Mild versus severe COVID-19: Laboratory markers

Velavan, Thirumalaisamy P.; Meyer, Christian G.

doi:10.1016/j.ijid.2020.04.061

Cited by 486 publications

(482 citation statements)

References 14 publications

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“…It is noteworthy that severe COVID-19 patients usually have an imbalance between anti-in ammatory and pro-in ammatory processes. Clinical and experimental studies have shown that patients with severe COVID-19 may exhibit features of systemic hyper-in ammation and in ammatory cytokine storm, which releases proin ammatory cytokines excessively and uncontrollably including IL-6 and TNF-α [19,35]. And clinical reports showed that anti-in ammation therapies (such as glucocorticoids, immunosuppressants and in ammatory cytokines antagonists), which may help in preventing further injury in severe and critical COVID-19 patients, is an effective treatment to improve the clinical outcome [36].…”

Section: Discussionmentioning

confidence: 99%

Changes in lipid metabolism in patients with severe COVID-19

Li¹,

Zhang²,

Dai³

et al. 2020

Preprint

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Background: Dyslipidemia plays an important role in the pathogenesis and evolution of critical illness, but limited information exists regarding the lipid metabolism of severe coronavirus disease 2019 (COVID-19) patients. The aim of this study was to investigate role of dyslipidemia in patients with severe COVID-19Methods: We retrospectively reviewed 216 severe COVID-19 patients with clarified outcomes (discharged or deceased), admitted to the West Court of Union Hospital in Wuhan, China, between February 1 and March 31, 2020. The dynamic changes of lipid profiles and their relationships with disease severity and clinical outcomes were analyzed.Results: A total of 216 severe COVID-19 patients, including 24 non-survivors and 192 survivors, were included in the final analyses. The levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein AI (Apo-AI) on admission were significantly lower in non-survivors compared to survivors. During hospitalization, low-density lipoprotein cholesterol (LDL-C), total cholesterol(TC), HDL-C and Apo-AI were shown an increasing trend in survivors, but maintained lower levels or shown downward trend in non-survivors. The serum levels of HDL-C and Apo-AI were inversely correlated with C-reactive protein (CRP), length of hospital stay of survivors and disease severity. The receiver operating characteristic (ROC) curve analysis identified a CRP/ HDL-C ratio cut-off value of 62.54 as the predictor for in-hospital mortality (AUC=0.823, Sensitivity=83.3%, Specificity=70.8%). Logistic regression analysis demonstrated that hypertension, neutrophils-to-lymphocytes ratio(NLR), platelet count and high CRP/ HDL-C ratio (>62.54) were independent factors to predict in-hospital mortality.Conclusions: The results demonstrated that dyslipidemia was associated with the inflammatory response, disease severity and poor prognosis of COVID-19. High CRP/ HDL-C ratio may serve as an independently potential predictor for hospital mortality among patients with severe COVID-19.

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Section: Discussionmentioning

confidence: 99%

Changes in lipid metabolism in patients with severe COVID-19

Li¹,

Zhang²,

Dai³

et al. 2020

Preprint

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“…These variables were identi ed as markers of severe disease by previous studies [11]. Medians of other well-established markers of serious disease, D-dimer and ferritin were higher in patients who developed hypoxemia, however, the differences were not statistically signi cant.…”

Section: Discussionmentioning

confidence: 92%

“…There is a substantial body of evidence linking the IL-6 concentration to the severity of disease and unfavorable outcome of Covid-19 [11,12,13,14,15,16,18,19,20]. However, to our knowledge, this study is the rst study which evaluated the ability of IL-6 to predict the need for supplementary oxygen administration as a surrogate marker of severe Covid-19 requiring hospital admission in the population of high risk elderly patients.…”

Section: Discussionmentioning

confidence: 97%

“…Such patients need close monitoring and early transfer to the hospital. Various biomarkers, especially in ammatory markers like C-reactive protein (CRP), ferritin, brinogen, D-dimer and Interleukin 6 (IL-6) are associated with Covid-19 progression [10,11]. According to known evidence, IL-6 is superior to CRP and other markers of in ammation in predicting respiratory failure in Covid-19 [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a Long-term Care Facility during Covid-19 Outbreak

Sabaka

Koščálová

Straka³

et al. 2020

Preprint

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Background: Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe illness and death. We explored the role of interleukin 6 (IL-6) as a predictor for severe disease during the outbreak of Covid-19 in one LTCF in Slovakia.Methods: We conducted a retrospective data analysis of cases of COVID-19, diagnosed during the outbreak in one LTCF in Slovakia between April 11, 2020, and May 5, 2020. Within 24 hours after the diagnosis of Covid-19, clinical and laboratory screening was performed in the LTCF to identify patients in need of hospitalization. Patients with oxygen saturation below 90% were immediately referred to the hospital. Patients staying in the LFTC were monitored daily and those that developed hypoxemia were transferred to the hospital. We analyzed the association between the IL-6 at the initial assessment and development of hypoxemia during follow up and determined the cut-off of the IL-6 able to predict the development of hypoxemia requiring oxygen therapy.Results: Fifty-three patients (11 men, 42 women) with diagnosed Covid-19 were included in the analysis. 19 (53%) patients developed hypoxemia during the disease. Patients with hypoxemia had significantly higher concentrations of IL-6, C-reactive protein, procalcitonin, fibrinogen, total bilirubin, aspartate aminotransferase and alanine aminotransferase at initial screening. ROC analyses identified IL-6 as the most robust predictor of hypoxemia. The concentration of IL-6 > 24 pg/mL predicted the development of hypoxemia with the sensitivity of 100% and specificity of 88.9%. The positive and negative predictive values were 76.9%, and 100% respectively.Conclusions: The concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.

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“…Older patients and those with pre-existing respiratory or cardiovascular conditions, diabetes, hypertension, and cancer appear to be at the greatest risk for poor outcomes or severe complications [1,[3][4][5]. Leucocytosis, low lymphocyte count, serum levels of D-dimer, lactate dehydrogenase (LDH), ferritin, cardiac troponin, and higher concentrations of proin ammatory cytokines were reported to be risk factors associated with severe and fatal COVID-19 in hospitalised patients [1,6,7]. Typical imaging features of COVID-19 were established to help early screening and evaluation of the severity and extent of disease.…”

Section: Introductionmentioning

confidence: 99%

Predictive Parameters for the Worsening Clinical Course of Mild COVID-19 Pneumonia

Hahm¹,

Lee²,

Oh³

et al. 2020

Preprint

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Background: This study aimed to determine parameters for worsening oxygenation in mild COVID-19 pneumonia.Methods: This retrospective cohort study included confirmed COVID-19 pneumonia in a single public hospital in South Korea from January to April 2020. Parameters were compared between the two groups on the basis of clinical course: the desaturation group was defined as those with oxygen saturation ≤ 94% on ambient air, or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the nonevent group who were without any respiratory event up to 28 days. The severity and extent of viral pneumonia from an initial single chest CT were calculated using artificial intelligence (AI) algorithms and measured visually by a radiologist. Results: We included 136 patients with 32 (23.5%) in the desaturation group, of whom two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups, however, univariate logistic regression analysis revealed that a variety of parameters at admission were associated with an increased risk of a desaturation event. In a sex-, age-, and comorbid illness-matched case-control study, ferritin ≥ 280 μg/L (OR 3.600, 95% CI 1.142-11.346; p=0.029), LDH≥ 240 U/L (OR 3.600, 95% CI 1.142-11.346; p=0.029), pneumonia burden (OR 1.010, 95% CI 1.002-1.019; p=0.021), and extent (OR 1.194, 95% CI 1.017-1.401; p=0.030) by AI, and visual severity scores (OR 1.146, 95% CI 1.005-1.307; p=0.042) were the predictive parameters for worsening clinical course with desaturation. Conclusion: Our study presents initial CT parameters measured by AI or visual severity scoring as well as serum markers of inflammation at admission as the best parameters for predicting worsening oxygenation in the COVID-19 pneumonia cohort. Initial chest CT scans may help clinicians diagnose viral pneumonia and evaluate the prognosis in mild COVID-19.

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Mild versus severe COVID-19: Laboratory markers

Cited by 486 publications

References 14 publications

Changes in lipid metabolism in patients with severe COVID-19

Changes in lipid metabolism in patients with severe COVID-19

Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a Long-term Care Facility during Covid-19 Outbreak

Predictive Parameters for the Worsening Clinical Course of Mild COVID-19 Pneumonia

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