Temporal evolution of laboratory characteristics in patients critically ill with COVID‑19 admitted to the intensive care unit (Review)

Kokkoris, Stelios; Kanavou, Angeliki; Kremmydas, Panagiotis; Katsaros, Dimitrios; Karageorgiou, Stavros; Gkoufa, Aikaterini; Georgakopoulou, Vasiliki; Spandidos, Demetrios; Giannopoulos, Charalampos; Kardamitsi, Marina; Routsi, Christina

doi:10.3892/mi.2023.112

Cited by 3 publications

(4 citation statements)

References 73 publications

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“…It should be noted that PLT counts in the patients in the present study were maintained mostly within or higher than the normal range, indicating a hypercoagulation state that persisted over time. This finding is in accordance with that by Wendel Garcia et al ( 24 ), although they are in contrast to findings reported elsewhere showing thrombocytopenia in patients critically ill with COVID-19 ( 27 , 31 ) . The lower counts of PLT in non-survivors relative to survivors may be attributed to their more severe inflammatory status, leading to increased PLT destruction, either mechanically through disseminated intravascular coagulation, or immunologically.…”

Section: Discussionsupporting

confidence: 92%

“…It should be noted that in survivors, although the mean NLR values were gradually decreasing, apart from day 21, they remained elevated, namely >10, indicating, along with the non-resolving lymphopenia, a persistent inflammation. These temporal changes in NLR are consistent with those of previous studies ( 27 , 28 , 35 ), confirming the superior role of NLR, as compared to the WBC count, concerning risk stratification in the clinical context of COVID-19.…”

Section: Discussionsupporting

confidence: 90%

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Temporal trends in laboratory parameters in survivors and non‑survivors of critical COVID‑19 illness and the effect of dexamethasone treatment

Kokkoris,

Kanavou,

Katsaros

et al. 2023

Biomed Rep

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Although coronavirus disease 2019 (COVID-19)-induced changes in laboratory parameters in patients upon admission have been well-documented, information on their temporal changes is limited. The present study describes the laboratory trends and the effect of dexamethasone treatment on these parameters, in patients with COVID-19 in the intensive care unit (ICU). Routine laboratory parameters, namely white blood cell (WBC), neutrophil, lymphocyte and platelet (PLT) counts, fibrinogen, C-reactive protein (CRP), lactate dehydrogenase (LDH) and albumin concentrations, were recorded upon admission to the ICU and, thereafter, on days 3, 5, 10, 15 and 21; these values were compared between survivors and non-survivors, as well as between those who were treated with dexamethasone and those who were not. Among the 733 patients in the ICU, (mean age, 65±13 years; 68% males; ICU mortality rate 45%; 76% of patients treated with dexamethasone), the WBC and neutrophil counts were persistently high in all patients, without significant differences over the first 15 days. Initially, low lymphocyte counts exhibited increasing trends, but remained higher in survivors compared to non-survivors (P=0.01). The neutrophil-to-lymphocyte ratio (NLR) was persistently elevated in all patients, although it was significantly higher in non-survivors compared to survivors (P < 0.001). The PLT count was initially increased in all patients, although it was significantly decreased in non-survivors over time. The fibrinogen and LDH values remained similarly elevated in all patients. However, the increased levels of CRP, which did not differ between patients upon admission, further increased in non-survivors compared to survivors after day 10 (P=0.001). Declining trends in albumin levels over time, overall, with a significant decrease in non-survivors compared to survivors, were observed. Dexamethasone treatment significantly affected the temporal progression of fibrinogen and CRP in survivors and that of NLR in non-survivors. On the whole, the present study demonstrates that patients in the ICU with COVID-19 present persistently abnormal laboratory findings and significant differences in laboratory trends of NLR, CRP, PLT and albumin, but not in WBC and neutrophil count, and fibrinogen and LDH levels, between survivors and non-survivors. The temporal progression of fibrinogen, CRP and NLR is affected by dexamethasone treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Temporal trends in laboratory parameters in survivors and non‑survivors of critical COVID‑19 illness and the effect of dexamethasone treatment

Kokkoris,

Kanavou,

Katsaros

et al. 2023

Biomed Rep

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“…CK-NAC and CK-MB increases signify serious cardiovascular complications in COVID-19 patients [57]. A total protein decrease is not a common change, though albumin decrease, together with urea, troponin, and PCT increase, are usual changes in the routine laboratory biomarkers for the detection of severe COVID-19 disease [1,56,58,59]. The study of esterase status, with the additional determination of the level of MDA in the blood plasma, revealed statistically significant differences in the following indicators (Table 3): BChE activity with ATCh and BTCh as substrates (decrease by 27% and 37%, respectively) and MDA concentration (increase by 1.5-fold).…”

Section: Resultsmentioning

confidence: 99%

“…The search for diagnostic and prognostic markers, the fastest possible stratification of patients upon admission to hospital, and the assessment of the risk and probability of death in the case of many diseases, including COVID-19, is an urgent task of biochemistry, physiology, and experimental medicine. There are distinct temporal trends in selected routine laboratory parameters between survivors and non-survivors with severe COVID-19 admitted to the intensive care unit (ICU), indicating their importance in the prognosis of clinical outcome [1]. Recent investigations revealed new diagnostic biomarkers of the disease, such as mid-regional pro-adrenomedullin [2,3], monocyte distribution width [4,5], electrolyte imbalances [6], pentameric C-reactive protein [7], and pentraxin-3 [8,9].…”

Section: Introductionmentioning

confidence: 99%

Searching for New Biomarkers to Assess COVID-19 Patients: A Pilot Study

Goncharov,

Avdonin,

Voitenko

et al. 2023

Metabolites

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During the initial diagnosis of urgent medical conditions, which include acute infectious diseases, it is important to assess the severity of the patient’s clinical state as quickly as possible. Unlike individual biochemical or physiological indicators, derived indices make it possible to better characterize a complex syndrome as a set of symptoms, and therefore quickly take a set of adequate measures. Recently, we reported on novel diagnostic indices containing butyrylcholinesterase (BChE) activity, which is decreased in COVID-19 patients. Also, in these patients, the secretion of von Willebrand factor (vWF) increases, which leads to thrombosis in the microvascular bed. The objective of this study was the determination of the concentration and activity of vWF in patients with COVID-19, and the search for new diagnostic indices. One of the main objectives was to compare the prognostic values of some individual and newly derived indices. Patients with COVID-19 were retrospectively divided into two groups: survivors (n = 77) and deceased (n = 24). According to clinical symptoms and computed tomography (CT) results, the course of disease was predominantly moderate in severity. The first blood sample (first point) was taken upon admission to the hospital, the second sample (second point)—within 4–6 days after admission. Along with the standard spectrum of biochemical indicators, BChE activity (BChEa or BChEb for acetylthiocholin or butyrylthiocholin, respectively), malondialdehyde (MDA), and vWF analysis (its antigen level, AGFW, and its activity, ActWF) were determined and new diagnostic indices were derived. The pooled sensitivity, specificity, and area under the receiver operating curve (AUC), as well as Likelihood ratio (LR) and Odds ratio (OR) were calculated. The level of vWF antigen in the deceased group was 1.5-fold higher than the level in the group of survivors. Indices that include vWF antigen levels are superior to indices using vWF activity. It was found that the index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) had the best discriminatory power to predict COVID-19 mortality (AUC = 0.91 [0.83, 1.00], p < 0.0001; OR = 72.0 [7.5, 689], p = 0.0002). In addition, [Urea] × 1000/(BChEb × [ALB]) was a good predictor of mortality (AUC = 0.95 [0.89, 1.00], p < 0.0001; OR = 31.5 [3.4, 293], p = 0.0024). The index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) was the best predictor of mortality associated with COVID-19 infection, followed by [Urea] × 1000/(BChEb × [ALB]). After validation in a subsequent cohort, these two indices could be recommended for diagnostic laboratories.

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Predictive value of D-dimer to albumin ratio for severe illness and mortality in patients with COVID-19

Xiao,

Yang,

Liang

et al. 2024

Front. Med.

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ObjectiveAlthough the impact of the variants of COVID-19 on the general population is diminishing, there is still a certain mortality rate for severe and critically ill patients, especially for the elderly with comorbidities. The present study investigated whether the D-dimer to albumin ratio (DAR) can predict the severity of illness and mortality in COVID-19 patients.MethodsA total of 1,993 patients with COVID-19 were retrospectively reviewed and the association of DAR with severe or critical illness or death during hospitalization was analyzed. The area under the ROC curve was used to screen the best indicators, Chi-square test, rank sum test, and univariate and multivariate binary logistic regression analysis were used to calculate the mean value of difference and adjusted odds ratio (aORs) with their 95% CI, and finally, survival was analyzed using Kaplan–Meier (KM) curves.ResultsAmong 1,993 patients with COVID-19, 13.4% were severely ill, and the mortality rate was 2.3%. The area under the curve (AUC) using DAR to predict severe and critically ill patients was higher than that using other parameters. The best cut-off value of DAR was 21 in the ROC with a sensitivity of 83.1% and a specificity of 68.7%. After adjusting age, gender, comorbidities, and treatment, the binary logistic regression analysis showed that elevated DAR was an independent risk factor for severely ill and mortality of COVID-19 patients. The KM curve suggested that patients with a higher DAR was associated with worse survival. The negative predictive value of DAR (21) for adverse prognosis and death was 95.98 and 99.84%, respectively, with a sensitivity of 80.9 and 95.65%, respectively.ConclusionThe DAR may be an important predictor for severe illness and mortality in COVID-19 patients.

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Temporal evolution of laboratory characteristics in patients critically ill with COVID‑19 admitted to the intensive care unit (Review)

Cited by 3 publications

References 73 publications

Temporal trends in laboratory parameters in survivors and non‑survivors of critical COVID‑19 illness and the effect of dexamethasone treatment

Temporal trends in laboratory parameters in survivors and non‑survivors of critical COVID‑19 illness and the effect of dexamethasone treatment

Searching for New Biomarkers to Assess COVID-19 Patients: A Pilot Study

Predictive value of D-dimer to albumin ratio for severe illness and mortality in patients with COVID-19

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