Laboratory Parameters In Patients Research Articles

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Background: Hepatic dysfunction (HD) after liver transplantation (LT) or extended hepatic resection (EHR) is associated with graft failure and high short-term mortality. We evaluated the safety and depurative efficacy of CytoSorb® in these settings. The primary endpoint was the change in serum total bilirubin at the end of the treatment compared to the baseline value. The secondary endpoint was to evaluate the trend of serum total bilirubin and coagulation parameters up to 72 h after discontinuation of CytoSorb®. The effects of CytoSorb® therapy on the degree of hepatic encephalopathy (HE), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease (MELD) scores as well as the hemodynamic status compared to baseline were also assessed. Methods: Adult patients with a serum total bilirubin level > 10 mg/dL admitted to the Intensive Care Unit were included. Exclusion criteria were hemodynamic instability, postoperative bleeding and platelet count < 20,000/mm3. Results: Seven patients were treated. Serum total bilirubin was significantly reduced at the end of treatment. However, seventy-two hours after the discontinuation of extracorporeal therapy, bilirubin levels returned to baseline levels in four patients. A decrease in platelet count was found during therapy, and platelet transfusion was required in six cases. A significant increase in D-dimer at the end of treatment was detected. HE degree, SOFA and MELD scores remained stable, while a deterioration in hemodynamic status was observed in two cases. Conclusions: Our preliminary findings did not show the possible benefits of CytoSorb® in rebalancing clinical and laboratory parameters in patients with HD after LT or EHR.

Analysis of laboratory parameters in patients diagnosed with al amyloidosis with kidney involvement

Analysis of laboratory parameters in patients diagnosed with al amyloidosis with kidney involvement

Factor of psychopharmacotherapy in in the course of COVID-19 in psychiatric inpatients

The aim of this study is to examine the relationship between the severity and duration criteria of COVID-19 and the psychopharmacotherapy administered to patients in within a psychiatric hospital.Materials and Methods. We analyzed 169 case histories involving completed clinical cases of COVID-19 treatment in a specialized infectious psychiatric department in St. Petersburg, covering the period from May 2020 to January 2021. Correlation, dispersion, and regression analyses were employed to evaluate severe and mild COVID-19 progression indicators, as well as the duration of persistent SARS-CoV-2 viral shedding. We assessed the clinical and laboratory parameters in patients, along with the psychopharmacotherapy administered, including antidepressants, antipsychotics, and acid sphingomyelinase inhibitors (FIASMA-active drugs).Results. Cardiovascular diseases emerged as a predictor of severe COVID-19 when combined with an increasing platelet-to-lymphocyte ratio (PLR), increasing the risk of severe course by over two-fold. The use of any psychotropic agents was associated with a 0.9% increase in the risk of severe course of COVID-19 for each unit increase in the systemic inflammation index PLR, specifically in patients with intellectual disability (ICD-10 codes F70-79), when compared to patients with schizophrenia (ICD-10 codes F20-29). High PLR values and the use of FIASMA-active drugs were associated with prolonged COVID-19 duration, while antidepressant therapy and elevated C-reactive protein levels were associated with a reduced predicted duration of viral shedding in 13.8% of variance. Additional consideration of the nosology of psychiatric disorders in the regression model increased the proportion of explained variance to 22.8%.Conclusion. Consideration should be given to thymoanaleptic therapy for individuals with psychiatric disorders during periods of increased disease incidence leading up to potential SARS-CoV-2 infection, as it may serve as a protective factor against COVID-19. Furthermore, there is no evidence to suggest adverse effects of antipsychotics on the severity and duration of COVID-19. Further research is required to investigate the effects of FIASMA-active psychopharmacological agents within nosologically homogeneous groups.

Placental Vimentin Expression in Preeclampsia and Gestational Diabetes Mellitus

OBJECTIVE: This study investigated vimentin expression in placentas of patients with preeclampsia and gestational diabetes mellitus (GDM). STUDY DESIGN: Placentas of preeclamptic women (n=25), women with GDM (n=25), and control cases (n=25) were enrolled in this study. Placental samples were fixed in zinc-formalin and further processed for paraffin wax tissue embedding. Demographic and laboratory parameters of patients were recorded. Vimentin immune activity was analyzed in the placental sections with immunohistochemistry. Sections were imaged and analyzed under a light microscope. A semiquantitative measurement was done between groups by comparing the Vimentin signal and significance was calculated. Network construction and pathway enrichment analysis were conducted using Cytoscape (v3.10.1) and ShinyGO, respectively. RESULTS: Vimentin expression was high in the placental sections of the control group. The preeclampsia group showed positive Vimentin expression in cytotrophoblast and syncytiotrophoblast cells and connective tissue of placental villi in the preeclampsia group. Vimentin expression was generally recorded as negative in placental villi, fibrinoid substances, and connective tissue cells in the GDM group. Bioinformatic analysis showed that the AGE-RAGE signaling pathway and cancer-related pathways were mainly observed in Vimentin-associated pathways, which finally activate inflammatory pathways in both preeclampsia and GDM. CONCLUSION: Vimentin expression patterns in placental tissue sections reveal nuanced regulatory mechanisms, emphasizing the need for further exploration into the functional roles of vimentin in placental physiology and pathology.

Growth differentiation factor-15 serum concentrations reflect disease severity and anemia in patients with inflammatory bowel disease.

Population of patients with inflammatory bowel disease (IBD) is burdened by various extraintestinal manifestations which substantially contribute to greater morbidity and mortality. Growth-differentiation factor-15 (GDF-15) is often over-expressed under stress conditions, such as inflammation, malignancies, heart failure, myocardial ischemia, and many others. To explore the association between GDF-15 and IBD as serum concentrations of GDF-15 were shown to be an independent predictor of poor outcomes in multiple diseases. An additional aim was to determine possible associations between GDF-15 and multiple clinical, anthropometric and laboratory parameters in patients with IBD. This cross-sectional study included 90 adult patients diagnosed with IBD, encompassing both Crohn's disease (CD) and ulcerative colitis (UC), and 67 healthy age- and sex-matched controls. All patients underwent an extensive workup, including colonoscopy with subsequent histopathological analysis. Disease activity was assessed by two independent gastroenterology consultants specialized in IBD, employing well-established clinical and endoscopic scoring systems. GDF-15 serum concentrations were determined following an overnight fasting, using electrochemiluminescence immunoassay. In patients with IBD, serum GDF-15 concentrations were significantly higher in comparison to the healthy controls [800 (512-1154) pg/mL vs 412 (407-424) pg/mL, P < 0.001], whereas no difference in GDF-15 was found between patients with CD and UC [807 (554-1451) pg/mL vs 790 (509-956) pg/mL, P = 0.324]. Moreover, multiple linear regression analysis showed that GDF-15 levels predict CD and UC severity independent of age, sex, and C-reactive protein levels (P = 0.016 and P = 0.049, respectively). Finally, an association between GDF-15 and indices of anemia was established. Specifically, negative correlations were found between GDF-15 and serum iron levels (r = -0.248, P = 0.021), as well as GDF-15 and hemoglobin (r = -0.351, P = 0.021). Accordingly, in comparison to IBD patients with normal hemoglobin levels, GDF-15 serum levels were higher in patients with anemia (1256 (502-2100) pg/mL vs 444 (412-795) pg/mL, P < 0.001). For the first time, we demonstrated that serum concentrations of GDF-15 are elevated in patients with IBD in comparison to healthy controls, and the results imply that GDF-15 might be involved in IBD pathophysiology. Yet, it remains elusive whether GDF-15 could serve as a prognostic indicator in these patients.

Analysis of neuropsychological and laboratory parameters in patients with cerebrovascular disease and SARS-CoV-2 compared to those without SARS-CoV-2

Background. Severe acute respiratory syndrome сoronavіrus 2 (SARS-CoV-2, formerly known as 2019-nCoV) is the cause of coronavirus disease 2019 (COVID-19), and was first reported in Wuhan, China. However, it is also contagious to humans and spreads rapidly around the world through close contact between infected people or through a relatively simple transmission mechanism (airborne transmission). COVID-19 is known to affect almost all systems of the human body. Initial reports suggest that hypertension may be a risk factor for susceptibility to SARS-CoV-2 infection, a more severe course of COVID-19, and increased mortality associated with COVID-19. It is estimated that 1–3 % of COVID-19 patients experience transient ischemic attacks with a frequency similar to other coronavirus infections (SARS-CoV-1 and MERS-CoV). The cause of ischemic stroke associated with COVID-19 is unknown, but previous studies have suggested that an inflammatory cytokine storm may cause hypercoagulation and endothelial damage. We see that COVID-19 is closely related to neurological complications because there are potential factors that can cause them. Materials and methods. Cerebrovascular diseases were analyzed in 111 patients infected with SARS-CoV-2 (n = 71) and those without a history of SARS-CoV-2 (n = 40). The subject of the study was neuropsychological and laboratory indicators. The following methods were used: psychometric — Beck Anxiety Inventory, Hamilton Depression Rating Scale, Fatigue Assessment Scale; neuropsychological — Mini-Mental State Examination, Montreal Cognitive Assessment, Frontal Assessment Battery; clinical — neurological status; polymerase chain reaction to detect COVID-19 RNA; statistical methods. Results. In patients who suffered transient ischemic attack and ischemic stroke with a minimal neurological deficit and COVID-19, there were elevations in the erythrocyte sedimentation rate, leukocytes, segmented neutrophils, while an increase in C-reactive protein was noted in all participants with cerebrovascular disease and COVID-19, with more significant levels among those with ischemic stroke. All subgroups with COVID-19 showed an increase in D-dimer and fibrinogen with higher content in patients after ischemic stroke. Also in this subgroup, the procalcitonin index exceeded the norm, which indicates the severity of the course of COVID-19 with the addition of co-infection. Data of neuropsychological tests in patients with ischemic stroke with a minimal neurological deficit with SARS-CoV-2 revealed a decrease in the Montreal Cognitive Assessment score, indicating mild cognitive changes in these patients. The level of anxiety in patients with hypertension with frequent crises and ischemic stroke with a minimal neurological deficit was above the reference values, with a slight predominance in patients who did not have COVID-19. It follows that both laboratory and neuropsychological parameters differed in three subgroups depending on cerebrovascular disease, as well as the presence and absence of SARS-CoV-2, which makes it possible to develop more appropriate diagnostic methods in order to predict the course and outcome of COVID-19.

Metabolic biomarkers in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction

BACKGROUND: Half of all patients with chronic heart failure (CHF) have preserved ejection fraction (CHF-nEF). The drug’s use effective for treatment of CHF with reduced ejection fraction (CHF-nFV) reduces the hospitalization incidence but does not affect the cardiovascular incidence or overall mortality in patients with CHF-nFV. Finding differences between CSN-SFV and CSN-nFV biomarkers is a pressing scientific problem.AIM: To study the metabolic disorders biomarkers intergenic relationships, myocardial damage, and to evaluate their role in the CHF development in patients with DM2.MATERIALS AND METHODS: We studied the lipid and carbohydrate metabolism disorder genes polymorphisms frequencies in patients with CHF-CFV and DM2 (48 patients), CHF-NFV and DM2 (46) and patients with metabolic syndrome (MS) without CHF (68), mean age of patients was 69,7±5,3 yo. DNA was isolated from venous blood according to the manufacturer’s methodology. Gene polymorphisms were determined by real time PCR. The studied polymorphisms correlations with clinical and laboratory data and associations between clinical and laboratory tests were identified by regression analysis.RESULTS: In the control group, PPARG, APOC3 C3238G rs5128, LIPC -250 G&gt;A rs2070895, APOA1 G-75A rs670, FABP2 Ala54Thr G&gt;A rs1799883, ADRB2 5318 C&gt;G rs1042714 genes polymorphisms, along with co-dependent ADRB3, FTO, FABP2 genes polymorphic form a gene network regulating plasma concentrations of LDL, uric acid and CAD. Gene polymorphisms have been found to be associated with clinical and/or laboratory parameters in patients with CHF-CFV: PPARGC1AGly482Ser G&gt;A rs8192678 with CAD; PPARGT-2821C rs12497191 with glycated hemoglobin level; FTO A&gt;T rs9939609 (α-ketoglutarate dependent dioxygenase gene) with waist circumference; LEPR A&gt;G rs1137101 (leptin receptor gene) with MAP. The following polymorphisms were found to be associated in patients with CHF-nFV: LIPC-250 G&gt;A rs2070895 (liver triglyceride lipase gene) with MAP; PPARGC1A Gly482Ser G&gt;A rs8192678 with MAP; FTO A&gt;T rs9939609 with waist volume.CONCLUSIONS: From the study results, it is evident that patients with DM2 having CHF with different PV differ significantly among themselves by the presence of polymorphic genes prone to network interactions. The greatest number of such interactions is observed in the group of CHF-sFV, which determines a more complex course of this variant of CHF than in patients with CHF-nFV.

Clinical and Laboratory Features and Maternal Outcomes in Pregnant Women with Critical Lung Damage in the COVID-19

Introduction. The spread of the delta strain of the SARS-CoV-2 virus during the third and fourth waves of the pandemic led to the fact that a large cohort of pregnant women and maternity women needed respiratory support, standard treatment methods had no effect, and negative outcomes for the mother and fetus has increased.Purpose of the study. The aim is to determine clinical and laboratory features and maternal outcomes in pregnant women with the coronavirus disease 2019 (COVID-19) and critical lung damage.Materials and methods. A comparative study was conducted, followed by a retrospective analysis of clinical and laboratory features, maternal outcomes in 56 pregnant women with COVID-19 treated in this maternity hospital in the first-fourth wave of the pandemic. The research method is continuous, sequential. The first group (main) consisted of 28 women with severe or extremely severe form of the course of COVID-19 and critical lung damage (more 75 %); The second group (comparison) — 28 pregnant women with a moderate form of the disease and lung damage of 25–50 %. Screening assessment of the degree of endogenous intoxication was carried out. The severity of the disease was determined by the evaluation scale National Early Warning Score (NEWS).Results. Laboratory parameters of patients at admission and at the height of the disease have statistically significant differences in the general blood test, such as higher levels of leukocytes, eosinophils, rod-shaped neutrophils, hemoglobin, as well as lymphopenia and monocytopenia in women of the main group at the height of the disease. At the same time, the hematological indices of intoxication in the main group exceed the value of these indicators in the comparison group by two times. Patients of both groups had high levels of acute-phase markers of inflammation — C-reactive protein and ferritin, — an indicator of tissue destruction of lactate dehydrogenase, however, both at admission and at the height of the disease, these indicators were statistically significantly higher in the group of women with critical lung damage. In general, 20/28 patients (71.4 %) of group 1 had an extremely severe course of the disease, 8/28 (28.6 %) had a severe course. In second group, 28/28 patients (100 %) had moderate-severe NCI (p = 0.000), while recovery was noted in all of them. Outcomes of COVID-19 in women with critical lung damage: recovered — 25/28 (89 %); 3/28 (10.7 %) the patients died from complications of COVID-19 of an extremely severe degree.Discussion. The most frequent laboratory anomaly was leukocytosis and a rod-shaped shift in the midst of the disease in women with critical lung damage, as well as a statistically significant increase in the level of C-reactive protein, lactate dehydrogenase, D-dimer. Pulmonary complications (parapneumonic pleurisy, pneumothorax, pneumomediastinum, hydrothorax, lung abscess) and extrapulmonary complications (encephalopathy, panic attacks, acute liver injury, sepsis, thromboembolic complications) were observed only with critical lung damage.Conclusion. In the laboratory, at the height of the disease, in the group of pregnant women with critical lung damage, leukocytosis and stab shift are statistically significantly more common. Hematological indices of intoxication, leukocyte and hematological, confirm endogenous intoxication at the height of the disease. A statistically significantly higher level of aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, D-dimer is determined upon admission to the hospital and at the height of the disease as markers of systemic inflammatory response and cytolysis, which demonstrates the defeat of several organ systems simultaneously.

Do admission glucose levels independently predict coagulopathy in multiple trauma patients? A retrospective cohort analysis.

Coagulopathy is prevalent in multiple trauma patients and worsens bleeding complications, leading to higher morbidity and mortality rates. Hyperglycemia upon admission predicts hemorrhagic shock and mortality in severely injured patients. This study aimed to assess admission glucose levels as an independent prognostic factor for coagulopathy in multiply injured patients. This retrospective cohort study observed multiple trauma patients treated at a level I trauma center between January 1, 2005, and December 31, 2020. Coagulopathy was defined as an international normalized ratio (INR) > 1.4 and/or activated thromboplastin time (APTT) > 40 s. Analysis of variance compared clinical and laboratory parameters of patients with and without coagulopathy. Receiver-operating-characteristic (ROC) and multivariate logistic regression analyses identified risk factors associated with coagulopathy. The study included 913 patients, of whom 188 (20%) had coagulopathy at admission. Coagulopathy patients had higher mortality than those without (26% vs. 5.0%, p < 0.001). Mean glucose level in coagulopathy patients was 10.09 mmol/L, significantly higher than 7.97 mmol/L in non-coagulopathy patients (p < 0.001). Admission glucose showed an area under the curve (AUC) of 0.64 (95% CI [0.59-0.69], p < 0.001) with an optimal cut-off point of 12.35 mmol/L. After adjusting for other factors, patients with high admission glucose had a 1.99-fold risk of developing coagulopathy (95% CI 1.07-3.60). Other laboratory parameters associated with coagulopathy included haemoglobin, bicarbonate (HCO3), and lactate levels. This study emphasizes the significance of admission blood glucose as an independent predictor of coagulopathy. Monitoring hyperglycemia can aid in identifying high-risk patients.

The Impact of Oral Probiotics on Laboratory Parameters in Patients With Alcohol Toxicity: A Single-blinded Intervention Study

Background: Alcohol toxicity is a significant medical emergency with implications for patient management and outcomes. This single-blinded randomized intervention study investigated the effects of oral probiotics on various laboratory parameters in patients with acute alcohol toxicity. Methods: A total of 30 eligible patients were randomly assigned to either the control (placebo) or intervention (oral probiotics) group. Results: While the study did not reveal a significant impact on the length of hospital stay (LOHS), it did demonstrate notable improvements in laboratory variables, including pH, serum glutathione level, serum vitamin B6 level, and O2 saturation, in the probiotic group. Conclusion: These findings suggest the potential benefits of probiotics in mitigating certain aspects of alcohol toxicity.

CLINICAL MANIFESTATIONS AND LABORATORY PROFILE OF DENGUE FEVER CASES AT THE TIME OF PRESENTATION IN TERTIARY CARE HOSPITAL

Dengue is the most common arboviral disease worldwide in tropical and subtropical regions. Clinical manifestations of dengue fever are mild illnesses like classical dengue fever and severe illnesses like dengue shock syndrome, and dengue hemorrhagic fever. The study was aimed to determine the clinical manifestations and laboratory parameters of patients with Dengue fever Materials And Methods: This prospective study was conducted at a tertiary teaching hospital, Nellore over 6 months. All the patients above the age of 14 years who were diagnosed with Dengue with a positive result for NS1Ag or IgM or IgG antibodies were included. All the necessary clinical and laboratory investigation parameters of the patients were noted and the data was analyzed by frequency and percentage. Results: During the study period, a total of 73 dengue cases were included in the study. Of these, there were 38 (52%) males and 33 (48%) females between 15 and 80 years of age. The most common clinical presentations were fever (100%), headache 56 (76.7%), myalgia 52 (71.2%), and nausea/vomiting 46 (63%). The common hematological findings were thrombocytopenia 58 (79.4%), followed by raised liver transaminases 42 (57.5%), leucopenia 37 (50.6%), leucocytosis 22 (30.1%) and raised hematocrit 21(28.7%) Conclusion: Fever, headache, and anorexia are the most prevalent clinical manifestations of Dengue fever. Low platelet count, raised liver transaminases, and a rise in hematocrit are the most prevalent laboratory abnormalities. Early detection and monitoring of dengue cases can prevent the serious complications of dengue fever.

Mortality predictors of patients diagnosed with severe hyponatremia in the emergency department.

To determine the factors affecting mortality as a result of the analysis of the demographic and clinical characteristics and laboratory parameters of patients whose serum Na value was determined to be 125mEq/L or below at the time of admission to the emergency department (ED). Patients over 18years of age who admitted to the ED of a tertiary hospital between September 2021 and September 2022 and whose serum sodium level was determined to be 125mEq/L and below were included in the study. Demographic and clinical characteristics, admission complaints, medications used, Charles comorbidity index (CCI), laboratory parameters, and outcomes of the patients included in the study were recorded in the data form. Three hundred ninety-nine patients were included in the study. When the 30-day mortality of the patients is examined, the mortality rate was found to be 21.6%. In the analyses performed for the predictive power of laboratory parameters for mortality, it was determined that the highest predictive power among the predictive values determined by the area under the curve (AUC) was the albumin level (AUC 0.801, 95% CI 0.753-0.849, p < 0.001). In the binary logistic regression analysis, urea and albumin were independent predictors of 30-day mortality. According to study data, albumin and urea levels are independent predictors of 30-day mortality in patients diagnosed with severe hyponatremia in the emergency department.

O-12 A rare cause of parathyroid hormone independent hypercalcemia: 1,25-(OH)2D-24 Hydroxylase (CYP24A1) deficiency

Abstract Background Common causes of parathyroid hormon (PTH)-independent hypercalcemia in adulthood are malignancy, granulomatous diseases, and endocrinopathies. Loss-of-function mutations of CYP24A1 gene, encoding for 1,25-dihydroxyvitamin D3 24-hydroxylase, can also be a rare cause of supressed intact PTH levels, usually associated with, nephrolithiasis and nephrocalcinosis. This disease, defined as idiopathic infantile hypercalcemia, classically presents with hypercalcemia in infants. However, some individuals have also been reported with late-onset clinical manifestation or late diagnosis in adulthood. Clinical Case A 59-year-old male patient with a known diagnosis of type 2 diabetes mellitus for 30 years. He had a history of recurrent kidney stones since 2006. His blood and urine tests revealed elevated creatinine level, hypercalcemia with normal phosphorus levels, normal 25-hydroxycholecalciferol levels, suppressed intact PTH level and normal 24-hour urinary calcium level (Table 1). Urinary ultrasonography was consisted with medullary nephrocalcinosis and chronic kidney disease. PTH-independent causes of hypercalcemia were investigated. Malignancies, granulomatous diseases and endocrinopathies were ruled out. The 1,25-dihydroxycholecalciferol level was within the normal range. Parathormone related peptide level was determined as 1.60 pmol/L (normal value &amp;lt;4.2). Genetic workup revealed a homozygous loss-of-function mutation p.E143del in the CYP24A1 gene. Thereupon, genetic screening started on the siblings of the patient which not been finalized yet. However, none of them were found to have hypercalcemia in the laboratory evaluation. Treatment was started with low-dose fluconazole, which inhibits enzymes (including 25-hydroxylases and 1-α-hydroxylase) synthesizing vitamin D. After a month of treatment at a dose of 50 mg/day, no change was observed in the patient's calcium values. Follow-up with calcium-restricted diet and adequate oral hydration therapy was planned. Conclusion Idiopathic infantile hypercalcemia may manifest later or diagnosed later in adulthood. Genetic examination should be considered in adult patients in whom other causes of PTH-independent hypercalcemia have been excluded.Table 1.Patient's laboratory parameters

Clinical and laboratory assessment of the state of periapical tissues in systemic lupus erythematosus.

Aim: To evaluate changes in clinical and laboratory parameters in patients with SLE depending on the severity and activity of the disease. Materials and Methods: The study included 50 patients with SLE of different age groups, 10 men and 40 women. Results: Systemic lupus erythematosus (SLE) is a chronic disease that belongs to the group of rheumatic diseases and is characterised by autoimmune tissue damage. Chronic inflammatory periodontal diseases remain one of the most common dental pathologies. Chronic gingivitis and periodontitis in SLE are described as one of the earliest and most striking symptoms of the disease. Approximately the same trend was found in patients with SLE depending on the degree of clinical and laboratory activity of the disease. Patients with minimal, 1 degree of activity (characterized by the longest duration of SLE) showed the greatest decrease in bone mineral density (up to 2.25 points), and patients with higher activity had a significantly shorter duration of SLE and, accordingly, a smaller decrease in bone mineral density: in patients with 2 degrees of activity (1.79 points), with 3 degrees of activity (1.94 points). Conclusions: In patients with acute SLE, the maximum value of the Muhlemann-Cowell index was 2.31 points, in patients with subacute SLE - 1.89 points, and in patients with chronic SLE - 1.58 points. CPITN values increase inversely with the nature of the course of SLE, which is associated with the duration of the underlying disease.

Temporal trends in laboratory parameters in survivors and non‑survivors of critical COVID‑19 illness and the effect of dexamethasone treatment.

Although coronavirus disease 2019 (COVID-19)-induced changes in laboratory parameters in patients upon admission have been well-documented, information on their temporal changes is limited. The present study describes the laboratory trends and the effect of dexamethasone treatment on these parameters, in patients with COVID-19 in the intensive care unit (ICU). Routine laboratory parameters, namely white blood cell (WBC), neutrophil, lymphocyte and platelet (PLT) counts, fibrinogen, C-reactive protein (CRP), lactate dehydrogenase (LDH) and albumin concentrations, were recorded upon admission to the ICU and, thereafter, on days 3, 5, 10, 15 and 21; these values were compared between survivors and non-survivors, as well as between those who were treated with dexamethasone and those who were not. Among the 733 patients in the ICU, (mean age, 65±13 years; 68% males; ICU mortality rate 45%; 76% of patients treated with dexamethasone), the WBC and neutrophil counts were persistently high in all patients, without significant differences over the first 15 days. Initially, low lymphocyte counts exhibited increasing trends, but remained higher in survivors compared to non-survivors (P=0.01). The neutrophil-to-lymphocyte ratio (NLR) was persistently elevated in all patients, although it was significantly higher in non-survivors compared to survivors (P<0.001). The PLT count was initially increased in all patients, although it was significantly decreased in non-survivors over time. The fibrinogen and LDH values remained similarly elevated in all patients. However, the increased levels of CRP, which did not differ between patients upon admission, further increased in non-survivors compared to survivors after day 10 (P=0.001). Declining trends in albumin levels over time, overall, with a significant decrease in non-survivors compared to survivors, were observed. Dexamethasone treatment significantly affected the temporal progression of fibrinogen and CRP in survivors and that of NLR in non-survivors. On the whole, the present study demonstrates that patients in the ICU with COVID-19 present persistently abnormal laboratory findings and significant differences in laboratory trends of NLR, CRP, PLT and albumin, but not in WBC and neutrophil count, and fibrinogen and LDH levels, between survivors and non-survivors. The temporal progression of fibrinogen, CRP and NLR is affected by dexamethasone treatment.

Development of a New Model of Insulin Sensitivity in Patients With Type 2 Diabetes and Association With Mortality.

Despite being one of the major drivers of diabetes incidence, the degree of insulin resistance in patients with type 2 diabetes (T2D) is not usually evaluated in clinical practice or in large epidemiologic studies. To identify a model of insulin sensitivity using widely available clinical and laboratory parameters in patients with T2D and evaluate its association with all-cause and cardiovascular mortality. One hundred forty patients with T2D underwent a euglycemic hyperinsulinemic clamp to measure total body glucose disposal rate (mg kg-1 minute-1). We used demographic, clinical, and common laboratory parameters to estimate insulin sensitivity (IS) via stepwise linear regression on 85 patients (training cohort) and validated it in the remaining 55 (validation cohort). The identified equation was then applied to 3553 patients with T2D from the 1999-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to evaluate its association with all-cause and cardiovascular mortality up to December 2015. The best model included triglycerides, gamma glutamyl transpeptidase, albumin excretion rate, and body mass index. The identified IS score correlated well with the clamp-derived glucose disposal rate in both the training (r = 0.77, P < .001) and the validation (r = 0.74, P < .001) cohorts. In the NHANES cohort, after a median follow-up of 8.3 years, 1054 patients died, 265 of cardiovascular causes. In a multivariable Cox proportional hazard model adjusted for age, sex, race-ethnicity, education, cigarette smoke, total cholesterol, chronic kidney disease, blood pressure, prevalent cardiovascular disease, and alcohol consumption, a higher estimated IS was associated with a lower risk of both all-cause and cardiovascular mortality. We propose a new model of IS in patients with T2D based on readily available clinical and laboratory data. Its potential applications are in both diagnosis as well as prognostication.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ И ЛАБОРАТОРНЫХ ПОКАЗАТЕЛЕЙ У ПАЦИЕНТОВ С ИНФЕКЦИЕЙ SARS-COV-2 В ЗАВИСИМОСТИ ОТ РЕЗУЛЬТАТОВ СЕРОЛОГИЧЕСКОЙ ДИАГНОСТИКИ

To date, over 270 million people have been ill with COVID-19 and more than 2 million have died. Tens of thousands of new cases of the disease are still registered in the world every day, so the assessment of the methods for diagnosing SARS-CoV-2 associated pathology remains highly relevant. The aim of the study was to evaluate the variability of clinical and laboratory parameters in patients with SARS-CoV-2 infection depending on the results of serological diagnostics. Material and methods. 170 patients (88 women, 82 men aged 23 to 90 years) diagnosed with community-acquired interstitial pneumonia following SARS-CoV-2 infection were examined in accordance with the clinical protocol, in 80 of them the blood levels of IL-1β, IL-6, IL-18, CXCL8, and interferon-α were determined. Results. It was found that only in 34.09% of cases a negative PCR result for the presence of the genetic material of SARS-CoV-2 viruses in patients diagnosed with interstitial pneumonia coincided with a negative result of testing for IgG and/or IgM to the viral antigen. A positive PCR result was confirmed by the presence of elevated levels of antibodies in 64.29% of cases. In PCR-positive patients, stage II III respiratory failure was determined significantly more often than in PCR-negative ones (in 40.28% and 16.32% of cases, respectively, p&lt;0.01), and their condition was more often regarded as severe and extremely severe (in 31.94% and 10.0% of cases, respectively, p&lt;0.05). The level of antibodies was associated with the severity of the immune response to a viral infection: the volume of lung damage, the blood level of the pro-inflammatory cytokine IL-18, acute phase inflammation proteins, and the activity of intracellular enzymes were significantly higher in patients with elevated levels of IgG and/or IgM than in patients with negative results of these tests. Conclusions. The determining of IgM and IgG specific to the Spike antigen of the SARS-CoV-2 virus does not duplicate, but complements the molecular genetic study. PCR helps to detect the presence of the genetic material of the virus. Detection of the level of antibodies can be used to make a conclusion about the intensity and stage of the immune response to a viral infection.

Impact of subclinical hypothyroidism on in-hospital outcomes and long-term mortality among acute myocardial infarction patients with diabetic mellitus

Background Thyroid-stimulating hormone (TSH) has been regarded as a predictor of poor outcomes in patients with acute myocardial infarction (AMI). AMI complicated by diabetes mellitus (DM) tends to have a high prevalence and a worse prognosis. We aim to evaluate the association between thyroid dysfunction and in-hospital outcomes and short- and medium-term mortality in diabetic patients with AMI. Methods From January 2017 to November 2020, a total of 432 patients with AMI were included in this study, including 209 DM patients and 223 non-DM patients. Baseline characteristics, medical history, and laboratory parameters of patients were recorded after admission. In-hospital outcomes and 30-day mortality were recorded, and long-term mortality was recorded with a median follow-up of 34.2 ± 5.6 months. Results Subclinical hypothyroidism (SCH) was defined as an elevated TSH level of more than with a normal range of circulating thyroid hormones. In AMI with DM group, 26/209 (12.4%) patients were complicated with SCH, these patients tend to be older and experienced worse in-hospital outcomes compared to patients without SCH, including higher rates of acute heart failure, acute kidney injury, and atrial fibrillation. Moreover, patients with SCH had a higher prevalence of 30-day mortality and long-term mortality, compared with patients without SCH. Conclusions Diabetic AMI patients with SCH had worse in-hospital outcomes and higher 30-day and long-term mortality. Patients with diabetic AMI should pay attention to thyroid function, and SCH is an independent risk factor for short-term and long-term mortality in diabetic AMI patients.

Increased proportion of CD226 + CD14 + monocytes correlates with clinical features and laboratory parameters in patients with primary Sjögren's syndrome.

CD226 is widely expressed on the surface of immune cells as a co-stimulatory receptor, which is involved in the development of many autoimmune diseases. The purpose of this study was to investigate the proportion of CD226 on CD14 + monocytes in the peripheral circulation of patients with primary Sjögren's syndrome (pSS) and the clinical significance of pSS. The proportion of CD226 on the surface of CD14 + monocytes was measured by flow cytometry in 45 pSS patients and 25 healthy controls (HC). The correlations between the proportion of CD226 + CD14 + monocytes and the clinical features and laboratory parameters of pSS were analyzed. Meanwhile, we analyzed the change in proportion of CD226 + CD14 + monocytes before and after treatment, and the clinical significance of pSS was evaluated. The proportion of CD226 on CD14 + monocytes markedly increased in pSS patients compared to HC (p < .01). We found the proportion of CD226 + CD14 + monocytes was positively correlated with the disease activity and severity of pSS patients. The proportion of CD226 + CD14 + monocytes in pSS patients with decayed tooth, fatigue, interstitial lung disease (ILD), low WBC, high IgG, anti-Ro60, and anti-SSB positive increased compared to that in negative patients (p < .05). Furthermore, the proportion of CD226 + CD14 + monocytes was significantly higher in active patients than in nonactive patients (p < .01). Additionally, the proportion of CD226 + CD14 + monocytes decreased in seven pSS patients after treatment (p < .01). Our study suggested that an increased CD226 proportion on CD14 + monocytes was associated with the clinical manifestations, disease activity, and prognosis of pSS patients. CD226+ CD14 + monocytes may present a potential target and a biomarker for the prognosis and therapy of pSS patients.

P‐TS‐13 | Assessment of the Rates of Positive HLA Class I Antibody Testing in Relation to Clinical and Laboratory Parameters in Patients with Platelet Refractoriness

P‐TS‐13 | Assessment of the Rates of Positive HLA Class I Antibody Testing in Relation to Clinical and Laboratory Parameters in Patients with Platelet Refractoriness