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Sun X, Zhang H, Zhang M, Fei M, Xiong L, Li C. High myoglobin level as an independent risk factor for death in elderly patients with critical COVID-19 infection: a retrospective case-control study. BMC Infect Dis 2024; 24:842. [PMID: 39164612 PMCID: PMC11334602 DOI: 10.1186/s12879-024-09621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/16/2024] [Indexed: 08/22/2024] Open
Abstract
AIM This study aimed to discover risk factors for death in patients with critical COVID-19 infection in order to identify patients with a higher risk of death at an early stage. METHODS We retrospectively analyzed the clinical data of patients with critical COVID-19 infection from April 2022 to June 2022. Data were collected from the electronic medical records. Propensity matching scores were used to reduce the effect of confounding factors, such as patient baseline variables. Independent risk factors affecting patient prognosis were assessed using univariate logistic regression and multivariate logistic regression analysis. Restricted cubic spline curves were used to assess the relationship between independent and dependent variables. RESULTS The data of 132 patients with critical COVID-19 infection were included in the study. Of the 132 patients, 79 survived and 53 died. Among laboratory indicators, patients who died had higher proportions of abnormalities in procalcitonin, aspartate aminotransferase (AST), creatinine, cardiac troponin I, and myoglobin. Univariate and multivariate logistic regression analyses suggested that abnormal AST (OR = 4.98, P = 0.02), creatinine (OR = 7.93, P = 0.021), and myoglobin (OR = 103.08, P = 0.002) were independent risk factors for death. After correction for AST and creatinine, a linear relationship between myoglobin and risk of death in patients was found using restricted cubic splines. CONCLUSION High myoglobin level is an independent risk factor for death and is therefore a prognostic marker in elderly patients with severe COVID-19 infection.
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Affiliation(s)
- Xiaoxiao Sun
- Department of Critical Care Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, No. 1279, Sanmen Road, Hongkou District, Shanghai, 200434, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China
| | - Hui Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China
| | - Meixian Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China
| | - Miaomiao Fei
- Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China.
| | - Cheng Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, China.
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Hamdy RM, Samy M, Mohamed HS. Clinical utility of ambulatory ECG monitoring and 2D-ventricular strain for evaluation of post-COVID-19 ventricular arrhythmia. BMC Cardiovasc Disord 2024; 24:429. [PMID: 39148011 PMCID: PMC11328462 DOI: 10.1186/s12872-024-03982-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/17/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND A relatively common complication of COVID -19 infection is arrhythmia. There is limited information about myocardial deformation and heart rate variability (HRV) in symptomatic post COVID patients presented by ventricular arrhythmia. AIM OF THE STUDY Our goal was to assess 2D-ventricular strain and heart rate variability indices (evaluated by ambulatory ECG monitoring) in post-COVID-19 patients suffering from ventricular arrhythmia. METHODS The current observational case-control study performed on 60 patients one month after they had recovered from the COVID-19 infection. Thirty healthy volunteers served as the control group. Each participant had a full medical history review, blood tests, a 12-lead surface electrocardiogram (ECG), 24-h ambulatory ECG monitoring, and an echo-Doppler examination to evaluate the left ventricular (LV) dimensions, tissue Doppler velocities, and 2D-speckle tracking echocardiography (2D-STE) for both the LV and right ventricular (RV) strain. RESULTS Symptomatic post-COVID patients with monomorphic premature ventricular contractions (PVCs) showed a substantial impairment of LV/RV systolic and diastolic functions, LV/RV myocardial performance (MPI) with reduced indices of HRV. Patients with higher versus lower ventricular burden had poorer functional status, higher levels of inflammatory biomarkers and reduced parameters of HRV (New York Heart Association (NYHA) class: 2.1 ± 0.9 vs. 1.5 ± 0.6, p < 0.001, C-reactive protein (CRP): 13.3 ± 4.1 vs. 8.3 ± 5.9 mg/L, p < 0.0001, low frequency/high frequency (LF/HF): 3.6 ± 2.4 vs. 2.2 ± 1.2, p < 0.002, the root mean square of the difference between successive normal intervals (rMSSD): 21.8 ± 4.7 vs. 29.3 ± 14.9 ms, p < 0.039 and the standard deviation of the RR interval (SDNN): 69.8 ± 19.1 vs.108.8 ± 37.4 ms, p < 0.0001). The ventricular burden positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.33, p < 0.001), CRP (r = 0.60, p < 0.0001), while it negatively correlated with LV-global longitudinal strain (GLS) (r = -0.38, p < 0.0001), and RV-GLS (r = -0.37, p < 0.0001). CONCLUSIONS Patients with post-COVID symptoms presented by ventricular arrhythmia had poor functional status. Patients with post-COVID symptoms and ventricular arrhythmia had subclinical myocardial damage, evidenced by speckle tracking echocardiography while having apparently preserved LV systolic function. The burden of ventricular arrhythmia in post-COVID patients significantly correlated with increased inflammatory biomarkers and reduced biventricular strain.
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Affiliation(s)
- Rehab M Hamdy
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
| | - Mohammed Samy
- Department of Cardiology, Faculty of Medicine (for Boys), Al-Azhar University, Cairo, Egypt
| | - Huda Shaban Mohamed
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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Lipski D, Radziemski A, Wasiliew S, Wyrwa M, Szczepaniak-Chicheł L, Stryczyński Ł, Olasińska-Wiśniewska A, Urbanowicz T, Perek B, Tykarski A, Komosa A. Assessment of COVID-19 risk factors of early and long-term mortality with prediction models of clinical and laboratory variables. BMC Infect Dis 2024; 24:685. [PMID: 38982355 PMCID: PMC11234702 DOI: 10.1186/s12879-024-09592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) may lead to serious complications and increased mortality. The outcomes of patients who survive the early disease period are burdened with persistent long-term symptoms and increased long-term morbidity and mortality. The aim of our study was to determine which baseline parameters may provide the best prediction of early and long-term outcomes. METHODS The study group comprised 141 patients hospitalized for COVID-19. Demographic data, clinical data and laboratory parameters were collected. The main study endpoints were defined as in-hospital mortality and 1-year mortality. The associations between the baseline data and the study endpoints were evaluated. Prediction models were created. RESULTS The in-hospital mortality rate was 20.5% (n = 29). Compared with survivors, nonsurvivors were significantly older (p = 0.001) and presented comorbidities, including diabetes (0.027) and atrial fibrillation (p = 0.006). Assessment of baseline laboratory markers and time to early death revealed negative correlations between time to early death and higher IL-6 levels (p = 0.032; Spearman rho - 0.398) and lower lymphocyte counts (p = 0.018; Pearson r -0.438). The one-year mortality rate was 35.5% (n = 50). The 1-year nonsurvivor subgroup was older (p < 0.001) and had more patients with arterial hypertension (p = 0.009), diabetes (p = 0.023), atrial fibrillation (p = 0.046) and active malignancy (p = 0.024) than did the survivor subgroup. The model composed of diabetes and atrial fibrillation and IL-6 with lymphocyte count revealed the highest value for 1-year mortality risk prediction. CONCLUSIONS Diabetes and atrial fibrillation, as clinical factors, and LDH, IL-6 and lymphocyte count, as laboratory determinants, are the best predictors of COVID-19 mortality risk.
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Affiliation(s)
- Dawid Lipski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
| | - Artur Radziemski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Stanisław Wasiliew
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Wyrwa
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ludwina Szczepaniak-Chicheł
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Stryczyński
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, ul. Długa 1/2, Poznan, 61-848, Poland
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, ul. Długa 1/2, Poznan, 61-848, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, ul. Długa 1/2, Poznan, 61-848, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Komosa
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Cao A, Luo W, Wang L, Wang J, Zhou Y, Huang C, Zhu B. The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study. Medicine (Baltimore) 2024; 103:e38213. [PMID: 38758852 PMCID: PMC11098216 DOI: 10.1097/md.0000000000038213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
Identifying prognostic factors in elderly patients with severe coronavirus disease 2019 (COVID-19) is crucial for clinical management. Recent evidence suggests malnutrition and renal dysfunction are associated with poor outcome. This study aimed to develop a prognostic model incorporating prognostic nutritional index (PNI), estimated glomerular filtration rate (eGFR), and other parameters to predict mortality risk. This retrospective analysis included 155 elderly patients with severe COVID-19. Clinical data and outcomes were collected. Logistic regression analyzed independent mortality predictors. A joint predictor "L" incorporating PNI, eGFR, D-dimer, and lactate dehydrogenase (LDH) was developed and internally validated using bootstrapping. Decreased PNI (OR = 1.103, 95% CI: 0.78-1.169), decreased eGFR (OR = 0.964, 95% CI: 0.937-0.992), elevated D-dimer (OR = 1.001, 95% CI: 1.000-1.004), and LDH (OR = 1.005, 95% CI: 1.001-1.008) were independent mortality risk factors (all P < .05). The joint predictor "L" showed good discrimination (area under the curve [AUC] = 0.863) and calibration. The bootstrapped area under the curve was 0.858, confirming model stability. A combination of PNI, eGFR, D-dimer, and LDH provides useful prognostic information to identify elderly patients with severe COVID-19 at highest mortality risk for early intervention. Further external validation is warranted.
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Affiliation(s)
- Angyang Cao
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
| | - Wenjun Luo
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
| | - Long Wang
- Nephrology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Jianhua Wang
- Radiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Yanling Zhou
- Anesthesiology Department, Kunming Third People’s Hospital, Yunnan, China
| | - Changshun Huang
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Binbin Zhu
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
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Xi Y, Mao Y, Zhu W, Xi P, Huang F, Tan H, Liao X, Zhou L. IL-6 is a predictor and potential therapeutic target for coronavirus disease 2019-related heart failure: A single-center retrospective study. Cytokine 2024; 176:156514. [PMID: 38277928 DOI: 10.1016/j.cyto.2024.156514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Inflammation is linked to coronavirus disease 2019 (COVID-19)-related heart failure (HF), but the specific mechanisms are unclear. This study aimed to assess the relationship between specific inflammatory factors, such as interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-17, interferon (IFN)-α, and IFN-γ, and COVID-19-related HF. METHODS We retrospectively identified 212 adult patients with COVID-19 who were hospitalized at Shanghai Public Health Center from March 1 to May 30, 2022 (including 80 patients with HF and 132 without HF). High-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and inflammatory factors, including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-17, IFN-α, and IFN-γ, were compared between patients with COVID-19 with and without HF. RESULTS Patients with COVID-19 having and not having HF differed with regard to sex, age, hs-CRP, PCT, and IL-6 levels (p < 0.05). Logistic regression analysis indicated a significant positive association between IL and 6 and HF (odds ratio = 1.055; 95 % confidence interval: 1.019-1.093, p < 0.005). Sex, age, and hs-CRP were also associated with HF. Women had a greater risk of HF than men. Older age, higher levels of hs-CRP, and IL-6 were associated with a greater risk of HF. CONCLUSIONS In patients with COVID-19, increased IL-6 levels are significantly associated with COVID-19-related HF.
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Affiliation(s)
- Yan Xi
- Department of General Practice, Tongji Hospital, School of Medicine, Tongji University, Shanghai 20065, China
| | - Yu Mao
- Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 20065, China
| | - Wei Zhu
- General Hospital of Eastern Theater Command, Nanjing City, Jiangsu Province 210000, China
| | - Peng Xi
- Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 20065, China
| | - Feifei Huang
- Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 20065, China
| | - Hongwei Tan
- Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 20065, China
| | - Xudong Liao
- Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 20065, China
| | - Lin Zhou
- Department of Cardiology, Tongji Hospital, Tongji University, Shanghai 20065, China.
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Heer RS, Selby FL, Mandal AKJ, Baktash V, Szawarski P, Mattoo S, Mohiaddin H, Makuloluwa KK, Chreif H, Amin FR, Missouris CG. Fragmentation of the QRS Complex Is Associated with Right Ventricular Dilatation and Mortality in Critically Unwell Coronavirus Disease 2019 Patients. Anatol J Cardiol 2024; 28:286-293. [PMID: 38530215 PMCID: PMC11168715 DOI: 10.14744/anatoljcardiol.2024.3494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND QRS fragmentation (fQRS) is a depolarization disorder that can be detected on routine electrocardiography (ECG). Current evidence suggests that fQRS is a prognosticator of adverse cardiovascular events. This study aimed to assess the relationship between fQRS and all-cause mortality in critically unwell coronavirus disease 2019 (COVID-19) patients and to investigate the significance of associated abnormalities on echocardiography. METHODS A retrospective cohort study of COVID-19 patients in a critical care setting was performed. Electrocardiography was performed on presentation to hospital, admission to the critical care unit, and at subsequent points according to clinical need. Transthoracic echocardiography was performed at clinical discretion to assess for structural and functional cardiac abnormalities. Primary outcome was in-hospital mortality and secondary outcome was the need for mechanical invasive ventilation. RESULTS Totally, 212 consecutive patients were included of which 120 (57%) exhibited fQRS and inferior leads were involved in 88% of the patients. Overall, fQRS was a significant predictor of mortality [65% vs. 44% P =.003; multivariate odds ratio = 2.96, 95% confidence interval (CI): 1.42-6.40, P =.005] and inferior fQRS itself was a significant predictor of mortality (P =.03). There was no significant association between fQRS and the need for invasive mechanical ventilation. A total of 112 patients underwent echocardiography. There was a greater incidence of right ventricular (RV) dilatation in the fQRS group (16% vs. 2% respectively, P =.02) and pulmonary hypertension (33% vs. 14% respectively, P =.03) based on echocardiographic criteria. CONCLUSION Our study demonstrates that fQRS is significantly associated with RV dilation, pulmonary hypertension, and mortality in critically unwell COVID-19 patients.
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Affiliation(s)
| | - Faye L. Selby
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | - Vadir Baktash
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | - Sirtaaj Mattoo
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | | | - Hussein Chreif
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Fouad R. Amin
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Constantinos G. Missouris
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
- University of Nicosia Medical School, Nicosia, Cyprus
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Karaca B, Esin F, Tiryaki MM, Akkan G, Kiris T. Combining C-reactive protein, procalcitonin, and serum albumin to predict long-term mortality in patients with infective endocarditis. J Int Med Res 2023; 51:3000605231208910. [PMID: 37891466 PMCID: PMC10612466 DOI: 10.1177/03000605231208910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To determine the predictive value of C-reactive protein (CRP) plus albumin plus procalcitonin for long-term mortality in patients with infective endocarditis. METHODS This retrospective study included patients hospitalized with infective endocarditis between February 2008 and December 2021. CRP, procalcitonin, and albumin levels were measured within 24 h of admission and dichotomized as high or low. A CRP plus procalcitonin plus albumin points system (range, 3-6) was generated based on high or low CRP, procalcitonin, and albumin concentrations. Patients were divided into two groups: low-risk (≤4 points) and high-risk (>4 points), according to total score. The primary outcome was defined as all-cause mortality rate at long-term follow-up. RESULTS Out of 204 patients in total, the high-risk group (n = 29) had higher procalcitonin and CRP levels versus the low-risk group (n = 175), but lower albumin level versus the low-risk group (2.7 ± 0.5 versus 3.5 ± 0.6 g/dl). Matching based on propensity scores showed a higher mortality rate in high-risk versus low-risk patients (76% versus 44%, respectively). In multivariate analysis after matching, the high-risk group was associated with increased long-term mortality (adjusted hazard ratio 2.87, 95% confidence interval 1.32, 6.26).Conclusions: A high CRP plus albumin plus procalcitonin score was associated with long-term mortality risk in patients with infective endocarditis.
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Affiliation(s)
- Banu Karaca
- Department of Infectious Diseases, Atatürk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
| | - Fatma Esin
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
| | - Muhammet Mücahit Tiryaki
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
| | - Gökhun Akkan
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
| | - Tuncay Kiris
- Department of Cardiology, Atatürk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
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Bao J, Gao Z, Hu Y, Liu W, Ye L, Wang L. Serum fibrinogen-to-albumin ratio predicts new-onset atrial fibrillation risk during hospitalization in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective study. BMC Cardiovasc Disord 2023; 23:432. [PMID: 37658287 PMCID: PMC10474692 DOI: 10.1186/s12872-023-03480-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) is a common adverse outcome of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and is closely correlated with hospital stay and prognosis. In recent years, serum fibrinogen-to-albumin ratio (FAR), a novel biomarker for inflammation and thrombosis, has been used to predict the severity and prognosis of coronary artery disease. Our study aimed to investigate the relationship between FAR and NOAF during hospitalization after PCI in patients with AMI. METHODS We retrospectively analyzed the incidence of NOAF during hospitalization and follow-up in 670 patients with AMI after PCI. Data were collected on patient age, sex, body mass index, medical history, current medication, heart failure, laboratory tests, culprit blood vessels, echocardiographic characteristics, and AMI type. The enrolled patients were divided into NOAF and non-NOAF groups. The baseline characteristics of patients in the two groups were compared, and the predictive correlation between FAR and NOAF was evaluated using logistic regression analysis and the receiver operating characteristic curve. RESULTS Fifty-three (7.9%) patients developed NOAF during hospitalization. The occurrence of NOAF was found to be independently associated with higher FAR besides older age, higher neutrophil count, greater left atrial size, worse Killip class upon admission, lower body mass index, lower platelet count, lower left ventricle ejection fraction, and target left circumflex artery disease. FAR exhibited a better predictive value for the occurrence of NOAF during hospitalization (area under the curve, 0.732; 95% confidence interval, 0.659-0.808). CONCLUSIONS FAR is a robust tool for predicting NOAF risk during hospitalization in patients with AMI after PCI and has a better predictive value than serum fibrin and serum albumin levels alone.
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Affiliation(s)
- Jiaqi Bao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhicheng Gao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yilan Hu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wenquan Liu
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Lifang Ye
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lihong Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China.
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Li H, Meng S, Chen W, Lei X, Kong X, Zhu H. Comparison of Different Systemic Inflammatory Markers in Predicting Clinical Outcomes with Syntax Score in Patients with Non-ST Segment Elevation Myocardial Infarction: A Retrospective Study. Int J Gen Med 2023; 16:2595-2607. [PMID: 37362824 PMCID: PMC10289247 DOI: 10.2147/ijgm.s413538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Background The clinical value of the Syntax score in patients with non-ST segment elevation myocardial infarction (NSTEMI) has been well established. The neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the high sensitivity C-reactive protein (hsCRP)-albumin ratio (hsCAR), and systemic immune-inflammatory (SII) index are promising systemic inflammation (SI) biomarkers in coronary artery diseases. However, studies which compare the predicting value of these SI indicators with the Syntax score in NSTEMI patients are limited. Material and Methods NSTEMI patients who underwent coronary angiography (CAG) in our department were retrospectively enrolled. Both univariable and multivariable logistic regression analyses were performed to evaluate the clinical value between SI biomarkers and Syntax score in these patients. The area under the receiver operating characteristic curve (ROC) was used to compare the clinical values of these parameters in predicting 6-month major cardiovascular events (MACE) and over-all mortality. Results A total of 429 NSTEMI patients were finally enrolled in this study. The level of NLR, PLR, as well as hsCAR, and SII in patients with high Syntax scores, are significantly higher than patients with the low Syntax score. Multivariable logistic regression analysis demonstrated that all of the SI indicators but not the Syntax score were the independent risk factors of 6-month MACE in NSTEMI patients. ROC showed that all of the SI indicators had better predictive value than the Syntax score in these patients (0.637, 0.592, 0.631, 0.590, 0.559, respectively) in predicting MACE and similar predictive value in over-all mortality (0.530, 0.524, 0.761, 0.553, 0.620, respectively). Conclusion Novel SI biomarkers including NLR, PLR, hsCAR, and SII have better predictive value in MACE and similar predictive value in over-all mortality compared with Syntax score in NSTEMI patients.
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Affiliation(s)
- Hong Li
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuai Meng
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weiguang Chen
- Department of Cardiology, 1st Hospital Affiliated of Hebei North University, Zhangjiakou, Hebei Province, People’s Republic of China
| | - Xuan Lei
- Department of Cardiology, Beijing Chest Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiangyun Kong
- Department of General Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Huagang Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China
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Kurtipek E, Mermer M, Yıldırım B, Yazar MA, Duran M, Duksal F. Factors Affecting Duration of Hospital Stay in Deceased COVID-19 Patients. Int J Gen Med 2023; 16:929-936. [PMID: 36938305 PMCID: PMC10022436 DOI: 10.2147/ijgm.s406021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Extensive research has been conducted to identify the predictive criteria for COVID-19 disease. White blood cell, C-reactive protein, CRP/albumin ratio, neutrophil-to-lymphocyte ratio and ferritin are among the indicators of increased inflammatory response; hence, they could be used to determine the prognosis of COVID-19 cases. Within the scope of this study, we aimed to elucidate the predictivity of NLR, CAR and other laboratory parameters on the duration of hospital stay and mortality in patients with COVID-19. Materials and Method The data of 1516 COVID-19 patients who were hospitalized in our institution have been analyzed retrospectively. Patients were divided into two groups those who deceased within the first 10 days of hospitalization (Group I, ≤10 days) and those who deceased in the later period (Group II, >10 days). Age, gender, time to mortality after hospitalization, neutrophil count, CRP, neutrophil-to-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and d-dimer values were obtained from blood samples taken during hospitalization. Results NLR and CAR values were significantly higher in those who died in the first 10 days compared to the other group (p<0.02 and p<0.001, respectively). In addition, WBC, neutrophil, CRP and d-dimer levels were statistically significantly higher than the other group (p<0.05). Logistic regression analysis results for NLR and CAR were significant. The cut-off values were calculated (5.74 and 4.27, respectively) for both parameters. Among the most common comorbid diseases were hypertension (HT) in 41%, coronary artery disease (CAD) in 41.7%, asthma-chronic obstructive pulmonary disease (COPD) in 36.7%, diabetes mellitus (DM) in 36.1%. Conclusion NLR and CAR may have a decisive influence in determining the length of stay in hospital for patients who die in hospital due to COVID-19. In addition, it is recommended that COVID-19 cases with diabetes be followed closely.
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Affiliation(s)
- Ercan Kurtipek
- Department of Chest Diseases, University of Health Sciences, Konya City Hospital, Karatay, Konya, Turkey
- Correspondence: Ercan Kurtipek, Department of Chest Diseases, University of Health Sciences, Konya City Hospital, Karatay, Konya, Turkey, Email
| | - Mehmet Mermer
- Department of Chest Diseases, University of Health Sciences, Konya City Hospital, Karatay, Konya, Turkey
| | - Bilgenur Yıldırım
- Department of Chest Diseases, University of Health Sciences, Konya City Hospital, Karatay, Konya, Turkey
| | - Mehmet Akif Yazar
- Department of Anesthesiology and Reanimation, University of Health Sciences, Konya City Hospital, Karatay, Konya, Turkey
| | - Mustafa Duran
- Department of Cardiology, University of Health Sciences, Konya City Hospital, Karatay, Konya, Turkey
| | - Faysal Duksal
- Department of Chest Diseases, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Selcuklu, Konya, Turkey
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11
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Özdemir S, Altunok İ. Comparison of the Predictive Ability of the Blood Urea Nitrogen/Albumin, C-Reactive Protein/Albumin, and Lactate/Albumin Ratios for Short-Term Mortality in SARS-CoV-2-Infected Patients. Avicenna J Med 2023; 13:43-48. [PMID: 36969347 PMCID: PMC10038752 DOI: 10.1055/s-0043-1761471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background Hematological parameters and their ratios are the most studied biomarkers for prediction of mortality or severe illness in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to compare the power of the blood urea nitrogen (BUN)/albumin ratio, lactate/albumin ratio, and C-reactive protein (CRP)/albumin ratio, measured at the time of admission, in predicting 30-day mortality in SARS-CoV-2-infected patients presenting to the emergency department (ED). Materials and Methods This retrospectively designed, single-center, observational study was performed in the ED of a tertiary education health care center. We documented the data of patients admitted with a confirmed SARS-CoV-2 infection between September 1, 2020, and January 1, 2021. Results Of the 470 patients included in the study, 232 (49.4%) were female. The all-cause 30-day mortality rate was 23.8%. The area under the curve values for the BUN/albumin ratio, lactate/albumin ratio, and CRP/albumin ratio in the prediction of 30-day mortality were 0.725, 0.641, and 0.749, respectively. Sensitivity and negative predictive value for CRP/albumin ratio (≥0.049) and specificity for BUN/albumin ratio (≥1.17) were 92.86, 94.9, and 71.23, respectively. The odds ratio values of the BUN/albumin ratio (≥1.17), CRP/albumin ratio (≥0.049), and lactate/albumin ratio (≥0.046) for 30-day mortality were determined as 4.886, 9.268, and 2.518, respectively. Conclusion The BUN/albumin ratio and CRP/albumin ratio can be used to predict 30-day mortality in SARS-CoV-2-infected patients admitted to ED. Furthermore, CRP/albumin ratio had the highest sensitivity and negative predictive value, while BUN/albumin ratio had the highest specificity.
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Affiliation(s)
- Serdar Özdemir
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - İbrahim Altunok
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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12
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Rathore SS, Oberoi S, Iqbal K, Bhattar K, Benítez‐López GA, Nieto‐Salazar MA, Velasquez‐Botero F, Moreno Cortes GA, Hilliard J, Madekwe CC, Madekwe CC, Flowers TC, Khalil K. Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: A meta-analysis. Rev Med Virol 2022; 32:e2390. [PMID: 36029484 PMCID: PMC9538909 DOI: 10.1002/rmv.2390] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 01/08/2023]
Abstract
With COVID-19 still hovering around and threatening the lives of many at-risk patients, an effective, quick, and inexpensive prognostic method is required. Few studies have shown fibrinogen to albumin ratio (FAR) and C-reactive protein to albumin ratio (CAR) to be promising as prognostic markers for COVID-19 disease. However, their implications remain unclear. This meta-analysis aimed to elucidate the prognostic role of FAR and CAR in COVID-19 disease. A systematic literature search was undertaken using PubMed and Embase till April 2022. Inverse variance standardised mean difference (SMD) was calculated to report the overall effect size using random effect models. The generic inverse variance random-effects method was used to pool the area under the curve (AUC) values. All statistical analyses were performed on Revman and MedCalc Software. A total of 23 studies were included. COVID-19 non-survivors had a higher CAR on admission compared with survivors (SMD = 1.79 [1.04, 2.55]; p < 0.00001; I2 = 97%) and patients with a severe COVID-19 infection had a higher CAR on admission than non-severe patients (SMD = 1.21 [0.54, 1.89]; p = 0.0004; I2 = 97%). Similarly, higher mean FAR values on admission were significantly associated with COVID-19 mortality (SMD = 0.55 [0.32, 0.78]; p < 0.00001; I2 = 82%). However, no significant association was found between mean FAR on admission and COVID-19 severity (SMD = 0.54 [-0.09, 1.18]; p = 0.09; I2 = 91%). The pooled AUC values found that CAR had a good discriminatory-power to predict COVID-19 severity (AUC = 0.81 [0.75, 0.86]; p < 0.00001; I2 = 80%) and mortality (AUC = 0.81 [0.74, 0.87]; p < 0.00001; I2 = 86%). FAR had a fair discriminatory-power to predict COVID-19 severity (AUC = 0.73 [0.64, 0.82]; p < 0.00001; I2 = 89%). Overall, CAR was a good predictor of both severity and mortality associated with COVID-19 infection. Similarly, FAR was a satisfactory predictor of COVID-19 mortality but not severity.
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Affiliation(s)
| | - Sharvi Oberoi
- Dr. D. Y. Patil Medical CollegeHospital & Research CentrePimpriPuneIndia
| | - Kinza Iqbal
- Department of Internal MedicineDow Medical CollegeDow University of Health SciencesKarachiPakistan
| | | | | | | | | | | | - Jonathan Hilliard
- All Saints University College of MedicineAmos ValeSaint Vincent and the Grenadines
| | | | | | - Thomas C. Flowers
- All Saints University College of MedicineAmos ValeSaint Vincent and the Grenadines
| | - Khalil Khalil
- Department of Emergency MedicineThe Queen Elizabeth HospitalKing's LynnUK
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13
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Çınar T, Hayıroğlu Mİ, Çiçek V, Selçuk M. Comment on: "Comparison of C-reactive protein and C-reactive protein-to-albumin ratio in predicting mortality among geriatric coronavirus disease 2019 patients". Rev Assoc Med Bras (1992) 2022; 68:975-976. [PMID: 35946777 PMCID: PMC9574965 DOI: 10.1590/1806-9282.20220386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Tufan Çınar
- Health Sciences University, Sultan I, Abdülhamid Han Training and Research Hospital, Department of Cardiology - Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Health Sciences University, Dr. Siyami Ersek Training and Research Hospital, Department of Cardiology - Istanbul, Turkey
| | - Vedat Çiçek
- Health Sciences University, Sultan I, Abdülhamid Han Training and Research Hospital, Department of Cardiology - Istanbul, Turkey
| | - Murat Selçuk
- Health Sciences University, Sultan I, Abdülhamid Han Training and Research Hospital, Department of Cardiology - Istanbul, Turkey
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14
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Giner-Galvañ V, Pomares-Gómez FJ, Quesada JA, Rubio-Rivas M, Tejada-Montes J, Baltasar-Corral J, Taboada-Martínez ML, Sánchez-Mesa B, Arnalich-Fernández F, Del Corral-Beamonte E, López-Sampalo A, Pesqueira-Fontán PM, Fernández-Garcés M, Gómez-Huelgas R, Ramos-Rincón JM. C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19. Biomedicines 2022; 10:1393. [PMID: 35740416 PMCID: PMC9219981 DOI: 10.3390/biomedicines10061393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551−0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001−1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865−0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188−1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course.
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Affiliation(s)
- Vicente Giner-Galvañ
- Department of Internal Medicine, Hospital Clínico Universitario San Juan de Alicante, 03550 Alicante, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46020 Valencia, Spain;
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
| | - Francisco José Pomares-Gómez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46020 Valencia, Spain;
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
- Department of Endocrinology, Hospital Clínico Universitario San Juan de Alicante, 03550 Alicante, Spain
| | - José Antonio Quesada
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, 08097 L’Hospitalet de Llobregat, Spain;
| | - Javier Tejada-Montes
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | | | | | - Blanca Sánchez-Mesa
- Department of Internal Medicine, Hospital Costa del Sol, 20603 Marbella, Spain;
| | | | | | - Almudena López-Sampalo
- Department of Internal Medicine, Regional University Hospital of Málaga, 29010 Málaga, Spain; (A.L.-S.); (R.G.-H.)
- Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29590 Málaga, Spain
| | - Paula María Pesqueira-Fontán
- Department of Internal Medicine, Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Mar Fernández-Garcés
- Department of Internal Medicine, Doctor Peset University Hospital, 46017 Valencia, Spain;
| | - Ricardo Gómez-Huelgas
- Department of Internal Medicine, Regional University Hospital of Málaga, 29010 Málaga, Spain; (A.L.-S.); (R.G.-H.)
- Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29590 Málaga, Spain
| | - José Manuel Ramos-Rincón
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
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Cakir Guney B, Hayiroglu M, Senocak D, Cicek V, Cinar T, Kaplan M. Evaluation of N/LP Ratio as a Predictor of Disease Progression and Mortality in COVID-19 Patients Admitted to the Intensive Care Unit. Medeni Med J 2021; 36:241-248. [PMID: 34915683 PMCID: PMC8565580 DOI: 10.5222/mmj.2021.95676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/21/2021] [Indexed: 01/21/2023] Open
Abstract
Objective This research aimed to evaluate whether the neutrophil to lymphocyte and platelet (N/LP) ratio may be used to predict the risk of admission to the intensive care unit (ICU), the need for mechanical ventilation and in-hospital mortality in Coronavirus disease 2019 (COVID-19) cases. Methods The study was conducted retrospectively on the data of 134 COVID-19 patients who were admitted to the ICU. The N/LP ratio was calculated as follows: neutrophil count x 100 / (lymphocyte count x platelet count). Each member of the research cohort was categorised into 1 of 2 groups based on their survival status (survivor and non-survivor groups). Results In total, 82 (61%) patients died during the ICU stay. Patients who required mechanical ventilation and died in the ICU stay had significantly higher N/LP ratio than those who did not require it and survived [10 (IQR=4.94-19.38) vs 2.51 (IQR=1.67-5.49), p<0.001] and [11.27 (IQR=4.53-30.02) vs 1.65 (IQR=1-3.24), p<0.001], respectively. The N/LP ratio was linked with the requirement of mechanical ventilation and in-hospital death according to multivariable analysis. In receiver operating characteristic curve analysis, we found that N/LP in predicting admission to the ICU was >4.18 with 61% sensitivity and 62% specificity, it was >5.07 with 74% sensitivity and 73% specificity for the need for mechanical ventilation, and >3.69 with 81% sensitivity and 81% specificity to predict in-hospital death. Conclusion To our knowledge, this is the first study showing that the N/LP ratio, which is a novel and widely applicable inflammatory index, may be used to predict the risk of ICU admission, mechanical ventilation and in-hospital death in patients with COVID-19 disease .
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Affiliation(s)
- Basak Cakir Guney
- Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Mert Hayiroglu
- Health Sciences University, Dr. Siyami Ersek Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Didar Senocak
- Health Sciences University, Haydarpasa Numune Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Vedat Cicek
- Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Tufan Cinar
- Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Kaplan
- Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
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Early Prediction of Disease Progression in Patients with Severe COVID-19 Using C-Reactive Protein to Albumin Ratio. DISEASE MARKERS 2021; 2021:6304189. [PMID: 34900028 PMCID: PMC8664519 DOI: 10.1155/2021/6304189] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023]
Abstract
Background Early identification of patients with severe coronavirus disease (COVID-19) at an increased risk of progression may promote more individualized treatment schemes and optimize the use of medical resources. This study is aimed at investigating the utility of the C-reactive protein to albumin (CRP/Alb) ratio for early risk stratification of patients. Methods We retrospectively reviewed 557 patients with COVID-19 with confirmed outcomes (discharged or deceased) admitted to the West Court of Union Hospital, Wuhan, China, between January 29, 2020 and April 8, 2020. Patients with severe COVID-19 (n = 465) were divided into stable (n = 409) and progressive (n = 56) groups according to whether they progressed to critical illness or death during hospitalization. To predict disease progression, the CRP/Alb ratio was evaluated on admission. Results The levels of new biomarkers, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, CRP/Alb ratio, and systemic immune-inflammation index, were higher in patients with progressive disease than in those with stable disease. Correlation analysis showed that the CRP/Alb ratio had the strongest positive correlation with the sequential organ failure assessment score and length of hospital stay in survivors. Multivariate logistic regression analysis showed that percutaneous oxygen saturation (SpO2), D-dimer levels, and the CRP/Alb ratio were risk factors for disease progression. To predict clinical progression, the areas under the receiver operating characteristic curves of Alb, CRP, CRP/Alb ratio, SpO2, and D-dimer were 0.769, 0.838, 0.866, 0.107, and 0.748, respectively. Moreover, patients with a high CRP/Alb ratio (≥1.843) had a markedly higher rate of clinical deterioration (log − rank p < 0.001). A higher CRP/Alb ratio (≥1.843) was also closely associated with higher rates of hospital mortality, ICU admission, invasive mechanical ventilation, and a longer hospital stay. Conclusion The CRP/Alb ratio can predict the risk of progression to critical disease or death early, providing a promising prognostic biomarker for risk stratification and clinical management of patients with severe COVID-19.
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Özdemir İH, Özlek B, Özen MB, Gündüz R, Çetin N, Özlek E, Yıldız BS, Bilge AR. Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients. Clin Exp Hypertens 2021; 43:683-689. [PMID: 34225505 DOI: 10.1080/10641963.2021.1937205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. METHODS It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. RESULTS 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p<0.001). The area under the ROC curve for CAR for mortality was 0.807, with sensitivity of 0.71 and specificity of 0.71. The cut-off value for CAR was calculated as 56.62. In logistic regression analysis, CAR increases mortality 4.9 times compared to the cut-off value. CONCLUSION CAR is a powerful and independent prognostic marker for predicting mortality and disease progression in hypertensive COVID-19 patients.
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Affiliation(s)
| | - Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Faculty of Medicine, Mugla, TURKEY
| | | | - Ramazan Gündüz
- Department of Cardiology, Manisa City Hospital, Manisa, TURKEY
| | - Nurullah Çetin
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, TURKEY
| | - Eda Özlek
- Department of Cardiology, Mugla Sitki Kocman University Faculty of Medicine, Mugla, TURKEY
| | - Bekir Serhat Yıldız
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, TURKEY
| | - Ali Rıza Bilge
- Department of Cardiology, Celal Bayar University Faculty of Medicine, Manisa, TURKEY
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Sanlialp SC, Sanlialp M. Impact of Hypertension on the Prognosis of COVID-19 Disease and Uncertainties that Need to be Clarified. Angiology 2021; 73:485-486. [PMID: 34261339 PMCID: PMC8968412 DOI: 10.1177/00033197211032784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sara Cetin Sanlialp
- The Department of Cardiology, 430817Servergazi State Hospital, Denizli, Turkey
| | - Musa Sanlialp
- The Department of Cardiology, 558907Denizli State Hospital, Denizli, Turkey
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