scholarly journals The The PaO2/FiO2 ratio on admission is independently associated with prolonged hospitalization in COVID-19 patients

2021 ◽  
Vol 15 (03) ◽  
pp. 353-359
Author(s):  
Angelo Zinellu ◽  
Andrea De Vito ◽  
Valentina Scano ◽  
Panagiotis Paliogiannis ◽  
Vito Fiore ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Severity Score ◽  
Clinical Laboratory ◽  
Length Of Hospital Stay ◽  
Chest Ct ◽  
Lung Damage ◽  
University Hospital ◽  
Consecutive Series ◽  
Roc Curve Analysis ◽  
Therapeutic Decisions

Introduction: The early identification of factors that predict the length of hospital stay (HS) in patients affected by coronavirus desease (COVID-19) might assist therapeutic decisions and patient flow management. Methodology: We collected, at the time of admission, routine clinical, laboratory, and imaging parameters of hypoxia, lung damage, inflammation, and organ dysfunction in a consecutive series of 50 COVID-19 patients admitted to the Respiratory Disease and Infectious Disease Units of the University Hospital of Sassari (North-Sardinia, Italy) and alive on discharge. Results: Prolonged HS (PHS, >21 days) patients had significantly lower PaO2/FiO2 ratio and lymphocytes, and significantly higher Chest CT severity score, C-reactive protein (CRP) and lactic dehydrogenase (LDH) when compared to non-PHS patients. In univariate logistic regression, Chest CT severity score (OR = 1.1891, p = 0.007), intensity of care (OR = 2.1350, p = 0.022), PaO2/FiO2 ratio (OR = 0.9802, p = 0.007), CRP (OR = 1.0952, p = 0.042) and platelet to lymphocyte ratio (OR = 1.0039, p = 0.036) were significantly associated with PHS. However, in multivariate logistic regression, only the PaO2/FiO2 ratio remained significantly correlated with PHS (OR = 0.9164; 95% CI 0.8479-0.9904, p = 0.0275). In ROC curve analysis, using a threshold of 248, the PaO2/FiO2 ratio predicted PHS with sensitivity and specificity of 60% and 91%, respectively (AUC = 0.780, 95% CI 0.637-0.886 p = 0.002). Conclusions: The PaO2/FiO2 ratio on admission is independently associated with PHS in COVID-19 patients. Larger prospective studies are needed to confirm this finding.

scholarly journals PMN-MDSC Frequency Discriminates Active Versus Latent Tuberculosis and Could Play a Role in Counteracting the Immune-Mediated Lung Damage in Active Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Germana Grassi ◽  
Valentina Vanini ◽  
Federica De Santis ◽  
Alessandra Romagnoli ◽  
Alessandra Aiello ◽  
...  
Keyword(s):  
Severity Score ◽  
Defense Mechanisms ◽  
Latent Tuberculosis ◽  
Suppressor Cells ◽  
Infectious Agent ◽  
Lung Damage ◽  
Roc Curve Analysis ◽  
X Ray ◽  
Chest X Ray ◽  
Active Disease

Tuberculosis (TB), due to Mycobacterium tuberculosis infection, is still the principal cause of death caused by a single infectious agent. The balance between the bacillus and host defense mechanisms reflects the different manifestations of the pathology. Factors defining this variety are unclear and likely involve both mycobacterial and immunological components. Myeloid derived suppressor cells (MDSC) have been shown to be expanded during TB, but their role in human TB pathogenesis is not clear. We evaluated the frequency of circulating MDSC by flow-cytometry in 19 patients with active TB, 18 with latent TB infection (LTBI), and 12 healthy donors (HD) as control. Moreover, we investigated the capacity of MDSC to modulate the mycobactericidal activity of monocytes. The association between MDSC level and TB chest X-ray severity score was analyzed. We observed that, unlike active TB, polymorphonuclear (PMN)-MDSC are not expanded in LTBI patients, and, by performing a receiver operating characteristic (ROC) curve analysis, we found that PMN-MDSC frequency supported the discrimination between active disease and LTBI. Interestingly, we observed an association between PMN-MDSC levels and the severity of TB disease evaluated by chest X-ray. Specifically, PMN-MDSC frequency was higher in those classified with a low/mild severity score compared to those classified with a high severity score. Moreover, PMN-MDSC can impact mycobacterial growth by inducing ROS production in Bacillus Calmette et Guerin (BCG)-infected monocytes. This effect was lost when tested with M. tuberculosis (MTB), In conclusion, our data indicate that the elevated frequency of PMN-MDSC in IGRA-positive individuals is associated with active TB. Our findings also pointed out a beneficial role of PMN-MDSC during human active TB, most likely associated with the limitation of inflammation-induced tissue damage.

scholarly journals Increased RV:LV Ratio on Chest CT-Angiogram in COVID-19 is a Marker of Adverse Outcomes

2021 ◽  
Author(s):  
Ran Tao ◽  
Zuzana Burivalova ◽  
Sofia Carolina Masri ◽  
Naga Dharmavaram ◽  
Aurangzeb Baber ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Normal Subjects ◽  
Chest Ct ◽  
Adverse Outcomes ◽  
Lung Damage ◽  
The Novel ◽  
Organizing Pneumonia ◽  
Chamber View ◽  
Ct Angiogram ◽  
Novel Coronavirus

Abstract PurposeOur study aimed to use chest CT-angiogram (CTA) to assess if right ventricular (RV) dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the novel coronavirus (COVID-19) infection.MethodsWe reviewed clinical, laboratory, and chest CTA findings in COVID-19 patients (n=100), and two control groups: normal subjects (n=10) and subjects with organizing pneumonia (n=10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view; and dimensions of pulmonary artery (PA) and aorta (AO) at the PA bifurcation level. ResultsAmong the COVID-19 cohort, the mean age (±SD) was 55.1±14.9 years and 55% were female. A higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death. In patients with adverse outcomes, the RV:LV ratio was 1.06±0.10, vs 0.95±0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia, the lung parenchymal damage was lower (22.6±9.0 vs 32.7±6.6), yet the RV:LV ratio was higher (1.06±0.14 vs 0.89±0.07). In ROC analysis, RV:LV ratio had an AUC= 0.707 with an optimal cut-off of RV:LV 1.1 as a predictor of adverse outcomes. In a validation cohort (n=25), an RV:LV ≥1.1 as a cut-off predicted adverse outcomes with an odds ratio of 76:1.ConclusionIn COVID-19 patients, RV:LV ratio ≥1.1 on CTA-chest is correlated with adverse outcomes. RV dilation in COVID-19 is out of proportion to parenchymal lung damage, pointing towards a vascular and/or thrombotic injury in the lungs.

Diagnostic Accuracy of α1-Acid Glycoprotein Fucosylation for Liver Cirrhosis in Patients Undergoing Hepatic Biopsy

2002 ◽  
Vol 48 (12) ◽  
pp. 2195-2201 ◽  
Author(s):  
Ingvar Rydén ◽  
Peter Påhlsson ◽  
Stefan Lindgren
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Biochemical Markers ◽  
Clinical Laboratory ◽  
University Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Men And Women ◽  
Acid Glycoprotein

Abstract Background: Increased fucosylation of serum glycoproteins has previously been reported in patients with liver disease. We analyzed α1-acid glycoprotein (AGP) fucosylation in serum samples from patients investigated for suspected liver disease to evaluate its value as a biochemical marker for liver cirrhosis. Methods: We used a novel lectin immunoassay adapted to the AutoDELFIA system to analyze AGP fucosylation in 261 consecutive patients admitted for liver biopsy at Malmö University Hospital in Southern Sweden. The results were compared with histopathologic findings. In addition, AGP fucosylation was compared with other biochemical markers described as useful in the diagnosis of liver cirrhosis. The biochemical markers were compared by ROC curve analysis. Results: AGP fucosylation was significantly (P <0.05) higher in patients with liver cirrhosis (n = 65) than in healthy controls (n = 72), patients with normal histology (n = 29), patients with steatosis only (n = 38), patients with viral or chronic hepatitis without cirrhosis (n = 71), and patients with other liver diseases without histologic signs of cirrhosis (n = 58). By calculating the AGP fucosylation index (AGP-FI = AGP fucosylation/AGP serum concentration), we obtained a high diagnostic accuracy. The areas under the ROC curves for AGP-FI were 0.83 and 0.74 for men and women, respectively, compared with 0.82 for hyaluronic acid and 0.77 for the aspartate aminotransferase/alanine aminotransferase ratio in both men and women. Conclusions: AGP fucosylation appears to be useful in identifying patients with liver cirrhosis among patients investigated for liver disease. The lectin immunoassay showed satisfactory reproducibility and is suitable for routine use in a clinical laboratory.

scholarly journals Laboratory Risk Indicator for Necrotizing Fasciitis of the Oro-Cervical Region (LRINEC-OC): A Possible Diagnostic Tool for Emergencies of the Oro-Cervical Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Masaru Ogawa ◽  
Satoshi Yokoo ◽  
Yu Takayama ◽  
Jun Kurihara ◽  
Takaya Makiguchi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Necrotizing Fasciitis ◽  
Test Data ◽  
Diagnostic Tool ◽  
Blood Test ◽  
University Hospital ◽  
Cervical Region ◽  
Risk Indicator ◽  
Roc Curve Analysis ◽  
Cutoff Value

Aim. Oro-cervical necrotizing fasciitis (OCNF) treatment requires early surgical debridement and opening of the wound, and therefore, early diagnosis is very important. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score based on blood test data has recently been proposed as an auxiliary diagnostic tool. However, in some cases, it is difficult to diagnose OCNF. We performed a pooled analysis of patients with OCNF at Gunma University Hospital and literature cases, with the goal of designing a new auxiliary diagnostic tool for OCNF by adding physical characteristics of the oro-cervical region to blood test data in the first examination. Methods. Univariate and multivariate logistic regression was used to select predictors of OCNF. The LRINEC-Oro-Cervical (OC) score was then designed using correlation coefficients of items selected in logistic regression analysis. A cutoff value for the LRINEC-OC score was determined using receiver operating characteristic (ROC) curve analysis. Results. CRP, WBC, Cr, and skin flare in the cervical and precordial regions were extracted as independent factors (p<0.05) and evaluated as predictors of OCNF. The LRINEC-OC score for the prediction of OCNF was designed using the regression coefficients in logistic analysis. The cutoff value for the LRINEC-OC score was 6 points with a sensitivity of 88.5% and a specificity of 93.4%, and the AUC was 0.909. Conclusion. Delays in diagnosis and surgical treatment for OCNF led to a fatal prognosis, and the potential utility of the LRINEC-OC score for improving the prognosis was shown in this study.

scholarly journals Correlation between Chest CT Severity Scores and the Clinical Parameters of Adult Patients with COVID-19 Pneumonia

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ghufran Aref Saeed ◽  
Waqar Gaba ◽  
Asad Shah ◽  
Abeer Ahmed Al Helali ◽  
Emadullah Raidullah ◽  
...  
Keyword(s):  
Severity Score ◽  
Length Of Hospital Stay ◽  
Chest Ct ◽  
Clinical Severity ◽  
Rt Pcr ◽  
Original Cohort ◽  
Severity Scores ◽  
The Mean ◽  
Oxygen Requirements ◽  
Serum Crp

Purpose. Our aim is to correlate the clinical condition of patients with COVID-19 infection with the 25-point CT severity score by Chang et al. (devised for assessment of ARDS in patients with SARS in 2005). Materials and Methods. Data of consecutive symptomatic patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March to April 2020. All patients underwent two consecutive RT-PCR tests and had a noncontrast HRCT scan done at presentation. From the original cohort of 1062 patients, 160 patients were excluded leaving a total number of 902 patients. Results. The mean age was 44.2 ± 11.9 years (85.3% males, 14.7% females). CT severity score was found to be positively correlated with lymphopenia, increased serum CRP, d-dimer, and ferritin levels ( p < 0.0001 ). The oxygen requirements and length of hospital stay were increasing with the increase in scan severity. Conclusion. The 25-point CT severity score correlates well with the COVID-19 clinical severity. Our data suggest that chest CT scoring system can aid in predicting COVID-19 disease outcome and significantly correlates with lab tests and oxygen requirements.

scholarly journals Correlation between Chest CT Severity Scores and the Clinical Parameters of Adult Patients with COVID-19 pneumonia

2020 ◽  
Author(s):  
Ghufran Aref Saeed ◽  
Waqar Gaba ◽  
Asad Shah ◽  
Abeer Ahmed Al Helali ◽  
Emadullah Raidullah ◽  
...  
Keyword(s):  
Severity Score ◽  
Length Of Hospital Stay ◽  
Chest Ct ◽  
Clinical Severity ◽  
Rt Pcr ◽  
Original Cohort ◽  
Severity Scores ◽  
The Mean ◽  
Oxygen Requirements ◽  
Serum Crp

AbstractPurposeOur aim is to correlate the clinical condition of patients with COVID-19 infection with the 25 Point CT severity score by Chang et al (devised for assessment of ARDS in patients with SARS in 2005).Material and MethodsData of consecutive symptomatic patients who were suspected to have COVID-19 infection and presented to our hospital, was collected from March to April 2020. All patients underwent two consecutive RT-PCR tests and had a non-contrast HRCT scan done at presentation. From the original cohort of 1062 patients, 160 patients were excluded leaving a total number of 902 patients.ResultsThe mean age was 44.2 ±11.9 years [85.3%males, 14.7%females]. CT severity score found to be positively correlated with lymphopenia, increased serum CRP, d-dimer and ferritin levels (p < 0.0001). The oxygen requirements as well as length of hospital stay were increasing with the increase of scan severity.ConclusionThe 25-point CT severity score correlates well with the COVID-19 clinical severity. Our data suggest that chest CT scoring system can aid in predicting COVID-19 disease outcome and significantly correlates with lab tests and oxygen requirements.

COVID-19 pneumonia diagnosis using a simple 2D deep learning framework with a single chest CT image (Preprint)

2020 ◽  
Author(s):  
Jinseok Lee
Keyword(s):  
Deep Learning ◽  
Diagnostic Performance ◽  
Ct Images ◽  
Chest Ct ◽  
University Hospital ◽  
Detection Accuracy ◽  
Ct Image ◽  
Test Dataset ◽  
Learning Framework ◽  
Testing Dataset

BACKGROUND The coronavirus disease (COVID-19) has explosively spread worldwide since the beginning of 2020. According to a multinational consensus statement from the Fleischner Society, computed tomography (CT) can be used as a relevant screening tool owing to its higher sensitivity for detecting early pneumonic changes. However, physicians are extremely busy fighting COVID-19 in this era of worldwide crisis. Thus, it is crucial to accelerate the development of an artificial intelligence (AI) diagnostic tool to support physicians. OBJECTIVE We aimed to quickly develop an AI technique to diagnose COVID-19 pneumonia and differentiate it from non-COVID pneumonia and non-pneumonia diseases on CT. METHODS A simple 2D deep learning framework, named fast-track COVID-19 classification network (FCONet), was developed to diagnose COVID-19 pneumonia based on a single chest CT image. FCONet was developed by transfer learning, using one of the four state-of-art pre-trained deep learning models (VGG16, ResNet50, InceptionV3, or Xception) as a backbone. For training and testing of FCONet, we collected 3,993 chest CT images of patients with COVID-19 pneumonia, other pneumonia, and non-pneumonia diseases from Wonkwang University Hospital, Chonnam National University Hospital, and the Italian Society of Medical and Interventional Radiology public database. These CT images were split into a training and a testing set at a ratio of 8:2. For the test dataset, the diagnostic performance to diagnose COVID-19 pneumonia was compared among the four pre-trained FCONet models. In addition, we tested the FCONet models on an additional external testing dataset extracted from the embedded low-quality chest CT images of COVID-19 pneumonia in recently published papers. RESULTS Of the four pre-trained models of FCONet, the ResNet50 showed excellent diagnostic performance (sensitivity 99.58%, specificity 100%, and accuracy 99.87%) and outperformed the other three pre-trained models in testing dataset. In additional external test dataset using low-quality CT images, the detection accuracy of the ResNet50 model was the highest (96.97%), followed by Xception, InceptionV3, and VGG16 (90.71%, 89.38%, and 87.12%, respectively). CONCLUSIONS The FCONet, a simple 2D deep learning framework based on a single chest CT image, provides excellent diagnostic performance in detecting COVID-19 pneumonia. Based on our testing dataset, the ResNet50-based FCONet might be the best model, as it outperformed other FCONet models based on VGG16, Xception, and InceptionV3.

scholarly journals Correlation between serum carbohydrate antigen 19-9 levels and computed tomography severity score in patients with nontuberculous mycobacterial pulmonary disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kangjoon Kim ◽  
Seung Hyun Yong ◽  
Su Hwan Lee ◽  
Sang Hoon Lee ◽  
Ah Young Leem ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Disease Activity ◽  
Pulmonary Disease ◽  
Severity Score ◽  
Partial Correlation ◽  
Elevated Serum ◽  
Carbohydrate Antigen ◽  
Chest Ct ◽  
Clinical Biomarker ◽  
Serum Carbohydrate Antigen

AbstractThere is no validated clinical biomarker for disease severity or treatment response for nontuberculous mycobacterial pulmonary disease (NTM-PD). We investigated the correlation between elevated serum carbohydrate antigen (CA) 19-9 levels and NTM-PD disease activity, defined using an imaging severity score based on chest computed tomography (CT). We retrospectively examined 79 patients with NTM-PD who underwent serum CA19-9 level assessments and chest CT less than 1 month apart. NTM-PD severity was rated using a CT-based scoring system. The correlation between the CT score and serum CA19-9 levels was evaluated. Chest CT revealed nodular bronchiectasis without cavitation in most patients (78.5%). Serum CA19-9 levels were elevated in 19 (24%) patients. Serum CA19-9 levels were positively correlated with the total CT score and bronchiectasis, bronchiolitis, cavity, and consolidation subscores. Partial correlation analysis revealed a significant positive correlation between serum CA19-9 levels and CT scores for total score and bronchiectasis, bronchiolitis, cavitation, and consolidation subscores after controlling for age, sex, and BMI. Serum CA19-9 levels were positively correlated with the CT severity score for NTM-PD. Serum CA19-9 may be useful in evaluating disease activity or therapeutic response in patients with NTM-PD.

scholarly journals The association between clinical laboratory data and chest CT findings explains disease severity in a large Italian cohort of COVID-19 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simone Canovi ◽  
◽  
Giulia Besutti ◽  
Efrem Bonelli ◽  
Valentina Iotti ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Organ Damage ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Arterial Oxygen ◽  
Emergency Rooms ◽  
Cross Sectional ◽  
Ct Findings ◽  
Patient Prognosis

Abstract Background Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. Methods This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. Results Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. Conclusions Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.

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