Initial Laboratory Research Articles

Interleukin-29 profiles in COVID-19 patients: Survival is associated with IL-29 levels.

Interleukin-29 profiles in COVID-19 patients: Survival is associated with IL-29 levels.

Preterm Infant with Craniofacial Dysmorphic Features and Posture.

Preterm Infant with Craniofacial Dysmorphic Features and Posture.

A Pain in the Neck: An Adolescent with Neck Pain.

A Pain in the Neck: An Adolescent with Neck Pain.

Abstract 94: Efficacy of cabergoline treatment in men with giant prolactinomas

Introduction: Giant prolactinomas in males are rare tumours in whom outcome data is scarce.Aims and Objectives: To evaluate the outcomes of therapy in men with ‘giant prolactinomas’ (>4 cm).Results: Of twenty-five males with macroprolactinoma following up in the Endocrinology Clinic; ten fulfilled the criteria of Giant Prolactinoma and were included in this retrospective study. The mean age was 34.2±12.67 years. Headache (n=10) and visual field defects (n=8) followed by hypogonadal symptoms (n=8) were the common presenting symptoms. A significant decrease of the Prolactin (PRL) values was observed in all patients (6420±1343.3 to 97.5±1.72 ng/dl; p= 0·0005). Persistent normalization of PRL levels was achieved in 7/10 patients. Significant tumour shrinkage (5±0.40 to 2.7±0.28 cm, p = 0·02) was achieved in 8/10 patients, with a volume reduction > 90% in three, >50% in four and >25% in one patient.Gonadotropin deficiency (n=9); TSH deficiency (n=4) and Cortisol deficiency (n=4) were uncovered on initial laboratory evaluation. The gonadotropin axis recovered in 1/9 and cortisol axis in 3/4 deficient subjects after normoprolactinaemia was achieved. The thyrotropin axis was affected irreversibly.Discussion and Conclusion: In male subjects with giant prolactinomas, recovery in other pituitary axes did not occur in spite of normalizing PRL levels and achieving tumour shrinkage.

Clinical implications and current perspectives of statin-induced rhabdomyolysis syndrome – case presentation

Abstract Though rare, statins can produce serious adverse effects with clinical implications that urge prompt intervention. However, in high-risk patients that require intense hypolipemiant treatment, such situations can be challenging and require complimentary therapies. We report the case of a 82-year-old hypertensive female patient admitted for diffuse myalgia, mainly in the lower limbs, fatigue and shortness of breath. The patient is known with a recent myocardial infarction (MI) treated by primary stent implantation. The electrocardiogram and transthoracic echocardiography confirmed the recent MI, with non-dilated left ventricle mildly reduced ejection fraction. Initial laboratory studies revealed elevated NT-proBNP, moderate renal impairment and increased serum levels of creatine kinase (CK), CK-MB fraction and transaminases. After stopping statin and receiving supportive treatment, the patient's paraclinical test results and symptoms improved: CK levels and transaminase dropped significantly and both myalgia and general fatigue resolved mostly within 4 days. PCSK9 inhibitor has been introduced with favourable results at follow-ups. Even though statins are effective and safe, they may still generate potential dangerous adverse effects in rare cases. Statin dose adjustment or replacement and adding other lipid lowering therapies represent current therapeutical options, especially in high-risk populations.

Letter to the editor: Liver transplantation following severe acute respiratory syndrome‐coronavirus‐2 vaccination–induced liver failure

Several case reports have described development of liver injury following severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccination in Hepatology.[1, 2] These cases showed autoimmune hepatitis (AIH) features, and all cases responded well to corticosteroid therapy. Herein, we present a patient who underwent liver transplantation due to fulminant liver failure following vaccination with the BioNTech vaccine. A 53-year-old previously healthy man received a first dose of BioNTech vaccine on the June 5, 2021. Ten days after vaccination, he developed mild abdominal pain, erythematous skin eruption, and pruritus. Initial laboratory findings were alanine aminotransferase (ALT) 333 (upper limit of normal [ULN] 55 U/L), aspartate aminotransferase (AST) 168 (ULN 34 U/L), alkaline phosphatase 102 (ULN 150 U/L), and total bilirubin 0.8 (ULN 1.2 mg/dl). The patient’s symptoms were considered to be a hypersensitivity reaction. Oral antihistaminic therapy and topical steroids did not lead to clinical improvement. On day 18 after vaccination, prednisolone 32 mg/day for 10 days followed by 16 mg/day for 20 days was commenced. One week into the steroid course, symptoms significantly improved, and aminotransferases decreased (Figure 1). The patient was reluctant to receive a second vaccine dose for fear of additional side effects but had travel plans and needed a full vaccination chart. He, therefore, scheduled a second Pfizer-BioNTech vaccine dose 6 weeks after the first dose. Following the second vaccination, similar symptoms reoccurred after a few days. The dose of prednisolone was increased to 32 mg/day, gradually tapered, and discontinued in mid-August 2021. One month after, he developed abdominal pain, myalgia, fatigue, and jaundice. The symptoms and laboratory findings did not improve over 10 days, and he was referred to a tertiary liver transplant center. At admission, ALT was 485, AST was 629, total bilirubin was 6.6 mg/dl, and the international normalized ratio was 1.36. Serum IgG levels were 28.3 (7.0–16.4 g/L). Viral serology was negative for hepatitis A–E, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus. Antinuclear antibodies, smooth muscle actin, antimitochondrial antibodies, anti–liver–kidney microsome 1, liver cytosolic antigen 1, and anti–soluble liver antigen were all negative; and ceruloplasmin was normal. The liver biopsy showed portal inflammation with interface activity and significant lobular necroinflammatory activity, hepatocellular rosette formation and emperipolesis that are typical components of AIH. Treatment with prednisolone (40 mg/day, i.v.) and plasma exchange did not improve the liver function. The patient developed HE and underwent living donor liver transplantation. One month after liver transplantation, he was alive with significantly improved laboratory findings. We presented a report of severe outcome of liver injury that developed after SARS-CoV-2 vaccination. We are aware that it is difficult to establish a definitive causality between SARS-CoV-2 vaccine and hepatitis. However, our case demonstrates strong evidence of vaccine-induced immune-mediated liver injury. The patient developed liver injury after a first dose of Pfizer-BioNTech vaccine which on reexposure led to severe liver injury. Our case, along with other reports, suggests that AIH-like hepatitis may develop after SARS-CoV-2 vaccination. Early diagnosis and effective management seem to be very important in this emerging condition. Nothing to report. Cumali Efe, Murat Harputluoğlu, and Sezai Yilmaz conceptualized the study. Cumali Efe, Murat Harputluoğlu, and Neşe Karadağ Soylu collected and analyzed data. All authors approved the final version of the manuscript. All data that support the findings of this study are presented in the text.

Inadequate hypertension control rates: A global concern for countries of all income levels.

Inadequate hypertension control rates: A global concern for countries of all income levels.

Enfermedad celiaca en adultos chilenos

Introduction and aimTo characterize a university hospital population of Chilean adult patients with celiac disease. Patients and methodWe retrospectively reviewed the records of patients under control that were diagnosed with celiac disease through clinical characteristics, serology, and histology. ResultsA total of 149 patients were included, 119 (79.9%) of whom were women. Mean patient age was 42years at diagnosis and 13.4% of patients had a family history of celiac disease. Mean body mass index was 24.3kg/m2, 55.3% presented with normal weight, 37.9% with overweight and obesity, and 6.8% with underweight. The main reasons for consultation were diarrhea (47%), weight loss (31%), dyspepsia (43%), and fatigue (26.1%). Anemia (26.1%), elevated transaminases (17.4%), low ferritin (11.4%), and hypovitaminosisD (9.3%) stood out, among others, in the initial laboratory work-up. The more frequent associated diseases were hypothyroidism (15.4%) and depressive disorder (11.4%). Small intestinal bacterial overgrowth was found in 10.1% and lactose malabsorption in 15.4%. The primary histologic diagnosis was celiac disease, with Marsh stage 3a villous atrophy (34.9%). ConclusionOur results were similar to those of other case series on adults, finding that celiac disease was more frequent in women, disease began in the fourth decade of life, extraintestinal symptoms predominated, and there was an association with other autoimmune diseases. An important percentage of patients were also overweight and obese.

Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic.

ContextThe effects of the coronavirus disease 2019 (COVID-19) pandemic on the incident cases of pediatric type 1 diabetes (T1D) and type 2 diabetes (T2D) are not clear.ObjectiveTo identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic.MethodsA retrospective chart review was conducted. Demographics, anthropometrics, and initial laboratory results from patients ages 0 through 21 years who presented with new-onset diabetes to a pediatric tertiary care center were recorded.ResultsDuring the pandemic, incident cases of pediatric T1D increased from 31 in each of the prior 2 years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (P = 0.009). Patients with T2D were more likely to present in diabetic ketoacidosis (DKA), though this was not statistically significant (P = 0.093). Severe DKA was higher compared with moderate DKA (P = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than one-half of all newly diagnosed pediatric diabetes cases (53%).ConclusionsThere were more incident pediatric T1D and T2D cases as well as an increase in DKA severity in T2D at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the pediatric diabetes trends with profound individual and community health consequences.

POEMS Syndrome: a clinical challenge / Síndrome de POEMS: um desafio clínico

A 42-year-old male patient admitted to our service with a history of progressive and symmetrical weakness, paresthesia of the lower limbs, weight loss and urinary retention for about 8 months. Physical examination demonstrated poor general condition, lower limb edema, hepatomegaly and digital clubbing. Neurological examination showed a polyneuropathic pattern, with hypoesthesia and absence of deep reflexes of the lower limbs. Initial laboratory investigation demonstrated erythrocytosis and thyroid and adrenal dysfunction in addition to hypergammaglobulinemia. CSF analysis, due to the clinical suspicion of chronic inflammatory demyelinating polyneuropathy, resulted in protein-cytological dissociation. PIDC was hypothesized to be due to light-chain disease, but for this association we supplemented with bone marrow analysis and whole-body CT scan, which showed 4% atypia in plasma cells and osteolytic and osteoblastic lesions in the vertebro-costal region between the 8th and 9th vertebrae. Subsequent biopsy confirmed plasmacytoma. He performed autologous bone marrow transplantation, but evolved with infectious complications and died within 3 months.

Characteristics, Outcomes, and Severity Risk Factors Associated With SARS-CoV-2 Infection Among Children in the US National COVID Cohort Collaborative

Understanding of SARS-CoV-2 infection in US children has been limited by the lack of large, multicenter studies with granular data. To examine the characteristics, changes over time, outcomes, and severity risk factors of children with SARS-CoV-2 within the National COVID Cohort Collaborative (N3C). A prospective cohort study of encounters with end dates before September 24, 2021, was conducted at 56 N3C facilities throughout the US. Participants included children younger than 19 years at initial SARS-CoV-2 testing. Case incidence and severity over time, demographic and comorbidity severity risk factors, vital sign and laboratory trajectories, clinical outcomes, and acute COVID-19 vs multisystem inflammatory syndrome in children (MIS-C), and Delta vs pre-Delta variant differences for children with SARS-CoV-2. A total of 1 068 410 children were tested for SARS-CoV-2 and 167 262 test results (15.6%) were positive (82 882 [49.6%] girls; median age, 11.9 [IQR, 6.0-16.1] years). Among the 10 245 children (6.1%) who were hospitalized, 1423 (13.9%) met the criteria for severe disease: mechanical ventilation (796 [7.8%]), vasopressor-inotropic support (868 [8.5%]), extracorporeal membrane oxygenation (42 [0.4%]), or death (131 [1.3%]). Male sex (odds ratio [OR], 1.37; 95% CI, 1.21-1.56), Black/African American race (OR, 1.25; 95% CI, 1.06-1.47), obesity (OR, 1.19; 95% CI, 1.01-1.41), and several pediatric complex chronic condition (PCCC) subcategories were associated with higher severity disease. Vital signs and many laboratory test values from the day of admission were predictive of peak disease severity. Variables associated with increased odds for MIS-C vs acute COVID-19 included male sex (OR, 1.59; 95% CI, 1.33-1.90), Black/African American race (OR, 1.44; 95% CI, 1.17-1.77), younger than 12 years (OR, 1.81; 95% CI, 1.51-2.18), obesity (OR, 1.76; 95% CI, 1.40-2.22), and not having a pediatric complex chronic condition (OR, 0.72; 95% CI, 0.65-0.80). The children with MIS-C had a more inflammatory laboratory profile and severe clinical phenotype, with higher rates of invasive ventilation (117 of 707 [16.5%] vs 514 of 8241 [6.2%]; P < .001) and need for vasoactive-inotropic support (191 of 707 [27.0%] vs 426 of 8241 [5.2%]; P < .001) compared with those who had acute COVID-19. Comparing children during the Delta vs pre-Delta eras, there was no significant change in hospitalization rate (1738 [6.0%] vs 8507 [6.2%]; P = .18) and lower odds for severe disease (179 [10.3%] vs 1242 [14.6%]) (decreased by a factor of 0.67; 95% CI, 0.57-0.79; P < .001). In this cohort study of US children with SARS-CoV-2, there were observed differences in demographic characteristics, preexisting comorbidities, and initial vital sign and laboratory values between severity subgroups. Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission. Further work is needed to translate this knowledge into improved outcomes.

Mobitz Type I as the Initial Presentation of Multisystem Inflammatory Syndrome in Children.

To The Editors: Since the emergence of the novel coronavirus SARS-CoV-2, great attention was drawn to the multisystem inflammatory syndrome in children (MIS-C) – a life-threatening complication. Although conduction disorders are uncommon in childhood, a growing number of mild cases address these abnormalities with MIS-C.1 Usually they include prolonged QTc interval, first-degree atrioventricular block (AVB), right bundle branch block, ST-segment changes and tachyarrhythmias.1 This report illustrates the importance of cardiovascular monitoring in patients with MIS-C admitted to the pediatric intensive care unit (PICU). A previously healthy 9-year-old boy presented with a high fever of 39.4°C and vomiting lasting for 4 days. He tested positive for SARS-CoV-2 by RT-PCR from a nasopharyngeal swab. On physical examination, the patient was hypotensive (blood pressure of 90/50 mm Hg) and tachycardic (heart rate of 103 beats per minute). Initial laboratory tests revealed a WBC count of 6.3 × 109/L with relative neutrophilia (85%), elevated inflammatory markers (procalcitonin of 0.949 mcg/L, C-reactive protein of 165.6 mg/L, ferritin of 280.3 mcg/L, interleukin-6 of 352.8 ng/L, fibrinogen of 7.6 g/L and D-dimers of 4.45 mg/L) and elevated cardiac markers (troponin of 0.970 mcg/L and NT-pro-BNP of 6092 ng/L). Upon sudden development of bradycardia (heart rate of 45 beats per minute), electrocardiogram (ECG) revealed Mobitz type I second-degree AVB. Echocardiography documented moderate mitral regurgitation and normal left ventricular ejection fraction without pericardial effusion. Treatment in the PICU included empiric antimicrobial therapy with ceftriaxone and clindamycin, intravenous immunoglobulins, glucocorticoids, vasopressor support and diuretics. The fever receded after 7 days. The blood cultures were negative. However, ECG raised suspicion of possible progression to more advanced blocks with a P:QRS ratio of 3:1 while the cardiac markers were still elevated (troponin of 0.062 mcg/L and NT-pro-BNP of 4110 ng/L). Serial ECG revealed spontaneous conversion to normal sinus rhythm within 3 days, confirmed by the 24-hour ECG monitoring. The patient was discharged after 14 days. At the 3- and 6-months follow-up, a 24-hour ECG recording and ergometric testing showed normal rhythm without any signs of AVB. Mobitz type I second-degree AVB secondary to MIS-C is clinically difficult to recognize due to the predominant development of hypotension and tachycardia upon admission, whereas low and irregular heart rate would be indicative of such conduction disorder in a child without MIS-C.2 Several studies explored acute cardiovascular manifestations in MIS-C where Valverde et al included 286 cases and Regan et al described serial ECGs in 63 cases with a median of 5 ECGs per patient.1,3 Neither study reported a second-degree AVB. All patients with severe MIS-C require PICU admission due to possible rapid hemodynamic deterioration. Furthermore, all patients with Mobitz type I second-degree AVB should be admitted and monitored due to possible progression to bradycardia, hypotension and/or higher degree AVB.2 In conclusion, MIS-C cases started having unique presentations, including cardiac conduction disorders. Second-degree AVB can be a presenting finding of MIS-C and high clinical suspicion must be held for patients presenting with signs of shock.

Lactate dehydrogenase to albumin ratio as a prognostic factor in lower respiratory tract infection patients.

To verify the role of lactate dehydrogenase to albumin (LDH/ALB) ratio as an independent prognostic factor for mortality due to the lower respiratory tract infection (LRTI) in the emergency department (ED). We reviewed the electronic medical records of patients who were admitted to the ED for the management of LRTI between January 2018 and December 2020. Initial vital signs, laboratory data, and patient severity scores in the ED were collected. The LDH/ALB ratio was compared to other albumin-based ratios (blood urea nitrogen to albumin ratio, C-reactive protein to albumin ratio, and lactate to albumin ratio) and severity scales (pneumonia severity index, modified early warning score, CURB-65 scores), which are being used as prognostic factors for in-hospital mortality. Multivariable logistic regression was performed to identify independent risk factors. The LDH/ALB ratio was higher in the non-survivor group than in the survivor group (median [interquartile range]: 217.6 [160.3;312.0] vs. 126.4 [100.3;165.1], p<0.001). In the comparison of the area under the receiver operating characteristic curve (AUC) for predicting in-hospital mortality, the AUC of the LDH/ALB ratio (0.808, 95% confidence interval: 0.757-0.842, p<0.001) was wider than other albumin-based ratios and severity scales, except the blood urea nitrogen to albumin ratio. In the multivariable logistic regression analysis, the LDH/ALB ratio independently affected in-hospital mortality. The LDH/ALB ratio may serve as an independent prognostic factor for in-hospital mortality in patients with LRTI.

Annals for Educators - February 2022.

Annals for Educators - February 2022.

Retrospective analysis on efficacy of convalescent plasma in acute respiratory distress syndrome due to COVID-19.

Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nineteen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.

Neurological sequelae in acute carbon monoxide poisoning: Aprospective observational study with MRI data.

Acute carbon monoxide (CO) poisoning survivors may experience persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS). This study evaluated the clinical features, laboratory results, acute brain lesions (ABLs) on diffusion-weighted imaging (DWI) at presentation, and long-term outcomes and explored differences between patients with PNS and DNS. The study included 443 patients who had experienced CO poisoning, underwent DWI and completed 1-year follow-ups. The demographics, comorbidities, symptomatology, laboratory results, ABLs on DWI at presentation, and long-term outcomes were compared between patients with PNS and those with DNS. The 42 (9.5%) and 96 (21.7%) patients with PNS and DNS, respectively, showed no significant differences in demographics, duration of CO exposure, initial conscious level, symptomatology, and laboratory results. ABLs on DWI were observed in 33 patients (33/42) with PNS and 62 patients (62/96) with DNS. The most common region of ABLs was the globus pallidus (60.6% and 56.6% in PNS and DNS, respectively). The proportion of ABLs present and lesion distribution did not differ significantly between the two groups. At 1year, a significantly higher proportion of patients in the PNS group showed a good outcome (defined as modified Rankin Scale [mRS] scores of 0-2, 81%) compared with the DNS group (81% vs. 56.3%, p=.047). Demographics, clinical features, laboratory results, and acute brain lesions on MRI at presentation did not differ between the PNS and DNS groups. However, the long-term outcome of PNS was better than that of DNS.

Gallstone Ileus: A Rare Cause of Small Bowel Obstruction

A 71-year-old woman with a history of hypertension presented to the Emergency Department with nausea, vomiting, and vague abdominal cramping for 3 days. She had not had a bowel movement during this time, but continued to pass minimal flatus. Her only surgical history was an uncomplicated hysterectomy many years prior. Her vital signs were normal on arrival and her abdominal examination was notable for mild upper abdominal tenderness without guarding, mild distension, and normal bowel sounds. Initial laboratory values demonstrated a leukocytosis (20.8 × 109/L) and an elevated lactate (2.3 mmol/L).

Long-term alkali–silica mitigation of high-alkali concrete with cement replacements

In this study, the impact of high-alkali Portland cements on the prescribed level of supplementary cementitious materials (SCMs) required in the Canadian standard for alkali–silica reaction mitigation was evaluated. On the basis of the results, for concretes containing aggregates exhibiting moderate reactivity, the maximum allowable cement alkali limit was increased from 1.00 to 1.15%. For all the levels of aggregate reactivity, cement alkali contents could be allowed up to 1.25% provided the recommended level of mitigation by SCMs was increased. In the initial laboratory study, mortar bars and concrete prisms were cast and monitored using two different reactive aggregates and recommended levels of fly ash and slag. For the concrete prism tests, the alkali contents of cements were increased to 1.25%, as per the standard, or were increased by 0.25%. Instrumented outdoor exposure concrete blocks, along with additional concrete prisms stored at different temperatures, were cast from numerous mixtures prepared with cement alkali equivalents ranging up to 1.22%. This paper reports on the long-term performance of prisms and concrete blocks after 12 and 27 years. The performance of the outdoor blocks is also compared with the predicted performance based on the results of accelerated mortar bar and concrete prism test.

Ризик і предиктори розвитку артеріальної гіпертензії у хворих на системну склеродермію

Актуальність. Пацієнти із запальними захворюваннями суглобів (ЗЗС), до яких можна зарахувати системну склеродермію (ССД), мають підвищений ризик кардіоваскулярних (КВ) ускладнень порівняно із загальною популяцією. Артеріальна гіпертензія (АГ) є потужним фактором, що піддається модифікації та впливає на КВ-ризики у пацієнтів із ЗЗС. Мета. Дослідити ризик і пре­диктори розвитку АГ у хворих на ССД. Матеріали та методи. Ми провели 5-річне проспективне спостереження за 73 пацієнтами, які перебували у регіональному регістрі. Дослідження ризику розвитку АГ проводилося за допомогою процедури Каплана — Мейєра. Обчислення впливу предикторів на ризик розвитку АГ проводилося за допомогою регресії Кокса. Результати. П’ятирічний ризик розвитку АГ при ССД становить 20,3 %. Ризик розвитку АГ через 1, 3 та 5 років — 18,2, 25,0 та 19,4 % відповідно. Отримано показники впливу початкових клініко-лабораторних показників на ризик розвитку АГ (відношення ризиків): вік &gt; 45 років — 2,04, дифузна склеродермія — 0,65, синдром Рейно — 1,17, набряк кистей — 1,74, артрит — 0,99, пневмофіброз — 1,84, анемія — 0,78, швидкість осідання еритроцитів (ШОЕ) &gt; 25 мм/год — 1,68, С-реактивний протеїн (СРП) &gt; 5 мг/л — 1,52, ревматоїдний фактор (РФ) &gt; 14 МО/мл — 1,48, протеїнурія — 1,09. Висновки. П’ятирічний ризик розвитку АГ при ССД становить 20,3 %. Найбільший вплив на ризик розвитку АГ при ССД показали: вік &gt; 45 років, наявність набряку кистей, пневмофіброзу, ШОЕ &gt; 25 мм/год, СРП &gt; 5 мг/л, РФ &gt; 14 МО/мл. У пацієнтів, які мали АГ у дебюті ССД, у п’ятирічній перспективі можна очікувати збільшення зустрічальності протеїнурії та зниження швидкості клубочкової фільтрації.

Development of severity and mortality prediction models for covid-19 patients at emergency department including the chest x-ray

ObjectivesTo develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. MethodsAll symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model. ResultsA total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC = 0.94 and AUC-PRC = 0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC = 0.97 and AUC-PRC = 0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics. ConclusionThe developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour.