Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin

2020 ◽  
Vol 12 (3) ◽  
pp. 17-33
Author(s):  
Rohmantuah Trada Purba ◽  
Mahendratama Purnama Adhi ◽  
Erna Kusumawardhani ◽  
Rapto Hardian ◽  
Andri Lumban Tobing
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Interleukin 6 ◽  
Virus Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Corona Virus ◽  
D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin.Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis.Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin.Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit <10 hari. Perlu dilakukan penelitian lebih lanjut untuk menilai efek terapeutik dan timing pemberian yang tepat.

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