The Predictive Value of Cell Blood Count Parameters to Diagnose Pulmonary Embolism in Patients with SARS-CoV-2 Infection: A Case Control Study

Strazzulla, Alessio; Halima, Sarra Abroug Ben; Chouchane, Ibrahim; Rezek, Marwa; Stiebler, Marcella Pinto; Hamrouni, Sarra; Maalaoui, Mohammad; Ghriss, N.; Guedec-Ghelfi, Renaud; Moini, Cyrus; Monchi, Mehran; Belfeki, Nabil

doi:10.3390/antibiotics11010060

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…The association of SARS-CoV-2 infection with thromboembolic events is well known, with a risk of up to 30% of developing an embolic event in severe forms [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Moreover, Strazzulla et al [ 12 ] discovered that the total number of neutrophils (OR:1.20; 95% CI:1.04–1.40; p = 0.01) and lymphocytes (OR:0.45; 95% CI:0.23–0.86; p = 0.01) were independently associated with acute pulmonary embolism a cohort of 184 COVID-19 patients. Furthermore, Roncati L. et al explained the influence of an abnormal inflammatory response in severe COVID-19 patients on pro-coagulant status through platelet release [ 56 , 57 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

“…The pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has affected, until the present day (26 August 2022), a total of 604,392,189 cases and caused 6,483,256 deaths [ 1 ], having a negative impact on medical activities [ 2 , 3 ]. Patients’ symptoms range from minor (headache, loss of taste and smell) to severe (major lung damage, admission to critical care units, the necessity of invasive mechanical ventilation, sepsis, and, more recently, thromboembolic events) [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients

Arbănași¹,

Hălmaciu

Kaller³

et al. 2022

Diagnostics

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Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of thromboembolic events and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)] and the CT Severity Score in acute limb ischemia (ALI) risk, intensive unit care (ICU) admission, and mortality in COVID-19 patients.; Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients older than 18 years of age with a diagnosis of COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2020 and December 2021. Results: Non-Survivors and “ALI” patients were associated with higher incidence of cardiovascular disease [atrial fibrillation (AF) p = 0.0006 and p = 0.0001; peripheral arterial disease (PAD) p = 0.006 and p < 0.0001], and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, PLR, SII, SIRI, AISI, and the CT Severity Score independent predictor of adverse outcomes for all recruited patients (all p < 0.0001). Moreover, the presence of AF and PAD was an independent predictor of ALI risk and mortality. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, and CT Severity Score values at admission strongly predict ALI risk, ICU admission, and mortality. Moreover, patients with AF and PAD had highly predicted ALI risk and mortality but no ICU admission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients

Arbănași¹,

Hălmaciu

Kaller³

et al. 2022

Diagnostics

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“…An increased hematological ratio may reflect an immunological imbalance between a potential ongoing clinical or sub-clinical acute inflammation and an impaired immune defense. The importance of these hematological indicators in predicting coagulopathy risk and thromboembolic risk was widely researched [ 24 , 26 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hematological reports, based on neutrophil, monocyte, lymphocyte, and platelets total number: monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), are routine inflammatory biomarkers, easy to use, with low costs. Moreover, the predictive role of these reports has been recently demonstrated in the literature in the case of cardiovascular pathology [ 24 , 25 , 26 , 27 ], pulmonary embolism [ 28 , 29 ], chronic kidney disease [ 30 , 31 , 32 ], the case of COVID-19 patients [ 33 , 34 , 35 , 36 , 37 , 38 ], as well as in the case of peri-prosthetic infection after total joint arthroplasty [ 39 , 40 , 41 ].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty

Melinte

Arbănași²,

Blesneac

et al. 2022

Medicina

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Background and objectives: Deep vein thrombosis (DVT) is one of the most serious post-operative complications in the case of total knee arthroplasty (TKA). This study aims to verify the predictive role of inflammatory biomarkers [monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI)] in acute DVT following TKA. Materials and methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with surgical indications for TKA, admitted to the Department of Orthopedics, Regina Maria Health Network, Targu Mures, Romania, and the Department of Orthopedics, Humanitas MedLife Hospital, Cluj-Napoca, Romania between January 2017 and July 2022. The primary endpoint was the risk of acute DVT following the TKA, and the secondary endpoint was the length of hospital stay, and the outcomes were stratified for the baseline’s optimal MLR, NLR, PLR, SII, SIRI, and AISI cut-off value. Results: DVT patients were associated with higher age (p = 0.01), higher incidence of cardiac disease [arterial hypertension (p = 0.02), atrial fibrillation (p = 0.01)], malignancy (p = 0.005), as well as risk factors [smoking (p = 0.03) and obesity (p = 0.02)]. Multivariate analysis showed a high baseline value for all hematological ratios: MLR (OR: 11.06; p < 0.001), NLR (OR: 10.15; p < 0.001), PLR (OR: 12.31; p < 0.001), SII (OR: 18.87; p < 0.001), SIRI (OR: 10.86; p < 0.001), and AISI (OR: 14.05; p < 0.001) was an independent predictor of DVT after TKA for all recruited patients. Moreover, age above 70 (OR: 2.96; p = 0.007), AH (OR: 2.93; p = 0.02), AF (OR: 2.71; p = 0.01), malignancy (OR: 3.98; p = 0.002), obesity (OR: 2.34; p = 0.04), and tobacco (OR: 2.30; p = 0.04) were all independent predictors of DVT risk. Conclusions: Higher pre-operative hematological ratios MLR, NLR, PLR, SII, SIRI, and AISI values determined before operations strongly predict acute DVT following TKA. Moreover, age over 70, malignancy, cardiovascular disease, and risk factors such as obesity and tobacco were predictive risk factors for acute DVT.

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“…Moreover, other biomarkers, such as PDW and NLR, were significantly higher in patients with PE as compared to patients without PE. Interestingly, both PDW and NRL have also been described as severity markers in COVID-19 (33,34), with more increased NLR among PE cases (35). Higher PDW, a surrogate marker of platelet activation, has also been found in non-COVID-19 PE patients (36).…”

Section: D-dimer and Other Potential Biomarkers Of Pulmonary Embolism...mentioning

confidence: 96%

A Prospective Study Evaluating Cumulative Incidence and a Specific Prediction Rule in Pulmonary Embolism in COVID-19

et al. 2022

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RationaleAbnormal values of hypercoagulability biomarkers, such as D-dimer, have been described in Coronavirus Disease 2019 (COVID-19), which has also been associated with disease severity and in-hospital mortality. COVID-19 patients with pneumonia are at greater risk of pulmonary embolism (PE). However, the real incidence of PE is not yet clear, since studies have been limited in size, mostly retrospective, and PE diagnostic procedures were only performed when PE was clinically suspected.Objectives(1) To determine the incidence, clinical, radiological, and biological characteristics, and clinical outcomes of PE among patients hospitalized for COVID-19 pneumonia with D-dimer > 1,000 ng/mL. (2) To develop a prognostic model to predict PE in these patients.MethodsSingle-center prospective cohort study. Consecutive confirmed cases of COVID-19 pneumonia with D-dimer > 1,000 ng/mL underwent computed tomography pulmonary angiography (CTPA). Demographic and laboratory data, comorbidities, CTPA scores, treatments administered, and clinical outcomes were analyzed and compared between patients with and without PE. A risk score was constructed from all these variables.ResultsBetween 6 April 2020 and 2 February 2021, 179 consecutive patients were included. The overall incidence of PE was 39.7% (71 patients) (CI 95%, 32–47%). In patients with PE, emboli were located mainly in segmental/subsegmental arteries (67%). Patients with PE did not differ from the non-PE group in sex, age, or risk factors for thromboembolic disease. Higher urea, D-Dimer, D-dimer-to-ferritin and D-dimer-to-lactate dehydrogenase (LDH) ratios, platelet distribution width (PDW), and neutrophil-to-lymphocyte ratio (NLR) values were found in patients with PE when compared to patients with non-PE. Besides, lymphocyte counts turned out to be lower in patients with PE. A score for PE prediction was constructed with excellent overall performance [area under the ROC curve-receiver operating characteristic (AUC-ROC) 0.81 (95% CI: 0.73–0.89)]. The PATCOM score stands for Pulmonary Artery Thrombosis in COVID-19 Mallorca and includes platelet count, PDW, urea concentration, and D-dimer-to-ferritin ratio.ConclusionCOVID-19 patients with pneumonia and D-dimer values > 1,000 ng/mL were presented with a very high incidence of PE, regardless of clinical suspicion. Significant differences in urea, D-dimer, PDW, NLR, and lymphocyte count were found between patients with PE and non-PE. The PATCOM score is presented in this study as a promising PE prediction rule, although validation in further studies is required.

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The Predictive Value of Cell Blood Count Parameters to Diagnose Pulmonary Embolism in Patients with SARS-CoV-2 Infection: A Case Control Study

Cited by 12 publications

References 21 publications

Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients

Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients

Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty

A Prospective Study Evaluating Cumulative Incidence and a Specific Prediction Rule in Pulmonary Embolism in COVID-19

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