Patients of COVID-19 may benefit from sustained Lopinavir-combined regimen and the increase of Eosinophil may predict the outcome of COVID-19 progression

Liu, Fang; Xu, Aiqiang; Zhang, Yan; Xuan, Weiling; Yan, Tingbo; Pan, Kenv; Yu, Wenyan; Zhang, Jun

doi:10.1016/j.ijid.2020.03.013

Cited by 330 publications

(381 citation statements)

References 9 publications

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“…Interestingly, almost all patients (134, 95.0%) showed eosinophil count less than 0.10 × 10 9 /L in the early stages of the disease, and especially in severe patients, the eosinophil count was generally very low and returned to normal levels upon convalescence. This may be associated with a mechanism of stress response in the condition of acute lung injury caused by SARS-CoV-2, which inhibits the release of eosinophil in the bone marrow through glucocorticoid secretion [20]. As the disease recovers, the eosinophil gradually returns to normal levels, which means that decreasing and increasing eosinophil may be the signs of disease progression and recovery.…”

Section: Discussionmentioning

confidence: 99%

The hemocyte counts as a potential biomarker for predicting disease progression in COVID-19: a retrospective study

Zheng

Zhang

Chi

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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AbstractObjectivesIn December 2019, there was an outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, and since then, the disease has been increasingly spread throughout the world. Unfortunately, the information about early prediction factors for disease progression is relatively limited. Therefore, there is an urgent need to investigate the risk factors of developing severe disease. The objective of the study was to reveal the risk factors of developing severe disease by comparing the differences in the hemocyte count and dynamic profiles in patients with severe and non-severe COVID-19.MethodsIn this retrospectively analyzed cohort, 141 confirmed COVID-19 patients were enrolled in Taizhou Public Health Medical Center, Taizhou Hospital, Zhejiang Province, China, from January 17, 2020 to February 26, 2020. Clinical characteristics and hemocyte counts of severe and non-severe COVID patients were collected. The differences in the hemocyte counts and dynamic profiles in patients with severe and non-severe COVID-19 were compared. Multivariate Cox regression analysis was performed to identify potential biomarkers for predicting disease progression. A concordance index (C-index), calibration curve, decision curve and the clinical impact curve were calculated to assess the predictive accuracy.ResultsThe data showed that the white blood cell count, neutrophil count and platelet count were normal on the day of hospital admission in most COVID-19 patients (87.9%, 85.1% and 88.7%, respectively). A total of 82.8% of severe patients had lymphopenia after the onset of symptoms, and as the disease progressed, there was marked lymphopenia. Multivariate Cox analysis showed that the neutrophil count (hazard ratio [HR] = 4.441, 95% CI = 1.954–10.090, p = 0.000), lymphocyte count (HR = 0.255, 95% CI = 0.097–0.669, p = 0.006) and platelet count (HR = 0.244, 95% CI = 0.111–0.537, p = 0.000) were independent risk factors for disease progression. The C-index (0.821 [95% CI, 0.746–0.896]), calibration curve, decision curve and the clinical impact curve showed that the nomogram can be used to predict the disease progression in COVID-19 patients accurately. In addition, the data involving the neutrophil count, lymphocyte count and platelet count (NLP score) have something to do with improving risk stratification and management of COVID-19 patients.ConclusionsWe designed a clinically predictive tool which is easy to use for assessing the progression risk of COVID-19, and the NLP score could be used to facilitate patient stratification management.

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Section: Discussionmentioning

confidence: 99%

The hemocyte counts as a potential biomarker for predicting disease progression in COVID-19: a retrospective study

Zheng

Zhang

Chi

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…A total of 2,355,853 recorded cases were registered, with 164,656 fatalities as of the 20 April 2020 [13]. On 29 January 2020, Li et al's case study reported in the New Britain Journal of Medicine summarizes the 425 first documented cases in Wuhan [3,14].…”

Section: Coronavirus Familymentioning

confidence: 99%

“…Lopinavir (LPV) is a HIV type 1 aspartate protease inhibitor while ritonavir (RTV) is usually combined to it to increase the plasma half-life of LPV by inhibiting CYP450 enzyme [14]. Since the outbreak, several clinical trials have been investigated on the potentials of this combination (LPV/RTV) on SARS-CoV-2 patients outcomes.…”

Section: Antiviral Agentsmentioning

confidence: 99%

“…Therefore interfering with IL-6 and other mediators may have potential clinical benefits in reversing respiratory dysfunction in those patients. A retrospective study from China hospitals demonstrated the benefits of tocilizumab in addition to the standard therapy of 26 patients with severe and critical care conditions [14,80,98]. Tocilizumab was given at a dose of 400 mg once through an intravenous drip in 18 patients.…”

Section: Immunomodulators and Immunosuppressantsmentioning

confidence: 99%

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COVID-19 Pandemic: an Overview of epidemiology, pathogenesis, Diagnostics and Potential Vaccines and Therapeutics

et al. 2020

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At the time of writing this review, severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has infected more than 2,355,853 patients and resulted in more than 164,656 deaths worldwide (as of 20 April 2020). This review highlights the preventive measures, available clinical therapies and the potential of vaccine development against SARS-CoV-2 by taking into consideration the strong genetic similarities of the 2003 epidemic SARS-CoV. Recent studies are investigating the repurposing of US FDA-approved drugs as there is no available vaccine yet with many attempts under clinical evaluation. Several antivirals, antimalarials and immunomodulators that have shown activity against SARS-CoV and Middle East coronavirus respiratory syndromes are being evaluated. In particular, hydroxychloroquine, remdesivir, favipiravir, arbidol, tocilizumab and bevacizumab have shown promising results. The main aim of this review is to provide an overview of this pandemic and where we currently stand. Graphical abstract:

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“…Eosinophils have also been reported to be decreased in previous studies 17,18 . Increasing eosinophil count may even be a predictor of improvement in patients with SARS-Cov-2 infection 19 . A low proportion of basophils has also been reported in severe cases 12 but no previous study has reported low basophil cell count as a marker of SARS-Cov-2 infection.…”

Section: Discussionmentioning

confidence: 99%

Pre-test probability for SARS-Cov-2-related Infection Score: the PARIS score

Universities¹,

Tordjman

Ahmed³

et al. 2020

Preprint

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Background: Diagnostic tests for SARS-CoV-2 infection (mostly RT-PCR and Computed Tomography) are not widely available in numerous countries, expensive and with imperfect performance Methods: This multicenter retrospective study aimed to determine a pre-test probability score for SARS-CoV-2 infection based on clinical and biological variables. Patients were recruited from emergency and infectious disease departments and were divided into a training and a validation cohort. Demographic characteristics, clinical symptoms, and results of blood tests (complete white blood cell count, serum electrolytes and CRP) were collected. The pre-test probability score was derived from univariate analyses between patients and controls, followed by multivariate binary logistic analysis to determine the independent variables associated with SARS-CoV-2 infection. Points were assigned to each variable to create the PARIS score. ROC curve analysis determined the area under the curve (AUC) Findings: One hundred subjects with clinical suspicion of SARS-CoV-2 infection were included in the training cohort, and 300 other consecutive individuals were included in the validation cohort. Low lymphocyte (<1.3 G/L), eosinophil (<0.06G/L), basophil (<0.04G/L) and neutrophil counts (<5G/L) were associated with a high probability of SARS-CoV-2 infection. No clinical variable was statistically significant. The score had a good performance in the validation cohort (AUC=0.889 (CI: [0.846-0.932]; STD=0.022) with a sensitivity and Positive Predictive Value of high-probability score of 80.3% and 92.3% respectively. Furthermore, a low-probability score excluded SARS-CoV-2 infection with a Negative Predictive Value of 99.5% Interpretation: The PARIS score based on complete white blood cell count has a good performance to categorize the pre-test probability of SARS-CoV-2 infection. It could help clinicians avoid diagnostic tests in patients with a low-probability score and conversely keep on testing individuals with high-probability score but negative RT-PCR or CT. It could prove helpful in countries with a low-availability of PCR and/or CT during the current period of pandemic

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Patients of COVID-19 may benefit from sustained Lopinavir-combined regimen and the increase of Eosinophil may predict the outcome of COVID-19 progression

Cited by 330 publications

References 9 publications

The hemocyte counts as a potential biomarker for predicting disease progression in COVID-19: a retrospective study

The hemocyte counts as a potential biomarker for predicting disease progression in COVID-19: a retrospective study

COVID-19 Pandemic: an Overview of epidemiology, pathogenesis, Diagnostics and Potential Vaccines and Therapeutics

Pre-test probability for SARS-Cov-2-related Infection Score: the PARIS score

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