Procalcitonin as a predictive marker in COVID-19: A systematic review and meta-analysis.

BACKGROUND: Coronavirus disease 2019 has emerged as a global pandemic causing millions of critical cases and deaths. Early identification of at-risk patients is crucial for planning triage and treatment strategies. METHODS AND FINDINGS: We performed this systematic review and meta-analysis to determine the pooled prognostic significance of procalcitonin in predicting mortality and severity in patients with COVID-19 using a robust methodology and clear clinical implications. DESIGN: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions guidelines. We included thirty-two prospective and retrospective cohort studies involving 13,154 patients. RESULTS: The diagnostic odds ratio of procalcitonin for predicting mortality were estimated to be 11 (95% CI: 7 to 17) with sensitivity, specificity, and summary area under the curveof 0.83 (95% CI: 0.70 to 0.91), 0.69 (95% CI: 0.58 to 0.79), and 0.83 (95% CI: 0.79 to 0.86) respectively. While for identifying severe cases of COVID-19, the odds ratio was 8.0 (95% CI 5.0 to 12.0) with sensitivity, specificity, and summary area under the curve of 0.73 (95% CI 0.67 to 0.78), 0.74 (0.66 to 0.81), and 0.78 (95% CI 0.74 to 0.82) respectively. CONCLUSION: Procalcitonin has good discriminatory power for predicting mortality and disease severity in COVID-19 patients. Therefore, procalcitonin measurement may help identify potentially severe cases and thus decrease mortality by offering early aggressive treatment.

Does Neutrophil-to-lymphocyte Ratio at Admission Predict Severity and Mortality in COVID-19 Patients? A Systematic Review and Meta-analysis.

Background: Coronavirus disease-2019 (COVID-2019) pandemic continues to be a significant public health problem. Severe COVID-19 cases have a poor prognosis and extremely high mortality. Prognostic factor evidence can help healthcare providers understand the likely prognosis and identify subgroups likely to develop severe disease with increased mortality risk so that timely treatments can be initiated. This meta-analysis has been performed to evaluate the neutrophil-to-lymphocyte ratio (NLR) at admission as a prognostic factor to predict severe coronavirus disease and mortality. Materials and methods: A literature search was conducted through April 30, 2021, to retrieve all published studies, including gray literature and preprints, investigating the association between NLR and severity or mortality in COVID-19 patients. Screening of studies and data extraction have been done by two authors independently. The methodological quality of the included studies was assessed by the Quality in Prognosis Studies (QUIPS) tool. Results: Twenty-four studies involving 4,080 patients reported the prognostic value of NLR for severe COVID-19. The pooled sensitivity (SEN), specificity (SPE), and area under the curve were 0.75 (95% CI 0.69-0.80), 0.74 (95% CI 0.70-0.78), and 0.81 (95% CI 0.77-0.84). Fifteen studies involving 4,071 patients reported the prognostic value of NLR for mortality in COVID-19. The pooled sensitivity (SEN), specificity (SPE), and area under curve were 0.80 (95% CI 0.72-0.86), 0.78 (95% CI 0.69-0.85), and 0.86 (95% CI 0.83-0.89). Conclusion: The prognostic value of NLR at admission for severity and mortality in patients with COVID-19 is good. Evaluating the NLR at admission can assist treating clinicians to identify early the cases likely to worsen. This would help to conduct early triage, identify potentially high-risk cases, and start optimal monitoring and management, thus reducing the overall mortality of COVID-19. Trial registry: This meta-analysis was prospectively registered on PROSPERO database (Registration Number: CRD42021247801). How to cite this article: Sarkar PG, Pant P, Kumar J, Kumar A. Does Neutrophil-to-lymphocyte Ratio at Admission Predict Severity and Mortality in COVID-19 Patients? A Systematic Review and Meta-analysis. Indian J Crit Care Med 2022;26(3):361-375.

Prevalence and patterns of coronary artery anomalies in 28,800 adult patients undergoing angiography in a large tertiary care centre in India.

Coronary artery anomalies (CAAs) are a diverse group of disorders with varied clinical presentation and pathophysiological mechanisms. A majority of these anomalies are asymptomatic and often an incidental finding on coronary angiogram or autopsy. This retrospective study included 28,800 patients who underwent coronary angiography from 2016 to 2020. The coronary angiograms were reviewed by two independent reviewers and CAAs were documented. CAAs were classified into i) anomalies of coronary artery connection, ii) anomalies of intrinsic coronary arterial anatomy and iii) anomalies of myocardial/coronary artery interaction as proposed by the European Society of Cardiology. Of the 28,800 coronary angiograms, CAAs were present in 4.12% with anomalies in the left coronary artery (LCA) being most common. Anomalies of coronary artery connection were most common (48.48%) followed by anomalies of myocardial/coronary artery interaction (34.49%) and anomalies of intrinsic coronary artery anatomy (17.03%). Among anomalies of coronary artery connection, absent left main trunk or split LCA with separate origins of left anterior descending coronary artery and left circumflex coronary artery from the left coronary sinus of Valsalva (22.59%) was most common. An intramural course or "myocardial bridge" had an incidence of 1.16%  while incidence of coronary artery fistulae (CAF) was 0.115%.

Restoration of vision by endovascular revascularization in Takayasu arteritis: A case series.

Takayasu arteritis (TA) is a rare, inflammatory vasculitis affecting aorta and its branches. Stenotic occlusive lesions of multiple arch arteries can cause severe cerebral ischemia leading to impaired vision. We present three consecutive young patients of TA with severe diminution of vision on upright posture, where we attempted restoration of sight by improving cerebral blood flow by percutaneous endovascular revascularization. All three patients could be successfully revascularized with substantial improvement in vision. There was no complication. On follow up, one patient developed recurrence of visual symptoms due to restenosis, which was successfully treated by cutting balloon angioplasty. The objective of this case series is to highlight the role of endovascular techniques in reversing visual loss in such situations. .

Tumor necrosis factor-alpha -308G/A gene polymorphism and novel biomarker profiles in patients with Takayasu arteritis.

BACKGROUND: Takayasu arteritis (TA) is an idiopathic chronic inflammatory disease of the aorta and its branches, leading to stenosis, occlusion, and aneurysmal dilatation. Tumor necrosis factor-alpha (TNF-α) is a cytokine with pleomorphic actions and plays a pivotal role in inflammation; the serum level of TNF-α is genetically determined. However, the literature lacks adequate information on the association of TNF-α polymorphisms with TA. Hence, the present study investigates the contribution of TNF-α polymorphism toward the complex etiology of TA. METHODS: A cross-sectional study was performed in 87 patients with TA and 90 controls. A promoter region polymorphism of TNF-α, rs1800629 G/A, or -308G/A was genotyped in all the study subjects followed by a case-control association study. Furthermore, to understand the biomarker profile, levels of specific markers such as erythrocyte sedimentation rate, serum high-sensitivity C-reactive protein, interleukin-18, interleukin-6, and TNF-α were measured in all the study subjects. RESULTS: All the inflammatory markers were significantly higher in the TA patients than in the controls. The genetic study (available for 57 TA patients and 36 controls) revealed that the TNF-α -308A allele was overrepresented in the TA patients (12% vs 7%). The TNF-α -308A allele correlated with the increased TNF-α levels, but it could not attain significance because of a small sample size. CONCLUSION: The TNF-α -308G/A polymorphism is associated with TNF-α levels in Indian population, which might have implications for clinical risk stratification and treatment. The different TNF-α gene promoter polymorphism might contribute to the molecular pathogenesis of TA. However, further study of the underlying mechanism is warranted.