Background: The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality. Materials: This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve. Results: Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (p Log-Rank ¼ 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR ¼ 6.9, 95% CI [2.0-24.1], p ¼ 0.002 and HR ¼ 6.2, 95% CI [2.1-18.3], p ¼ 0.001) respectively. Conclusion: This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor shortterm prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.
Coronavirus Disease 2019 is a very fast-spreading infectious disease. Severe forms are marked by a high mortality rate. The objective of this study is to identify routine biomarkers that can serve as early predictors of the disease progression. This is a prospective, single-center, cohort study involving 330 SARS-CoV-2 infected patients who were admitted at the University Hospital of Blida, Algeria in the period between the 27th of March and 22nd of April 2020. The ROC curve was used to evaluate the predictive performance of biomarkers, assessed at admission, in the early warning of progression toward severity. Multivariate logistic regression was used to quantify the independent risk for each marker. After an average follow-up period of 13.9 ± 3.5 days, 143 patients (43.3%) were classified as severe cases. Six biological abnormalities were identified as potential risk markers independently related to the severity: elevated urea nitrogen (>8.0 mmol/L, OR ¼ 9.3 [2.7-31.7], p < .00001), elevated CRP (>42mg/L, OR ¼ 7.5 [2.4-23.3], p ¼ .001), decreased natremia (<133. 6 mmol/L, OR ¼ 6.0 [2.0-17.4], p ¼ .001), decreased albumin (<33.5 g/L, OR ¼ 5.2 [1.7-16.6], p ¼ .003), elevated LDH (>367 IU/L, OR ¼ 4.9 [1.7-14.2], p ¼ .003) and elevated neutrophil to lymphocyte ratio (>7.99, OR ¼ 4.2, [1.4-12.2], p ¼ .009). These easy-to-measure, time-saving and very low-cost parameters have been shown to be effective in the early prediction of the COVID-19 severity. Their use at the early admission stage can improve the risk stratification and management of medical care resources in order to reduce the mortality rate.
Introduction/Objective: Sepsis is one of the leading causes of mortality in the intensive care unit (ICU). Its diagnosis is often complex and represents a real clinical challenge. The objective of this study was to evaluate the usefulness of procalcitonin (PCT) as a diagnostic marker of sepsis. Methods: This prospective cohort study included 65 patients hospitalized in the ICU. Demographic and clinical data were collected according to a specific information sheet. All patients underwent an inflammatory assessment including PCT, hypersensitive C -reactive protein (hsCRP), and complete blood count. The Sequential Organ Failure Assessment (SOFA) score was calculated. Patients were classified into septic (SOFA ≥ 2 points) and non-septic (SOFA < 2 points). The Receiver Operating Characteristic (ROC) curve was used to evaluate the diagnostic performance of inflammatory parameters. Results: Of 65 included patients, 46 had developed sepsis. Among the investigated inflammatory markers, PCT has the best discriminative capacity; its area under the curve (AUC), of 0.78, was the highest, followed by the neutrophils to lymphocytes ratio (NLR) and hsCRP with a lower but statically significant AUC. The optimal PCT threshold for sepsis diagnosis was 4.5ng/ml with a specificity of 83% and a sensitivity of 60%. A positive correlation between the PCT levels and the SOFA score was also found (p=0.002).
Conclusion:This study provides additional evidence of the performance of PCT in the diagnosis of septic states in patients admitted to ICU. The newly established cut-off value provides the best balance between specificity and sensitivity. Its superiority over conventional inflammatory markers has been demonstrated.
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