Independent Risk Factor For Severity Research Articles

Association of coagulation markers with the severity of white matter hyperintensities in cerebral small vessel disease.

This study aimed to explore the correlation and causal relationship between fibrinogen, D-dimer, and the severity of cerebral white matter hyperintensity (MMH). A retrospective analysis of 120 patients with cerebral small vessel disease (CSVD) confirmed by head MRI attending the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine from August 2021 to February 2023 was performed. According to the Fazekas scale score, the patients were divided into 42 cases in the mild group, 44 cases in the moderate group, and 34 cases in the severe group. The levels of fibrinogen and D-dimer were compared among the three groups; the correlations between fibrinogen, D-dimer, and WMH severity were further analyzed; and independent risk factors for WMH severity were explored using the multivariate ordered logistic regression analysis. Furthermore, a two-sample Mendelian randomization (MR) analysis was performed to investigate the genetically predicted effect of fibrinogen and D-dimer on WMH. As the severity of WMH increased, the levels of D-dimer and fibrinogen also gradually increased, and the results showed a positive correlational association, with significant differences within the groups (all p < 0.05); the multivariate ordered logistic regression model showed that after adjusting for the relevant covariates, D-dimer (OR = 5.998, 95% CI 2.213-16.252, p < 0.001) and fibrinogen (OR = 9.074, 95% CI 4.054-20.311, p < 0.001) remained independent risk factors for the severity of WMH. In the MR study, the random-effect inverse variance weighted (IVW) model showed that increased levels of genetically predicted D-dimer (OR, 1.01; 95% confidence interval 0.95-1.06; p = 0.81) and fibrinogen (OR, 1.91; 95% confidence interval 0.97-3.78; p = 0.06) were not associated with increased risk of WMH. The authors did not obtain strong evidence of a direct causal relationship between D-dimer, fibrinogen, and WMH. In this retrospective-based study, the authors found possible associations between D-dimer, fibrinogen, and WMH, but there was no obvious causal evidence. Further efforts are still needed to investigate the pathophysiology between D-dimer, fibrinogen, and WMH.

Related Factors for Severe, Critical and Death in Children with Healthcare-Associated COVID-19

Abstract Background Since the beginning of the pandemic, the American Academy of Pediatrics and the Children′s Hospital Association have reported over 15.4 million cases of COVID-19 in children in the United States (18% of all cases).1 UNICEF on the other hand, has reported more than 288 million cases all over the world and 4.1 million deaths related to COVID-19 in children.2 Healthcare-Associated Infections (HAI) represent a big burden on the health care system, with a subsequent increase in morbidity, hospital stay, medication/procedures, intensive care unit admissions, mortality, etc. Globally there is not enough data of HAI for SARS-CoV-2 in children, specially from low and lower-middle income countries. Methods Prognosis study through the description and analysis of an ambispective cohort in children at a tertiary care pediatric hospital [Hospital Infantil de Mexico Federico Gomez: (HIMFG)] in Mexico City from April 2020 to December 2022. We identified patients &amp;lt;18 years old with probable and definite healthcare-associated (HA) COVID-19 according to the CDC definition:3 symptom onset (or positive test) on day 8 or on, after admission. Independent variables included socio-demographic information, clinical symptoms, laboratory results, among others. Outcome variables measured included severity (severe and critical), and death.4 Chi square and Wilcoxon tests were performed to identify independent risk factors for severity and death. After the bivariate analysis, logistic regression models were used to identify factors associated with patient severity and mortality. Results 102 patients were included; mean age was 6.4 years (min 0.02, max 17.9) and 57 were male. 32 were asymptomatic, 27 had mild disease, 6 were moderate, 31 severe and 6 critical; of this total, 6 patients died. 98 patients had at least one comorbidity, and 54 had at least 2: 35 with immunosuppression, 28 with cancer, 18 with heart disease, 14 with pulmonary disease and 14 with neurologic disease. 14 patients required admission to a Pediatric Intensive Care Unit. Mean hospital stay at diagnosis was 35.5 days (min 8, max 143): 24 patients were identified with probable HA-COVID-19 (8-14 days after admission) and 78 with definite HA-COVID-19 (&amp;gt;14 days after admission). Conclusions Since the beginning of the COVID-19 pandemic, multiple strategies in infection prevention and control have been implemented at our hospital: universal screening before admission, active surveillance for patients/caretakers/health-care workers with respiratory symptoms and for contacts, universal use of facemasks, isolation of patients with respiratory symptoms, among others. Despite all these measures, a free Hospital from HA-COVID-19 remains a challenge. Our study found that the sudden onset of symptoms, the presence of fever, irritability and polypnea increases significantly the risk for severity in patients that acquired the disease in the hospital. On the other hand, patients with an underlying heart disease have 30 times more risk of dying than those who doesn’t. The presence of O2 desaturation and admission to a PICU increases significantly the mortality in patients with HA-COVID-19. Overall, mortality in children with HA-COVID-19 was 5.9% (up to 8.6% if strictly considering only the symptomatic), much more that the one reported globally (1.4%).2

COVID-19 in Patients with Active Cancer: Higher Inflammatory Activity Predicts Poor Outcome

Introduction: Active malignancies have been identified as an independent risk factor for severity and mortality in COVID-19. However, direct comparisons between SARS-CoV-2-infected patients with active (acP) and non-active cancers (n-acP) remain scarce. Patients and Methods: We retrospectively analyzed a cohort of cancer patients with PCR-confirmed SARS-CoV-2 infection, enrolled from March 16, 2020, to July 31, 2021. Data on demographics, cancer, and laboratory findings were collected. Descriptive and subsequent regression analyses were performed. Endpoints were “deterioration to severe COVID-19” and “infection-associated mortality.” Results: In total, 987 cancer patients (510 acP vs. 477 n-acP) were included in our analysis. The majority was >55 years old, more men than women were included. At detection of SARS-CoV-2, 65.5% of patients had mild/moderate symptoms, while deterioration to severe COVID-19 was slightly more common in acP (19 vs. 16%; p = 0.284). COVID-19-associated mortality was significantly higher in acP (24 vs. 17.5%, p < 0.001). In terms of laboratory tests, severe cytopenia and elevated levels of inflammatory markers were common findings in acP at baseline, particularly in those who developed a severe infection or died. Multivariate analysis revealed that ferritin (HR 14.24 [2.1–96], p = 0.006) and CRP (HR 2.85 [1.02–8.02], p = 0.046) were associated with severity and mortality. In n-acP, association was seen for ferritin only (HR 4.1 [1.51–11.17], p = 0.006). Conclusion: Comparing patients with active and non-active cancer, the former showed higher mortality rates. Also, inflammatory markers were significantly increased, assuming higher levels of inflammation may play a role in the adverse outcome of COVID-19 in aCP.

Disease and Quality of Life Aspects of Cat Allergy in Non-Pet Owners with Allergic Rhinitis

Introduction: The severity of cat allergy-related symptoms varies widely. The rising prevalence of cat owning makes it a significant human health problem. The aim of this study was to evaluate disease severity and quality of life (QoL) aspects of cat sensitization and allergy in non-pet owners with allergic rhinitis (AR). Methods: In this study, 231 out of 596 patients with AR were enrolled. The disease severity and QoL measures of the non-pet owner patients were evaluated according to their demographics and allergen sensitizations. The data were re-gathered after cat exposure for cat-sensitized patients (n = 53). Results: The median age of the patients (174 females, 57 males) was 33 (18–70). The overall frequency of cat sensitization was 12.6% (75/596). The frequency of cat allergy in this cohort was 13.9% (32/231). Family history of atopy and multi-allergen sensitization were more common in the cat-sensitized patients. Disease severity and QoL scores were higher in the cat allergy group after cat exposure. Cat allergy was the major independent risk factor for the severity of AR and QoL measures. Conclusion: Due to the fact that indirect exposure to cat dander allergens can occur anywhere, even where cats are not present, cat-sensitized people should be aware of cat allergy. Cat allergy appears to be an independent risk factor for disease severity and QoL effects for non-pet owner patients with AR.

Study of D-dimer, CRP &amp; ferritin status as independent risk factors for severity of the clinical aspects in patients with COVID-19 in Erbil, Iraq

BACKGROUNDCoronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory disease which can evolve into multi-organ failure (MOF), leading to death. Several biochemical alterations have been described in COVID-19 patients. This study aimed to look at the ratio of D-dimer, CRP (C- reactive protein), and ferritin as independent risk variables in COVID-19 illness patients in Erbil Governorate, Iraq.MATERIALS AND METHODSIn this retrospective data collection study, we aimed to determine the number of patients diagnosed with COVID-19 who were admitted to Rizgary and Komary hospitals. Moreover, we collected data, including demographic features and laboratory analysis results regarding: D-dimer, Ferritin and CRP(C- reactive protein) extracted from the patient's medical records. Patients were Erbil residents admitted to Rizgary &amp; Komary educational hospital from 1st April to 1st November 2020, with a confirmed diagnosis of COVID-19 infection using SARS-CoV-2 viral nucleic acid using RT-PCR. CRP, D-dimer, and ferritin levels had been routinely measured on admission.RESULTSCRP, D-dimer, and ferritin levels were measured in 234 individuals (115 men and 119 women). The group aged 15-25 was the least afflicted, while the age group 45-55 had the most COVID-19 patients. The frequency of this disorder did not differ statistically significantly between men and women. According to a massive increase in CRP, men showed a far higher risk than women. In the research groups, there were no statistically significant differences in ferritin changes between males and females. In terms of D-dimer, there was no statistically significant difference between males and females in either of the studied groups.CONCLUSIONSHigher CRP levels, indicating a higher risk of disease and predicting and measuring the onset of the disease in the first few days, are mandatory in tracking COVID-19 disease.

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children

ObjectiveTo identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.DesignMulticentre retrospective cohort study.Setting18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May...

Vitamin D Levels and its Association with Inflammatory Markers, Severity and Outcome in Hospitalised COVID-19 Patients - An Indian Perspective

Background: The recent COVID-19 pandemic has taken over the world in enormous proportions like none other in recent times. Vitamin D plays an essential role in the immune system and has proven to have importance in the context of many respiratory infections. This study aims to unveil the possible correlation between vitamin D levels and disease outcome and affirm the role of hypovitaminosis D as an independent risk factor for severity in COVID 19.Methods: We studied 209 RTPCR confirmed COVID 19 positive cases. Serum 25(OH) D levels were done at the time of admission. HRCT chest and inflammatory markers (serum ferritin, D dimer, IL6 and CRP) were estimated on admission and repeated on case-to-case basis.Results: Out of 209 patients studied, 44.49% had vitamin D deficiency, 24.40% had Vitamin D insufficiency, and 31.11% had normal Vitamin D levels. Vitamin D deficiency significantly increased with advancing age. The mean vitamin D level in our study is 27.47 ± 21.86. 27.8% had mild COVID-19 disease as evidenced by HRCT imaging, 21.1% showed moderate disease, and 51.2% showed severe COVID-19. The mean values of inflammatory markers in Vitamin Ddeficient patients were as follows: D dimer (3298.88 ± 2230.14), Serum Ferritin (530.88 ± 497.14) CRP (175.34 ± 87.27) IL6 (125.39 ± 275.72). Significant correlation of Vitamin D with C reactive protein (r = -0.18, p ≤ 0.05), D-Dimer (r = -0.42, p &lt; 0.0001), and CT severity score (r = -0.24, p ≤ 0.0001) was noted. Conclusion: In our study, Vitamin D inversely proportional levels were inversely proportional to CRP, D-Dimer, and CT severity.

Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Data from 2461 patients were extracted from the international, prospective, multicentre AP registry operated by the Hungarian Pancreatic Study Group. Data from patients with albumin measurement in the first 48 h (n = 1149) and anytime during hospitalization (n = 1272) were analysed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. The prevalence of hypoalbuminemia (< 35 g/L) was 19% on admission and 35.7% during hospitalization. Hypoalbuminemia dose-dependently increased the risk of severity, mortality, local complications and organ failure and is associated with longer hospital stay. The predictive value of hypoalbuminemia on admission was poor for severity and mortality. Severe hypoalbuminemia (< 25 g/L) represented an independent risk factor for severity (OR 48.761; CI 25.276–98.908) and mortality (OR 16.83; CI 8.32–35.13). Albumin loss during AP was strongly associated with severity (p < 0.001) and mortality (p = 0.002). Hypoalbuminemia represents an independent risk factor for severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure and length of stay.

Hypertension as an independent risk factor for severity and mortality in patients with COVID-19: a retrospective study

Purpose of the studyHypertension is one of the most common comorbidities in COVID-19 pneumonia. However, whether it is an independent factor on the severity and mortality of COVID-19 has not...

Review of the Metabolic Risk Factors for Increased Severity of Coronavirus Disease-2019.

The coronavirus 2019 (COVID-19) pandemic has presented many new challenges to the healthcare community with the sheer number of individuals affected and the range of symptoms at presentation. Early findings have shown that increased age is an independent risk factor for COVID-19 severity. Diabetes and hypertension were also found to be strong independent risk factors for severe COVID-19. It was later discovered that obesity is a strong risk factor for severe disease as well. Possible mechanisms for the increased risk associated with metabolic disease include the increased prevalence of acute respiratory syndrome, immune cell dysfunction, and chronic inflammatory states associated with obesity and diabetes. Acknowledging these risk factors has consequences for addressing vaccination strategies as well as healthcare disparities.

WITHDRAWN: D-Dimer and Serum Ferritin as an Independent Risk Factor for Severity in COVID-19 Patients

Ferritin is an intracellular blood protein that contains iron, covid-19 diseases is an infectious disease caused by a virus called corona virus, the infected person mostly experiences mild to moderate respiratory illness ferritin level in blood mostly depend on severity of the covid-19 disease. Ferritin level could be used as an indicator for the covid-19 disease. Within 120 corona virus patients that used as individual in this study, the ferritin level in the blood were tested, also each of (D-Dimer, ESR, C.R protein) Depend on the results, the patients with over 60 years have a high ferritin level also the d-dimer were abnormal with 65% higher than normal range.

Monitoring neutrophil-to-lymphocyte ratio in patients with coronavirus disease 2019 receiving tocilizumab

The novel coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2, an enveloped nonsegmented positive-sense RNA β-coronavirus. The virus can trigger a cascade of biological events that can lead to critical illness. It is urgent to gain an in-depth understanding of the critical activators that foreshadow patients at highest risk for mortality.1Zhou F. Yu T. Du R. et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.Lancet. 2020; 395: 1054-1062Abstract Full Text Full Text PDF PubMed Scopus (15792) Google Scholar Patients who have received tocilizumab for COVID-19–related cytokine storm have had improvements in C-reactive protein (CRP), lymphocytosis, and chest computed tomography findings.2Mehta P. McAuley D.F. Brown M. et al.COVID-19: consider cytokine storm syndromes and immunosuppression.Lancet. 2020; 395: 1033-1034Abstract Full Text Full Text PDF PubMed Scopus (5727) Google Scholar There exists a lack of understanding on which patients would benefit from tocilizumab administration. We aimed to characterize the group of patients who received tocilizumab and failed to improve, needed mechanical ventilation, or suffered mortality. We studied clinical and laboratory variables in patients receiving tocilizumab, comparing those who did not require mechanical ventilation with those needing mechanical ventilation including those who suffered mortality. Adult patients with polymerase chain reaction–confirmed COVID-19 infection treated with tocilizumab at Spectrum Health System Hospitals from March 20, 2020, to May 18, 2020, were studied. Laboratory indices analyzed were metabolic panel, blood count, CRP, ferritin, fibrinogen, D-dimer, lactate dehydrogenase, and triglycerides. Our institutional protocol dictated that patients received tocilizumab when they required at least 4 L of oxygen or more respiratory support and had less than 14 days of symptoms. Tocilizumab dosing was as follows: 400 mg for 50 to 60 kg, 600 mg for 60 to 85 kg, and 800 mg for greater than 85 kg. Doses could be given every 8 hours and for a maximum of 3 doses. Day 0 was defined as the day tocilizumab was started. Cytokine panels were performed on day 0. Patients were followed for a maximum of 30 days until they met the end point of hospital discharge or mortality. Quantitative data were expressed as mean plus or minus SD, whereas nominal data were expressed as percentages. The groups studied (intubated vs nonintubated or survivors vs deceased) were analyzed using the unpaired 2-tailed t test, whereas difference for nominal data was determined using the χ2 test or the Fisher's exact test. In addition, mixed-effects general linear modeling was performed. The independent variables were days following tocilizumab administration (days −1, 0, 1, and 3; reference value: day 0) and either intubation status or mortality. For all analyses, significance was assessed at P < .05. All analyses were performed using Stata version 16.1 (StataCorp LLC, College Station, Texas). Baseline characteristics revealed more type 2 diabetes in intubated patients and more smokers in the deceased group (Table 1). Neutrophil-to-lymphocyte ratio (NLR) increased from day negative 1 to 0 in intubated patients (P = .057) and decreased in the nonintubated group from 6.9 to 3 compared with 6.8 to 6.7 from day 0 to 3 in the intubated group. Similarly, in the survivors, there was a marked decrease in NLR from day 0 to day 3 from 7.1 to 3.3 (51.2% decrease), whereas in the nonsurvivors, there was an increase from 5 to 6.8 (33.6% increase). In all groups, mean absolute neutrophil count was highest on day 0. In nonsurvivors, day 0 absolute lymphocyte count was 34.1% lower (P = .046). No significant interactions were found in NLR from day negative 1 to day 0 in all groups.Table 1Patient Characteristics Between GroupsCharacteristicsIntubationMortalityNo (n = 34)Yes (n = 32)P valueNo (n = 54)Yes (n = 12)P valueAge, y (mean)56.1 ± 15.257.2 ± 11.0.74555.2 ± 13.463.3 ± 10.6.053Sex.569.512 Male20 (58.8)21 (65.6)32 (59.3)9 (75.0) Female14 (41.2)11 (34.4)22 (40.7)3 (25.0)Race or ethnicity.414.463 White11 (32.4)13 (40.6)18 (33.3)6 (50.0) African American4 (11.8)3 (9.4)5 (9.3)2 (16.7) Hispanic14 (41.2)15 (46.9)25 (46.3)4 (33.3) Asian5 (14.7)1 (3.1)6 (11.1)0 (0)BMI (mean)29.7 ± 5.031.4 ± 7.2.25930.1 ± 5.432.2 ± 9.2.304GFR >6028/31 (90.3)26/31 (83.9).70745/50 (90.0)9 (75.0).177Diabetic7 (20.6)18 (56.3).00319 (35.2)6 (50.0).348Smoking history9 (26.5)15 (46.9).08513 (24.1)11 (91.7)<.001Hypertension15 (44.1)21 (65.6).07926 (48.2)10 (83.3).051Tocilizumab dose, mg688 ± 112688 ± 113.979693 ± 108667 ± 130.471Number of tocilizumab doses.147.659 11 (2.9)0 (0)1 (1.9)0 (0) 25 (14.7)1 (3.1)6 (11.1)0 (0) 328 (82.4)31 (96.9)47 (87.0)12 (100)Additional therapies Convalescent plasma11 (32.4)14 (43.8).34020 (37)5 (41.7).754 Remdesivir01 (3.1).48501 (8.3).182 Hydroxychloroquine20 (58.8)18 (56.3).83333 (61)5 (41.7).333 Corticosteroids5 (14.7)9 (28.1).18311 (20.4)3 (25).708Infections Positive sputum cultures11 (20.2)8 (66.7)<.001 Candida in sputum2 (3.7)5 (41.7)<.001Abbreviations: BMI, body mass index; GFR, glomerular filtration rate.NOTE: Data are presented as number (percentage) unless indicated otherwise. Open table in a new tab Abbreviations: BMI, body mass index; GFR, glomerular filtration rate. NOTE: Data are presented as number (percentage) unless indicated otherwise. Only interleukin (IL)-10 and IL-6 were higher in intubated patients than in nonintubated patients (20.4 pg/mL vs 9.5, P = .001; 26.5 pg/mL vs 10.5, P = .002); there was no difference in serum soluble IL-2 receptor, IL-10, and IL-6 in patients who survived compared with deceased. A moderate correlation was observed between day 0 NLR and IL-6 (ρ = 0.307; P = .021) and between day 0 NLR and CRP (r = 0.326; P < .001). No correlation was observed between day 0 NLR and serum soluble IL-2 receptor, IL-10, or ferritin. Studies have found an increased NLR to be an independent risk factor for severity in patients with COVID-19 infections. This is congruent with mounting evidence on importance of neutrophil response in severe COVID-19. Although nonspecific, existing cohorts have revealed onetime NLR greater than 3.13 and an interquartile NLR range of 5.82 to 15.1 to be predictive of critical illness and persistent elevation correlated with death.3Hwang S.Y. Shin T.G. Jo I.J. et al.Neutrophil-to-lymphocyte ratio as a prognostic marker in critically ill septic patients.Am J Emerg Med. 2017; 35: 234-239Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar,4Liu J. Liu Y. Xiang P. et al.Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage.J Transl Med. 2020; 18: 206Crossref PubMed Scopus (425) Google Scholar The mean ratio dropped between days 0 and 3 across all groups except in the patients suffering mortality. Furthermore, NLR correlated with IL-6 levels and may represent a proxy to monitor response to IL-6 blockade. Beyond neutrophilia, neutrophil activation and degranulation are the most biologically active processes in severe COVID-19.5Morrissey S.M. Geller A.E. Hu X. et al.Emergence of low-density inflammatory neutrophils correlates with hypercoagulable state and disease severity in COVID-19 patients.https://www.medrxiv.org/content/10.1101/2020.05.22.20106724v1Date accessed: January 12, 2020Google Scholar Increased activated neutrophil extracellular traps are associated with severity of illness in patients with severe COVID-19.6Middleton E.A. He X.Y. Denorme F. et al.Neutrophil extracellular traps (NETs) contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome.Blood. 2020; 136: 1169-1179Crossref PubMed Scopus (677) Google Scholar,7Zuo Y. Yalavarthi S. Shi H. et al.Neutrophil extracellular traps in COVID-19.JCI Insight. 2020; 5e138999PubMed Google Scholar Neutrophil extracellular trap activation contributes to neutrophilia in COVID-19 simultaneously increasing IL-1β and IL-6, giving biologic plausibility to their respective blockade being therapeutic in severe COVID-19.6Middleton E.A. He X.Y. Denorme F. et al.Neutrophil extracellular traps (NETs) contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome.Blood. 2020; 136: 1169-1179Crossref PubMed Scopus (677) Google Scholar,7Zuo Y. Yalavarthi S. Shi H. et al.Neutrophil extracellular traps in COVID-19.JCI Insight. 2020; 5e138999PubMed Google Scholar The patients who seem to have a more favorable clinical course after tocilizumab are the same patients who had a drop in neutrophil levels. This is true for other biological conditions in which patients receiving tocilizumab have clinical improvement which correlated with a drop in neutrophil count during therapy.8Ghang B. Kwon O. Hong S. Lee C.K. Yoo B. Kim Y.G. Neutrophil-to-lymphocyte ratio is a reliable marker of treatment response in rheumatoid arthritis patients during tocilizumab therapy.Mod Rheumatol. 2017; 27: 405-410Crossref PubMed Scopus (18) Google Scholar,9Moots R.J. Sebba A. Rigby W. et al.Effect of tocilizumab on neutrophils in adult patients with rheumatoid arthritis: pooled analysis of data from phase 3 and 4 clinical trials.Rheumatology (Oxford). 2017; 56: 541-549PubMed Google Scholar The elevated IL-6 and IL-10 and persistently elevated NLR in the deceased group indicate that further studies may be needed to determine whether the elevated levels suggest an advanced disease state resistant to tocilizumab therapy. We posit that immunophenotyping such differences in prospective trials will be imperative to individualize treatment for these patients. Limitations of our cohort include its retrospective nature and smaller number of patients. Because all patients in the cohort received tocilizumab owing to the severe nature of their illness, we are unable to make a statement on clinical effectiveness of tocilizumab. We instead focused on biologic markers that could be indicative of disease severity and death. Our study period encompassed a time of varying hydroxychloroquine use, and dexamethasone was not widely used; however, there was no baseline difference between the groups. This report suggests that persistently elevated NLR is associated with unfavorable outcomes, but it is unclear whether COVID-19 disease, secondary infections, or other causes are driving elevated NLR in patients with more severe disease. We suggest that an elevated NLR is one potential marker. Further prospective studies are needed to reveal the performance of NLR vs in combination with other markers (CRP, complement components, cytokines, etc). NLR should be considered as a marker for COVID-19 that is resistant to anti-inflammatory therapy, with a need for infection monitoring and aggressive life support measures. We acknowledge Dr Amanda Holsworth for her careful editing, input, and feedback during the preparation of the article.

Risk factor profile of stroke patients with special focus on determinants of severity

Stroke is the second major cause of death worldwide and the fourth major cause of death in India. Kerala is becoming the hotspot of lifestyle diseases. Almost 90% of the cases reported in Kerala are associated with one or two modifiable risk factor(s) in the form of lifestyle diseases.Objectives:This study is aimed at risk factor profiling of stroke patients and identifying the determinants of stroke severity. Methods:A descriptive study was conducted among stroke patients admitted in Govt. Medical College Thiruvananthapuram from August to September 2013. The risk factor profile was studied. A case control comparison was done to identify the determinants of severity of stroke. Results:: The age of incidence of stroke ranged from 37 years to 88 years. Mean age was 65.30 (SD =12.80). Hypertension was identified as the most common risk factor followed by diabetes, low physical activity and heart diseases. Limb weakness was the most common clinical presentation. Diabetes Mellitus emerged as an independent risk factor of severity with adjusted odds ratio of 3.82 (1.034-14.09). Conclusion: Hypertension was the most important risk factor prevalent in stroke patients. Diabetes Mellitus was identified as the only independent determinant of severity of stroke. Early identification of risk factors and its proper management should be done with more rigor, in order to decrease the incidence of stroke and reducing its severity.

Associations between serum amyloid A, interleukin-6, and COVID-19: A cross-sectional study.

BackgroundSerum amyloid A (SAA), interleukin‐6 (IL‐6) and neutrophil‐to‐lymphocyte ratio (NLR) play critical roles in inflammation and are used in clinical laboratories as indicators of inflammation‐related diseases. We aimed to provide potential laboratory basis for auxiliary distinguishing coronavirus disease (COVID‐19) by monitoring above indicators.MethodsA total of 84 patients with confirmed COVID‐19 were enrolled in the study. Baseline characteristics and laboratory results were collected and analyzed. Receiver operating characteristic (ROC) curve analysis was used to combined detection of SAA and IL‐6 in patients with COVID‐19, and independent risk factors for severity of COVID‐19 were assessed by using binary logistic regression.ResultsThe main clinical symptoms of patients with COVID‐19 were fever (98.8%), fatigue (61.9%), and dry cough (58.3%). SAA, IL‐6, and NLR were significantly higher in patients with COVID‐19 (all P < .001), and compared with nonsevere patients, three indicators of severe patients were significantly elevated. Besides, combined detection of SAA and IL‐6 better separates healthy people from patients with COVID‐19 than detection of SAA or IL‐6 alone. In addition, elevated SAA, IL‐6, and NLR can be used as independent variables for predicting the severity of patients with COVID‐19.ConclusionSerum amyloid A and IL‐6 could be used as addition parameters to helping the distinguish of patients with COVID‐19 from healthy people, and can provide potential basis for separating patients with nonsevere and severe clinical signs.

358 Clinical Features of Reflux Esophagitis in a Predominantly Hispanic Population at a Large Safety-Net Hospital

INTRODUCTION: There are many variables whose role remains undefined in predicting esophagitis severity. This is particularly true for female and non-white populations for whom existing data is limited. Our aim was to determine clinical and endoscopic characteristics of reflux esophagitis in the predominantly Hispanic population of a large, safety-net hospital. METHODS: We performed a retrospective electronic medical record review of patients identified with mild (Los Angeles Grade A/B) and severe (Los Angeles Grade C/D) esophagitis between January 2017 to December 2018. Demographic, clinical, and endoscopic data were recorded. Continuous and categorical data was analyzed using a two tailed T-test and/or chi-square test or Fisher’s Exact test. RESULTS: Reflux esophagitis was identified in 382 patients; 56.5% (n = 216) males, 79.8% (n = 305) Hispanic, 8.4% (n = 32) Caucasian, 5.8% (n = 22) African American, and 6.0% (n = 23) other. Among the cohort, 59% (n = 225) had mild esophagitis and 41% (n = 157) had severe esophagitis with median ages 56 and 58 years, respectively (P = 0.05). Patients with mild esophagitis had a higher body mass index (BMI) as compared to those with severe esophagitis [median 28.4 (25.5, 33.7) vs. 26.3 (21.9, 29.6); P &lt; 0.01], were more frequently female (P = 0.03), diagnosed in the outpatient setting vs. inpatient (P &lt; 0.01), and had higher rates of cirrhosis (P = 0.03). Gastroparesis (P = 0.02) and immunosuppression (P = 0.01) were more common in severe vs. mild esophagitis. Hiatal hernia (P &lt; 0.01) and esophageal strictures (P = 0.01) were more frequent in severe esophagitis. Gastrointestinal bleed (P &lt; 0.01), dysphagia (P &lt; 0.01) and nausea/vomiting (P = 0.02) were more frequently the indication for endoscopy in severe vs. mild esophagitis. Esophagitis severity was not associated with tobacco or alcohol use. CONCLUSION: In this predominantly Hispanic cohort, patients with severe esophagitis were more frequently male, hospitalized, and had lower BMI compared to those with mild esophagitis. Ongoing multivariate analysis is underway to determine whether these variables are independent risk factors for severity of esophagitis in this unique population after adjustment for age, BMI, and hospitalization status.

605 Independent Risk Factors for Severity and Mortality in Lower Gastrointestinal Bleeding and Proposal of New Prognosis Score

INTRODUCTION: Risk stratification is key in the assessement and management of patients with lower gastrointestinal bleeding (LGIB). AIM: To identity risk factors for mortality and severity, namely: critical care requirement, prolonged hospitalization, rebleeding, blood transfusions, re-admissions or surgery in a cohort of patients with LGIB in a hospital in Peru. METHODS: Analytic prospective cohort study, performed between June 2016 and April 2018 in a tertiary care hospital. The sample size (80 Patients) was calculated considering an incidence of 0.3% with a confidence level of 95%. Data was collected during the hospitalization, including sex, age, comorbidities, medication, etiology, time to colonoscopy, vital signs, laboratory and the outcomes. The independent factors were determined using binomial logistic regression, these factors were used to developed a score. Thirty – day survival was calculated using a Kaplan-Meier curve. RESULTS: A total of 98 patients were included, of which 13 patients (13, 3%) died, and 56 (57, 1%) met severity criteria. Sixty-two patients (63, 3%) were male, the average age was 54.89 ± 19.37 years. The most frequent etiologies were hemorrhoids (20.4%), colorectal cancer (19.4%), and diverticulosis (13.3%). Thirteen patients died and the most frequent cause of death was pneumonia in twelve (92.3%). The independent risks factor for mortality was Glasgow scale under 15, and for severe bleeding were: Systolic blood pressure under 100 mm Hg and albumin lower than 2, 8 g/dL. With these factors the score SGA (S systolic, G Glasgow, and A albumin) was developed. An area under Receiving Operator Curve (AUC ROC) of 87.5% with a P &lt; 0.000, the value of 2 or more predicted mortality with a sensitivity of 90.9% and a specificity of 69.7%, positive predictive value 33.7%, negative predictive value 97.9%. The value 2 or more predicted severity with a sensitivity of 59.6% and a specificity of 93.3%, positive predictive value 93.3%, negative predictive value 59.6%. The survival curve with the kaplan meier test is statistically significant, when comparing the value 0 or 1 versus the value 2 or 3. CONCLUSION: We found a high mortality rate and frequent severity parameters in our population with LGIB, the main risk factors being systolic blood pressure under 100 mm Hg, Glasgow score lower than 15, and albumin lower than 2.8 g/dL. Early identification of these associated factors would improve the management of LGB in the emergency room.

2980 Obesity Does Not Increase Risk of Mortality in Necrotizing Pancreatitis

INTRODUCTION: Obesity is considered an independent risk factor for increased severity of acute pancreatitis. However, the association of obesity with acute necrotizing pancreatitis and the impact on outcomes of necrotizing pancreatitis is sparsely described. Therefore, we aimed at impact of obesity on necrotizing pancreatitis in terms of inpatient mortality, length of stay and hospitalization charges. METHODS: This was a retrospective study utilizing the 2016 National Inpatient Database for all principal discharges of acute pancreatitis in obese patients more than 18 years of age utilizing ICD 10 codes. Primary outcomes were incidence of necrotizing pancreatitis in obese patients. Secondary outcomes were mortality, impact on healthcare utilization between the two cohorts. Multivariate analysis was utilized to adjust for confounders for evaluation of predictors of mortality. Poisson regression was performed for length of stay and hospitalization charges. RESULTS: Among total of 288,479 discharges with principal diagnoses of Acute Pancreatitis, 13.83% were associated with obesity. Acute necrotizing pancreatitis was associated with only 0.8% of the obese population with pancreatitis. There were no significant differences in terms of age, gender, ethnic differences in obese and normal BMI cohort. Acute kidney injury in necrotizing pancreatitis was more frequently observed in obese patients. There were no increased odds of mortality in obese patients with necrotizing pancreatitis as compared to patients with normal BMI after adjustment of confounders. Increasing age and male gender were significantly associated with increased odds of mortality in necrotizing patients. The length of stay was not significantly different in either of the cohorts (11.72 days vs 14.53 days). However, hospitalization charges were significantly higher in obese patients with necrotizing pancreatitis (27,867$ vs 44,113$, P 0.02). CONCLUSION: Even though obesity is an independent risk factor for severity of acute pancreatitis, incidence of obesity with necrosis was infrequent from a National Cohort. Acute kidney injury was more common in setting of obesity with necrosis which might explain the increased severity. However, obesity did not independently increase the odds of mortality in setting of necrotizing pancreatitis. Increasing age and male gender in setting of necrotizing pancreatitis leads to increased mortality. Further studies are warranted to elucidate the association of gender and necrotizing pancreatitis.

Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other's Deteriorating Effects.

IntroductionThe incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations.MethodsFrom 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated.Results1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure [OR: 2.98 (CI: 1.33–6.66)] and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days, p = 0.008). HT increased the risk of severe AP [OR: 3.41 (CI: 1.39–8.37)], renal failure [OR: 7.46 (CI: 1.61–34.49)], and the length of hospitalization (11.8 vs. 10.5 days, p = 0.020). HL increased the risk of local complications [OR: 1.51 (CI: 1.10–2.07)], renal failure [OR: 6.4 (CI: 1.93–21.17)], and the incidence of newly diagnosed DM [OR: 2.55 (CI: 1.26–5.19)]. No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ± SD: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors.ConclusionOB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other’s detrimental effect. It is important to search for and follow up on the components of MetS in AP.

Association of ABO blood groups with the severity of coronary artery disease: a cross-sectional study.

ObjectiveTo investigate whether ABO blood groups is associated with the severity of coronary artery disease (CAD).MethodsBetween January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups.ResultsThe Gensini score was significantly higher in the blood group A than in the non-A groups (41.2 ± 32 vs. 38 ± 27; P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD (β = 3.298, 95% CI: 0.91–6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score (P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension.ConclusionIn this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes.

Comorbid conditions responsible for the higher complications and poorer outcome in cardiac and vascular surgery: Time to reconsider hyperhomocysteinemia and its repercussions

Background: Plasma homocysteine is a perceived risk factor for the cardiovascular diseases. Many studies confirmed its remarkably high level with severity of the disease. There are no studies to correlate plasma homocysteine level and outcome of surgery in patients suffering from cardiovascular diseases. Objective: The purpose of our clinical study is to analyze the correlation of plasma Homocysteine levels in patients undergoing coronary artery bypass grafting (CABG) and various peripheral vascular surgeries regarding various patient variables such as age, sex, and also the severity of disease and outcome of surgery. Materials and Methods: The plasma homocysteine levels of 200 patients undergoing CABG and various vascular surgeries, between January 2016 and January 2018 were analyzed. This was a prospective study, data about patient variables obtained from questionnaires handed out to the patients during the preoperative period. All peripheral arterial diseases patients were symptomatic and belong to Rutherford stage 3, 4, 5, and 6. The severity of disease was evaluated based on coronary angiogram (CAG), who was undergoing CABG and computed tomography (CT) angiograms for patients presenting with peripheral vascular disease (PVD) and peroperative findings. A total of 178 CAG and 100 CT peripheral angiograms assessed. Homocysteine levels were determined by CLIA method and levels of >13 mmol/L taken as hyperhomocysteinemia. All patients had surgical vascular intervention in the form of CABG, peripheral vascular bypass, and thromboembolectomy. The results and complications evaluated postoperatively. Result: Higher homocysteine levels associated with a higher number of triple vessel coronary disease and symptomatic PVD. They had greater severity of the disease. It is also associated with poorer target vessels with an increased morbidity and postoperative fatality. Conclusion: Homocysteine level is one of the independent risk factors for severity of CAD. It can have predictive value in CABG, peripheral vascular surgery, and poor postoperative outcome.