Prognostic Indicator Of Severity Research Articles

Association between Hypertriglyceridemia and Disease Severity in Visceral Leishmaniasis.

Visceral leishmaniasis (VL) is a tropical disease endemic to Brazil. The clinical manifestations of the infection range from asymptomatic to severe. In VL, changes in lipid metabolism, such as hypocholesterolemia and hypertriglyceridemia, occur that are believed to be related to its progression and severity. This study investigated the associations between serum levels of cholesterol, triglycerides, and lipoproteins (high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein) with clinical and hematological parameters that predict severity in a case series of 83 VL patients. Severely ill patients had higher mean serum triglyceride levels than non-severely ill patients. There was a significant positive correlation between disease severity score and serum triglyceride levels, very low-density lipoprotein, international normalized ratio for prothrombin time test, total bilirubin, and age. An inverse correlation was detected between the disease severity score and mean platelet and neutrophil counts. Hypertriglyceridemia can be a prognostic indicator of severity in patients diagnosed with VL.

Procalcitonin levels in COVID-19 patients in a tertiary care center

BACKGROUND: Procalcitonin (PCT) is a glycoprotein calcitonin prohormone released by the thyroid parafollicular cells. In case of a microbial infection, PCT synthesis can be stimulated by the elevation of proinflammatory cytokines, including interleukin-6, interleukin-1b, and tumor necrosis factor-α. These mediators are massively involved in the so-called cytokine storm, typical of the progression from the viremic to the hyperinflammatory stage of COVID-19 and characterized by the onset of respiratory symptoms and interstitial pulmonary infiltrates. Thus, PCT elevation may represent a direct consequence of the COVID-19 cytokine storm and could also be interpreted as a “viral sepsis” syndrome.AIM: (1) To estimate serum PCT levels in patients with COVID-19 infection. (2) To access PCT level as a predictor of mortality.MATERIALS AND METHODS: A cross-sectional study was conducted on a total of 200 patients in Bengaluru during the study period from March 2021 to July 2021. A case record form with follow-up chart was used to record the duration of disease, history of treatment, and complications. Patients underwent biochemical investigations and PCT level.RESULTS: The study includes 200 patients; the majority were above 50 years of age group. Out of 200 patients, 170 were discharged and 30 died. The mean PCT level was 4.44 ± 45.34 ng/ml. PCT in those who are discharged was 1.25 ± 8.81 ng/ml and compared to those who died was 28.06 ± 128.4 ng/ml. This difference was statistically significant (P = 0.00).CONCLUSION: PCT can be used as a prognostic biomarker in COVID-19 patients; initially elevated levels may be used as a prognostic indicator of severity, deteriorating clinical picture, and even mortality.

Usefulness of the blood urea nitrogen-to-serum albumin ratio as a prognostic indicator of severity in acute ischemic stroke

Objectives: Acute ischemic stroke (AIS) is one of the most important and major causes of mortality worldwide. In AIS patients, the blood urea nitrogen to creatinine ratio (B/C ratio) was investigated as a dehydrated biomarker in previous studies. However, the B/C ratio can be affected by medications and past medical history. We hypothesized addition of serum albumin, which has been shown to have beneficial neuroprotective effects, could compensate for the disadvantages. In the present study, the BUN to serum albumin ratio (B/A ratio) was evaluated association with AIS patient’s prognosis. Methods: This retrospective cohort study of AIS in our hospital was conducted from February 2018 through June 2020. First, demographic and clinical data were collected and compared with the prevalence of mortality and ICU admission. Then, the B/C ratio and the B/A ratio were calculated. Differences in the performance between the B/C ratio and the B/A ratio for outcome prediction were evaluated based on the area under the curve of the receiver operating characteristic (AUROC). Results: Among the 1,164 patients enrolled in this study, 77 (6.6%) died during hospitalization and 467 (40.1%) were admitted to ICU. Multivariate logistic regression had shown that the B/A ratio was a significant predictor of mortality and admission to ICU. In addition, the B/A ratio was significantly higher in ICU-admitted patients and non-survivors. The AUROC of the B/A ratio was 0.687 and the B/C ratio was 0.533 for predicting mortality; the B/A ratio was statistically superior to the B/C ratio. For predicting ICU admission, the AUROC values of the B/A ratio and the B/C ratio were 0.567 and 0.556, respectively, and a statistically significant difference was not observed. Conclusion: The B/A ratio is a simple and useful tool for predicting the outcomes of ischemic stroke patients.

Treg dysregulation contributes to pathogenesis of Myelodysplastic syndrome

Abstract A strong clinical correlation exists between a history of autoimmunity and Myelodysplastic syndromes (MDS), but immune etiology remains unclear. However, a hallmark of disease is that Regulatory T cells (Tregs) are significantly altered in MDS patients. Thus, Tregs can be used as prognostic indicators of severity. Additionally, dysregulated CD4 T cell responses are causally linked to inflammatory disorders in MDS patients, yet the cellular dynamics that underlie these responses is poorly understood. We now show that Treg dysfunction mimics the pre-leukemic phenotypes of MDS including increased HSC proliferation and myeloid-skewed differentiation. Furthermore, we show that mice with Treg-restricted MDS driver mutations, TET2 and ASXL1, develop an inflammatory disease with unstable Tregs that secrete inflammatory cytokines and lose immunosuppressive capacities. TET2 and ASXL1 deficiency in Tregs leads to hyperproliferation of CD4+Foxp3+ T cells with a conversion into IL-17-producing cells. Importantly, CD4 and CD8 T cells are also altered in MDS and show impaired effector function as well as hallmarks of T cell exhaustion and anergy leading to expansion of malignant clones. Together, this indicates that T cell abnormalities and lack of immune function effectively propel leukemic evolution. Our findings indicate that the pro-inflammatory environments of MDS deteriorate T cell stability and accelerate the expansion of hematopoietic stem/progenitor cells carrying MDS-associated pre-leukemic mutations. Therapeutic intervention targeting both Tregs and effector cells in pre-malignant diseases such as MDS are likely to prevent progression to less treatable acute myeloid leukemia.

C reactive protein as a prognostic indicator of severity in patients with acute pancreatitis

Background: Acute pancreatitis ranges from a mild illness to a severe disease with high morbidity and mortality. Severity affects the treatment and outcome. The existing scoring systems for assessment of its severity require are time consuming and expensive. This study was an attempt to evaluate the effectiveness of C-reactive protein (CRP) as a prognostic indicator and a marker of severity of acute pancreatitis.Methods: This was a prospective observational study conducted between among 50 patients diagnosed with acute pancreatitis. The Ranson’s score and CTSI was calculated for these patients. CRP levels were measured 48 hours after the onset of symptoms. They were observed for the development of local and systemic complications, and outcome. These were compared with the CRP values. Pearson coefficient was used to study the correlation between the variables. A p value of less than 0.05 was considered to be statistically significant.Results: 30 of the 50 patients had no local complications. 14 patients (28%) had peripancreatic collection and 6 (12%) had pancreatic necrosis. 24 of the 50 patients had systemic complications (48%). 25 patients had mild disease and 25 had severe disease as evidenced by the Ranson’s score. These 25 patients with severe disease also had raised CRP (p<0.05). There was no statistically significant correlation between the CTSI and CRP values. 4 patients with CRP values more than 400 succumbed to the illness.Conclusions: CRP can serve as an inexpensive alternative to the conventional severity assessment methods for the prediction of severity and outcome of patients with acute pancreatitis.

Oxidative Stress Biomarkers as Prognostic Indicators of Severity in Patients With Dengue

There is evidence for the role of oxidative stress in severe dengue pathogenesis. However, previous observational studies presents certain methodological limitations, which may affect its internal and external validity. This study was a case-control analysis of patients with severe dengue and dengue with warning signs, to evaluate the serum protein carbonyls-PCOs and lipid hydroperoxides-LOOHs levels and activities of superoxide dismutases-SODs (MnSOD, Cu/ZnSOD and total SOD), as potential prognosis indicators of severity in dengue patients, using binary logistic regression analysis and strategy of double cross-validation. Therefore, the study population was subdivided into a derivation group (pediatric patients, Barranquilla-Colombia) and an external validation group (children and adults patients, National Institute of Health of Peru). PCOs was the only oxidative stress markers that showed a strongest association with the severity of dengue, both in children and adults. In the derivation group, the optimal cut-off point was estimated at 5.29 nmol/mg of protein, and in the external validation group, it was 5.77 nmol/mg of protein. The prognostic models based on these two diagnostic thresholds showed a high discriminatory capacity of dengue severity, external reproducibility, geographic transportability, and typical characteristics of diagnostic validity and safety of screening tests.