Routine laboratory parameters predict serious outcome as well as length of hospital stay in COVID-19

Objectives:To validate C-reactive protein (CRP), red cell distribution width (RDW), and neutrophil lymphocyte ratio (NLR) for both serious outcomes and length of hospital stay (LOS) among hospitalized coronavirus disease-19 (COVID-19) patients.Methods:Laboratory data of adult COVID-19 patients (n=74) was collected in this retrospective cohort. Logistic regression was employed for risk factor evaluation and receiver operating curve was used for comparison of these risk factors for the prediction of serious outcome. Multiple regression was applied to determine the association between routine analytes and LOS.Results:Higher levels of CRP (3 times), white blood cells (20%), and neutrophil counts (40%) were seen in the serious category. Odds ratio for CRP for the serious outcome was 1.052 (p=0.007) and RDW for the serious outcome was 1.218 (p=0.040) in unadjusted model and odds ratio for CRP for the serious outcome was 1.048 (p=0.024) and for RDW 1.286 (p=0.023) in adjusted model. In a multivariate regression analysis for the LOS of the unadjusted models consisting of NLR, monocyte lymphocyte ratio (MLR) and platelet lymphocyte ratio (PLR), the beta coefficients (BC) for the CRP were 0.006 (NLR), 0.005 (MLR) and 0.006 (PLR), whereas -0.029 (NLR), -0.034 (MLR) and -0.027 (PLR) were BCs for mean corpuscular hemoglobin concentration (MCHC). Additionally, in adjusted models, the BCs for MCHC were -0.044 (NLR), -0.047 (MLR) and -0.043 (PLR). However, the CRP was consistent with 0.004 (BC) in all models.Conclusion:We observed that CRP is a better predictor than RDW and NLR for serious outcome among COVID-19 patients. Besides, CRP was positively, whereas MCHC was negatively associated with LOS.     

血小板淋巴细胞比值、中性粒淋巴细胞比值与胆源性急性胰腺炎病人预后的关系

目的研究血小板淋巴细胞比值(PLR)、中性粒淋巴细胞比值(NLR)与胆源性急性胰腺炎病人预后关系, 并比较二者在预测胆源性急性胰腺炎预后中的价值。方法回顾性分析2015年1月至2020年1月338例首诊的胆源性急性胰腺炎病人临床资料, 利用受试者工作特征曲线(ROC)得出PLR与NLR最佳界值; 比较不同水平PLR和NLR病人的临床特征, 分析胆源性急性胰腺炎预后的危险因素。结果以生存状态为依据PLR最佳界值为344.7, NLR的最佳界值为17.8。PLR的ROC曲线下面积(AUC)大于NLR (Z=2.03, P < 0.05)。多因素Cox回归模型表明, 低PLR病人死亡风险是高PLR病人死亡风险的3.551倍(95%CI: 1.161~10.868);高NLR病人死亡风险是低NLR病人死亡风险的2.769倍(95%CI: 1.039~7.397)。结论PLR和NLR可能与胆源性急性胰腺炎预后相关。与NLR相比, PLR预测急性胰腺炎预后更加准确。     

脑出血患者外周血中性粒细胞/淋巴细胞和血小板/淋巴细胞比值的临床意义

目的  研究自发性脑出血（ICH）患者外周血中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）的临床意义。方法  随机选取自发性脑出血患者363例及健康体检者95例归为脑出血组及对照组。比较两组及不同神经功能缺损程度患者的NLR、PLR,计算受试者工作曲线（ROC）,用曲线下面积评价各指标的诊断价值。发病90d时进行随访,比较生存组及死亡组的NLR、PLR。结果  ICH组的NLR、PLR高于健康对照组,差异有统计学意义（P <0.05）;高血压脑出血组与非高血压脑出血组的NLR、PLR比较差异均无统计学意义（P >0.05）;NLR、PLR的ROC曲线下面积分别为0.887和0.635;NLR、PLR在轻度神经功能缺损组与中度神经功能缺损组间比较差异无统计学意义（P >0.05）;而NLR、PLR在重度神经功能缺损组与中度组及轻度组间比较差异有统计学意义（P <0.05）;生存患者与死亡患者的NLR比较,差异无统计学意义（P >0.05）;生存患者与死亡患者的PLR比较,差异有统计学意义（P <0.05）;以ROC曲线的临界值分组,与PLR<157组的患者相比,PLR>157组患者的神经功能预后更差（P <0.05）。结论  脑出血患者的NLR、PLR均升高,NLR的诊断价值高于PLR,NLR可能与患者急性期神经功能缺损程度相关,PLR可能与患者的90d神经功能预后相关。

     

中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值诊断强直性脊柱炎的价值

目的 评估中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）在强直性脊柱炎（AS）诊断中的价值。方法 纳入海军军医大学（第二军医大学）长海医院收治的AS患者80例（AS组）及健康体检者100例（健康对照组）作为研究对象。采集研究对象清晨空腹静脉血进行血常规检查并计算NLR和PLR,比较两组NLR和PLR的差异,采用受试者工作特征（ROC）曲线评价NLR、PLR诊断AS的灵敏度和特异度并进行联合诊断试验。结果 与健康对照组相比,AS组NLR、PLR均增高,差异均有统计学意义[2.25（1.66,3.35）vs 1.50（1.23,2.09）,P<0.01;147.94（104.11,188.80）vs 105.75（89.55,148.02）,P<0.01]。ROC曲线分析显示,NLR诊断AS的曲线下面积（AUC）为0.694[95%置信区间（CI）：0.615~0.772,P<0.01],以最佳截断值（1.64）为诊断标准时其灵敏度和特异度分别为77.5%和58.0%;PLR诊断AS的AUC为0.662（95%CI：0.580~0.756）,以最佳截断值（120.91）为诊断标准时其灵敏度和特异度分别为66.2%和63.0%。联合诊断试验结果显示,NLR与PLR并联试验（NLR/PLR）诊断AS的灵敏度和特异度分别为83.8%和50.0%,NLR与PLR串联试验（NLR+PLR）诊断AS的灵敏度和特异度分别为61.2%和75.0%。结论 NLR和PLR对AS具有一定的诊断价值,二者联合诊断可提高诊断的灵敏度和特异度。     

Outcomes of tracheostomy in COVID-19 patients in National Guard Health Affairs,Riyadh, Saudi Arabia

Objectives:To evaluate coronavirus disease 2019 (COVID-19) patient tracheostomy outcomes.Methods:All COVID-19 patients at the National Guard Hospital, Riyadh, Saudi Arabia, were retrospectively recruited. Those who had tracheostomies between April and December 2020 were included.Results:The population was 45 patients, of which 30 (66.7%) were males, 15 (33.3%) were females and the mean age was 66.76±12.74 years. The tracheostomy indications were anticipated prolonged weaning in 40 (88.9%) and failed extubation in 5 (11.1%) of the patients. The mean intubation to tracheostomy duration was 20.62±7.21 days. Mortalities were high, with most attributed to COVID-19. Mortality and a pre-tracheostomy C-reactive protein (CRP) uptrend were significantly related (p=0.039). Mortality and intubation to tracheostomy duration were not significantly related. The mean post-tracheostomy time to death was 10.64±6.9 days. Among the survivors, 20 (44.4%) males and 11 (24.4%) females were weaned off mechanical ventilation; 9 (20%) remained on ventilation during the study. The mean ventilation weaning time was 27.92±20 days.Conclusion:The high mortality rate was attributed to COVID-19. Mortality and a pre-tracheostomy CRP uptrend were significantly related; uptrend patients experienced far more mortalities than downtrend patients. Unlike previous findings, mortality and intubation to tracheostomy duration were not significantly related.     

The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study

Objectives:To assess the neutrophil-to-lymphocyte ratio (NLR) diagnostic and prognostic value in the context of Coronavirus disease-2019 (COVID-19) infection in Saudi Arabia.Methods:A case-control study in which 701 confirmed COVID-19 patients (of which 41 were intensive care unit [ICU]-admitted) and 250 control subjects were enrolled. The study was conducted retrospectively in October on patients admitted to 3 separate hospitals in Saudi Arabia namely: King Abdullah Bin Abdulaziz University Hospital (Riyadh), Ohud Hospital (Madinah), and Nojood Medical Center (Madinah) between May and September 2020. Neutrophil-to-lymphocyte ratio was calculated based on absolute neutrophil and lymphocyte count. Institutional ethical approval was obtained prior to the study.Results:Patients (median age 35 years), of which 54.8% were females, were younger than the control cohort (median age 48 years). Patients had significantly higher NLR compared to the control group. Intensive care unit admitted patients had significantly higher platelet, WBC and neutrophil counts. The ICU patients’ NLR was almost twice as of the non-intensive patients. The NLR value of 5.5 was found to be of high specificity (96.4%) and positive predictive value (91.4%) in diagnosing COVID-19. Furthermore, it had a very good sensitivity (86.4%) in predicting severe forms of disease, such as, ICU admission.Conclusion:Neutrophil-to-lymphocyte ratio is an important tool in determining the COVID-19 clinical status. This study further confirms the prognostic value of NLR in detecting severe infection, and those patients with high NLR should be closely monitored and managed.     

淋巴细胞、C反应蛋白联合外周血中性粒细胞淋巴细胞比值检测在新型冠状病毒肺炎早期诊断中的应用价值

目的探讨中性粒细胞淋巴细胞比值（NLR）、淋巴细胞（LY）和C反应蛋白（CRP）单独与联合检测在新型冠状病毒肺炎（COVID-19）早期诊断中的临床应用价值。方法选取对53例COVID-19病人（COVID-19组）以及同期90例其他呼吸系统疾病病人（对照组）,回顾性分析和比较2组病人中性粒细胞淋巴细胞比值（NLR）、淋巴细胞（LY）和C反应蛋白（CRP）的表达水平。并利用ROC曲线分析NLR、LY、CRP单独以及NLR+LY+CRP联合检测对COVID-19的早期诊断价值。结果COVID-19组NLR、CRP水平均高于对照组,LY水平低于对照组（P < 0.01）。NLR、LY、CRP单独及联合用于COVID-19感染诊断的ROC曲线下面积分别为0.610、0.705、0.833、0.817;灵敏度分别为31.0%、69.8%、67.9%、58.5%;特异度分别为96.7%、62.2%、80.0%、92.2%,NLR+LY+CRP联合诊断的价值高于单独诊断价值。结论NLR、LY、CRP联合诊断可以提高COVID-19早期诊断的特异度和灵敏度,从而指导临床尽早采取合理治疗措施,提高COVID-19的治愈率。     

COVID-19普通型与危重型患者的生化分析及中性粒细胞/淋巴细胞比值的临床应用

目的 寻求影响COVID-19患者临床分型与转归的关键指标以指导临床诊疗,并探索中性粒细胞/淋巴细胞比值（NLR）在COVID-19中的应用。方法 收集2020年2~4月援鄂期间在湖北省鄂州市中心医院确诊的COVID-19患者共93例,其中ICU危重病例43例,随机选择呼吸科普通型病例50例进行对照研究,收集所有患者入院时和住院期间的基线资料、血常规、生化指标。计算NLR值,按照文献NLR四分类法对患者进行COX生存分析;根据患者转归信息绘制受试者工作曲线（ROC）,根据NLR截断值将患者分为2类,与临床分类比较以评价截断值分类的科学性;根据患者转归、NLR截断值分类及临床分型进行多重二元logistics回归,筛选关键变量,并探讨其在COVID-19中的意义。结果 NLR四分类法不适合COVID-19患者预后判断;NLR预测患者死亡的截断值为11.26,敏感性为0.903,特异性为0.839;NLR<11.26患者血常规,生化指标与普通型无统计学差 异（P>0.05）,NLR≥11.26患者上述指标与危重型患者无统计学差异（P>0.05）;NLR,白血病计数（WBC）,中性粒细胞绝对值（NEUT）,降钙素原（PCT）,D-二聚体（DD）,尿素氮（BUN）,肌钙蛋白（I TNI）,脑钠肽（BNP）,乳酸脱氢酶（LDH）对患者临床分型、转归均有明显影响（P<0.05）;此外,血肌酐（Cr）、血清钙（Ca）、PH、乳酸（Lac）对患者转归有较大影响（P<0.05）;血清钠（Na）与动脉血二氧化碳分压（PCO2）对患者临床分型有较大影响（P<0.05）。结论 NLR可以作为COVID-19临床分型、预后评估、生化异常的重要预警因子;危重型及预后差的患者多合并细菌感染、炎症反应更强烈、心肺肾功能损伤更重,常伴有DD,LDH明显升高;NLR、NEUT、DD、TNI、BNP、LDH、Ca、PCT、PH、Lac对COVID-19预后影响较大,应动态观察。     

Challenges in diabetic foot treatment during pandemic of COVID-19

Objectives:To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation.Methods:Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed.Results:Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=−1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted.Conclusion:No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.     

外周血中性粒细胞淋巴细胞比值、血小板淋巴细胞比值、CEA和AFP在原发性肝癌辅助诊断中的临床价值

目的:探讨中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板淋巴细胞比值(platelet to lymphpcyte ratio,PLR)、癌胚抗原(carcinoembryonic antigen,CEA)和甲胎蛋白(alpha fetal protein,AFP...     

COVID-19 in children ranging from asymptomatic to a multi-system inflammatory disease: A single-center study

Objectives:To identify clinical and laboratory characteristics of the Saudi children with confirmed COVID-19.Methods:Eighty-eight children (0-14 years) with COVID-19 who were admitted to Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia from April to June 2020 were recruited.Results:Mean age was 5.74 ± 4.7 years with 41 (49.4%) males and 42 (50.6%) females. The length of hospital stay (LOS) ranged from 1 to 17 days. The main source of infection was infected family members. Mean values of C-reactive protein (CRP), serum ferritin, and lactate dehydrogenase (LDH) were noticeably above normal. Degree of severity and length of stay was significantly correlated with lymphopenia (r= -0.36; p=0.001), whereas it was positively correlated with absolute neutrophil count and with high inflammatory markers, such as CRP, LDH, and others.Conclusions:Identifying the clinical and laboratory characteristics of the Saudi children with confirmed COVID-19 will improve understanding of this disease’s presentation and will help put rapid and proper management strategies into place to face this pandemic. A high index of suspicion is needed for cases presenting with multi-system inflammatory disease, which represented 5.7% of the included study population.     

中性粒细胞/淋巴细胞比值可作为重型COVID-19的预警信号

目的 探寻重型新型冠状病毒肺炎（COVID-19）的预警信号。方法 回顾性分析湖北中西医结合医院呼吸四病区及一病区收治的63例COVID-19患者的临床资料,按照诊断标准分为普通型组（32例）和重型组（31例）。比较两组患者在一般资料、基础疾病、临床表现及实验室检查指标的差异,采用相关和回归分析糖尿病、中性粒细胞/淋巴细胞比值（NLR）、血清淀粉样蛋白A （SSA）、C反应蛋白（CRP）、血清白蛋白（ALB）与重型COVID-19的相关性,结合受试者工作特征曲线（ROC曲线）分析NLR的曲线下面积（AUC）,评估其在COVID-19的预测效能。结果 两组患者在糖尿病、NLR、SSA、CRP、ALB具有显著性差异（P< 0.05）;糖尿病、NLR、SSA、CRP与重型COVID-19存在正性相关（P<0.05）;ALB与重型COVID-19存在负性相关（P<0.05）;通过多因素Logistic回归分析显示：NLR为重型COVID-19的独立危险因素（OR=1.264,95%CI：1.046~1.526,P=0.015）;应用ROC曲线计算AUC为0.831（95%CI：0.730~0.932）,相对应的NLR最佳界值为4.795,敏感度为0.839,特异性为0.750。结论 NLR可以作为重型COVID-19的预警信号,能为早期识别重型COVID-19提供客观依据。     

NLR与PLR在非小细胞肺癌患者化疗疗效及预后评估中的价值

目的 探究外周血中性粒细胞与淋巴细胞比值(NLR)以及血小板与淋巴细胞比值(PLR)在非小细胞肺癌(NSCLC)患者化疗疗效及预后中的评估价值。方法 选择2019年3月—2021年6月我院收治87例NSCLC患者各项资料予以回顾性分析,患者在化疗治疗前均测定外周血中性粒细胞、淋巴细胞、血小板,并计算NLR与PLR,评估患者疗效及预后,分析NLR与PLR在患者化疗疗效及预后中的评估价值。结果 NLR、PLR水平与患者吸烟史、肿瘤分期、是否出现淋巴结转移有关(P<0.05);患者接受两个周期化疗后治疗有效率为71.26%,有效组患者NLR与PLR水平显著低于无效组(P<0.05);受试者工作特征曲线显示,NLR、PLR及两者联合用于评估患者化疗疗效曲线下面积分别为0.859、0.785、0.926;患者预后不良发生率为32.18%,单因素与多元Logistic回归分析显示分化程度、PLR、NLR与患者预后有关(P<0.05)。结论 外周血NLR、PLR与患者多项临床特征有关,不仅可用于患者评估患者化疗疗效,还与患者预后关系密切。     

PLR与NLR对急性脑梗死患者预后的预测价值

目的 血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）对急性脑梗死患者预后的预测价值。方法 回顾性连续纳入2016年1月~2016年12月于笔者医院神经内科住院的急性脑梗死患者507例,依照改良Rankin量表（mRS）对所有患者进行神经功能评分并分为预后良好组318例（≤ 2分）,预后不良组189例（>2分）。比较两组基线资料,根据入院时血小板计数、中性粒细胞计数与淋巴细胞计数计算NLR、PLR值。采用多因素Logistic回归分析急性脑梗死患者预后不良影响因素,采用ROC曲线评价入院时PLR、NLR水平对急性脑梗死患者预后的预测作用。结果 预后不良组年龄、空腹血糖、NEUT计数、PLT计数、入院时NLR水平、入院时PLR水平、入院NIHSS评分、脑梗死病史率均显著高于预后良好组,组间比较差异有统计学意义（P<0.05）;预后不良组尿酸、LYM计数均显著低于预后良好组,组间比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示,尿酸水平升高是AIS患者预后良好的独立保护因素;年龄、NEUT计数、PLT计数、入院NIHSS评分、入院时高水平NLR和PLR是AIS患者发生预后不良的独立危险因素。入院时PLR、NLR水平对急性脑梗死患者预后不良的诊断界值分别为137.47、3.92,敏感度分别为69.8%、64%,特异性分别为70.8%、82.7%,PLR和NLR联合预测敏感度为74.1%,特异性为75.2%。结论 入院时PLR、NLR水平对急性脑梗死患者预后有良好的预测价值,高PLR、NLR水平提示预后不良。     

动态监测NLR、PLR变化与晚期肺腺癌一线化疗疗效及预后关系

目的探讨中性粒细胞淋巴细胞比率(NLR)及血小板淋巴细胞比率(PLR)的动态变化对晚期肺腺癌病人化疗疗效及生存期的预测价值。方法回顾性分析193例经一线化疗的晚期肺腺癌病人病历资料,收集其化疗前、化疗2周期后及化疗4周期后的相关资料进行疗效评定,并分别计算NLR、PLR;分析NLR、PLR的动态变化与各种临床特征、一线化疗疗效及总生存期(OS)之间的关系。结果NLR、PLR水平在化疗前及化疗后疾病进展组均高于完全缓解+部分缓解+疾病稳定组(P < 0.01);在化疗疗效方面,除NLR4(P>0.05)外,NLR0、NLR2、PLR0、PLR2、PLR4与2周期化疗疗效呈负相关关系(P < 0.05~P < 0.01);而NLR0、NLR2、NLR4、PLR0、PLR2、PLR4与4周期化疗疗效均呈负相关关系(P < 0.01);Kaplan-Meier生存分析表明,OS在不同NLR0、NLR4、PLR0、PLR2、PLR4、2周期化疗疗效及4周期化疗疗效中差异均有统计学意义(P < 0.01),且多因素分析表明,NLR0与PLR4是生存期的独立危险因素(P < 0.05和P < 0.01)。结论NLR、PLR与一线化疗晚期肺腺癌疗效及生存密切相关,治疗前NLR与化疗4周后PLR是一线化疗晚期肺腺癌病人的独立预后因素。     

血小板与淋巴细胞比值对肝硬化患者肾脏损伤病情的评估效果

目的 探索血小板与淋巴细胞比值对肝硬化患者肾脏损伤病情的评估效果。方法 回顾性分析2018年1月—2019年1月于保定市传染病医院接受治疗的196例肝硬化患者的临床资料,114例单纯肝硬化患者为对照组,82例肝硬化合并肾脏损伤患者为观察组。收集两组患者临床资料及实验室指标进行对比,对具有统计学意义的可能影响肝硬化患者肾脏损伤的相关因素进行多因素logistic回归分析,计算ESR、NLR、PLR指标对评估肝硬化患者肾脏损伤病情的灵敏度、准确度及特异度。结果 两组患者BMI差异无统计学意义（P>0.05）;观察组收缩压、ESR、NLR、PLR、hs-CRP、IL-6、BUN、Scr指标水平高于对照组（P<0.05）。多因素Logistic回归分析结果显示,ESR、NLR、PLR、IL-6、BUN、Scr指标是影响肝硬化患者并发肾脏损伤的相关因素（P<0.05）。本次研究共82例肝硬化并发肾脏损伤患者,ESR、NLR、PLR三项指标单独检测中ESR特异度最高,NLR灵敏度最高,PLR准确度最高;联合检测灵敏度、准确度、特异度均分别高于单独检测。结论 ESR、NLR、PLR能够反映肝硬化患者肾脏损伤的发生风险,联合检测对肝硬化患者肾脏损伤病情的评估效果较好,临床医师治疗时可以根据患者ESR、NLR、PLR水平对患者病情进行初步判断。     

Clinical and epidemiological characteristics of COVID-19 mortality in Saudi Arabia

Objectives:To analyze the clinical and epidemiological characteristics for 224 of in-hospital coronavirus disease 2019 (COVID-19) mortality cases. This study’s clinical implications provide insight into the significant death indicators among COVID-19 patients and the outbreak burden on the healthcare system in the Kingdom of Saudi Arabia (KSA).Methods:A multi-center retrospective cross-sectional study conducted among all COVID-19 mortality cases admitted to 15 Armed Forces hospitals across KSA, from March to July 2020. Demographic data, clinical presentations, laboratory investigations, and complications of COVID-19 mortality cases were collected and analyzed.Results:The mean age was 69.66±14.68 years, and 142 (63.4%) of the cases were male. Overall, 30% of the COVID-19 mortalities occurred in the first 24 hours of hospital admission, while 50% occurred on day 10. The most prevalent comorbidities were diabetes mellitus (DM, 73.7%), followed by hypertension (HTN, 69.6%). Logistic regression for risk factors in all mortality cases revealed that direct mortality cases from COVID-19 were more likely to develop acute respiratory distress syndrome (odds ratio [OR]: 1.75, confidence intervel [CI: 0.89-3.43]; p=0.102) and acute kidney injury (OR: 1.01, CI: [0.54-1.90]; p=0.960).Conclusion:Aging, male gender and the high prevalence of the underlying diseases such as, DM and HTN were a significant death indicators among COVID-19 mortality cases in KSA. Increases in serum ferritin, procalcitonin, C-reactive protein (CRP), and D-dimer levels can be used as indicators of disease progression.     

Macrophage exosomes transfer angiotensin II type 1 receptor to lung fibroblasts mediating bleomycin-induced pulmonary fibrosis

Background:Macrophages are involved in the pathogenesis of idiopathic pulmonary fibrosis, partially by activating lung fibroblasts. However, how macrophages communicate with lung fibroblasts is largely unexplored. Exosomes can mediate intercellular communication, whereas its role in lung fibrogenesis is unclear. Here we aim to investigate whether exosomes can mediate the crosstalk between macrophages and lung fibroblasts and subsequently induce fibrosis.Methods:In vivo, bleomycin (BLM)-induced lung fibrosis model was established and macrophages infiltration was examined. The effects of GW4869, an exosomes inhibitor, on lung fibrosis were assessed. Moreover, macrophage exosomes were injected into mice to observe its pro-fibrotic effects. In vitro, exosomes derived from angiotensin II (Ang II)-stimulated macrophages were collected. Then, lung fibroblasts were treated with the exosomes. Twenty-four hours later, protein levels of α-collagen I, angiotensin II type 1 receptor (AT1R), transforming growth factor-β (TGF-β), and phospho-Smad2/3 (p-Smad2/3) in lung fibroblasts were examined. The Student''s t test or analysis of variance were used for statistical analysis.Results:In vivo, BLM-treated mice showed enhanced infiltration of macrophages, increased fibrotic alterations, and higher levels of Ang II and AT1R. GW4869 attenuated BLM-induced pulmonary fibrosis. Mice with exosomes injection showed fibrotic features with higher levels of Ang II and AT1R, which was reversed by irbesartan. In vitro, we found that macrophages secreted a great number of exosomes. The exosomes were taken by fibroblasts and resulted in higher levels of AT1R (0.22 ± 0.02 vs. 0.07 ± 0.02, t = 8.66, P = 0.001), TGF-β (0.54 ± 0.05 vs. 0.09 ± 0.06, t = 10.00, P < 0.001), p-Smad2/3 (0.58 ± 0.06 vs. 0.07 ± 0.03, t = 12.86, P < 0.001) and α-collagen I (0.27 ± 0.02 vs. 0.16 ± 0.01, t = 7.01, P = 0.002), and increased Ang II secretion (62.27 ± 7.32 vs. 9.56 ± 1.68, t = 12.16, P < 0.001). Interestingly, Ang II increased the number of macrophage exosomes, and the protein levels of Alix (1.45 ± 0.15 vs. 1.00 ± 0.10, t = 4.32, P = 0.012), AT1R (4.05 ± 0.64 vs. 1.00 ± 0.09, t = 8.17, P = 0.001), and glyceraldehyde-3-phosphate dehydrogenase (2.13 ± 0.36 vs. 1.00 ± 0.10, t = 5.28, P = 0.006) were increased in exosomes secreted by the same number of macrophages, indicating a positive loop between Ang II and exosomes production.Conclusions:Exosomes mediate intercellular communication between macrophages and fibroblasts plays an important role in BLM-induced pulmonary fibrosis.     

外周血淋巴细胞计数在血氧饱和度下降的新型冠状病毒感染患者中的应用

目的 回顾性比较50例血氧饱和度下降的新型冠状病毒感染（COVID-19）患者和50例血氧饱和度正常的COVID-19患者外周血淋巴细胞计数、中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio，NLR）、超敏C反应蛋白（hypersensitive C-reactive protein，hs-CRP）水平和肺部影像资料，并分析COVID-19患者外周血淋巴细胞计数、NLR、hs-CRP水平、肺部影像学资料与发生血氧饱和度下降的关系。方法 选取50例血氧饱和度下降的COVID-19患者（血氧饱和度下降组）和50例血氧饱和度正常的COVID-19患者（血氧饱和度正常组），各组所有纳入对象均进行外周血淋巴细胞计数、NLR计算、hs-CRP水平检测，分析血氧饱和度下降组和血氧饱和度正常组的影像学资料。结果 血氧饱和度下降组NLR与血氧饱和度正常组相比差异无统计学意义；血氧饱和度下降组淋巴细胞百分率（percentage of lymphocyte，LYM%）显著低于血氧饱和度正常组；血氧饱和度下降组hs-CRP水平显著高于血氧饱和度正常组；血氧饱和度下降组肺部感染率显著高于血氧饱和度正常组。结论 COVID-19患者外周血淋巴细胞降低可能是炎症更加严重和更加容易发生肺部感染的直接原因，进而更容易引起患者血氧饱和度下降。     

Curve evolution during bracing in children with scoliosis secondary to early-onset neurofibromatosis type 1: indicators of rapid curve progression

Background:Scoliosis secondary to neurofibromatosis type 1 (NF1) in children aged <10 years is an important etiology of early-onset scoliosis (EOS). This study was performed to investigate the curve evolution of patients with EOS secondary to NF1 undergoing bracing treatment and to analyze high-risk indicators of rapid curve progression.Methods:Children with EOS due to NF1 who underwent bracing treatment from 2010 to 2017 were retrospectively reviewed. The angle velocity (AV) at each visit was calculated, and patients with rapid curve progression (AV of >10°/year) were identified. The age at modulation and the AV before and after modulation were obtained. Patients with (n = 18) and without rapid curve progression (n = 10) were statistically compared.Results:Twenty-eight patients with a mean age of 6.5 ± 1.9 years at the initial visit were reviewed. The mean Cobb angle of the main curve was 41.7° ± 2.4° at the initial visit and increased to 67.1° ± 8.6° during a mean follow-up of 44.1 ± 8.5 months. The overall AV was 6.6° ± 2.4°/year for all patients. At the last follow-up, all patients presented curve progression of >5°, and 20 (71%) patients had progressed by >20°. Rapid curve progression was observed in 18 (64%) patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up (t = 2.868, P = 0.008 and <0.001, respectively). The mean AV was 4.4° ± 1.2°/year before modulation and 11.8° ± 2.7°/year after modulation (t = 11.477, P < 0.010).Conclusions:Curve progression of >10°/year is associated with younger age at the initial visit, and modulation change indicated the occurrence of the rapid curve progression phase.