Useful Predictor Of Severity Research Articles

Interleukin-33 and Soluble ST2 Levels in Infants with Hypoxic-Ischemic Encephalopathy

Introduction: Interleukin (IL)-33 and its receptor ST2L play key roles in the IL-33/ST2 signaling pathway. Soluble ST2 (sST2) inhibits the proper function of IL-33. sST2 levels are increased in patients with several neurological diseases, but in infants with hypoxic-ischemic encephalopathy (HIE), IL-33 and sST2 levels have not been studied. This study aimed to investigate whether serum levels of IL-33 and sST2 are useful as biomarkers of HIE severity and prognostic factors for infants with HIE. Methods: Twenty-three infants with HIE and 16 controls (gestational age ≥36 weeks and ≥1,800 g birth weight) were enrolled in this study. Serum levels of IL-33 and sST2 were measured at <6 h, 1–2, 3, and 7 days of age. Hydrogen-1 magnetic resonance spectroscopy was performed, and ratios of peak integrals of lactate/N-acetylaspartate (Lac/NAA) were calculated as objective indicators of brain damage. Results: In the moderate and severe HIE, serum sST2 concentrations were increased and there was a good correlation between serum sST2 and HIE severity on days 1–2, whereas no variation was observed in serum IL-33. Serum sST2 levels were positively correlated with Lac/NAA ratios (Kendall’s rank correlation coefficient = 0.527, p = 0.024), and both sST2 and Lac/NAA ratios were significantly higher in HIE infants with neurological impairment (p = 0.020 and <0.001, respectively). Conclusions: sST2 may be a useful predictor of severity and later neurological outcomes in infants with HIE. Further investigation is required to elucidate the relationship between the IL-33/ST2 axis and HIE.

A STUDY OF SERUM CALCIUM AND SERUM ALBUMIN LEVELS IN PREDICTING SEVERITY OF ACUTE PANCREATITIS

Background:Acute Pancreatitis (AP) is an acute inflammatory process of the pancreas that affects other regional tissues and more distant organ system through the systemic inflammatory response , resulting in organ dysfunction and death. Only Minority patients will develop a severe disease , while most patients suffer from a mild ,self limiting inflammatory process.About 10 to 20% of patients will progress to Severe Acute Pancreatitis (SAP) with a mortality rate of 6 to 10 %. Serum calcium and serum albumin obtained within the first 24 hours of hospital admission are useful predictors of severity in Acute Pancreatitis . With an adequate interpretation of their cut-off points, they are valuable for identifying the patients that require intensive care support, even in primary and secondary care centers.So easily availaibilty of these laboratory investigation can be used for early assessment and treatment of severe Acute Pancreatitis(SAP) and therefore helps in reducing mortality due to Acute pancreatitis. we also compared and correlated other scoring system in predicting the severity of acute pancreatitis. Materials and Methods: We conducted a prospective observational study of serum calcium and serum albumin levels in predicting severity of acute pancreatitis. Data was collected from 100 inpatients over 18 months admitted to in-patient in Department of general Medicine,Basaveshwara Teaching and General Hospital attached to M.R Medical College, Kalaburgi .Data was analyzed using SPSS software version 26. Results: Total of 100 patients with 87 males and 13 females were enrolled. Among the 100 patients 31 patients developed Severe Acute Pancreatitis (SAP) marked by evidence of end organ failure, local complications like psuedocyst, and /or prolonged ICU stay of more than 7 days and 9 patients died. Among the individual parameters Serum Albumin, Serum calcium, Corrected serum calcium including TC (Total cell count), Serum Urea, ,Serum creatinine , Pao2 ,Serum LDH showed a significant association with severity of acute pancreatitis . APACHE II systems had a sensitivity of 71.10% and specificity of 96.67 % in predicting severity.Sensitivity and specificity of Ransons score was 77.42% and 96.56% respectively. BISAP score had a low sensitivity of 61.67% and high specificity 98.33% . Conclusion:APACHE II score and Ransons score are the best scoring systems in predicting the severity of acute pancreatitis. Parameters like Hypoalbuminemia, Hypocalcemia including Hypoxia,uremia, Acute renal failure, leukocytosis, and increase in serum LDH levels weresignificantly associated with Severe Acute Pancreatitis(SAP).

Fibrinolytic markers could be useful predictors of severity in patients with pulmonary arterial hypertension: a retrospective study

BackgroundThe severity of pulmonary arterial hypertension (PAH) is classified based on mean pulmonary artery pressure (mPAP) levels. However, other markers have not been elucidated. Fibrinolytic markers, such as total plasminogen activator inhibitor-1 (tPAI-1) and thrombomodulin (TM), are known to reflect arterial endothelial function. However, the relationship between serum tPAI-1, TM and pulmonary circulation has not been completely determined.MethodsThis study included 100 consecutive patients (38 men), with a mean age of 68.9 ± 12.0 years, with cardiac diseases who underwent right heart catheterization. Serum coagulation and fibrinolytic marker levels were measured.ResultsThe average mPAP value was 25.1 ± 13.1 mmHg for all patients. The mPAP levels revealed a significant positive correlation with serum tPAI-1 (ρ = 0.24, p = 0.042) and uric acid (ρ = 0.29, p = 0.0031) levels. In the group with mPAP levels less than 25 mmHg (n = 58, ave. 17.3 ± 4.3 mmHg), mPAP levels showed a significant positive correlation with serum tPA-1 (ρ = 0.34, p = 0.034) and TM (ρ = 0.34, p = 0.043) values. The mean tPAI-1 (29.8 ± 23.3 ng/ml, p = 0.047) and uric acid (5.7 ± 1.8 mg/dl, p = 0.026) levels were significantly less in those with lower mPAP levels. A multivariate analysis revealed that tPAI-1 alone was a significant independent characteristic marker of PAH (odds ratio 1.02, 95%CI 1.000–1.036, p = 0.034).ConclusionsThese results indicate that serum tPAI-1 and TM may be useful predictors of severity, similar to mPAP in patients with PAH. They could be beneficial in predicting PAH among patients in the early stage of the disease.

ASSOCIATION OF LYMPHOCYTE COUNTS, NLR AND PLR WITH MORTALITY IN COVID-19 PATIENTS

Background/objectiveThe severity and outcome of COVID-19 are determined by the level of overstimulation of the immune response, age, and comorbidities in the patients infected by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Lymphopenia is the most consistent finding that characterizes the hemogram in COVID-19 patients. We evaluated the hemogram and compared the lymphocyte count (LC),neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) at diagnosis in COVID-19 patients hospitalized at the Clinical Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.MethodsIn this retrospective study, we reviewed the medical notes of 320 adult hospitalized patients with PCR-confirmed COVID-19 at the Clinical Hospital of UNICAMP, Campinas, from March 2020 to March 2021. The hemogram (performed using automated counter-XN 9000™, Sysmex, Japan) at COVID-19 diagnosis was analyzed, and NLR and PLR were calculated. The primary outcomes were discharge (n = 257 patients who recovered from the disease and were discharged from the hospital), and death (n = 63 those who died during treatment). Statistical analyses were performed using SPSS (version 22). Unpaired data of deceased and discharged COVID-19 patients were compared using Mann-Whitney tests. All results were significant if p < 0.05 or except otherwise stated.ResultsCompared to the 257 discharged patients, the 63 deceased patients were older 56.0 vs 64.7 ys respectively, p = 0.000), the males are more in each group and the duration of hospitalization was not different (18.6 vs 19.7 days respectively, p = 0.12). The leukocyte (8.89 ± 4.50 vs 10.37 ± 7.03, p = 0.289) and platelet counts (227.00 ± 91.15 vs 197.79 ± 97.47, p = 0.119) were not significantly different in the two groups, the hematocrit was higher in the discharged than in the deceased patients (38.84 ± 6.86 vs 35.89 ± 8.57, p = 0.021). The LC was lower in the deceased (0.81 ± 0.59 × 103 vs 1.09 ± 0.80x103/μL, p = 0.002), and negatively correlated with the age of the patients(r = -0.145, p=0.009 at a significant level of 0.01). The deceased group had a higher NLR (17.52 ± 19.20 vs 10.06 ± 12.31, p < 0.001) and PLR (366.32 ± 275.03 vs 319.23 ± 331.54, p = 0.047) higher than the discharged group, and both parameters were strongly correlated (r = 0.734, p < 0.001 significant level of 0.01). One hundred and thirty-eight (53.7%) of the discharged patients and 45 (71.4%) of the deceased had LC of < 1.0 × 103/μL. The LC is associated with the disease outcome (χ2 = 6.498, df = 1, p = 0.011), and the odds for a deceased to have a lymphopenia is 1.9 times that for the discharged patients [OR = 1.87 (95% CI = 1.135-3.085).DiscussionThough lymphopenia is consistent in COVID-19, the cause is unclear. Acute recruitment of lymphocytes to the site of infection (mainly the lung) may explain this, thus the lymphopenia may worsen and the LRs will be elevated with the increasing severity of COVID-19. The negative correlation of LC with age and higher odds of lymphopenia in the deceased patients suggest that LC and the LRs at diagnosis could be easily accessible and useful predictors of severity and mortality in these patients.ConclusionOur study supports that lymphopenia is negatively associated with mortality in COVID-19 patients and that the deceased patients have elevated NLR and PLR at diagnosis. These parameters are easily derived from the hemogram and could be utilized as affordable and accessible predictors of outcomes in patients with COVID-19.

Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis

Background: Acute pancreatitis is an acute inflammatory process of the pancreas. The Ranson and the modified Glasgow scores require 48 hours of data collection to asses’ severity. Hypocalcaemia is one of the components of Ranson's scoring system done to assess the severity of pancreatitis. Albumin-corrected calcium (ACC) has also been associated with severity, but no study has evaluated it as a prognostic severity factor within the first 24 h of the patient’s hospital admission. This study tries to evaluate total calcium and albumin corrected calcium as prognostic severity markers in acute pancreatitis within first 24 hour of admission.Methods: This prospective study was conducted in Bowring and Lady Curzon hospital, a tertiary care centre from June 2016 to May 2018. Inclusion criteria included all patients above 18 years of age, who presented within 72 hours of onset of epigastric pain. The clinical and demographic data with respect to gender, age, previous history of pancreatitis, total calcium taken 24 h after admission. In order to evaluate total calcium and albumin corrected calcium as prognostic factors of severity, the lowest total calcium values were collected within the first 24 h of hospital admission. These values were then corrected according to the serum albumin level.Results: A total of ninety-four patients were included in the study. There was no significant difference in the age of patients in each severity grade (p value: 0.242). No difference was observed in gender distribution of three groups. (P &gt;0.05). As compared to total calcium, mean values of albumin corrected calcium were 8.03, 7.18 and 6.28 for mild, moderate and severe acute pancreatitis respectively, which were also significant at 0.05.Conclusions: Total calcium and albumin-corrected calcium obtained within the first 24 hours of hospital admission are useful predictors of severity in acute pancreatitis.

The Interrelationship and Diagnostic Utility of Memory and Reaction Time in Concussed Students

More than 40 million American youth participate in interscholastic, community-based, and collegiate sports. A risk of participation is traumatic brain injury (TBI). In up to 40% of TBI cases, athletes experience persistent functional and cognitive deficits. It is important to understand the variables that lead to these deficits to improve diagnosis and prognostic management. PURPOSE: To evaluate memory and reaction time as markers of TBI severity among patients experiencing prolonged recovery. METHODS: We retrospectively analyzed student-athletes admitted to a Midwestern outpatient clinic for neuropsychological evaluation; 78 patients had relatively comprehensive profiles and were included in the analysis. We conducted a health history, a 22-item post-concussion symptom inventory, and the ImPACT computerized test, which evaluated memory and reaction time. Pearson’s and point-biserial correlation coefficients tested the direction and strength of association between memory, reaction time, and markers of injury severity. Logistic, negative binomial, and linear regressions tested memory and reaction time as predictors of whether symptoms were reported, the number of reported symptoms, and the severity of symptoms. RESULTS: Patients were 16.0 ± 2.6 years of age, 56.3% were male, and they had experienced 1.2 ± 1.5 previous concussions. Reaction time was 0.64 ± 0.13 seconds; visual motor speed score was 44.7 ± 34.6; visual memory score was 92.0 ± 69.3; verbal memory score was 98.0 ± 80.9; cognitive efficiency score was 0.34 ± 0.12. Reaction time was a significant predictor (p<0.05) of balance problems, dizziness, mental fogginess, and sensitivity to light and noise; it was a trending predictor (p=0.061) of the summed severity of symptoms. Verbal memory was a significant predictor (p<0.05) of balance problems, sleeping problems, and fatigue. Visual memory, visual motor speed, and cognitive efficiency index were poor predictors of injury severity. CONCLUSIONS: Reaction time and memory are common components of testing batteries for concussed athletes. In our sample, reaction time and verbal memory emerged as useful predictors of severity among patients suffering long-term symptoms of TBI. It may be of value for coaches and athletic trainers to establish baseline values at the onset of a competitive season.

Acute Chest Syndrome in Children with Sickle Cell Disease.

Acute chest syndrome (ACS) is a frequent cause of acute lung disease in children with sickle cell disease (SCD). Patients may present with ACS or may develop this complication during the course of a hospitalization for acute vaso-occlusive crises (VOC). ACS is associated with prolonged hospitalization, increased risk of respiratory failure, and the potential for developing chronic lung disease. ACS in SCD is defined as the presence of fever and/or new respiratory symptoms accompanied by the presence of a new pulmonary infiltrate on chest X-ray. The spectrum of clinical manifestations can range from mild respiratory illness to acute respiratory distress syndrome. The presence of severe hypoxemia is a useful predictor of severity and outcome. The etiology of ACS is often multifactorial. One of the proposed mechanisms involves increased adhesion of sickle red cells to pulmonary microvasculature in the presence of hypoxia. Other commonly associated etiologies include infection, pulmonary fat embolism, and infarction. Infection is a common cause in children, whereas adults usually present with pain crises. Several risk factors have been identified in children to be associated with increased incidence of ACS. These include younger age, severe SCD genotypes (SS or Sβ0 thalassemia), lower fetal hemoglobin concentrations, higher steady-state hemoglobin levels, higher steady-state white blood cell counts, history of asthma, and tobacco smoke exposure. Opiate overdose and resulting hypoventilation can also trigger ACS. Prompt diagnosis and management with intravenous fluids, analgesics, aggressive incentive spirometry, supplemental oxygen or respiratory support, antibiotics, and transfusion therapy, are key to the prevention of clinical deterioration. Bronchodilators should be considered if there is history of asthma or in the presence of acute bronchospasm. Treatment with hydroxyurea should be considered for prevention of recurrent episodes. This review evaluates the etiology, pathophysiology, risk factors, clinical presentation of ACS, and preventive and treatment strategies for effective management of ACS.

Guideline on the management of acute chest syndrome in sickle cell disease.

1. Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust 2. Lane Fox Respiratory Unit, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust 3. Department of Haematology, North Middlesex Hospital 4. Department of Paediatric Haematology, Bristol Royal Hospital for Children 5. Department of Haematological Medicine, King’s College Hospital 6. Department of Haematology, Whittington Hospital

Natural anticoagulants can be useful predictors of severity in chronic liver disease

Protein S (PS), protein C (PC), and antithrombin (AT) are produced by the liver, and their levels were previously shown to be reduced in chronic as well as acute liver disease. The aim of this study was to determine whether measurement of PS, PC, and AT levels in patients would be as good as the commonly used clinical and histological parameters of liver disease in discriminating early and advanced hepatocyte dysfunction. A total of 154 patients were recruited and categorized into five groups: hepatitis B inactive carriers in group 1 (n = 29), nonalcoholic steatohepatitis patients in group 2 (n = 30), chronic hepatitis B patients with elevated liver enzymes in group 3 (n = 29), chronic hepatitis C patients with elevated liver enzymes in group 4 (n = 30), liver cirrhosis patients in group 5 (n = 36). There were significant differences between groups in the levels of PC (P = 0.0001), total PS (P = 0.0001), and free PS (P = 0.0001) and AT (P = 0.0001). These parameters were least affected in the control group, then groups 1 and 2, followed by groups 3 and 4, and most affected in group 5. No differences in these tests were detected between groups 1 and 2 and between groups 3 and 4. Univariate and multivariate analyses showed that free PS was the only predictor of significant inflammation (P = 0.0001), and AT (P = 0.001) and PC (P = 0.003) were the most important factors associated with advanced fibrosis. Both PS and PC are sensitive markers of liver disease, but PS is a sensitive marker of liver inflammation, whereas PC may be a more sensitive marker for liver fibrosis.

The whole-PTH/intact-PTH ratio is a useful predictor of severity of secondary hyperparathyroidism.

Background. The newer parathyroid hormone (PTH) assay, whole-PTH, uses an antibody that binds the region harbouring the first amino acid, making it specific for the complete molecule, 1–84-PTH. Especially among dialysis patients, it has been reported that the level of whole-PTH can be calculated as ∼60% of their intact-PTH value. In addition, since 1–84-PTH is part of intact-PTH, the whole-PTH/intact-PTH ratio should not theoretically exceed 1. However, an abnormally high 1–84-PTH/intact-PTH ratio is reported in a few patients with parathyroid carcinoma, primary hyperparathyroidism and secondary hyperparathyroidism. In this study, we examined the correlation between the 1–84-PTH/intact-PTH ratio and the severity of hyperparathyroidism in patients on haemodialysis (HD).Patients and methods. The study population comprised 196 HD patients (males 113, females 83, age 67.4 ± 13.6 years, HD period 8.1 ± 7.3 years; mean ± SD). The whole-PTH/intact-PTH ratio was compared in patients with high PTH levels (intact-PTH ≥300 pg/ ml; high PTH group, n = 32), moderate PTH levels (intact-PTH >150–<300 pg/ml; moderate PTH group, n = 50) and low PTH levels (intact-PTH <150 pg/ml; low PTH group, n = 114). The ratio was also compared in 25 patients with at least one enlarged gland >0.5 cm3 suggesting nodular hyperplasia, as determined by power Doppler ultrasonography (hyperplasia group) with seven patients without enlarged gland (non-hyperplasia group) and six patients who had undergone total parathyroidectomy (post-PTx group).Results. The whole-PTH/intact-PTH ratio of the high PTH group (0.68 ± 0.1) was significantly higher than those of the moderate (0.61 ± 0.1, P < 0.001) and low (0.52 ± 0.1, P < 0.001) groups. Moreover, the ratio was significantly higher in the hyperplasia group (0.70 ± 0.1) than those in the non-hyperplasia group (0.59 ± 0.1, P < 0.05) and post-PTx group (0.456 ± 0.12, P < 0.001).Conclusions. The whole-PTH/intact-PTH ratio correlated with the severity of hyperparathyroidism. Our results suggest that the ratio might be a useful predictor of severity of secondary hyperparathyroidism in HD patients.

Alexander Disease - Classification Revisited and Isolation of a Neonatal Form

Alexander disease is usually classified according to the age of onset, e.g. an infantile form with onset during the first two years of life, a juvenile form with onset in childhood, mainly school age. It has been recognized, however, that the clinical course can be very variable within these groups. Thus, this clinical classification is not a useful predictor of severity and progression of the disease. This is demonstrated here on the basis of the history of seven own patients and a literature review. Only an onset in very early infancy, during the neonatal period, seemed to be associated with a rather uniform pattern of disease course, often leading to early death. This neonatal form showed very stereotyped symptoms, in part different from later onset: Early, often intractable, generalized seizures; hydrocephalus with raised intracranial pressure due to aqueductal stenosis because of pathological astroglia proliferation; lack of developmental progression but without prominent spasticity or ataxia; elevated CSF protein content. This was associated with the well-established neuroradiological findings, e.g. severe white matter affection with fronto-temporal predominance, involvement of basal ganglia and periventricular enhancement as an obligatory symptom. The identification of this early onset form is especially important as seizures and signs of raised intracranial pressure may mislead the diagnosis.