Association between serum inflammatory parameters and the disease severity in COVID‐19 patients

ObjectiveMost patients infected with the novel coronavirus (SARS‐CoV‐2), as the causative agent of COVID‐19 disease, show mild symptoms, but some of them develop severe illness. The purpose of this study was to analyze the blood markers of COVID‐19 patients and to investigate the correlation between serum inflammatory cytokines and the disease severity.MethodsIn this prospective cross‐sectional study, 50 patients with COVID‐19 and 20 patients without COVID‐19 were enrolled. According to ICU admission criteria, patients were divided into two groups of non‐severe and severe. Differences in the serum levels of C‐reactive protein (CRP), IL‐6, and TNF‐α, as well as erythrocyte sedimentation rate (ESR), lymphocytes (LYM) count, and neutrophils (NEU) count between the two groups were determined and analyzed.ResultsOut of the 50 patients with COVID‐19, 14 were diagnosed as severe cases. There was no significant difference between the two groups of COVID‐19 patients in terms of gender and age. Blood tests of COVID‐19 patients showed a significant decrease and increase in NEU and LYM counts, respectively. There were significant differences in the serum levels of IL‐6, TNF‐α, and CRP between the severe and non‐severe groups, which were higher in the severe group.Also, there was a significant correlation between the disease severity and CRP with ESR (r = 0.79), CRP with IL‐6 (r = 0.74), LYM with NEU (r = −0.97), and ESR with TNF‐α (r = 0.7).ConclusionThe findings of this study, as the first study in Iran, suggest that the levels of IL‐6, TNF‐α, ESR, and CRP could be used to predict the severity of COVID‐19 disease.     

Risk of severe illness of COVID‐19 patients with NAFLD and increased NAFLD fibrosis scores

BackgroundThere is still little knowledge about the association of liver fibrosis with the clinical outcomes of COVID‐19 patients with non‐alcoholic fatty liver disease (NAFLD). The aim of the study was to determine the association of NAFLD fibrosis score (NFS)–determined liver fibrosis with clinical outcomes of COVID‐19 patients with NAFLD.MethodsThe NAFLD was diagnosed by the Hepatic Steatosis Index (HSI) in the absence of other causes of chronic liver diseases. NFS was used to evaluate the severity of liver fibrosis.ResultsA total of 86 COVID‐19 patients with NAFLD were included. The median age was 43.5 years, and 58.1% of patients were male. Thirty‐eight (44.2%) patients had advanced liver fibrosis according to the NFS. Multivariate analysis indicated that concurrent diabetes (odds ratio [OR] 8.264, 95% confidence interval [CI] 1.202–56.830, p = 0.032) and advanced liver fibrosis (OR 11.057, 95% CI 1.193–102.439, p = 0.034) were independent risk factors of severe illness in COVID‐19 patients with NAFLD.ConclusionNAFLD patients with NFS‐determined advanced liver fibrosis are at higher risk of severe COVID‐19.     

Kynurenine pathway in Coronavirus disease (COVID‐19): Potential role in prognosis

BackgroundIt is known that inflammatory responses play an important role in the pathophysiology of COVID‐19.AimsIn this study, we aimed to examine the role of kynurenine (KYN) metabolism on the severity of COVID‐19 disease AQ5.Materials & MethodsSeventy COVID‐19 patients of varying severity and 30 controls were included in the study. In addition to the classical laboratory parameters, KYN, tryptophan (TRP), kynurenic acid (KYNA), 3 hydroxykynurenine (3OHKYN), quinolinic acid (QA), and picolinic acid (PA) were measured with mass spectrometry.ResultsTRP, KYN, KYN:TRP ratio, KYNA, 3OHKYN, PA, and QA results were found to be significantly different in COVID‐19 patients (p < 0.001 for all). The KYN:TRP ratio and PA of severe COVID‐19 patients was statistically higher than that of mild‐moderate COVID‐19 patients (p < 0.001 for all). When results were examined, statistically significant correlations with KYN:TRP ratio, IL‐6, ferritin, and procalcitonin were only found in COVID‐19 patients. ROC analysis indicated that highest AUC values were obtained by KYN:TRP ratio and PA (0.751 vs 0.742). In determining the severity of COVID‐19 disease, the odd ratios (and confidence intervals) of KYN:TRP ratio and PA levels that were adjusted according to age, gender, and comorbidity were determined to be 1.44 (1.1–1.87, p = 0.008) and 1.06 (1.02–1.11, p = 0.006), respectively.Discussion & ConclusionAccording to the results of this study, KYN metabolites play a role in the pathophysiology of COVID‐19, especially KYN:TRP ratio and PA could be markers for identification of severe COVID‐19 cases.     

Comparison of IL‐6 measurement methods with a special emphasis on COVID‐19 patients according to equipment and sample type

BackgroundInterleukin‐6 (IL‐6) is a multifunctional cytokine associated with various diseases, including coronavirus disease (COVID‐19). Although IL‐6 levels can be assessed using serum samples, use of the AFIAS (Boditech Med Inc.) automated immunoassay analyzer enables quick and simple measurement of IL‐6 levels in both serum and whole blood specimens. This study aimed to assess the correlation between IL‐6 measurements obtained from the AFIAS IL‐6 assay and Elecsys IL‐6 assay (Roche Diagnostics). Additionally, utilization of the AFIAS IL‐6 assay was evaluated.MethodsThe IL‐6 levels from 113 serum samples quantified using two assay systems were evaluated for their degree of correlation. Meanwhile, the linearity, analytical sensitivity, and precision/reproducibility of the AFIAS IL‐6 assay were also assessed.ResultsQuantification of IL‐6 with the AFIAS IL‐6 and Elecsys IL‐6 assays showed excellent agreement (kappa 0.802) and were found to be correlated (y = −0.2781 + 1.068x; 95% confidence interval: 1.007–1.124). AFIAS IL‐6 showed good analytical performances. IL‐6 levels were significantly higher in deceased patients compared to those with non‐complicated disease and those who were intubated (p = 0.002 and p < 0.0001, respectively). Finally, IL‐6 levels more accurately predicted poor prognosis in patients, than did C‐reactive protein (area under the curve, 0.716 vs. 0.634).ConclusionThe overall analytical performance of the AFIAS assay was comparable to that of the Elecsys IL‐6 assay. In light of the ongoing COVID‐19 pandemic, the AFIAS may be an attractive tool for measuring IL‐6 levels.     

Th1, Th2, and Th17 cells are dysregulated,but only Th17 cells relate to C‐reactive protein,D‐dimer,and mortality risk in Stanford type A aortic dissection patients

BackgroundT helper (Th) cells are closely involved in vascular inflammation, endothelial dysfunction, and atherogenesis, which are the hallmarks of aortic dissection (AD). This study aimed to evaluate the clinical value of Th1, Th2, and Th17 cell measurements in Stanford type A AD patients.MethodsStanford type A AD patients (N=80) and non‐AD patients with chest pain (N = 40) were recruited. Then, Th1, Th2, and Th17 cells in peripheral blood CD4⁺ T cells from all participants were detected by flow cytometry. The 30‐day mortality of Stanford type A AD patients was recorded.ResultsTh1 and Th17 cells were higher, while Th2 cells were lower in Stanford type A AD patients compared with non‐AD patients (all p < 0.001). Meanwhile, Th1 cells (area under curve (AUC): 0.734, 95% confidence interval (CI): 0.640–0.828), Th2 cells (AUC: 0.841, 95% CI: 0.756–0.925), and Th17 cells (AUC: 0.898, 95% CI: 0.839–0.957) could distinguish Stanford type A patients from non‐AD patients. Moreover, Th1 cells (p = 0.037) and Th17 cells (p = 0.001) were positively related to CRP, and Th17 cells (p = 0.039) were also positively associated with D‐dimer in Stanford type A AD patients. Furthermore, Th17 cells were elevated in deaths compared with survivors (p = 0.001), also, it could estimate 30‐day mortality risk in Stanford type A AD patients with an AUC of 0.741 (95% CI: 0.614–0.867), which was similar to the value of CRP (AUC: 0.771, 95% CI: 0.660–0.882), but lower than the value of D‐dimer (AUC: 0.818, 95% CI: 0.722–0.913).ConclusionTh1, Th2, and Th17 cells are dysregulated, but only the Th17 cells relate to CRP, D‐dimer, and 30‐day mortality risk in Stanford type A AD patients.     

Neurological manifestations in patients with COVID‐19: A systematic review and meta‐analysis

IntroductionThe intensification of coronavirus disease 2019 (COVID‐19) complications, severe symptoms, and high mortality rate has led researchers to focus on this significant issue. While respiratory and cardiac complications have been described as high‐risk manifestations in patients with COVID‐19, neurological complications can also enhance mortality. This study aimed to evaluate the prevalence of neurological complications arises from SARS‐CoV‐2 and assess the mortality rate from neurological complications.Material and MethodsLiterature review was conducted by searching in PubMed/Medline, Web of Sciences, and Embase. After performing search strategies with relevant terms, a number of articles were excluded, including review articles, systematic review or meta‐analysis, duplicate publication of same researchers, congress abstracts, animal studies, case reports, case series, and articles reporting a history of neurological features prior to COVID‐19 infection. After retrieving the data, statistical analysis was performed using the STATA Version 14 software.ResultsFrom 4455 retrieved publications, 20 articles were selected for further analysis. Among 18,258 included patients, 2791 showed neurological symptoms, which were classified into different groups. Headache, confusion, and fatigue were reported as the most non‐specific neurological features in confirmed COVID‐19 patients. Psychiatric symptoms, CNS disorders, cerebrovascular disorders, CNS inflammatory disorders, PNS disorders, neuromuscular disorders, etc., were defined as specific neurological manifestations. The pooled prevalence of neurological manifestations and mortality rate of COVID‐19 patients with neurological features were estimated to be 23.0% (95% CI: 17.8–29.2) and 29.1% (95% CI: 20.3–39.8), respectively.ConclusionNeurological manifestations may commonly happen in patients with COVID‐19. This study reported a high prevalence of neurological complications and mortality rates in COVID‐19 patients. Therefore, patients with COVID‐19 who indicated neurological symptoms should be taken seriously and should receive early treatment to prevent undesirable events.     

Serum calprotectin can indicate current and future severity of COVID‐19

BackgroundPredictive and prognostic biomarkers to guide 2019 novel coronavirus disease (COVID‐19) are critically evolving. Dysregulated immune responses are the pivotal cause of severity mainly mediated by neutrophil activation. Thus, we evaluated the association of calprotectin, neutrophil secretory protein, and other mediators of inflammation with the severity and outcomes of COVID‐19.MethodsThis two‐center prospective study focused on PCR‐proven COVID‐19 patients (n = 76) with different clinical presentations and SARS‐CoV‐2 negative control subjects (n = 24). Serum calprotectin (SC) was compared with IL‐6 and other laboratory parameters.ResultsMedian levels of SC were significantly higher in COVID‐19 patients in comparison to the control group (3760 vs. 2100 ng/ml, p < 0.0001). Elevated SC was significantly respective of disease severity (3760 ng/ml in mild up to 5700 ng/ml in severe cases, p < 0.0001). Moreover, the significant positive and negative correlations of SC with disease severity and oxygenation status indicated disease progression and respiratory worsening, respectively. It was found that SC was high in severe patients during hospitalization and significantly declined to normal after recovery. The logistic analysis identified the independent predictive power of SC for respiratory status or clinical severity. Indeed, SC behaved as a better discriminator for both outcomes, as it exhibited the largest area under the curve (receiver operating curve analysis), with the highest specificity and sensitivity when the predictive value of inflammatory biomarkers was compared.ConclusionCalprotectin can be used as a reliable prognostic tool to predict the poor clinical outcomes of COVID‐19 patients.     

Worldwide prevalence of microbial agents’ coinfection among COVID‐19 patients: A comprehensive updated systematic review and meta‐analysis

BackgroundTo provide information about pathogens’ coinfection prevalence with SARS‐CoV‐2 could be a real help to save patients’ lives. This study aims to evaluate the pathogens’ coinfection prevalence among COVID‐19 patients.MethodIn order to find all of the relevant articles, we used systematic search approach. Research‐based databases including PubMed, Web of Science, Embase, and Scopus, without language restrictions, were searched to identify the relevant bacterial, fungal, and viral coinfections among COVID‐19 cases from December 1, 2019, to August 23, 2021. In order to dig deeper, other scientific repositories such as Medrxiv were probed.ResultsA total of 13,023 studies were found through systematic search. After thorough analysis, only 64 studies with 61,547 patients were included in the study. The most common causative agents of coinfection among COVID‐19 patients were bacteria (pooled prevalence: 20.97%; 95% CI: 15.95–26.46; I ²: 99.9%) and less frequent were virus coinfections (pooled prevalence: 12.58%; 95% CI: 7.31–18.96; I ²: 98.7%). The pooled prevalence of fungal coinfections was also 12.60% (95% CI: 7.84–17.36; I ²: 98.3%). Meta‐regression analysis showed that the age sample size and WHO geographic region did not influenced heterogeneity.ConclusionWe identified a high prevalence of pathogenic microorganism coinfection among COVID‐19 patients. Because of this rate of coinfection empirical use of antibacterial, antifungal, and antiviral treatment are advisable specifically at the early stage of COVID‐19 infection. We also suggest running simultaneously diagnostic tests to identify other microbiological agents’ coinfection with SARS‐CoV‐2.     

Cautions on the laboratory indicators of COVID‐19 patients on and during admission

BackgroundDifferent disease severities of COVID‐19 patients could be reflected on clinical laboratory findings.MethodsIn this single‐centered retrospective study, demographic, clinical, and laboratory indicators on and during admission were compared among 74 participants with mild, moderate, critical severe, or severe classification. Risk factors associated with disease severity were analyzed by multivariate analyses. The AUC and 95% CI of the ROC curve were calculated.ResultsThe most common manifestations of these patients were fever and cough. Critical severe or severe group owned the longest length of stay (23 (19,31), p < 0.001). After multivariate logistic regression, independent influence factors on admission for severity of disease were CK‐MB (OR 0.674; 95% CI 0.489–0.928; p = 0.016), LDH (OR 1.111 or 1.107; 95% CI 1.026–1.204 or 1.022–1.199; p = 0.009 or 0.013), normal T‐BIL (OR 4.58 × 10⁻⁸; 95% CI 3.05 × 10⁻⁹–6.88 × 10⁻⁷; p < 0.001), LYM% (OR 0.008; 95% CI 0–0.602; p = 0.029), and normal ESR (OR 0.016; 95% CI 0–0.498; p = 0.019). Factors during hospitalization were normal T‐BIL (OR 8.56 × 10⁻⁹; 95% CI 8.30 × 10⁻¹⁰–8.83 × 10⁻⁸; p < 0.001), LYM (OR 0.068; 95% CI 0.005–0.934; p = 0.044), albumin (OR 0.565; 95% CI 0.327–0.977; p = 0.041), and normal NEU% (OR 0.013; 95% CI 0.000–0.967; p = 0.048). Combined indicators of AUC were 0.860 (LYM, LDH, and normal ESR on admission, p < 0.001) and 0.750 (CK‐MB, LDH, and normal T‐BIL during hospitalization, p = 0.020) when predicting for severe or critical severe patients.ConclusionTo pay close attention to the progression of COVID‐19 and take measures promptly, we should be cautious of the laboratory indicators when patients on admission especially CK‐MB, LDH, LYM%, T‐BIL as well as ESR; and T‐BIL, LYM, albumin, NEU% with the process of disease.     

The prognostic value of general laboratory testing in patients with COVID‐19

BackgroundLymphocyte count (LYM) of peripheral blood and some indices of general biochemical analysis had diagnostic and prognostic value for coronavirus disease 2019 (COVID‐19), and the value of other remaining indices is rare.MethodsA total of 94 patients with COVID‐19 were enrolled at Renmin Hospital of Wuhan University. According to the severity of COVID‐19, the patients were divided into three groups (moderate 49, severe 35, and critical 10), and 40 healthy cases were enrolled in the same period as healthy controls. The diagnostic and prognostic value of indices in peripheral blood cell count and general biochemical analysis was analyzed.ResultsCompared with healthy cases, the value differences in peripheral blood analysis in patients with COVID‐19 were statistically significant (p < 0.01), the differences in LYM, neutrophil count (Neu), platelet count (PLT), and white blood cell count (WBC) were statistically significant among different severity of COVID‐19 (p < 0.05). Compared with healthy cases, the differences in general biochemical results in patients with COVID‐19 were statistically significant (p < 0.01), the value differences in direct bilirubin (DBIL), low‐density lipoprotein cholesterol (LDL‐Ch), and nitrogen (urea) were statistically significant among different severity of COVID‐19 (p < 0.05). Neutrophil/lymphocyte ratio (NLR) had higher sensitivity and specificity for COVID‐19 diagnosis.ConclusionsSome indices of peripheral blood cell count and general biochemical analysis were valuable in discriminating COVID‐19 and predicting severity and adverse outcome of patients with COVID‐19. For clinician, it is better to use more economical and easy‐to‐get indices to diagnose and predict the prognosis of COVID‐19.     

Assessment of antiphospholipid antibodies and calprotectin as biomarkers for discriminating mild from severe COVID‐19

BackgroundTo explore the association of thrombo‐inflammatory biomarkers with severity in coronavirus disease (COVID‐19), we measured antiphospholipid antibodies (aPL) and calprotectin in sera of COVID‐19 patients.MethodsAnticardiolipin antibodies (aCL) and anti‐β2‐glycoprotein I antibodies were measured using enzyme‐linked immunosorbent assay (ELISA) and multiplex flow immunoassay (MFIA) in hospitalized COVID‐19 patients (N = 105) and healthy controls (N = 38). Anti‐phosphatidylserine/prothrombin antibodies, calprotectin, and C‐reactive protein (CRP) levels were also measured. We assessed the potential correlation between calprotectin levels and various laboratory parameters that were measured during the hospitalization period. After stratifying COVID‐19 patients into two groups by their oxygenation status or acute respiratory distress syndrome presentation, the discriminatory performance of each biomarker was evaluated.ResultsA high proportion of COVID‐19 patients (29.5%, 31/105) had low aCL IgM titers that were detectable by ELISA but mostly below the detection limit of MFIA. Calprotectin levels in severe groups of COVID‐19 were significantly higher than those in non‐severe groups, while CRP levels revealed no significant differences. Serum calprotectin levels showed strong to moderate degree of correlation with other routinely used parameters including peak levels of CRP, ferritin, procalcitonin, BUN, and neutrophil‐to‐lymphocyte ratio, but a negative correlation with minimal lymphocyte count and CD4⁺ T cells. The discriminatory performance was highest for calprotectin in discriminating severe groups of COVID‐19.ConclusionsSerum calprotectin levels were significantly elevated in severe COVID‐19 cases. The prevalence of clinically significant aPL did not differ. The link between calprotectin and inflammatory pathway in COVID‐19 may help improve the management and outcomes of COVID‐19 patients.     

Lymphocyte‐to‐monocyte ratio combined with CA19‐9 for predicting postoperative recurrence of colorectal cancer in patients with diabetes

ObjectiveTo investigate the significance of lymphocyte‐to‐monocyte ratio (LMR) combined with carbohydrate antigen (CA) 19‐9 for predicting postoperative recurrence of colorectal cancer (CRC) in patients with type II diabetes.MethodsWe conducted a retrospective analysis of 106 postoperative patients with stage II–III CRC and with type II diabetes. Their clinical indexes such as LMR and CA19‐9 were collected, and the patients were followed up for 5 years.ResultsThe CA19‐9 level was 119.7 U/ml at baseline in the relapsed group, while this was 24.81 U/ml in non‐relapsed group (p = 0.001). On the contrary, the LMR level was 5.10 and 2.57 for non‐relapsed and relapsed group (p < 0.001), respectively. Kaplan‐Meier survival curves stratified by CA19‐9 and LMR suggested that patients with lower CA19‐9 had higher survival probability (p < 0.001), while patients with high LMR level had higher survival probability (p < 0.001). The multivariable Cox proportional hazard regression analysis with CA19‐9 and LMR indicated that although the baseline CA19‐9 is significantly associated with increasing risk of disease recurrence, the HR (HR = 1.0, 95% CI 1.00–1.01) was small and close to 1, whereas the high baseline LMR (HR = 0.44, 95% CI 0.32–0.61) was associated with decrease in disease recurrence. Model with continuous CA19‐9 and LMR was able to better predict (AUC 73.17%) the disease recurrence.ConclusionLMR combined with CA19‐9 may become a new index for predicting postoperative recurrence of CRC in patients with diabetes.     

Association between preoperative lipid profiles and new‐onset diabetes after transplantation in Chinese kidney transplant recipients: A retrospective cohort study

BackgroundThis study investigated the association between the preoperative lipid profiles and new‐onset diabetes after transplantation (NODAT) in Chinese kidney transplant recipients (KTRs).MethodsIn this study, of 1140 KTRs registered between January 1993 and March 2018 in Zhongshan Hospital, Fudan University, 449 were enrolled. Clinical data, obtained through a chart review of the patient records in the medical record system, were evaluated, and NODAT was diagnosed based on the American Diabetes Association guidelines. Multivariate Cox regression analysis was conducted to determine whether the preoperative lipid profiles in KTRs were independently associated with NODAT incidence. The preoperative lipid profiles were analyzed as continuous variables and grouped into tertiles. Smooth curve fitting was used to confirm the linear associations.ResultsDuring a median follow‐up of 28.03 (interquartile range 12.00–84.23) months, 104 of the 449 (23.16%) participants developed NODAT. The multivariate model analysis, adjusted for all potential covariates, showed that increased values of the following parameters were associated with NODAT (hazard ratio, 95% confidence interval): preoperative total cholesterol (TC; 1.25, 1.09–1.58, p = 0.0495), low‐density lipoprotein cholesterol (LDL‐C; 1.33, 1.02–1.75, p = 0.0352), non‐high‐density lipoprotein cholesterol (non‐HDL‐C; 1.41, 1.09–1.82, p = 0.0084), TC/HDL‐C (1.28, 1.06–1.54, p = 0.0109), and non‐HDL‐C/HDL‐C (1.26, 1.05–1.52, p = 0.0138). However, the association between the preoperative triglyceride, HDL‐C, or TG/HDL‐C and NODAT was not significant.ConclusionsPreoperative TC, LDL‐C, non‐HDL‐C, TC/HDL‐C, and non‐HDL‐C/HDL‐C were independent risk factors for NODAT.     

The effect of smoking on COVID‐19–linked biomarkers in hospitalized patients with COVID‐19

BackgroundThe coronavirus pandemic, an infection (coronavirus disease 2019—COVID‐19), caused by severe acute respiratory disease coronavirus 2 (SARS‐CoV‐2), continues to have a strong influence worldwide. Although smoking is a major known risk factor for respiratory infectious disease, the effects of smoking on COVID‐19 are unclear. In this study, we aimed to evaluate the relationship between smoking and important hematologic (lymphocyte count, neutrophil count, platelet count, neutrophil‐lymphocyte ratio [NLR], platelet‐lymphocyte ratio [PLR]), inflammatory, and biochemical biomarkers in the prognosis of hospitalized patients with COVID‐19.MethodsIn a COVID‐19 pandemic hospital between June and August 2020, 200 adult patients aged over 18 years were hospitalized with COVID‐19 inflammatory and hematologic biomarkers at their first admission and smoking data were selected for this study.ResultsThe rate of smokers was much higher among men (91.5%) than in women (8.5%) (p = 0.001). Neutrophil counts were evaluated and was significantly higher in current smokers (p < 0.001) and ex‐smokers (p = 0.001), and NLR (p = 0.008) and ferritin (p = 0.004) levels were higher than in never smokers. The saturation of patients had a negative significant linear correlation of NLR, PLR, and pack years of smoking. Compared with never smokers, current smokers had higher neutrophil counts (OR = 0.828 [0.750–0.915]; p = 0.041), NLR values (OR = 0.948 [0.910–0.987]; p = 0.009), and CRP levels (OR = 0.994 [0.990–0.999]; p = 0.019).ConclusionSerum neutrophil, NLR, and ferritin levels, which are widely used in determining the prognosis of COVID‐19, were found higher in current smokers/ex‐smokers. These results support the view that a poor prognosis of COVID‐19 is associated with smoking.     

Neutrophil percentage‐to‐albumin ratio and monocyte‐to‐lymphocyte ratio as predictors of free‐wall rupture in patients with acute myocardial infarction

BackgroundsFree‐wall rupture (FWR) has a high mortality rate. We aimed to find sensitive predictive indicators to identify high‐risk FWR patients by exploring the predictive values of neutrophil percentage‐to‐albumin ratio (NPAR) and monocyte‐to‐lymphocyte ratio (MLR) on patients with acute myocardial infarction (AMI).Methods76 FWR patients with AMI were collected, and then 228 non‐CR patients with AMI were randomly selected (1:3 ratio) in this retrospective study. The independent influencing factors of FWR were evaluated by univariate and multivariate logistic regression analysis. The receiver‐operating characteristic (ROC) curve analysis was applied to evaluate the predictive value of NPAR and MLR for FWR.ResultsAccording to the results of multivariate logistic regression analysis, emergency percutaneous coronary intervention (PCI) (OR = 0.27, 95% CI: 0.094–0.751, p = 0.012), angiotensin‐converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) treatment (OR = 0.17, 95% CI: 0.044–0.659, p = 0.010), NPAR (OR = 2.69, 95% CI: 1.031–7.044, p = 0.043), and MLR (OR = 5.99, 95% CI: 2.09–17.168, p = 0.001) were the influencing factors of the FWR patients with AMI, independently. Additionally, the NPAR and MLR were the predictors of FWR patients, with AUC of 0.811 and 0.778, respectively (both p < 0.001).ConclusionsIn summary, the emergency PCI and ACEI/ARB treatment were independent protective factors for FWR patients with AMI, while the increase of MLR and NPAR were independent risk factors. What''s more, NPAR and MLR are good indicators for predicting FWR.     

Evaluation of point‐of‐care testing device for anemia detection: A cross‐sectional method comparison study from Thailand

BackgroundA comparison study is crucial before launching a new medical device; therefore, we compared the Mission Ultra Hb Testing System with the Sysmex XN‐3000 automated hematology analyzer in Thai adult males and non‐pregnant adult females.MethodsParallel studies were conducted using discarded venous K2‐ethylenediaminetetraacetic acid samples from participants requiring hematological investigations. According to the World Health Organization criteria, the participants were categorized as overall, anemia, and non‐anemia for analysis.ResultsThree hundred participants were included in this study. In all participants, near‐perfect correlation and agreement were observed between the two methods for Hb measurement (r = 0.963, p < 0.001) with an interclass correlation coefficient (ICC) of 0.981 (95% confidence interval [CI]: 0.976–0.985) and Hct measurement (r = 0.941, p < 0.001) with an ICC of 0.965 (95% CI: 0.956–0.972). The sensitivity and specificity of the device in detecting anemia were 86.2% (95% CI: 79.7–91.2) and 98.6% (95% CI: 95.2–99.8), respectively. The area under the curve was 0.976 (95% CI: 0.963–0.989). The device showed average biases of 0.76 g/dl (95% limits of agreement [LOA]: −1.03 to 2.54) for Hb measurement and −2.73% (95% LOA: −9.28 to 3.82) for Hct measurement in all participants.ConclusionAgreement between the Mission Ultra Hb Testing System and Sysmex XN‐3000 was observed. The device was excellent for detecting anemia. However, the essential evidence showing biases of the Hb and Hct measurements obtained from the device was revealed. Laboratory interpretation should be carefully performed, particularly at the near cut‐off values.     

Risk factors for prolonged virus shedding of respiratory tract and fecal in adults with severe acute respiratory syndrome coronavirus‐2 infection

BackgroundThe dynamic alteration and comparative study of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA shedding pattern during treatment are limited. This study explores the potential risk factors influencing prolonged viral shedding in COVID‐19.MethodsA total of 126 COVID‐19 patients were enrolled in this retrospective longitudinal study. A multivariate logistic regression analysis was carried out to estimate the potential risk factors.Results38.1% (48/126) cases presented prolonged respiratory tract viral shedding, and 30 (23.8%) cases presented prolonged rectal swab viral shedding. Obesity (OR, 3.31; 95% CI, 1.08–10.09), positive rectal swab (OR, 3.43; 95% CI, 1.53–7.7), treatment by lopinavir/ritonavir with chloroquine phosphate (OR, 2.5; 95% CI, 1.04–6.03), the interval from onset to antiviral treatment more than 7 days (OR, 2.26; 95% CI, 1.04–4.93), lower CD4+ T cell (OR, 0.92; 95% CI, 0.86–0.99) and higher NK cells (OR, 1.11; 95% CI, 1.02–1.20) were significantly associated with prolonged respiratory tract viral shedding. CD3−CD56+ NK cells (OR, 0.87; 95% CI, 0.76–0.99) were related with prolonged fecal shedding.ConclusionsObesity, delayed antiviral treatment, and positive SARS‐CoV‐2 for stool were independent risk factors for prolonged SARS‐CoV‐2 RNA shedding of the respiratory tract. A combination of LPV/r and abidol as the initial antiviral regimen was effective in shortening the duration of viral shedding compared with LPV/r combined with chloroquine phosphate. CD4+ T cell and NK cells were significantly associated with prolonged viral shedding, and further studies are to be warranted to determine the mechanism of immunomodulatory response in virus clearance.     

Lower level of IL‐28A as a predictive index of the artificial liver support system in effective treatment of patients with HBV‐ACLF

BackgroundHBV‐related acute‐on‐chronic liver failure (HBV‐ACLF) is the most common type of liver failure with high mortality. Artificial liver support system (ALSS) is an important mean to reduce the mortality of HBV‐ACLF but lacking index to assess its effectiveness. The cytokines are closely related to the prognosis of HBV‐ACLF patients with ALSS treatment, however, which is not fully understood.MethodsOne hundred forty‐two patients with HBV‐ACLF and 25 healthy donors were enrolled. The cytokine profile of peripheral blood was determined in the patients before and after ALSS treatment, and their relationship with effectiveness of ALSS treatment in HBV‐ACLF was analyzed.ResultsSerum IL‐28A levels were markedly lower in ALSS‐effective patients than those in non‐effective patients pre‐ALSS treatment. Similarly, serum IL‐6 was significantly lower in ALSS‐effective patients. Furthermore, for patients with effective treatment, serum IL‐28A levels were positively related with IL‐6 levels post‐ALSS (r = 0.2413, p = 0.0383). The ROC curve analysis showed that serum levels of IL‐28A (AUC = 0.6959 when alone or 0.8795 when combined with total bilirubin, platelet count and INR, both p < 0.0001) and IL‐6 (AUC = 0.6704, p = 0.0005) were useful indices for separating effective from non‐effective ALSS treatment of HBV‐ACLF patients. Multivariate logistic regression analysis demonstrated that lower level of IL‐28A was independently associated with higher effective rate of ALSS treatments.ConclusionsLower level of IL‐28A is a predictive biomarker for ALSS in effective treatment of HBV‐ACLF patients and IL‐28A may be potential target for the treatment of HBV‐ACLF.     

Prognostic value of inflammation‐immunity‐nutrition score in patients with hepatocellular carcinoma treated with anti‐PD‐1 therapy

BackgroundThere are no validated biomarkers that can predict the clinical benefit of immune checkpoint blockers against the programmed cell death protein 1 (PD‐1) treatments in hepatocellular carcinoma (HCC). This study aimed to investigate the prognostic value of inflammation‐immunity‐nutrition score (IINS) in patients with HCC treated with anti‐PD‐1 therapy.MethodsA consecutive series of 101 HCC patients treated with PD‐1 inhibitors in Sichuan Provincial People''s Hospital between January 2018 and August 2020 were enrolled in the retrospective study. IINS (0–6) was constructed based on pretreatment high‐sensitivity C‐reactive protein (hsCRP), lymphocyte (LYM), and albumin (ALB). The patients were divided into high and low IINS groups according to IINS values. Prognostic values of each variable were evaluated with univariate and multivariate time‐dependent Cox regression analyses. Survival curves were calculated and compared using the Kaplan–Meier method and log‐rank test. The prognostic performance of IINS was further compared with that of other traditional prognostic indicators by receiver operating characteristic (ROC) curve and the areas under the ROC curve.ResultsPatients with low IINS had longer overall survival (OS) (HR: 4.711, 95% CI: 1.80–12.37, p = .001) and progression‐free survival (HR: 3.411, 95% CI: 1.79–6.51, p < .0001) than those with high IINS. The multivariate analysis identified IINS (HR: 3.746, 95% CI: 1.05–13.38, p = .042) and tumor number (HR: 5.111, 95% CI: 1.075–24.299, p = .04) as independent prognostic factors. According to ROC analysis, IINS (AUC =0.729, 95% CI: 0.597–0.861, p = .002) presented better prognostic performance than other traditional prognostic indicators. The area of the IINS‐CA19‐9 under the ROC curve (AUC) was higher than that of the IINS or CA19‐9 levels for the prediction of OS.ConclusionThe results suggest that IINS may be an independent prognostic indicator for HCC patients treated with anti‐PD‐1 therapy. IINS‐CA19‐9 classification may be more effective in predicting clinical benefit of anti‐PD‐1 therapy in HCC patients.