Neurological symptoms and neuronal damage markers in acute COVID-19: Is there a correlation? A pilot study.

A wide spectrum of neurological symptoms (NS) has been described in patients with COVID-19. We examined the plasma levels of neuron-specific enolase (NSE) and neurofilament light chain (NFL) together, as neuronal damage markers, and their relationships with clinical severity in patients with NS at acute COVID-19. A total of 20 healthy controls and 59 patients with confirmed COVID-19 were enrolled in this pilot prospective study. Serum NSE and NFL levels were measured by using the enzyme-linked immunoassay method from serum samples. Serum NSE levels were found to be significantly higher in the severe group than in the nonsevere group (p = 0.034). However, serum NFL levels were similar between the control and disease groups (p > 0.05). For the mild group, serum NFL levels were significantly higher in patients with the sampling time ≥5 days than in those with the sampling time <5 days (p = 0.019). However, no significant results for NSE and NFL were obtained in patients with either single or multiple NS across the groups (p > 0.05). Increased serum NSE levels were associated with disease severity regardless of accompanied NS in patients with acute COVID-19 infection. However, serum NFL levels may have a role at the subacute phase of COVID-19.

Joint Modeling Approach on Evaluating Time-Dependent CutOff Values for C-Reactive Protein in Mixed Intensive Care Unit Population.

BACKGROUND: Serial C-reactive protein (CRP) biomarker values are frequently recorded from patients in adult intensive care units (ICU). The aim of this study was to assess the time-dependent diagnostic accuracy of repeated CRP measurements in predicting ICU mortality and determine the time-dependent cutoff values for this biomarker in mixed ICU population. METHODS: Joint modeling was performed to model repeated CRP measurements and survival data. Time-dependent AUC (td-AUC) values were used to assess the diagnostic performances. Maximization of the product of sensitivity and specificity rule was applied to determine the time-dependent cutoff values. RESULTS: Time-dependent diagnostic performance of serial CRP values were found as moderate in overall, observed to be higher in males than females, ranging from 0.603 to 0.624 in females and 0.639 to 0.690 in males. On the other hand, time-dependent cutoff values either remained constant or decreased through the 3rd day after the last measurement for both gender groups. CONCLUSIONS: Newly proposed time-dependent cutoff values for CRP biomarker are suggested to be used in clinics to discriminate subjects who are at risk and who are not during the first three days after the last measurement. Furthermore, taking serial CRP values in predicting the risk of death at ICU is highly recommended, to be able to assess the change in longitudinal profiles of subjects throughout the follow-up period.