Lymphocyte and Platelet Counts, as well as Interleukin-6 Levels, Predict Mortality of Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Objective. To systematically evaluate the value of lymphocytes, platelets, and interleukin-6 in predicting the mortality of patients with coronavirus disease 2019 (COVID-19) and to provide medical evidence for the long-term prognosis of patients with COVID-19. Methods. The latest studies published until July 1, 2021, were retrieved from databases including PubMed, Embase, and Cochrane Library to analyze the ability of lymphocyte and platelet counts as well as interleukin-6 levels to predict mortality in patients with COVID-19. Two reviewers independently screened the literature and extracted data, then evaluated the risk of bias of included studies using the Newcastle–Ottawa Scale (NOS), and used Stata 15.0 software for meta-analysis. Results. A total of nine studies were included, involving 4340 patients. There were 1330 patients in the death group and 3010 patients in the survival group. Meta-analysis showed that, compared with the survival group, lymphocyte counts in the death group were significantly lower (SMD = −0.64, 95% CI: −0.86–−0.43, p < 0.01 ), platelet counts were significantly lower (SMD = −0.47, 95% CI: −0.67–−0.27, p < 0.01 ), and interleukin-6 levels were significantly higher (SMD = 1.07, 95% CI: 0.62–1.53, p < 0.01 ). Conclusion. Lymphocyte and platelet counts, as well as interleukin-6 levels, can help predict the mortality of patients with COVID-19. Due to the limitation of the number and quality of the included studies, these conclusions need to be validated by additional high-quality studies.

Study on Risk Factors for Death from Cardiomyopathy and Effectiveness of Health Information Management

Objective. To explore risk factors for death from cardiomyopathy and the effectiveness of health information management (HIM). Methods. A total of 80 patients with cardiomyopathy admitted in ICU of our hospital (January 2016–January 2020) were selected as study subjects, and the clinical data of the patients were retrospectively analyzed. The patients were divided into the survival group (n = 72) and the death group (n = 14) according to the treatment outcome. Then, according to the management mode, the survival group was further equally divided into the conventional group and the HIM group to investigate the influence of risk factors on prognosis of patients with cardiomyopathy and the effectiveness of HIM. Results. No significant difference was found in baseline body mass, myocardial enzymes, troponin, infection factors, history of heart disease, and gender between the survival group and the death group ( P > 0.05). Compared with the survival group, the patients of the death group were older ( P < 0.05), LVEF of the death group was obviously lower ( P < 0.05), and the scores of APACHE II and SOFA of the death group were obviously higher ( P < 0.05). Further logistic regression analysis of the univariate factors influencing the risk of death from cardiomyopathy led to the conclusion that LVEF was an independent risk factor for death in patients with cardiomyopathy. LVEF below 24.69% examined by echocardiography had a high predictive value, with a sensitivity of 98.6% and a specificity of 78.6%. No obvious difference was found in general data between the conventional group and the HIM group ( P > 0.05). Compared with the conventional group, the disease remission rate, complication rate, awareness rate of health knowledge, ICU length of stay, and scores of self-management efficacy of the HIM group were obviously better ( P < 0.05). No significant difference was found in 5-year mean survival rate between the conventional group and the HIM group ( P > 0.05). Conclusion. Older age, lower LVEF, and higher scores of APACHE II and SOFA are all risk factors for death from cardiomyopathy. Lower LVEF is an independent risk factor, and LVEF below 24.69% is an important indicator of increased risk of death. Moreover, HIM can effectively improve short-term treatment efficacy but has little effect on the long-term survival rate.

The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age &gt; 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (&gt;2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (&gt;28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (&gt;21 mg/dl, HR = 1.75), albumin (&lt;3.5 g/dl, HR = 2.02), troponin T (TnT) (&gt;0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (&gt;5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p &lt; 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

ANALYSIS OF PROGNOSTIC RISK FACTORS OF BLOODSTREAM INFECTIONS IN BEIJING COMMUNITIES: A RETROSPECTIVE STUDY FROM 2015 TO 2019

Objective: This study intends to investigate the prognostic risk factors of bloodstream infection in Beijing. Methods: This study is a clinical retrospective study. Patients with community-onset bloodstream infections (COBSI) who were admitted to the emergency department and inpatient department of Beijing Jishuitan Hospital from January 1,2015 to December 31,2019 were selected as the main research objects. According to whether the patient survives for 100 days or not, the patients are divided into survival group and death group. By analyzing the clinical data of the two groups of patients, the epidemiology, clinical characteristics, bacterial resistance and risk factors affecting the prognosis of the patients were analyzed. Results: A total of 446 patients with COBSI diagnosed by blood culture were included in this study, including 252 men and 194 women. According to 100-day survival or not, patients were divided into survival group and death group, of which 363 cases were in the survival group and 83 cases were in the death group. The results of this study show that solid tumors, combined septic shock, indwelling catheters and hemodialysis treatment are independent risk factors affecting the prognosis of COBSI patients. Reasonable initial antibiotic therapy is a protective factor affecting the prognosis of COBSI patients. Conclusion: Solid tumors, combined septic shock, indwelling catheters, hemodialysis treatment, Charlson score, APACHE II score and PITT score are independent risk factors affecting the prognosis of COBSI patients in Beijing, the capital of China, and reasonable initial antibiotic therapy is a protective factor affecting the prognosis of COBSI patients.

A Death-Related Gene Signature for Prognosis with Osteosarcoma

Purpose: Osteosarcoma is one of the most prevalent malignancies, and despite significant advances in its treatment, patient prognosis remains poor and survival rates are low. It is undoubtedly important to explore the possible reasons for the low survival rates of patients and to reveal the differences.Methods and Results: We obtained RNA-Seq (HT seq) and clinical characteristics of osteosarcoma patients from the TCGA database and divided them into survival group and death group. We defined the differentially expressed genes (DEGs) between the two groups as death-related genes (DRGs) and used them to construct a prognostic signature for overall survival of patients with osteosarcoma. The results of the validation demonstrated satisfactory accuracy and predictive prognostic value of the model. In addition, we performed a series of bioinformatic analyses that identified two key genes and the regulatory networks they constituted that may play a role in the progression of osteosarcoma.Conclusion: Our DRGs signature represents a novel and clinically useful prognostic biomarker for patients with osteosarcoma, helping to aid clinical decision-making.

Clinical Value of the Lactate/Albumin Ratio and Lactate/Albumin Ratio × Age Score in the Assessment of Prognosis in Patients With Sepsis

Objective: To examine the clinical significance of the blood lactate (Lac)/serum albumin (Alb) ratio and the Lac/Alb × age score for assessing the severity and prognosis of patients with sepsis.Methods: A total of 8,029 patients with sepsis, aged &gt;18 years were enrolled between June 2001 to October 2012 from the latest version of the Medical Information Mart for Intensive Care III (MIMIC-III v.1.4). The general data of the patients were obtained from hospital records and included gender, age, body mass index (BMI), laboratory indices, the sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS II). The patients were graded and scored according to their age and then divided into a survival or death group based on their prognosis. The Lac/Alb ratio after ICU admission was calculated and compared between the two groups. The risk factors for death in patients with sepsis were determined using multivariate logistic regression analysis, while mortality was examined using receiver operating characteristic (ROC) curve and survival curve plots. Finally, the values of the Lac/Alb ratio and Lac/Alb × age score for assessing prognosis of patients with sepsis were analyzed and compared.Results: After items with default values were excluded, a total of 4,555 patients with sepsis were enrolled (2,526 males and 2,029 females). 2,843 cases were classified as the death group and 1,712 cases in the survival group. (1) The mean age, BMI, SOFA and SAPS II scores were higher in the death group than those in the survival group. Significant differences in baseline data between the two groups were also observed. (2) The patients in the death group were divided further into four subgroups according to the quartile of the Lac/Alb ratio from low to high. Comparison of the four subgroups showed that the death rate rose with an increase in the Lac/Alb ratio, while analysis of the survival curve revealed that patients with a higher Lac/Alb ratio had a worse prognosis. (3) Multivariate logistic regression analysis showed that age ≥ 60 years, overweight (BMI ≥ 24 kg/m2), Lac/Alb ratio ≥ 0.16, SOFA score ≥ 2 points, and SAPS II ≥ 40 points were independent risk factors for death in patients with septic. (4) ROC curve analysis indicated that the SAPS II, Lac/Alb x age score, SOFA, and Lac/Alb ratio were the best predictors of death in patients with sepsis. The Lac/Alb × age score was characterized by its simple acquisition and ability to quickly analyze the prognosis of patients.Conclusion: (1)A high Lac/Alb ratio is an independent risk factor for death in patients with sepsis. (2) Although the prognosis of sepsis can be accurately and comprehensively assessed by multi-dimensional analysis of multiple indices, the Lac/Alb×age score is more accurate and convenient for providing a general assessment of prognosis, so is worthy of further clinical recognition.

The Value of Effective Lung Ventilation Area Ratio Based on CT Image Analysis Is a New Index to Predict the Shorter Outcome of Anti-melanoma Differentiation-Associated Protein 5 Positive Dermatomyositis Associated Interstitial Lung Disease: A Single-Center Retrospective Study

Background: Anti-melanoma differentiation-associated protein 5 (MDA5) positive dermatomyositis (MDA5+DM) patients have poor outcomes due to rapidly progressive interstitial lung disease (ILD). The accurate assessment of lung involvement is an urgent focus of research.Methods: A computer-aided lung interstitial image analysis technology has been developed, and a quantitative indicator named effective lung ventilation area ratio (ELVAR) that calculates the proportion of the area outside the lung interstitium in lung tissue has been established. 55 newly diagnosed MDA5+DM patients and 46 healthy individuals, matched for age and gender, were enrolled in this study. MDA5+DM patients were classified into early death group or early survival group according to their survival state within 3 months after diagnosis. Clinical characteristics, laboratory and immunological test results, lung involvement (including ELVAR value) and treatment were compared between early death group and early survival group to determine an index that can predict prognoses of patients with MDA5+DM.Results: There were significant differences between early death MDA5+DM patients and early survival MDA5+DM patients about 12 indices including age of onset, CRP, ferritin, albumin, and pulmonary involvement including severity of type I respiratory failure at diagnosis, P/F ratio, oxygen supplementation, values of ELVAR, FVC, and DLCO. The results of ROC analysis and correlation analysis showed the value of ELVAR had good diagnostic value and widely correlation with many clinical characteristics. Univariate analysis and Multivariate analysis showed four factors including age of onset, ferritin, value of ELVAR, and oxygen supplementation &gt;4 L/min significantly value for poor prognosis in MDA5+DM patients. A cutoff value of 0.835 about ELVAR had good predictive power for mortality within 3 months in 54.2% of MDA5+DM patients.Conclusion: The value of ELVAR derived from computed tomography image analysis is a new index that can predict poor outcomes in MDA5+DM patients with rapidly progressive interstitial lung disease.

EuroScore II is the best predictive model for the off pump coronary artery bypass graft surgery

Background Coronary artery bypass graft surgery (CABG) is the most common cardiac surgery performed in the world and a significant part of these surgeries are performed without cardiopulmonary bypass (off pump). Although none of the main surgical risk scores include pump use in their prediction model, the scores are widely used in risk stratification, including for patients who will be submitted to off pump CABG. Purpose To analyse and compare the predictive accuracy of EuroScore I, EuroScore II and STS Score for 30-day mortality after off pump CABG. Methods Single-centre cohort with 943 patients consecutively submitted to off pump CABG between January 2010 and December 2020. 31 baseline and operative variables were analysed. The primary outcome was the occurrence of death in the first 30 days after the surgery. Descriptive analysis, normality for quantitative data and univariate inference were performed to compare proportions and means between the survival group (n=930) and death group (n=13). Next, three logistic regression models were performed. Each of them had 30-day mortality as a dependent variable and one of the scores as an independent variable. The probabilities generated by the three models were saved and analysed by ROC curves. Thus, it was possible to assess the predictive accuracy of each of the scores. Finally, the values of the areas under the curves were compared using the DeLong test. The level of significance was 5% and the analysis was performed using the Python 3.0 programming language. Results The mean age of the general group was 63 years old and there was a predominance of male patients (68.4%). The means of the three evaluated risk scores were significantly higher in the Death group (p&lt;0,05). This pattern confirmed the findings of higher prevalence of several comorbidities in the death group. The 30-day mortality rate was 1.37%. Through the analysis of regressions and the probabilities generated through them, it was possible to verify that the predictive accuracy of EuroScore II was significantly higher than that of the other two scores. While the predictive accuracy of EuroScore II was 77.3%, the accuracy of two other scores was in the range of 69% (AUC EsI: 0.697; AUC EsII: 0.773; AUC STS: 0.695; p=0.029). Conclusion EuroScore II seems to be the most adequate surgical risk score for the assessment of mortality risk of patients who will undergoing to off pump CABG. The score had a predictive accuracy of 77.3%, almost 8% more than the other two scores. Therefore, although EuroScore II does not include in its model the use of cardiopulmonary bypass, it has a satisfactory accuracy to be used in clinical-surgical practice. On the other hand, the EuroScore I and the STS Score showed predictive accuracy not adequate for this type of surgery. FUNDunding Acknowledgement Type of funding sources: None. Predictive accuracies of risk scores

Laboratory biomarkers of COVID-19 outcome: findings from a high dependency unit of South Bengal

Background: Coronavirus disease-19 (COVID-19) has become a world wellbeing compromise. The danger factors for unfavorable occasions of coronavirus disease-19 (COVID-19) have not been very much depicted. This study aimed to explore clinical characteristics, laboratory results, and CT imaging characteristics of COVID-19 patients in Midnapore medical college and hospital and provide evidence for the prevention and treatment of COVID-19.Methods: In this retrospective, single-center study, data of all confirmed patients with COVID-19 admitted at SARI HDU of Midnapore medical college and hospital from 1st July to 21July 2021 were collected and analyzed. Data including clinical presentations, basic laboratory investigations, and CT severity scores were analyzed and compared between survival and death patients.Results: In this study total of 81 patients of COVID-19 admitted at SARI HDU were included (male=50, female=31). The patients were divided into 2 groups according to the outcome: survival group (n=38) and death group (n=43). Information on the overall clinical characteristics of the patients was collected, including age, sexual orientation, past medical history, clinical symptoms, and so on. Compared with the patients in the Survival group, the patients in the death group, the proportion of patients presented with Dyspnoea and suffering from Diabetes and hypertension were higher (p<0.05). In patients of the death group, TLC, CRP, D-dimer, urea, and creatinine had higher values, while the levels of albumin were significantly reduced, and the differences were statistically significant (p<0.05). Between the Survival group and death group, there was no significant difference in other indexes such as NLR, platelet count, and liver enzymes (SGOT, SGPT) (p>0.05). Conclusions: The risk factors of comorbidities, like diabetes, hypertension and others like leucocytosis, high CRP, high d-dimer, altered renal function, low serum albumin, and higher CT severity score could help clinicians identify patients with potential adverse events.

Value of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Red Blood Cell Distribution Width in Evaluating the Prognosis of Children with Severe Pneumonia

Objective. To investigate the value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red blood cell distribution width (RDW) in evaluating the prognosis of children with severe pneumonia (SP). Methods. A retrospective analysis of the data of 91 children with SP admitted to our hospital from March 2018 to March 2021. According to the survival status after 28 days of treatment, all children were divided into the survival group (n = 59) and the death group (n = 32). The clinical data and laboratory indicators of the patients were recorded. Multivariate logistic regression was used to analyze the risk factors of prognosis, and the ROC curve was used to analyze the predictive value of each index. Results. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and CURB-65 score of the death group were higher than those of the survival group ( P < 0.05 ). The RDW, NLR, PLR, and high-sensitivity C-reactive protein, procalcitonin blood lactic acid (Lac) of the death group, were higher than those of the survival group, and LYM was lower than the survival group ( P < 0.05 ). Multivariate regression analysis showed that APACHE II score, RDW, NLR, PLR, and Lac were all independent risk factors for poor prognosis in children with SP ( P < 0.05 ). The AUC of NLR, PLR, and RDW for evaluating the prognosis of children with SP were 0.798, 0.781, and 0.777, respectively. The sensitivity was 56.25%, 90.63%, and 56.25%, respectively, and the specificity was 89.83%, 55.93%, and 91.53%, respectively. The AUC of NLR, PLR, and RDW combined to evaluate the prognosis of children with SP was 0.943. When the best cut-off value was 0.8528, the sensitivity was 93.75%, and the specificity was 91.53%. Conclusion. NLR, PLR, and RDW have certain predictive value for the prognosis of children with SP; the combination of the three indicators has a higher value in evaluating the prognosis of children with SP, which can better guide the prognostic treatment.