ObjectivesCOVID-19 is an ongoing global pandemic. There is an urgent need for identification and understanding of clinical and laboratory parameters related to progression towards a severe and fatal form of this illness, often preceded by a so-called cytokine-storm syndrome (CSS). Therefore, we explored the hemocytometric characteristics of COVID-19 patients in relation to the deteriorating clinical condition CSS, using the Sysmex XN-10 hematology analyzer.MethodsFrom March 1st till May 16th, 2020, all patients admitted to our hospital with respiratory complaints and suspected for COVID-19 were included (n=1,140 of whom n=533 COVID-19 positive). The hemocytometric parameters of immunocompetent cells in peripheral blood (neutrophils [NE], lymphocytes [LY] and monocytes [MO]) obtained upon admission to the emergency department (ED) of COVID-19 positive patients were compared with those of the COVID-19 negative ones. Moreover, patients with CSS (n=169) were compared with COVID-19 positive patients without CSS, as well as with COVID-19 negative ones.ResultsIn addition to a significant reduction in leukocytes, thrombocytes and absolute neutrophils, it appeared that lymphocytes-forward scatter (LY-FSC), and reactive lymphocytes (RE-LYMPHO)/leukocytes were higher in COVID-19-positive than negative patients. At the moment of presentation, COVID-19 positive patients with CSS had different neutrophils-side fluorescence (NE-SFL), neutrophils-forward scatter (NE-FSC), LY-FSC, RE-LYMPHO/lymphocytes, antibody-synthesizing (AS)-LYMPHOs, high fluorescence lymphocytes (HFLC), MO-SSC, MO-SFL, and Reactive (RE)-MONOs. Finally, absolute eosinophils, basophils, lymphocytes, monocytes and MO-FSC were lower in patients with CSS.ConclusionsHemocytometric parameters indicative of changes in immunocompetent peripheral blood cells and measured at admission to the ED were associated with COVID-19 with and without CSS.

BackgroundGeneral practitioners (GPs) decide which patients with fever need referral to the emergency department (ED). Vital signs, clinical rules and gut feeling can influence this critical management decision.Aimto investigate which vital signs are measured by GPs, and whether referral is associated with vital signs, clinical rules, or gut feeling.Design & settingprospective observational study at two out-of-hours GP cooperativesMethodduring two nine-day periods, GPs performed their regular work-up in patients ≥18 y with fever (≥38.0°C). Subsequently, researchers measured missing vital signs for completion of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score. We investigated associations between the number of referrals, positive SIRS/qSOFA scores and GPs’ gut feeling.ResultsGPs measured and recorded all vital signs required for SIRS/qSOFA calculation in 24 of 108 (22.2%) assessed patients and referred 45 (41.7%) to the ED. Higher respiratory rates, temperatures, clinical rules and gut feeling were associated with referral. During 7-day follow-up, 9 (14.3%) of 63 initially not referred patients were admitted to hospital.ConclusionGPs measured and recorded all vital signs for SIRS and qSOFA in 1 in 5 patients with fever and referred half of 63 SIRS positive and almost all of 22 qSOFA positive patients. Some vital signs and gut feeling were associated with referral, but none were consistently present in all referred patients. The vast majority of patients who were not initially referred remained at home during follow-up.

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