Accuracy of routine biomarkers and blood leucocytes count to assist diagnosis of COVID-19-associated pneumonia in adult patients visiting the emergency department

Maincent, Cécile; Berthier, F.; Farhad, Ryan Lukas; Fissore-Magdelein, C.; Dittlot, Claire; Beau, Nathalie; Lépine, Jérémy; Lorillou, Marjorie; Dietz, Matthieu; Liberatore, M.; Pathak, Atul; Faraggi, Marc; Chaillou-Orpitz, Sylvie; Keïta-Perse, Olivia; Chironi, Gilles; Perrin, Christophe; Claessens, Yann-Érick

doi:10.21203/rs.3.rs-34817/v1

“…We retrospectively analyzed medical charts of adult patients visiting the ED of a general hospital center (Princess Grace Hospital, Monaco) with an ED diagnosis of CAP. Adults were enrolled from 1 January 2015 to 30 June 2020, as our geographical area mostly escaped the first wave of the COVID-19 pandemic [ 9 ]. No funding was obtained for this study.…”

Section: Methodsmentioning

confidence: 99%

Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency

Claessens¹,

Berthier²,

Baqué-Juston³

et al. 2022

European Journal of Emergency Medicine

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Chest CT-scan (CT) exceeds chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) but actual use and results remain unclear. We examine whether CT performed at ED visit improved ED diagnosis of CAP as compared to a final diagnosis of CAP at hospital discharge (gold standard diagnosis for the study), and how it impacts relevant clinical outcomes. This retrospective monocenter observational study was based on the analysis of the hospital database. Patients with a diagnosis of CAP in the ED (ICD-10 codes: J110, J111, from J12-to J18-, J440, J690, U0710, and U0711) were included. We compared ED patients who were diagnosed with CAP using CXR and CT. We measured diagnostic consistency, duration of ED visit, percentage of CXR and CT during hospital stay, hospital length-ofstay, ICU admission, and in-hospital mortality. Multivariate analysis was adjusted for CRB65 score by multiple logistic regression analysis for binary outcomes and by multivariate analysis of variance for continuous outcomes. We included 994 ED patients with an initial diagnosis of CAP (751 receiving CXR, 243 receiving CT). CT prescription in the ED increased over time (P < 0.001). In patients admitted after ED, CT improved diagnosis consistency for CAP [88.2% vs. 80.9%; difference 7.3% (95% confidence interval 1.2-13.3%)] with a trend for lower hospital length-of-stay [10.2 vs. 12.2 days; difference −2.0 (95% confidence interval −3.9 to −0.1)], but not ICU admission (P = 0.09) and in-hospital mortality (P = 0.056). Diagnosis of patients admitted with CAP improved when CT was obtained at ED visit. These results should be reproduced at a larger scale to test whether early CT conserves healthcare resources.

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“…COVID-19 was confirmed according to the World Health Organization (WHO) guidance 15 by a positive result of reverse transcription-polymerase chain reaction (RT-PCR) assay of nasal swabs, peripheral pulmonary ground-glass opacities (GGO), or air-space consolidation on their chest CT scan at admission and suggestive common laboratory findings. 16 Patients could not be included if their medical condition was unstable, if they were under mechanical ventilation or required critical care unit, in case of clinical evidence for lung superinfection or heart failure or in case of a pregnancy. Personal protective equipment was available for the staff, and all measures to ensure strict infection prevention were observed according to established guidance.…”

Section: Methodsmentioning

confidence: 99%

Microvascular injuries, secondary edema, and inconsistencies in lung vascularization between affected and nonaffected pulmonary segments of non-critically ill hospitalized COVID-19 patients presenting with clinical deterioration

Maincent

¹

,

Perrin

²

,

Chironi

³

et al. 2022

Ther Adv Respir Dis

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Purpose: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement without any identified worsening factors. Methods: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular dysfunction and for whom a pulmonary embolism was discarded by computed tomography (CT) pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 h later, left and right ventricular function by Tc-99m-labeled albumin-gated blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. Results: We included 20 patients with confirmed SARS-CoV-2 pneumonia. All had CT evidence of organizing pneumonia and normal left ventricular ejection fraction. No patient demonstrated preserved ventilation with perfusion defect (mismatch), which may discard a distal lung thrombosis. Patterns of ventilation and perfusion were heterogeneous in seven patients (35%) with healthy lung segments presenting a relative paradoxical hypoperfusion and hypoventilation compared with segments with organizing pneumonia presenting a relative enhancement in perfusion and preserved ventilation. Lung albumin retention in area of organizing pneumonia was observed in 12 patients (60%), indicating microvascular injuries, increase in vessel permeability, and secondary edema. Conclusion: In hospitalized non-critically ill patients without evidence of superinfection, pulmonary embolism, or cardiac dysfunction, various types of damage may contribute to clinical deterioration including microvascular injuries and secondary edema, inconsistencies in lung segments vascularization suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others. Summary Statement Microvascular injuries and dysregulation of the balance in perfusion between segments affected by COVID-19 and others are present in non-critically ill patients without other known aggravating factors. Key Results In non-critically ill patients without evidence of superinfection, pulmonary embolism, macroscopic distal thrombosis or cardiac dysfunction, various types of damage may contribute to clinical deterioration including 1/ microvascular injuries and secondary edema, 2/ inconsistencies in lung segments vascularization with hypervascularization of consolidated segments contrasting with hypoperfusion of not affected segments, suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others.

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“…COVID-19 was con rmed according to the WHO guidance [13] by a positive result of RT-PCR assay of nasal and pharyngeal swabs, peripheral pulmonary ground-glass opacities (GGO) or air-space consolidation on their chest CT scan at admission and common laboratory ndings including lymphocytopenia, eosinopenia, signi cantly elevated markers of organ in ammation such as brinogen and C-reactive protein [14]. Patients could not be included if their medical condition was unstable or precluded a safe transfer to the nuclear medicine department, if they were under mechanical ventilation (either non-invasive or invasive), if they required critical care unit, or in case of a pregnancy.…”

Section: Patientsmentioning

confidence: 99%

Microvascular Injury With Secondary Edema, Bronchoconstriction and Vasoconstriction of Non-involved Lung Parenchymal Segments May Contribute to Clinical Deterioration of Non-critically Ill Patients Hospitalized for SARS-CoV-2 Pneumonia Without Evidence of Pulmonary Embolism: A Preliminary Study.

Maincent

¹

,

Perrin

²

,

Chironi

³

et al. 2021

Preprint

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0

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Purpose: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement.Methods: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular (LV) dysfunction and for whom a pulmonary embolism was discarded by computed tomography pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 hours later, left and right ventricular function by 99mTc-labelled albumin gated-blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. Results: We included 13 patients with confirmed SARS-CoV-2 pneumonia. All had CT evidence of organizing pneumonia and normal LV ejection fraction.No patient demonstrated preserved ventilation with perfusion defect (mismatch), which may eliminate a distal lung thrombosis. Patterns of ventilation and perfusion were heterogeneous with sometimes healthy lung segments paradoxically hypoperfused and hypoventilated while both normal perfusion and ventilation were maintained in segments with organizing pneumonia (n=4). Lung albumin retention in area of organizing pneumonia was observed in 9 patients, indicating microvascular injuries, vessel permeability increase and secondary edema.Conclusion: In hospitalized non-critically ill patients without pulmonary embolism or LV dysfunction, various types of damage may contribute to clinical deterioration including microvascular injuries and secondary edema, broncho and vasoconstriction of area not involved by organizing pneumonia while no evidence was found for significant distal thrombosis detectable by LVP scintigraphy.

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Accuracy of routine biomarkers and blood leucocytes count to assist diagnosis of COVID-19-associated pneumonia in adult patients visiting the emergency department

Cited by 3 publications

References 21 publications

Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency

Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency

Microvascular injuries, secondary edema, and inconsistencies in lung vascularization between affected and nonaffected pulmonary segments of non-critically ill hospitalized COVID-19 patients presenting with clinical deterioration

Microvascular Injury With Secondary Edema, Bronchoconstriction and Vasoconstriction of Non-involved Lung Parenchymal Segments May Contribute to Clinical Deterioration of Non-critically Ill Patients Hospitalized for SARS-CoV-2 Pneumonia Without Evidence of Pulmonary Embolism: A Preliminary Study.

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