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Bell R, Zini G, d'Onofrio G, Rogers HJ, Lee YS, Frater JL. The hematology laboratory's response to the COVID-19 pandemic: A scoping review. Int J Lab Hematol 2021; 43:148-159. [PMID: 33180380 DOI: 10.1111/ijlh.13381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023]
Abstract
The ongoing COVID-19 pandemic has had a profound worldwide impact on the laboratory hematology community. Nevertheless, the pace of COVID-19 hematology-related research has continued to accelerate and has established the role of laboratory hematology data for many purposes including disease prognosis and outcome. The purpose of this scoping review was to assess the current state of COVID-19 laboratory hematology research. A comprehensive search of the literature published between December 1, 2019, and July 3, 2020, was performed, and we analyzed the sources, publication dates, study types, and topics of the retrieved studies. Overall, 402 studies were included in this scoping review. Approximately half of these studies (n = 202, 50.37%) originated in China. Retrospective cohort studies comprised the largest study type (n = 176, 43.89%). Prognosis/ risk factors, epidemiology, and coagulation were the most common topics. The number of studies published per day has increased through the end of May. The studies were heavily biased in favor of papers originating in China and on retrospective clinical studies with limited use of and reporting of laboratory data. Despite the major improvements in our understanding of the role of coagulation, automated hematology, and cell morphology in COVID-19, there are gaps in the literature, including biosafety and the laboratory role in screening and prevention of COVID-19. There is a gap in the publication of papers focused on guidelines for the laboratory. Our findings suggest that, despite the large number of publications related to laboratory data and their use in COVID-19 disease, many areas remain unexplored or under-reported.
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Affiliation(s)
- Robert Bell
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
| | - Gina Zini
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Roma, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Heesun J Rogers
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yi-Shan Lee
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
| | - John L Frater
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
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Tang KT, Hsu BC, Chen DY. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Front Immunol 2021; 12:645013. [PMID: 33777042 PMCID: PMC7994612 DOI: 10.3389/fimmu.2021.645013] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations. Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years. Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis. Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital Puli Branch, Nantou, Taiwan
| | - Der-Yuan Chen
- Translational Medicine Laboratory, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
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Zhao CL, Rapkiewicz A, Maghsoodi-Deerwester M, Gupta M, Cao W, Palaia T, Zhou J, Ram B, Vo D, Rafiee B, Hossein-Zadeh Z, Dabiri B, Hanna I. Pathological findings in the postmortem liver of patients with coronavirus disease 2019 (COVID-19). Hum Pathol 2021; 109:59-68. [PMID: 33307078 PMCID: PMC7722493 DOI: 10.1016/j.humpath.2020.11.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 12/19/2022]
Abstract
Although coronavirus disease 2019 (COVID-19) is transmitted via respiratory droplets, there are multiple gastrointestinal and hepatic manifestations of the disease, including abnormal liver-associated enzymes. However, there are not many published articles on the pathological findings in the liver of patients with COVID-19. We collected the clinical data from 17 autopsy cases of patients with COVID-19 including age, sex, Body mass index (BMI), liver function test (alanine aminotransaminase (ALT), aspartate aminotransaminase (AST), alkaline phosphatase (ALP), direct bilirubin, and total bilirubin), D-dimer, and anticoagulation treatment. We examined histopathologic findings in postmortem hepatic tissue, immunohistochemical (IHC) staining with antibody against COVID-19 spike protein, CD68 and CD61, and electron microscopy. We counted the number of megakaryocytes in liver sections from these COVID-19-positive cases. Abnormal liver-associated enzymes were observed in 12 of 17 cases of COVID-19 infection. With the exception of three cases that had not been tested for D-dimer, all 14 patients' D-dimer levels were increased, including the cases that received varied doses of anticoagulation treatment. Microscopically, the major findings were widespread platelet-fibrin microthrombi, steatosis, histiocytic hyperplasia in the portal tract, mild lobular inflammation, ischemic-type hepatic necrosis, and zone 3 hemorrhage. Rare megakaryocytes were found in sinusoids. COVID-19 IHC demonstrates positive staining of the histiocytes in the portal tract. Under electron microscopy, histiocyte proliferation is present in the portal tract containing lipid droplets, lysosomes, dilated ribosomal endoplasmic reticulum, microvesicular bodies, and coronavirus. The characteristic findings in the liver of patients with COVID-19 include numerous amounts of platelet-fibrin microthrombi, as well as various degrees of steatosis and histiocytic hyperplasia in the portal tract. Possible mechanisms are also discussed.
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Affiliation(s)
- Chaohui Lisa Zhao
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA.
| | - Amy Rapkiewicz
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Mona Maghsoodi-Deerwester
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Mala Gupta
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Wenqing Cao
- NYU Grossman School of Medicine, NYU Langone Health, Department of Pathology, 10016, USA
| | - Thomas Palaia
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Jianhong Zhou
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Bebu Ram
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Duc Vo
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Behnam Rafiee
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Zarrin Hossein-Zadeh
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Bahram Dabiri
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA
| | - Iman Hanna
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, 11501, USA.
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Garnier M, Quesnel C, Constantin JM. Atteintes pulmonaires liées à la COVID-19. LA PRESSE MÉDICALE FORMATION 2021. [PMCID: PMC7785274 DOI: 10.1016/j.lpmfor.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Le SARS-CoV-2, responsable de la COVID-19, est un nouveau bêta-coronavirus. Il engendre une réaction inflammatoire intense pouvant aller jusqu’à l’« orage cytokinique », avec des atteintes pulmonaires épithéliales sévères et un tableau de coagulopathie intravasculaire pulmonaire. Le tableau clinique est polymorphe, avec possible survenue d’un syndrome de détresse respiratoire aigu (SDRA). La ventilation non invasive et l’oxygénothérapie à haut débit permettent de traiter efficacement plus de la moitié des patients graves sans recours à l’intubation et sans risque pour le personnel soignant. Le seul traitement actuellement validé est la dexaméthasone à dose modérée (6 mg/j pendant 10 jours). Le haut risque thrombotique justifie en fonction des cas une anticoagulation préventive voire curative.
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Giorgetti A, Orazietti V, Busardò FP, Pirani F, Giorgetti R. Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients. Diagnostics (Basel) 2021; 11:190. [PMID: 33525705 PMCID: PMC7912253 DOI: 10.3390/diagnostics11020190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
Since December 2019, a new form of coronavirus, SARS-CoV-2, has spread from China to the whole word, raising concerns regarding Coronavirus Disease 2019 (COVID-19) endangering public health and life. Over 1.5 million deaths related with COVID-19 have been recorded worldwide, with wide variations among countries affected by the pandemic and continuously growing numbers. The aim of this paper was to provide an overview of the literature cases of deaths involving COVID-19 and to evaluate the application of the COVID-19 Significance Score (CSS) in the classification of SARS CoV-2-related fatalities, comparing it with the Hamburg rating scale. The results obtained allowed us to highlight that CSS used after a complete accurate post-mortem examination, coupled to the retrieval of in vivo data, post-mortem radiology, histology and toxicology, as well as to additional required analyses (e.g., electronic microscopy) is a useful and concise tool in the assessment of the cause of death and the role played by this virus. A shared use of this scale might hopefully lower the inhomogeneities in forensic evaluation of SARS CoV-2-related fatalities.
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Affiliation(s)
- Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy;
| | - Vasco Orazietti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Filippo Pirani
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
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Górgolas Hernández-Mora M, Cabello Úbeda A, Prieto-Pérez L, Villar Álvarez F, Álvarez Álvarez B, Rodríguez Nieto MJ, Carrillo Acosta I, Fernández Ormaechea I, Al-Hayani AWM, Carballosa P, Calpena Martínez S, Ezzine F, Castellanos González M, Naya A, López De Las Heras M, Rodríguez Guzmán MJ, Cordero Guijarro A, Broncano Lavado A, Macías Valcayo A, Martín García M, Bécares Martínez J, Fernández Roblas R, Piris Pinilla MÁ, Fortes Alen J, Sánchez Pernaute O, Romero Bueno F, Heili-Frades S, Peces-Barba Romero G. Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia. Int J Infect Dis 2021; 102:303-309. [PMID: 33115682 PMCID: PMC7585732 DOI: 10.1016/j.ijid.2020.10.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. METHODS We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. RESULTS A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). CONCLUSIONS TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.
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Affiliation(s)
| | - Alfonso Cabello Úbeda
- Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain.
| | - Laura Prieto-Pérez
- Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Felipe Villar Álvarez
- Department of Pneumology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Beatriz Álvarez Álvarez
- Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | | | - Irene Carrillo Acosta
- Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | | | | | - Pilar Carballosa
- Department of Pneumology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Silvia Calpena Martínez
- Division of Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Farah Ezzine
- Department of Pneumology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | | | - Alba Naya
- Department of Pneumology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | | | | | | | | | - Alicia Macías Valcayo
- Department of Microbiology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Marta Martín García
- Department of Microbiology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | | | | | | | - José Fortes Alen
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | - Olga Sánchez Pernaute
- Department of Rheumatology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
| | | | - Sarah Heili-Frades
- Department of Pneumology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
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Ieni A, Tuccari G. The COVID-19 pandemic: Pathologists support the clinical infectious diseases team. Int J Infect Dis 2020; 104:479-481. [PMID: 33383219 PMCID: PMC7836675 DOI: 10.1016/j.ijid.2020.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
The pathologist is involved in many diagnostic steps together with the clinical infectious disease team in the management of COVID-19-affected patients. In particular, cytological and histopathological procedures as well as autoptic findings may represent useful tools to better understand the pathobiology of the disease as well as to correctly define causes of death. Moreover, pathologists have been forced to reconsider the usual laboratory workflow and introduce adequate guidelines against virus diffusion in the COVID-19 pandemic, requiring high biosafety levels.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Section of Pathology, University of Messina, Messina, Italy.
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Section of Pathology, University of Messina, Messina, Italy.
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Booz GW, Altara R, Eid AH, Wehbe Z, Fares S, Zaraket H, Habeichi NJ, Zouein FA. Macrophage responses associated with COVID-19: A pharmacological perspective. Eur J Pharmacol 2020; 887:173547. [PMID: 32919938 PMCID: PMC7483085 DOI: 10.1016/j.ejphar.2020.173547] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 has caused worldwide death and economic destruction. The pandemic is the result of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has demonstrated high rates of infectivity leading to great morbidity and mortality in vulnerable populations. At present, scientists are exploring various approaches to curb this pandemic and alleviate its health consequences, while racing to develop a vaccine. A particularly insidious aspect of COVID-19 is the delayed overactivation of the body's immune system that is manifested as the cytokine storm. This unbridled production of pro-inflammatory cytokines and chemokines can directly or indirectly cause massive organ damage and failure. Systemic vascular endothelial inflammation and thrombocytopenia are potential consequences as well. In the case of COVID-19, the cytokine storm often fits the pattern of the macrophage activation syndrome with lymphocytopenia. The basis for the imbalance between the innate and adaptive immune systems is not clearly defined, but highlights the effect of SARS-CoV-2 on macrophages. Here we discuss the potential underlying basis for the impact of SARS-CoV-2 on macrophages, both direct and indirect, and potential therapeutic targets. These include granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin 6 (IL-6), interferons, and CXCL10 (IP-10). Various biopharmaceuticals are being repurposed to target the cytokine storm in COVID-19 patients. In addition, we discuss the rationale for activating the macrophage alpha 7 nicotinic receptors as a therapeutic target. A better understanding of the molecular consequences of SARS-CoV-2 infection of macrophages could lead to novel and more effective treatments for COVID-19.
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Affiliation(s)
| | - Raffaele Altara
- Department of Pathology, School of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA; Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway; KG Jebsen Center for Cardiac Research, Oslo, Norway
| | - Ali H Eid
- Department of Pharmacology and Toxicology, American University of Beirut Faculty of Medicine, Beirut, Lebanon; College of Medicine, Qatar University, Doha, Qatar
| | - Zena Wehbe
- Department of Biology, Faculty of Medicine, American University of Beirut, Beirut Lebanon
| | - Souha Fares
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Center for Infectious Disease Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nada J Habeichi
- Department of Pharmacology and Toxicology, American University of Beirut Faculty of Medicine, Beirut, Lebanon; INSERM Department of Signaling and Cardiovascular Pathophysiology-UMR-S1180, University Paris-Saclay, Châtenay-Malabry, France
| | - Fouad A Zouein
- Department of Pharmacology and Toxicology, American University of Beirut Faculty of Medicine, Beirut, Lebanon.
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59
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Affiliation(s)
- Arthur Kaser
- From the Cambridge Institute of Therapeutic Immunology and Infectious Disease and the Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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60
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Henry BM, Benoit JL, Benoit S, Pulvino C, Berger BA, de Olivera MHS, Crutchfield CA, Lippi G. Red Blood Cell Distribution Width (RDW) Predicts COVID-19 Severity: A Prospective, Observational Study from the Cincinnati SARS-CoV-2 Emergency Department Cohort. Diagnostics (Basel) 2020; 10:E618. [PMID: 32825629 PMCID: PMC7554711 DOI: 10.3390/diagnostics10090618] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
Since previous evidence has demonstrated that red blood cell distribution width (RDW) may be a useful prognostic parameter in many critical illnesses and infectious diseases, we investigated the utility of RDW for monitoring patients with coronavirus disease 2019 (COVID-19). The study population consisted of 49 COVID-19 patients, including 16 (32.6%) with severe illness, 12 (24.5%) with severe acute kidney injury (AKI), and 8 (16.3%) requiring renal replacement therapy (RRT). The predictive value of blood tests, performed during emergency department evaluation, was then addressed. A progressive increase of RDW was observed with advancing COVID-19 severity. The area under the curve (AUC) of RDW was 0.73 for predicting severe illness, 0.80 for severe AKI, and 0.83 for RRT, respectively. In multivariate analysis, elevated RDW was associated with 9-fold and 16-fold increased odds of severe COVID-19 and AKI, respectively. The results of this study suggest that RDW should be part of routine laboratory assessment and monitoring of COVID-19.
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Affiliation(s)
- Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Justin Lee Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45221, USA; (J.L.B.); (C.P.); (B.A.B.)
| | - Stefanie Benoit
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH 45229, USA
| | - Christina Pulvino
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45221, USA; (J.L.B.); (C.P.); (B.A.B.)
| | - Brandon A. Berger
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45221, USA; (J.L.B.); (C.P.); (B.A.B.)
| | | | - Christopher A. Crutchfield
- Department of Pathology & Laboratory Medicine, University of Cincinnati, College of Medicine, OH 45219, USA;
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, 37129 Verona, Italy;
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