Use Of Laboratory Parameters Research Articles

Clinical and Laboratory Characteristics of Anaemia in Hospitalized Patients with Inflammatory Bowel Disease.

Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Due to its multifactorial etiopathogenesis, the differential diagnosis and treatment of anaemia in IBD is a significant clinical problem. The main aim of our study was to assess the usefulness of laboratory parameters, including hepcidin, in differential diagnoses of anaemia in hospitalized IBD patients. This study also estimated the impact of anaemia on the length of hospitalization and its relationship with clinical data of analyzed patients. The study included 118 adult patients diagnosed with IBD-55 with ulcerative colitis (UC) and 63 with Crohn's disease (CD). Anaemia was significantly more frequent in patients with CD-42 (66.7%)-compared to 31 (56.4%) patients with UC (p = 0.033). The prevalence of anaemia increased significantly with the severity of IBD and the extent of inflammatory changes in the endoscopic examination. Hospitalization time was significantly longer in patients with anaemia, especially in the group with UC. Ferritin concentrations < 30 ng/mL were found only in 15 (20.55%) IBD patients (9 with UC and 6 with CD), and ferritin < 100 ng/mL was observed in 22 (30.14%) patients, equally frequent with UC and CD (p > 0.05). Significantly higher concentrations of transferrin were observed in patients with anaemia in the course of UC compared to CD (2.58 ± 0.90 g/L vs. 2.15 ± 0.82 g/L; p = 0.037). On the other hand, saturation of transferrin < 16% was equally common in UC and CD patients. In our study, hepcidin levels in anaemic UC patients were significantly lower compared to UC without anaemia (p = 0.042), with no similar differences in CD independently of anaemia presence (p = 0.565). To conclude, we observed a high incidence of anaemia in patients with IBD and its significant impact on the length of hospitalization in UC. Routinely determined single laboratory parameters are not sufficient for the differential diagnosis of anaemia, and a complex laboratory assessment, including of hepcidin levels, is necessary for the full picture of anaemia in the course of IBD.

RELATIONSHIP BETWEEN LEUKOCYTE COUNT AND PROTEINURIA IN COVID-19 PATIENTS

Background: Coronavirus Disease 2019 (COVID-19) is a disease caused by SARS-CoV-2 with flu-like symptoms that could be serious in high-risk individuals. The use of laboratory parameters is determined as a predictor in improving the quality of care and thereby reducing mortality and morbidity. One of the laboratory parameters itself is hematological examination, including leukocyte count. Several studies had shown that an increase in WBC count was independently associated with an increased risk of proteinuria.Aim: To determine the relationship between leukocytes and proteinuria in COVID-19 patients.Method: This cross-sectional study with retrospective data collection had a sample of patients with COVID-19 at Diponegoro National Hospital aged 19-60 years. The independent variable in this study was leukocyte count, while the dependent variable in this study was proteinuria. The type of data used was secondary data obtained by examining the medical records of COVID-19 patients. Data analysis between leukocyte count and proteinuria variables in patients with COVID-19 was tested using a bivariate chi-square analysis.Results: Samples that met the inclusion criteria were 34 samples with confirmed COVID-19. From the results of the chi square test, it was found that leukocytes to proteinuria had a p value of 0.601 (p&gt;0.05), which meant that there was no significant relationship between the number of leukocytes and proteinuria.Conclusion: There was no significant relationship between leukocyte count and proteinuria in patients with COVID-19.

Usefulness of laboratory parameters and chest CT in the early diagnosis of COVID-19.

ABSTRACTIn the present study, the importance of laboratory parameters and CT findings in the early diagnosis of COVID-19 was investigated. To this end, 245 patients admitted between April 1st, and May 30th, 2020 with suspected COVID-19 were enrolled. The patients were divided into three groups according to chest CT findings and RT-PCR results. The non-COVID-19 group consisted of 71 patients with negative RT-PCR results and no chest CT findings. Ninety-five patients with positive RT-PCR results and negativechest CT findings were included in the COVID-19 group; 79 patients with positive RT-PCR results and chest CT findings consistent with COVID-19 manifestations were included in COVID-19 pneumonia group. Chest CT findings were positive in 45% of all COVID-19 patients. Patients with positive chest CT findings had mild (n=30), moderate (n=21) andor severe (n=28) lung involvement. In the COVID-19 group, CRP levels and the percentage of monocytes increased significantly. As disease progressed from mild to severe, CRP, LDH and ferritin levels gradually increased. In the ROC analysis, the area under the curve corresponding to the percentage value of monocytes (AUC=0.887) had a very good accuracy in predicting COVID-19 cases. The multinomial logistic regression analysis showed that CRP, LYM and % MONO were independent factors for COVID-19. Furthermore, the chest CT evaluation is a relevant tool in patients with clinical suspicion of COVID-19 pneumonia and negative RT-PCR results. In addition to decreased lymphocyte count, the increased percentage of monocytes may also guide the diagnosis.

The use of laboratory parameters and computed tomography score to determine intensive care unit requirement in COVID-19

Abstract Objectives It is vital to determine the intensive care unit (ICU) requirement at an early stage to reduce the mortality rate in COVID-19 patients. The aim of the study was to find reliable predictive markers to determine the ICU requirement. Methods We retrospectively reviewed the clinical and laboratory records of 151 COVID-19 patients. The predictive abilities of biochemical parameters and computed tomography (CT) score were evaluated to determine of ICU requirement. Results The area under curve (AUC) values for procalcitonin, D-Dimer, C reactive protein (CRP), glucose, lactate dehydrogenase (LDH) and CT score were found higher than those for other parameters in the prediction of ICU requirement. The negative predictive values of these markers were higher than their positive predictive values. CT score was found to be highly correlated with fibrinogen and CRP. The glucose levels [odd ratio (OR): 95% CI; 1.07, p-value: 0.014] and CT score [OR: 95% CI; 1.05, p-value: 0.022] were associated with ICU requirement in COVID-19 patients. Conclusions CT score, procalcitonin, D-Dimer, CRP, glucose, and LDH are potential predictors to rule out ICU requirement on hospital admission. Fibrinogen and CRP can be used to follow up and predict lung damages in patients with COVID-19.

Use of laboratory tests to guide initiation of autologous hematopoietic progenitor cell collection by apheresis: results from the multicenter hematopoietic progenitor cell collection by Apheresis Laboratory Trigger Survey.

Limited literature describes the value of laboratory "triggers" to guide collection of peripheral blood (PB) hematopoietic progenitor cells (HPCs) by apheresis [HPC(A)]. We used a web-based survey to determine which parameters are used to initiate autologous HPC(A) collection in adult and pediatric patients and to identify common practice patterns. Members of the AABB Cellular Therapy Product Collection and Clinical Practices Subsection and the American Society for Apheresis HPC Donor Subcommittee drafted and developed relevant survey questions. A web link to the survey was distributed by electronic newsletter or email. Responses from 67 programs that perform autologous HPC(A) collections, including academic medical centers (n = 46), blood centers (n = 10), community hospitals (n = 5), and a variety of other medical institutions (n = 6), were analyzed. Ninety-three percent (62/67) of programs used a laboratory parameter to initiate HPC(A) collection. In both adult (40/54, 74%) and pediatric (29/38, 76%) patients, the PB CD34+ cell count was the most common parameter used to initiate HPC(A) collection. The median PB CD34+ trigger value was 10/μL for both patient populations. Among centers routinely using the PB CD34+ cell count to initiate apheresis, 51% (22/43) first sent the test before the patient presented for collection. Although more than 90% of centers used a laboratory test to trigger apheresis in cytokine-mobilized (44/48) or chemomobilized patients (50/53), only 57% (30/53) used a laboratory trigger if the patient was mobilized with granulocyte colony-stimulating factor plus plerixafor. Forty-two percent (21/50) of programs that routinely measured the PB CD34+ count before collection and discontinued further HPC(A) collection based on product CD34+ cell yield also stopped if the PB CD34+ value before apheresis was considered too low to proceed. Most programs use the PB CD34+ cell count to trigger autologous HPC(A) collection. Some centers also use this parameter to stop further collections. Laboratory tests are used less frequently to initiate apheresis when patients are mobilized with plerixafor. These data reveal ongoing diversity in clinical practices and suggest that consensus guidelines on use of laboratory parameters may further optimize HPC(A) collection.

Rationale und rationelle Diagnostik in unterschiedlichen Krankheitsphasen des Morbus Crohn

The treatment of patients with inflammatory bowel disease has become more complex in recent years through the introduction of various immunosuppressive agents as well as the approval of monoclonal antibodies. Patients receiving such treatment must be carefully monitored. National and international guidelines define a diagnostic and therapeutic context for the practitioner, but can only partially respond to specific questions on the procedure for individual patients. Within the framework of a project initiated by Abbott entitled "IBD ahead" 34 German IBD experts have elaborated concrete proposals for the utility of clinical symptom assessment, endoscopy and the use of laboratory parameters including foecal markers of inflammation. Furthermore, we discuss the significance of conventional X-rays, computed tomography, ultrasound and magnetic resonance tomography. These recommendations are illustrated by case studies from everyday practice in the participating centres.

Role of Biomarkers in Exacerbation of Chronic Obstructive Pulmonary Disease

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the main actuators of disease-related costs, morbidity, and mortality. Early and adequate recognition of an acute exacerbation as well as an individualized treatment is important to minimize mortality, morbidity, and worsening of lung function. However, the distinction of day-to-day variation of symptoms from exacerbations remains a clinical challenge. Accordingly, the use of laboratory parameters to improve the diagnostic accuracy in AECOPD is an area of continuous interest. In this article, we review the most relevant literature concerning the value of biological circulating blood markers for the diagnosis, assessment of morbidity as well as short-term and long-term survival in patients with COPD exacerbations. Potentially useful biomarkers at exacerbation of COPD might reflect inflammation and infection (C-reactive protein, procalcitonin, interleukin-6, serum interferon-γ–inducible protein), cardiac stress (copeptin, brain natriuretic peptide, atrial natriuretic peptide, pro-adrenomedullin, pro-endothelin), and other pathophysiological mechanisms (leptin and adiponectin, fibrinogen, surfactant protein D). So far, no biomarker has been established to possess the required high sensitivity and specificity for the definite diagnosis of AECOPD. Evidence supports the use of procalcitonin for antibiotic guidance in patients with AECOPD. Re-hospitalization and death within 6 months were particularly common in patients with high copeptin levels at exacerbation. Brain natriuretic peptide identifies patients requiring intensive care. Pro-atrial natriuretic peptide and pro- adrenomedullin levels at exacerbation are associated with a poor long-term survival after exacerbation. Considering the predictive value of serum biomarkers for the assessment of disease severity and outcome, they potentially play a major role in the individualization of therapy in COPD.

Value of Routine Admission Laboratory Tests to Predict Thirty-Day Mortality in Patients With Acute Myocardial Infarction

Most risk-stratification instruments that have been developed to predict outcome after myocardial infarction do not make use of laboratory parameters, although several laboratory parameters have been shown to be predictors of adverse outcome. To assess the prognostic value of routine admission laboratory tests, we studied a sample of 264 of 3,746 patients with myocardial infarction from a coronary care unit database of 12,043 patients for differences between survivors and nonsurvivors at 30 days. In multivariate analyses, higher white blood cell count, higher levels of serum creatinine, glucose, and lactate dehydrogenase, and lower platelet count were identified as independent risk factors for 30-day mortality. The model that incorporated these risk factors (added laboratory parameters model) had a 17% higher predictive power than did the model that contained only conventional risk factors (conventional risk factor model). The added laboratory parameters model showed better discriminative ability than the conventional risk factor model according to the area under the curve (0.87 vs 0.80). In conclusion, routine admission laboratory tests hold significant prognostic information, with value in addition to conventional risk factors. Incorporating these tests in risk-stratification instruments will further improve risk assessment of patients with myocardial infarction.

Pathogenesis and Diagnosis of Hyponatremia

This discussion emphasizes two aspects of hyponatremia: classification according to effective osmolality of the body fluid, and distinction between appropriate and inappropriate ADH secretion. Assessment of the effective osmolality is important because the main deleterious effect of hyponatremia is cell overhydration, which occurs only when the effective osmolality is reduced. Since most cases of hyponatremia are associated with low effective osmolality, cell overhydration is a hallmark of acute hyponatremia. On the other hand, one must be aware of other types of hyponatremia in which effective osmolality is either normal or even increased. Inappropriateness of ADH secretion is defined as ADH secretion that occurs despite low effective osmolality and normal or expanded effective vascular volume. ADH secretion that occurs in hyponatremia is deemed appropriate if the effective vascular volume is low. The use of laboratory parameters is much more reliable in determining effective vascular volume than is careful physical examination.

Immunofluorescence assays (IFA) and enzyme-linked immunosorbent assays (ELISA) in autoimmune disease diagnostics - technique, benefits, limitations and applications

Autoimmune diseases are relatively frequent disease complexes, affecting approximately five to seven percent of the population. After cardio-vascular and malignant diseases they come third in mortality. As the clinical diagnosis of rheumatic autoimmune diseases is difficult, laboratory tests are helpful in differential diagnosis and for verification of the clinical diagnosis. The most commonly used assay is the determination of ANAs (anti nuclear antibodies) by indirect immunofluorescence (IFA). However, this method lacks reliable standardisation and is very dependable on the qualification of the observer. Enzyme Immunoassays (EIA) and Immunoblotting techniques, on the contrary, attain good standardisation and comparability. However, the latter methods are limited to the presentation of defined autoantibodies only. There is a need to select a suitable strategy for the use of laboratory parameters in order to support the clinical diagnosis more efficiently. A possible strategy is to replace IFA as a first line screening-step by secondgeneration ANA-EIA kits.

Respiratory distress following major trauma. Predictive value of blood coagulation tests.

We have evaluated the use of laboratory parameters to predict the risk of adult respiratory distress syndrome (ARDS) at an early stage after major trauma. Patients with lung contusion were excluded. Five of 29 patients fulfilled our criteria of ARDS, i.e. PaO2/FiO2 less than or equal to 38. They showed lower platelet counts and antiplasmin as well as a tendency to lower antithrombin III, fibrinogen, and plasminogen. These changes indicated activation of the coagulation and fibrinolytic systems by trauma. The most sensitive indicator of ARDS seemed to be the platelet count, although it was also related to blood loss and amount of blood transfused. Hence the platelet count should be considered in relation to blood replacement in the patient with major trauma. Tentative laboratory values are suggested to indicate risk levels of developing ARDS.

Observations on the treatment of rheumatoid disease with penicillamine.

Summary Forty-five patients with severe rheumatoid arthritis were given D-penicillamine hydrochloride according to a fixed regimen for up to 2 years. The effects of treatment were observed both clinically and by the use of laboratory parameters. The results show that about 75% of patients exhibited objective improvement. Those with rheumatoid arthritis were found to do particularly well. The incidence, type and severity of side-effects are discussed.