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1.
Biomed Res Int ; 2021: 9987931, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34423043

RESUMO

Objective: Respiratory failure is the leading cause of mortality in COVID-19 patients, characterized by a generalized disbalance of inflammation. The aim of this study was to investigate the relationship between immune-inflammatory index and mortality in PSI IV-V patients with COVID-19. Methods: We retrospectively reviewed the medical records of COVID-19 patients from Feb. to Apr. 2020 in the Zhongfa Xincheng Branch of Tongji Hospital, Wuhan, China. Patients who presented high severity of COVID-19-related pneumonia were enrolled for further analysis according to the Pneumonia Severity Index (PSI) tool. Results: A total of 101 patients diagnosed with COVID-19 were identified at initial research. The survival analysis revealed that mortality of the PSI IV-V cohort was significantly higher than the PSI I-III group (p = 0.0003). The overall mortality in PSI IV-V patients was 32.1% (9/28). The fatal cases of the PSI IV-V group had a higher level of procalcitonin (p = 0.022) and neutrophil-to-lymphocyte ratio (p = 0.033) compared with the survivors. Procalcitonin was the most sensitive predictor of mortality for the severe COVID-19 population with area under receiver operating characteristic curve of 0.78, higher than the neutrophil-to-lymphocyte ratio (0.75) and total lymphocyte (0.68) and neutrophil (0.67) counts. Conclusion: Procalcitonin and neutrophil-to-lymphocyte ratio may potentially be effective predictors for mortality in PSI IV-V patients with COVID-19. Increased procalcitonin and neutrophil-to-lymphocyte ratio were associated with greater risk of mortality.


Assuntos
COVID-19/imunologia , COVID-19/fisiopatologia , Pandemias , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , COVID-19/mortalidade , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Inflamação/imunologia , Inflamação/fisiopatologia , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pró-Calcitonina/sangue , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
2.
Diagn Microbiol Infect Dis ; 101(2): 115344, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34243136

RESUMO

Ventilator associated pneumonia(VAP) is a severe complication that can lead to high mortality when not early identified or when therapy is delayed. The aim of this study was to evaluate procalcitonin(PCT) as a biomarker for VAP development. In total, 73 hospitalized patients with COVID-19 were analyzed. PCT levels greater than 0.975ng/mL were more related to VAP. No association was found for C-reactive protein (CRP). The results show that procalcitonin may be a pertinent biomarker for VAP diagnosis and can be a helpful tool for antibiotic withdrawal.


Assuntos
Gestão de Antimicrobianos/métodos , COVID-19/diagnóstico , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pró-Calcitonina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Biomarcadores/sangue , COVID-19/complicações , COVID-19/tratamento farmacológico , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/complicações , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Curva ROC , SARS-CoV-2
3.
Mediators Inflamm ; 2021: 5593806, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34326704

RESUMO

Aim: To investigate the clinical significance of procalcitonin (PCT) elevation on hospital admission for coronavirus disease-19 (COVID-19) and its association with mortality in oldest old patients (age > 75 years). Methods: The clinical records of 1074 patients with chest high-resolution computed-tomography (HRCT) positive for interstitial pneumonia and symptoms compatible for COVID-19, hospitalized in medical wards during the first pandemic wave in a single academic center in Northern Italy, were retrospectively analyzed. All patients had serum PCT testing performed within six hours from admission. Information on COVID-19-related symptoms, comorbidities, drugs, autonomy in daily activities, respiratory exchanges, other routine lab tests, and outcomes were collected. Clinical characteristics were compared across different admission PCT levels and ages. The association of admission PCT with mortality was tested separately in participants aged > 75 and ≤75 years old by stepwise multivariate Cox regression model with forward selection. Results: With increasing classes of PCT levels (<0.05, 0.05-0.49, 0.5-1.99, and ≥2 ng/ml), there was a significant trend (P < 0.0001) towards older age, male gender, wider extension of lung involvement on HRCT, worse respiratory exchanges, and several other laboratory abnormalities. Each incremental PCT class was associated with increased risk of hospital death at multivariate models in subjects older than 75 (hazard ratio for PCT ≥ 2 vs. <0.05 ng/ml: 30.629, 95% confidence interval 4.176-224.645, P = 0.001), but not in subjects aged 75 or younger. Conclusions: In patients admitted for COVID-19, PCT elevation was associated with several clinical, radiological, and laboratory characteristics of disease severity. However, PCT elevation was strongly associated with hospital mortality only in oldest old subjects (age > 75).


Assuntos
COVID-19/sangue , COVID-19/mortalidade , Pró-Calcitonina/sangue , Pró-Calcitonina/genética , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Teste para COVID-19 , Comorbidade , Eletrocardiografia , Feminino , Mortalidade Hospitalar , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Admissão do Paciente , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Risco , Tomografia Computadorizada por Raios X
4.
Emerg Med J ; 38(9): 685-691, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34289966

RESUMO

BACKGROUND: Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED). METHODS: This is a substudy of a large observational cohort study (PredictED study). The PredictED included adult patients from whom a blood culture was drawn at the ED of Haga Teaching Hospital, The Netherlands. For this substudy, all patients who tested positive for SARS-CoV-2 by PCR in March and April 2020 were included. The primary outcome was the incidence of bacterial coinfection. We used logistic regression analysis for associations of procalcitonin, C reactive protein (CRP), ferritin, lymphocyte count and PSI score with a severe disease course, defined as intensive care unit admission and/or 30-day mortality. The area under the receiver operating characteristics curve (AUC) quantified the discriminatory performance. RESULTS: We included 142 SARS-CoV-2 positive patients. On presentation, the median duration of symptoms was 8 days. 41 (29%) patients had a severe disease course and 24 (17%) died within 30 days. The incidence of bacterial coinfection was 2/142 (1.4%). None of the blood cultures showed pathogen growth while 6.3% was contaminated. The AUCs for predicting severe disease were 0.76 (95% CI 0.68 to 0.84), 0.70 (0.61 to 0.79), 0.62 (0.51 to 0.74), 0.62 (0.51 to 0.72) and 0.72 (0.63 to 0.81) for procalcitonin, CRP, ferritin, lymphocyte count and PSI score, respectively. CONCLUSION: Blood cultures appear to have limited value while procalcitonin and the PSI appear to be promising tools in helping physicians identify patients at risk for severe disease course in COVID-19 at presentation to the ED.


Assuntos
Infecções Bacterianas/diagnóstico , Técnicas Bacteriológicas/métodos , COVID-19/diagnóstico , Coinfecção/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/sangue , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Técnicas Bacteriológicas/estatística & dados numéricos , Proteína C-Reativa/análise , COVID-19/sangue , COVID-19/complicações , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Coinfecção/sangue , Coinfecção/epidemiologia , Coinfecção/microbiologia , Serviço Hospitalar de Emergência , Feminino , Ferritinas/sangue , Humanos , Incidência , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pró-Calcitonina/sangue , Prognóstico , Curva ROC , Estudos Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença
5.
Int Immunopharmacol ; 98: 107838, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303274

RESUMO

Since February-2020, the world has been battling a tragic public-health crisis with the emergence and spread of 2019-nCoV. Due to the lack of information about the pathogenesis-specific treatment of Covid-19, early diagnosis and timely treatment are important. However, there is still a lack of information about routine-blood-parameteres (RBP) findings and effects in the disease process. Although the literature includes various interventions, existing studies need to be generalized and their reliability improved. In this study, the efficacy of routine blood values used in the diagnosis and prognosis of Covid-19 and independent biomarkers obtained from them were evaluated retrospectively in a large patient group. Low lymphocyte (LYM) and white-blood-cell (WBC), high CRP and Ferritin were effective in the diagnosis of the disease. The (d-CWL) = CRPWBC∗LYM and (d-CFL) = CRP∗FerritinLYM biomarkers derived from them were the most important risk factors in diagnosing the disease and were more successful than direct RBP values. High d-CWL and d-CFL values largely confirmed the Covid-19 diagnosis. The most effective RBP in the prognosis of the disease was CRP. (d-CIT) = CRP*INR*Troponin; (d-CT) = CRP*Troponin; (d-PPT) = PT*Troponin*Procalcitonin biomarkers were found to be more successful than direct RBP values and biomarkers used in previous studies in the prognosis of the disease. In this study, biomarkers derived from RBP were found to be more successful in both diagnosis and prognosis of Covid-19 than previously used direct RBP and biomarkers.


Assuntos
Biomarcadores/sangue , Plaquetas , Teste para COVID-19 , COVID-19/diagnóstico , Linfócitos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , COVID-19/sangue , COVID-19/imunologia , Feminino , Ferritinas/sangue , Humanos , Coeficiente Internacional Normatizado , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Pró-Calcitonina/sangue , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Troponina/sangue , Adulto Jovem
6.
Breast ; 59: 102-109, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34225090

RESUMO

BACKGROUND: The COVID-19 pandemic is a significant worldwide health crisis. Breast cancer patients with COVID-19 are fragile and require particular clinical care. This study aimed to identify the clinical characteristics of breast cancer patients with COVID-19 and the risks associated with anti-cancer treatment. METHODS: The medical records of breast cancer patients with laboratory-confirmed COVID-19 were collected among 9559 COVID-19 patients from seven designated hospitals from 13th January to 18th March 2020 in Hubei, China. Univariate and multivariate analyses were performed to assess risk factors for COVID-19 severity. RESULTS: Of the 45 breast cancer patients with COVID-19, 33 (73.3%) developed non-severe COVID-19, while 12 (26.7%) developed severe COVID-19, of which 3 (6.7%) patients died. The median age was 62 years, and 3 (6.7%) patients had stage IV breast cancer. Univariate analysis showed that age over 75 and the Eastern Cooperative Oncology Group (ECOG) score were associated with COVID-19 disease severity (P < 0.05). Multivariate analysis showed that patients who received chemotherapy within 7 days had a significantly higher risk for severe COVID-19 (logistic regression model: RR = 13.886, 95% CI 1.014-190.243, P = 0.049; Cox proportional hazards model: HR = 13.909, 95% CI 1.086-178.150, P = 0.043), with more pronounced neutropenia and higher LDH, CRP and procalcitonin levels than other patients (P < 0.05). CONCLUSIONS: In our breast cancer cohort, the severity of COVID-19 could be associated with baseline factors such as age over 75 and ECOG scores. Chemotherapy within 7 days before symptom onset could be a risk factor for severe COVID-19, reflected by neutropenia and elevated LDH, CRP and procalcitonin levels.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , COVID-19/diagnóstico , Neutropenia/etiologia , SARS-CoV-2/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Neoplasias da Mama/mortalidade , Proteína C-Reativa , China/epidemiologia , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Pessoa de Meia-Idade , Neutropenia/epidemiologia , Pandemias , Pró-Calcitonina/sangue , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
7.
J Virol Methods ; 296: 114224, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34214571

RESUMO

INTRODUCTION: We evaluated the Roche Elecsys IL6 assay on the Cobas immunoassay analyser. METHOD: Serum IL6 of 144 controls were compared to 52 samples from patients with COVID-like respiratory symptoms (17 SARS-CoV-2 RT-PCR positive); 25 of these were from the intensive care unit (ICU). We compared the IL6 levels to C-reactive protein (CRP) and procalcitonin (PCT) levels in all cases. RESULTS: The IL6 assay had coefficient-of-variation (CV) of 2.3 % (34.1 pg/mL) and 2.5 % (222.5 pg/mL), a limit of quantitation <1.6 pg/mL, and was linear from 1.6 to 4948 pg/mL. There was a significant difference in IL6 values between patients with COVID-like respiratory symptoms versus controls (p < 0.001). ROC analysis showed that IL6 > 6.4 pg/mL identified symptomatic cases (AUC 0.94, sensitivity 88.2 %, specificity 97.2 %). There was a significant difference between the IL6 of symptomatic ICU/non-ICU cases (median IL6 228 vs 11 pg/mL, p < 0.0001); ROC analysis showed IL6 > 75 pg/mL (sensitivity 76.0 %, specificity 88.9 %) was superior to CRP and PCT in predicting ICU admission (AUC: IL6 0.83, CRP 0.71, PCT 0.82). CONCLUSION: The performance of Elecsys IL6 assay is in keeping with the manufacturer's claims. IL6 > 6.4 pg/mL differentiates healthy from suspected COVID-19 cases and appears to be raised earlier than the other inflammatory markers in some cases. IL6 > 75 pg/mL was a good predictor of ICU admission.


Assuntos
Teste Sorológico para COVID-19/métodos , COVID-19/imunologia , Interleucina-6/imunologia , SARS-CoV-2/imunologia , Biomarcadores/sangue , Proteína C-Reativa/imunologia , Feminino , Humanos , Imunoensaio , Testes Imunológicos , Unidades de Terapia Intensiva , Interleucina-6/sangue , Masculino , Pró-Calcitonina/sangue , Pró-Calcitonina/imunologia , Curva ROC , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade
8.
Nutrients ; 13(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34207873

RESUMO

BACKGROUND AND AIMS: Vitamin D inadequacy may be involved in the mechanisms of SARS-CoV-2 infection and in potential risk factors for disease propagation or control of coronavirus disease 2019 (COVID-19). This study assessed a short-term evolution of vitamin D status and its influence upon different clinical parameters in critically ill patients with COVID-19. METHODS: A prospective analytical study in which 37 critically ill volunteers between 41 and 71 years of age with COVID-19 were evaluated at baseline and three days of intensive care unit (ICU) stay. 25-OH-D3 and 25-OH-D2 were analyzed by liquid chromatography-tandem mass spectrometry and total 25-OH-D levels were calculated as the sum of both. RESULTS: All patients presented low 25-OH-D levels at baseline, decreasing total 25-OH-D (p = 0.011) mainly through 25-OH-D2 (p = 0.006) levels during ICU stay. 25-OH-D2 levels decreased a mean of 41.6% ± 89.6% versus 7.0% ± 23.4% for the 25-OH-D3 form during the ICU stay. Patients who did not need invasive mechanical ventilation presented higher levels of 25-OH-D2 at baseline and follow-up. Lower 25-OH-D and 25-OH-D3 levels were associated with higher D-dimer at baseline (p = 0.003; p = 0.001) and at follow up (p = 0.029), higher procalcitonin levels (p = 0.002; p = 0.018) at follow up, and lower percentage lymphocyte counts (p = 0.044; p = 0.040) during ICU stay. CONCLUSIONS: Deficient vitamin D status in critical patients was established at the admission and further worsened after three days of stay. Lower vitamin D levels were related to key altered clinical and biochemical parameters on patients with SARS-CoV-2 infection. Given the different response of the 25-OH-D3 and 25-OH-D2 forms, it would be useful to monitor them on the evolution of the critically ill patient.


Assuntos
COVID-19 , Estado Terminal , Hospitalização , Unidades de Terapia Intensiva , Índice de Gravidade de Doença , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Idoso , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/mortalidade , Cromatografia Líquida , Progressão da Doença , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Prognóstico , Estudos Prospectivos , SARS-CoV-2 , Deficiência de Vitamina D/sangue
9.
Emerg Med Clin North Am ; 39(3): 627-639, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215406

RESUMO

Pediatric fever is a common complaint in children. The most common cause is self-limited viral infection. However, neonates and young infants are evaluated and treated differently than older, vaccinated, and clinically evaluable children. Neonates should be admitted to the hospital, young infants in the second month of life may be risk stratified, and those deemed low risk on testing may be sent home with close follow-up. Children older than 2 months may be evaluated clinically for signs of bacterial infection that require intervention. Urinary tract infections cause more than 90% of serious bacterial illness in children, and younger children have a higher incidence of infection.


Assuntos
Febre/etiologia , Febre/terapia , Medicina de Emergência Pediátrica , Algoritmos , Anemia Falciforme/complicações , Antibacterianos/uso terapêutico , Antipiréticos/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Criança , Febre/diagnóstico , Humanos , Incidência , Doenças do Prematuro/diagnóstico , Infecções/diagnóstico , Infecções/tratamento farmacológico , Neutropenia/complicações , Pró-Calcitonina/sangue , Medição de Risco
10.
Medicine (Baltimore) ; 100(27): e26555, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232197

RESUMO

BACKGROUND: The patient suffering from urinary sepsis is often accompanied by elevated serum procalcitonin (PCT) levels and a decline in the average platelet count (PLT), which could result in a poor prognosis. This study aimed to evaluate the value of PCT and PLT in determining the severity of urinary sepsis. METHODS: A total of 120 urosepsis patients enrolled were divided into a survival group and a death group, respectively, according to their status within 14 days after admission. Changes in PCT and PLT levels between the 2 groups were compared at different time points. A receiver operating characteristic (ROC) curve was eventually obtained to predict the prognostic value of PCT and PLT. RESULTS: The PCT levels in the survival group declined gradually after admission, and the PLT decreased at first but increased rapidly in subsequence. The PCT level in the death group, however, declined in a flat-slope trend or was hardly noticeable together with the number of PLT reduced significantly. In particular, it is on the 3rd day that PCT tended to positively correlate with acute physiological and chronic health score II (APACHE II) score (r = 0.730, P < .05), but negatively with PLT (r = 0.472, P < .05). The APACHE II score and PLT (r = 0.612, P < .05) were also negatively correlated with each other. As indicated by the ROC curve, the PCT level on the 3rd day after admission was of great value for the clinical mortality prognosis, and the area under the curve was 0.858. Moreover, PLT also has a high predictive value for prognosis. Area under the curve is 0.951. When the PLT was more than 51 × 109 /L, the sensitivity was up to 90%, and the specificity was 90%. CONCLUSION: PLT and PCT levels are closely related to the APACHE II score, which could indicate the severity of urosepsis in patients. The contribution of this study was to confirm that dynamic monitoring of the changes in PCT and PLT helps determine the prognosis of urosepsis patients.


Assuntos
Plaquetas/patologia , Pró-Calcitonina/sangue , Sepse/sangue , Infecções Urinárias/sangue , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Sepse/etiologia , Infecções Urinárias/etiologia
11.
Sci Rep ; 11(1): 14094, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238962

RESUMO

We aimed to provide a laboratory basis for differential diagnosis of COVID-19 and severe fever with thrombocytopenia syndrome (SFTS). Clinical data were collected from 32 COVID-19 patients (2019-nCoV group), 31 SFTS patients (SFTS group) and 30 healthy controls (control group). For each group of hospitalized patients, a retrospective analysis was performed on specific indices, including cytokines, T-lymphocyte subsets, routine blood parameters, C-reactive protein (CRP) and procalcitonin (PCT), and receiver operating characteristic (ROC) curves for the indices revealed the differences among groups. Compared with the 2019-nCoV group, the SFTS group had a significantly and greatly decreased counts of WBC, absolute lymphocyte, PLT and absolute CD4+ T lymphocyte (P < 0.05); the IL-6, TNF-α, D-D and PCT levels of the SFTS group were higher than those of the 2019-nCoV group (P < 0.05). Compared with those of the SFTS group, the CRP and FIB levels of the 2019-nCoV group were greatly increased (P < 0.05). The ROC curves showed that area under the curves (AUCs) for FIB, PLT and TNF-α were greater than 0.85, demonstrating high diagnostic value. At the initial stage of SARS-CoV-2 or SFTS virus infection, PLT, FIB and TNF-α have definitive clinical value for the early and differential diagnosis of these two infections.


Assuntos
Biomarcadores/sangue , COVID-19/diagnóstico , Phlebovirus , SARS-CoV-2 , Febre Grave com Síndrome de Trombocitopenia/diagnóstico , Área Sob a Curva , Proteína C-Reativa , COVID-19/virologia , Diagnóstico Diferencial , Humanos , Contagem de Linfócitos , Pró-Calcitonina/sangue , Curva ROC , Estudos Retrospectivos , Febre Grave com Síndrome de Trombocitopenia/virologia , Fator de Necrose Tumoral alfa/sangue
12.
Int J Mol Sci ; 22(13)2021 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-34199069

RESUMO

Acute kidney injury (AKI) is a common yet complicated clinical entity with high morbidity and mortality. An essential strategy to improve AKI patients' prognoses is finding optimal biomarkers to identify AKI in a timely manner. Procalcitonin (PCT), a well-recognized biomarker for diagnosing infection and guiding antibiotics therapy, has been proposed to predict AKI development and recovery in many clinical settings. The current review provides comprehensive and updated information from relevant studies to evaluate PCT's AKI-predictive ability and the influence of infection on this predictive ability. PCT has demonstrated optimal predictive ability for AKI in various populations irrespective of infection. However, the predictive ability seems to be blunted by infection since infection and inflammation have a more potent influence than AKI on PCT elevation. We furthermore explain the complicated association between elevated PCT levels and AKI in infection and inflammation situations and recommend directions for further investigations to clarify the essential issue. In conclusion, although conflicting data exist, serum PCT level is a potential biomarker for predicting AKI in many clinical settings regardless of infection. Nevertheless, further studies are warranted to clarify the association between PCT, infection, and AKI and to confirm the utilization of PCT for AKI prediction.


Assuntos
Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Biomarcadores , Pró-Calcitonina/sangue , Injúria Renal Aguda/etiologia , Suscetibilidade a Doenças , Humanos , Testes de Função Renal , Prognóstico , Sepse/sangue
13.
Medicine (Baltimore) ; 100(22): e26131, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087864

RESUMO

ABSTRACT: To evaluate the development of coronavirus disease 2019 (COVID-19), the roles of interleukin 6 (IL-6) and procalcitonin (PCT) were assessed to diagnose severe COVID-19.Between January and February 2020, 100 consecutive patients with confirmed COVID-19 were included and divided into common (n = 56), severe (n = 28), and critical (n = 16) groups.IL-6 and PCT levels were assayed and compared among groups. IL-6 levels were significantly different among groups (common, 23.93±9.64 pg/mL; severe, 69.22 ±â€Š22.98 pg/mL; critical, 160.34 ±â€Š26.15 pg/mL; P < .05), and there was also a significant difference in the levels of PCT among groups (common, 0.23 ±â€Š0.13 ng/mL; severe, 0.38 ±â€Š0.16 ng/mL; critical, 0.73 ±â€Š0.36 ng/mL; P < .05). Further analysis showed that patients in the critical group had the highest levels of IL-6 and PCT, and those in the common group had the lowest levels (all P < .05).IL-6 and PCT are associated with the severity of COVID-19, and thus have potential value in the diagnosis of COVID-19.


Assuntos
COVID-19/sangue , Interleucina-6/sangue , Pró-Calcitonina/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Adulto Jovem
14.
J Laryngol Otol ; 135(8): 723-728, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34184623

RESUMO

OBJECTIVE: To analyse the correlations between olfactory psychophysical scores and the serum levels of D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio in coronavirus disease 2019 patients. METHODS: Patients underwent psychophysical olfactory assessment with the Connecticut Chemosensory Clinical Research Center test, and determination of blood serum levels of the inflammatory markers D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio within 10 days of the clinical onset of coronavirus disease 2019 and 60 days after. RESULTS: Seventy-seven patients were included in this study. D-dimer, procalcitonin, ferritin and neutrophil-to-lymphocyte ratio correlated significantly with severe coronavirus disease 2019. No significant correlations were found between baseline and 60-day Connecticut Chemosensory Clinical Research Center test scores and the inflammatory markers assessed. CONCLUSION: Olfactory disturbances appear to have little prognostic value in predicting the severity of coronavirus disease 2019 compared to D-dimer, ferritin, procalcitonin and neutrophil-to-lymphocyte ratio. The lack of correlation between the severity and duration of olfactory disturbances and serum levels of inflammatory markers seems to further suggest that the pathogenetic mechanisms underlying the loss of smell in coronavirus disease 2019 patients are related to local rather than systemic inflammatory factors.


Assuntos
COVID-19/patologia , Transtornos do Olfato/etiologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , COVID-19/sangue , COVID-19/complicações , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Inflamação/sangue , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/sangue , Transtornos do Olfato/patologia , Pró-Calcitonina/sangue , Índice de Gravidade de Doença
15.
Hemoglobin ; 45(2): 124-128, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34162301

RESUMO

This study aimed to examine the relationship between Hb A1c levels and the clinical course of coronavirus-19 (COVID-19) patients. Sixty-six COVID-19(+) patients with high Hb A1c and 46 with average Hb A1c and 30 COVID-19(-) patients with average Hb A1c were included. Hb A1c levels and parameters examined in COVID-19(+) patients were compared between groups, and correlation analysis was performed between these parameters and Hb A1c levels. The effect of Hb A1c levels on intensive care unit (ICU) admission and mortality rate in COVID-19 patients was analyzed with the χ2 test. It was observed that hemoglobin (Hb) and arterial oxygen saturation (SaO2) levels of the COVID-19 (+) groups was lower than the COVID-19 (-) group, while ferritin, D-dimer, procalcitonin (PCT), and C-reactive protein (CRP) levels were higher. The COVID-19 (+) group with high Hb A1c had higher lactate dehydrogenase (LDH), PCT and D-dimer levels than the other two groups, while Hb, partial arterial oxygen pressure (PaO2) levels were lower. The Hb A1c levels of the COVID-19 (+) groups were positively correlated with absolute neutrophil count (ANC), LDH, PCT and (K+) levels, while negatively correlated with Hb and PaO2 levels. Hb A1c was found to be associated with the inflammation process, coagulation disorders and low PaO2 in COVID-19 patients. The COVID-19 patients with high Hb A1c levels had a higher mortality rate than other COVID-19 patients. Using Hb A1c measurements with other prognostic markers would contribute to the patient's risk of death assessment.


Assuntos
COVID-19/sangue , Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Hiperglicemia/sangue , SARS-CoV-2 , Adulto , Idoso , Sedimentação Sanguínea , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/mortalidade , Cuidados Críticos/estatística & dados numéricos , Complicações do Diabetes/sangue , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiperglicemia/etiologia , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oxigênio/sangue , Pressão Parcial , Pró-Calcitonina/sangue , Prognóstico , Risco , Índice de Gravidade de Doença , Trombofilia/sangue , Trombofilia/etiologia
16.
Int J Biol Sci ; 17(8): 2124-2134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34131411

RESUMO

The efficacy of tocilizumab on the prognosis of severe/critical COVID-19 patients is still controversial so far. We aimed to delineate the inflammation characteristics of severe/critical COVID-19 patients and determine the impact of tocilizumab on hospital mortality. Here, we performed a retrospective cohort study which enrolled 727 severe or critical inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Huoshenshan Hospital (Wuhan, China), among which 50 patients received tocilizumab. This study confirmed that most recovered patients manifested relatively normal inflammation levels at admission, whereas most of the deceased cases presented visibly severe inflammation at admission and even progressed into extremely aggravated inflammation before their deaths, proved by some extremely high concentrations of interleukin-6, procalcitonin, C-reactive protein and neutrophil count. Moreover, based on the Cox proportional-hazards models before or after propensity score matching, we demonstrated that tocilizumab treatment could lessen mortality by gradually alleviating excessive inflammation and meanwhile continuously enhancing the levels of lymphocytes within 14 days for severe/critical COVID-19 patients, indicating potential effectiveness for treating COVID-19.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19/tratamento farmacológico , Inflamação/tratamento farmacológico , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , COVID-19/sangue , COVID-19/mortalidade , COVID-19/fisiopatologia , Comorbidade , Feminino , Humanos , Inflamação/sangue , Interleucina-6/sangue , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Pró-Calcitonina/sangue , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos
18.
J Cardiothorac Surg ; 16(1): 147, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044847

RESUMO

BACKGROUND: Up to 30% or even more of all infective endocarditis (IE) cases are recognized as blood culture negative, meaning that the causative agent is left unidentified. The prompt diagnosis together with the identification of causative microorganism and targeted antibiotic treatment can significantly impact the prognosis of the disease and further patient's health status. In some studies, blood culture negative endocarditis has been shown to be associated with delayed diagnosis, worse outcome and course of the disease, and a greater number of intra and postoperative complications. METHODS: We retrospectively analysed the medical records of all patients who underwent cardiac surgery for endocarditis between years 2016 and 2019. The aim of this study was to analyse short and long-term mortality and differences of laboratory, clinical and echocardiography parameters in patients with blood culture positive endocarditis (BCPE) and blood culture negative endocarditis (BCNE) and its possible impact on the clinical outcome. RESULTS: In our study population were 114 (55.1%) blood culture positive and 93 (44.9%) blood culture negative cases of infectious endocarditis. The most common pathogens in the blood culture positive IE group were S.aureus in 36 cases (31.6%), Streptococcus spp. in 27 (23.7%), E.faecalis in 24 (21.1%), and other microorganisms in 27 (23.7%). Embolic events were seen in 60 patients (28.9%). In univariate analyses, detection of microorganism, elevated levels of procalcitonin were found to be significantly associated with intrahospital death, however it did not reach statistical significance in multivariate analyses. Among microorganisms, S.aureus was significantly associated with intrahospital death in both univariate and multivariate analyses. CONCLUSIONS: There are no statistically significant differences between groups of BCPE and BCNE in terms of intrahospital mortality, hospital and ICU stay or 3-year mortality. There were higher levels of procalcitonin in BCPE group, however procalcitonin failed to show independent association with mortality in multivariate analysis. The most common microorganism in the BCPE group was S.aureus. It was associated with independently higher intrahospital mortality when compared to other causative microorganisms.


Assuntos
Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Adulto , Idoso , Hemocultura , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
19.
J Med Virol ; 93(9): 5405-5408, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33932304

RESUMO

The new type of coronavirus could cause severe acute respiratory syndrome and injuries in other systems as well. Multiple organ damage can occur rapidly in patients infected with coronavirus disease 2019 (COVID-19). Previous studies have shown that many laboratory biomarkers were not within the normal ranges in COVID-19 patients. We aimed to summarize laboratory parameters and the tumor markers in COVID-19 patients. This is a retrospective cohort study conducted on 53 women between the ages of 19-85 years infected with COVID-19 at a training and research hospital between May 2020 and August 2020. Of the 53 women, 16 (30.2%) had leukopenia. The mean C-reactive protein level was 18.42 ± 59.33 mg/L. The mean procalcitonin level was 0.1 ± 0.21 µg/L. The liver function tests were within normal limits. The mean creatinine level was 0.58 ± 0.37 mg/dl. Elevated levels of α-fetoprotein (AFP) in 1 patient, elevated levels of carcinoembryonic antigen (CEA) in 2 patients, elevated levels of cancer antigen 125 (CA125) in 4 patients, elevated levels of CA19-9 in 2 patients, and elevated levels of CA15-3 in 2 patients were detected. One of 4 patients who were taken to the intensive care unit had elevated levels of AFP. In addition, 2 of 4 patients who were taken to the intensive care unit had elevated levels of CA125 and CA15-3. Except for AFP, levels of all tumor markers of the patient who died were high. We found that COVID-19 had no effect on tumor markers (CA125, CA19-9, CA15-3, AFP, and CEA).


Assuntos
Antígeno Ca-125/sangue , Antígeno CA-19-9/sangue , COVID-19/sangue , Antígeno Carcinoembrionário/sangue , Leucopenia/sangue , Mucina-1/sangue , Pandemias , alfa-Fetoproteínas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Proteína C-Reativa/metabolismo , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Leucopenia/diagnóstico , Leucopenia/virologia , Linfócitos/virologia , Pessoa de Meia-Idade , Neutrófilos/virologia , Pró-Calcitonina/sangue , Estudos Retrospectivos , SARS-CoV-2/crescimento & desenvolvimento , SARS-CoV-2/patogenicidade , Troponina/sangue , Turquia/epidemiologia
20.
J Med Virol ; 93(9): 5474-5480, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33963559

RESUMO

In this study, laboratorial parameters of hospitalized novel coronavirus (COVID-19) patients, who were complicated with severe pneumonia, were compared with the findings of cytokine storm developing in macrophage activation syndrome (MAS)/secondary hemophagocytic lymphohistiocytosis (sHLH). Severe pneumonia occurred as a result of cytokine storm in some patients who needed intensive care unit (ICU), and it is aimed to determine the precursive parameters in this situation. Also in this study, the aim is to identify laboratory criteria that predict worsening disease and ICU intensification, as well as the development of cytokine storm. This article comprises a retrospective cohort study of patients admitted to a single institution with COVID-19 pneumonia. This study includes 150 confirmed COVID-19 patients with severe pneumonia. When they were considered as severe pneumonia patients, the clinic and laboratory parameters of this group are compared with H-score criteria. Patients are divided into two subgroups; patients with worsened symptoms who were transferred into tertiary ICU, and patients with stable symptoms followed in the clinic. For the patients with confirmed COVID-19 infection, after they become complicated with severe pneumonia, lymphocytopenia (55.3%), anemia (12.0%), thrombocytopenia (19.3%), hyperferritinemia (72.5%), hyperfibrinogenemia (63.7%) and elevated lactate dehydrogenase (LDH) (90.8%), aspartate aminotransaminase (AST) (31.3%), alanine aminotransaminase (ALT) (20.7%) are detected. There were no significant changes in other parameters. Blood parameters between the pre-ICU period and the ICU period (in which their situation had been worsened and acute respiratory distress syndrome [ARDS] was developed) were also compared. In the latter group lymphocyte levels were found significantly reduced (p = 0.01), and LDH, highly sensitive troponin (hs-troponin), procalcitonin, and triglyceride levels were significantly increased (p < 0.05). In addition, there was no change in hemoglobin, leukocyte, platelet, ferritin, and liver function test levels, including patients who developed ARDS, similar to the cytokine storm developed in MAS/sHLH. COVID-19 pneumonia has similar findings as hyperinflammatory syndromes but does not seem to have typical features as in cytokine storm developed in MAS/sHLH. In the severe patient group who has started to develop ARDS signs, a decrease in lymphocyte level in addition to the elevated LDH, hs-troponin, procalcitonin, and triglyceride levels can be a predictor in progression to ICU admission and could help in the planning of anti-cytokine therapy.


Assuntos
COVID-19/patologia , Síndrome da Liberação de Citocina/patologia , Linfo-Histiocitose Hemofagocítica/patologia , Síndrome de Ativação Macrofágica/patologia , SARS-CoV-2/patogenicidade , Idoso , Alanina Transaminase/sangue , Anemia/sangue , Anemia/diagnóstico , Anemia/imunologia , Anemia/patologia , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/imunologia , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/imunologia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Fibrinogênio/metabolismo , Humanos , Hiperferritinemia/sangue , Hiperferritinemia/diagnóstico , Hiperferritinemia/imunologia , Hiperferritinemia/patologia , Unidades de Terapia Intensiva , L-Lactato Desidrogenase/sangue , Linfo-Histiocitose Hemofagocítica/sangue , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/imunologia , Linfopenia/sangue , Linfopenia/diagnóstico , Linfopenia/imunologia , Linfopenia/patologia , Síndrome de Ativação Macrofágica/sangue , Síndrome de Ativação Macrofágica/diagnóstico , Síndrome de Ativação Macrofágica/imunologia , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Estudos Retrospectivos , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Trombocitopenia/imunologia , Trombocitopenia/patologia , Triglicerídeos/sangue , Troponina/sangue
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