Biochemical Parameters as Prognostic Markers in Severely Ill COVID-19 Patients

Pitamberwale, Anjali; Mahmood, Tariq; Ansari, Azmat Kamal; Ansari, Shabana Andleeb; Limgaokar, Kirti; Singh, Lalit; Karki, Geeta

doi:10.7759/cureus.28594

Cited by 8 publications

(15 citation statements)

References 29 publications

(103 reference statements)

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“…The area under the ROC curve was estimated for each biomarker combination (SPSS Software, IBM SPSS Statistics) to assess the aggregate performance. An AUC value in the range of 0.6–0.7, 0.7–0.8, 0.8–0.9, and 0.9–1.0 are considered acceptable, fair, good and excellent for classification, respectively 24 . Optimum thresholds were identified for biomarkers with AUC value greater than 0.6 24 based on sensitivity and specificity using two different methods, namely, by estimating the maximum Youden's Index, and the threshold corresponding to a minimum distance from (0,1) 25,26 …”

Section: Methodsmentioning

confidence: 99%

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Jayabal

Abiakam

Filingeri

et al. 2023

International Wound Journal

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Pressure Ulcers (PU) are a major burden for affected patients and healthcare providers. Current detection methods involve visual assessments of the skin by healthcare professionals. This has been shown to be subjective and unreliable, with challenges associated with identifying erythema in darker colour skin. Although there exists a number of promising non‐invasive biophysical techniques such as ultrasound, capacitance measurements, and thermography, the present study focuses on directly measuring the changes in the inflammatory status of the skin and underlying tissues. Therefore, in this study, we aim to analyse inflammatory cytokines collected through non‐invasive sampling techniques to detect early signs of skin damage. Thirty hospitalised patients presenting with Stage I PU were recruited to evaluate the inflammatory response of skin at the site of damage and an adjacent healthy control site. Sebutapes were collected over three sessions to investigate the temporal changes in the inflammatory response. The panel of cytokines investigated included high‐abundance cytokines, namely, IL‐1α and IL‐1RA, and low abundance cytokines; IL‐6, IL‐8, TNF‐α, INF‐γ, IL‐33, IL‐1β and G‐CSF. Spatial and temporal differences between sites were assessed and thresholds were used to determine the sensitivity and specificity of each biomarker. The results suggest significant (P < .05) spatial changes in the inflammatory response, with upregulation of IL‐1α, IL‐8, and G‐CSF as well as down‐regulation of IL‐1RA over the Stage I PU compared with the adjacent control site. There were no significant temporal differences between the three sessions. Selected cytokines, namely, IL‐1α, IL‐1RA, IL‐8, G‐CSF, and the ratio IL‐1α/IL‐1RA offered clear delineation in the classification of healthy and Stage‐I PU skin sites, with receiver operating characteristic curves demonstrating high sensitivity and specificity. There were limited influences of intrinsic and extrinsic factors on the biomarker response. Inflammatory markers provided a high level of discrimination between the sites presenting with Stage I PU and an adjacent healthy skin site, in a cohort of elderly inpatients. Indeed, the ratio of IL‐1α to IL‐1RA provided the highest sensitivity and specificity, indicative that inflammatory homeostasis is affected at the PU site. There was a marginal influence of intrinsic and extrinsic factors, demonstrating the localised effects of the inflammation. Further studies are required to investigate the potential of inflammatory cytokines incorporated within Point of Care technologies, to support routine clinical use.

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Section: Methodsmentioning

confidence: 99%

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Jayabal

Abiakam

Filingeri

et al. 2023

International Wound Journal

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“…Biochemical parameters correlate well with factors like oxygenation status and the pathophysiological processes linked to unfavourable outcomes. These can not only be used to predict respiratory failure but also the type of ventilatory support that these patients may require in intensive management [ 6 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is known that pathophysiological changes related to severe illness are bound to be reflected in terms of the alteration of biochemical parameters. Thus, routine laboratory parameters are used for effective patient monitoring in intensive care [ 10 , 13 – 14 ]. Based on these we assume that biochemical parameters can predict respiratory failure and thus can provide crucial details about the requirement of type of ventilation in the effective management of COVID-19 patients [ 6 – 7 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, routine laboratory parameters are used for effective patient monitoring in intensive care [ 10 , 13 – 14 ]. Based on these we assume that biochemical parameters can predict respiratory failure and thus can provide crucial details about the requirement of type of ventilation in the effective management of COVID-19 patients [ 6 – 7 , 9 , 10 , 11 , 12 , 13 , 14 ]. The majority of the studies on biochemical parameters in COVID-19 patients focus solely on their role as prognostic indicator of mortality.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of the studies on biochemical parameters in COVID-19 patients focus solely on their role as prognostic indicator of mortality. [ 7 , 10 , 11 , 13 ] Therefore, we designed this study to examine the utility of biochemical parameters as predictive indicators of requirement of particular type of ventilation in severely ill COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

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Study of Biochemical Parameters as Predictors for Need of Invasive Ventilation in Severely Ill COVID-19 Patients

Ansari,

Pitamberwale,

Ansari

et al. 2023

The Journal of Critical Care Medicine

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Background Though laboratory tests have been shown to predict mortality in COVID-19, there is still a dearth of information regarding the role of biochemical parameters in predicting the type of ventilatory support that these patients may require. Methods The purpose of our retrospective observational study was to investigate the relationship between biochemical parameters and the type of ventilatory support needed for the intensive care of severely ill COVID-19 patients. We comprehensively recorded history, physical examination, vital signs from point-of-care testing (POCT) devices, clinical diagnosis, details of the ventilatory support required in intensive care and the results of the biochemical analysis at the time of admission. Appropriate statistical methods were used and P-values < 0.05 were considered significant. Receiver operating characteristics (ROC) analysis was performed and Area Under the Curve (AUC) of 0.6 to 0.7, 0.7 to 0.8, 0.8 to 0.9, and >0.9, respectively, were regarded as acceptable, fair, good, and exceptional for discrimination. Results Statistically significant differences (p<0.05) in Urea (p = 0.0351), Sodium (p = 0.0142), Indirect Bilirubin (p = 0.0251), Albumin (p = 0.0272), Aspartate Transaminase (AST) (p = 0.0060) and Procalcitonin (PCT) (p = 0.0420) were observed between the patients who were maintained on non-invasive ventilations as compared to those who required invasive ventilation. In patients who required invasive ventilation, the levels of Urea, Sodium, Indirect bilirubin, AST and PCT were higher while Albumin was lower. On ROC analysis, higher levels of Albumin was found to be acceptable indicator of maintenance on non-invasive ventilation while higher levels of Sodium and PCT were found to be fair predictor of requirement of invasive ventilation. Conclusion Our study emphasizes the role of biochemical parameters in predicting the type of ventilatory support that is needed in order to properly manage severely ill COVID-19 patients.

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Unstimulated Luteinizing Hormone for Assessment of Suppression during Treatment of Central Precocious Puberty with 6-Month Subcutaneous Leuprolide Acetate: Correlations with Clinical Response

Klein,

Miller,

Mauras

2024

Horm Res Paediatr

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Introduction: Phase 3 trial of 6-month subcutaneous leuprolide acetate (SC-LA) in children with central precocious puberty (CPP) demonstrated efficacy and safety. Aims of this secondary analysis: evaluate unstimulated luteinizing hormone (LH) as efficacy measure; assess clinical suppression metrics; and present biochemical and clinical data for subgroups not achieving hormone suppression. Methods: 62 children with treatment-naïve CPP received 2 doses of 45 mg SC-LA at 24-week intervals. Unstimulated and GnRH-stimulated LH, E2, and T concentrations were measured. Clinical measures included bone age (BA) and predicted adult height (PAH). Results: 84% and 86% of children achieved unstimulated LH<1IU/L at weeks 24 and 48, respectively. Of 8 children not achieving unstimulated LH<1IU/L at week 24 that completed the study, all showed lack of pubertal stage progression and stable/decreased BA to chronological age ratio (BA/CA). Received operating characteristic (ROC) analyses suggested unstimulated LH is a good diagnostic predictor of GnRH-stimulated LH<4IU/L at week 24 and 48 (AUC=0.88). Across all children, mean BA/CA improved from 1.4 (screening) to 1.3 (week 48) and mean PAH increased by 3cm. Of 7 girls not achieving stimulated LH<4IU/L at week 24, all achieved E2<10pg/mL, showed lack of pubertal stage progression, and had stable or decreased BA/CA by week 48. Additionally, 6/7 had increased PAH by week 48 and 4 had unstimulated LH<1IU/L. Conclusion: Unstimulated LH has value as an efficacy measure and concentrations <1IU/L may be an adequate surrogate of treatment response in children with CPP. All children who completed the study had evidence of pubertal suppression.

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Biochemical Parameters as Prognostic Markers in Severely Ill COVID-19 Patients

Cited by 8 publications

References 29 publications

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Study of Biochemical Parameters as Predictors for Need of Invasive Ventilation in Severely Ill COVID-19 Patients

Unstimulated Luteinizing Hormone for Assessment of Suppression during Treatment of Central Precocious Puberty with 6-Month Subcutaneous Leuprolide Acetate: Correlations with Clinical Response

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