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LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19
INTRODUCTION: Covid-19 is an infectious disease with systemic involvement, which causes intense changes in the blood system, such as neutrophilia and lymphopenia, as well as changes in coagulation function and the concentration of acute phase proteins. Infected patients require laboratory follow-up...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Editora Ltda.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530580/ http://dx.doi.org/10.1016/j.htct.2021.10.083 |
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author | Oliveira, DC Schluga, YC Justus, JLP Martins, EA Rocha, MTL Azambuja, AP |
author_facet | Oliveira, DC Schluga, YC Justus, JLP Martins, EA Rocha, MTL Azambuja, AP |
author_sort | Oliveira, DC |
collection | PubMed |
description | INTRODUCTION: Covid-19 is an infectious disease with systemic involvement, which causes intense changes in the blood system, such as neutrophilia and lymphopenia, as well as changes in coagulation function and the concentration of acute phase proteins. Infected patients require laboratory follow-up to assist in clinical and therapeutic management. It is important to define efficient parameters to predict the clinical course of the disease, especially when the overall symptoms are becoming worse, in an attempt to anticipate therapeutic measures and to ensure the most appropriate assistance. PURPOSE: To correlate neutrophil and lymphocyte counts and their subtypes with the severity and outcome of patients with Covid-19. MATERIALS AND METHODS: Patients hospitalized for severe Covid-19, of both genders and without evidence of bacterial pneumonia, seen at the CHC-UFPR between April and June 2020, were included. Lymphocyte subpopulation analysis was performed by multiparametric flow cytometry (MFC) on whole blood sample using antibodies against CD45, CD3, CD4, CD8 and CD19. A BD FACSCanto™ II cytometer and Infinicyt™ 2.0 analysis software were used. ROC curve and other statistical relationships were performed with IBM SPSS™ v. 25 software. RESULTS: Patients were divided as moderate (not intubated, n = 41) and severe (intubated, n = 35). From the median total leukocyte, neutrophil and lymphocyte counts and their subsets, we define the cutoff values with the highest correlation with hospital discharge. Patients with lymphocyte counts higher than 489/μL, CD4 counts higher than 326 and CD8 counts higher than 121 had a greater chance of evolving with a better prognosis (p < 0.001). Patients who had neutrophil-to-lymphocyte ratio (NLR) higher than 15.2 showed greater correlation with worse prognosis. Patients with lymphopenia below cutoff values are 40 to 55% more likely to be intubated and 50 to 63% to progress to death. Patients with NLR higher than 15.2 have 53.1% more chances of being intubated and 78.1% of evolving to death. DISCUSSION: Laboratory evaluation is essential in the follow-up of patients with Covid-19. In addition to routinely used biochemical markers, cellular analysis can provide valuable information about the clinic and its progression. Lymphopenia and neutrophilia are common parameters in patients with severe disease, so NLR analysis presents itself as an objective scale for stratification of infected patients with a high correlation with possible outcomes. Associated with this, assessment of the immune profile with low levels of T-cells and especially low levels of positive CD4 cells has been associated with worse prognosis in patients with severe Covid-19. CONCLUSION: We conclude that analysis of the neutrophil/lymphocyte ratio routinely obtained from the complete blood count may provide relevant prognostic information for patients with Covid-19. In addition, flow cytometry analysis of CD4 and CD8 T-lymphocytes can complement the screening of patients with Covid-19 by providing information on the immune profile of the disease. |
format | Online Article Text |
id | pubmed-8530580 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Published by Elsevier Editora Ltda. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85305802021-10-22 LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 Oliveira, DC Schluga, YC Justus, JLP Martins, EA Rocha, MTL Azambuja, AP Hematol Transfus Cell Ther Article INTRODUCTION: Covid-19 is an infectious disease with systemic involvement, which causes intense changes in the blood system, such as neutrophilia and lymphopenia, as well as changes in coagulation function and the concentration of acute phase proteins. Infected patients require laboratory follow-up to assist in clinical and therapeutic management. It is important to define efficient parameters to predict the clinical course of the disease, especially when the overall symptoms are becoming worse, in an attempt to anticipate therapeutic measures and to ensure the most appropriate assistance. PURPOSE: To correlate neutrophil and lymphocyte counts and their subtypes with the severity and outcome of patients with Covid-19. MATERIALS AND METHODS: Patients hospitalized for severe Covid-19, of both genders and without evidence of bacterial pneumonia, seen at the CHC-UFPR between April and June 2020, were included. Lymphocyte subpopulation analysis was performed by multiparametric flow cytometry (MFC) on whole blood sample using antibodies against CD45, CD3, CD4, CD8 and CD19. A BD FACSCanto™ II cytometer and Infinicyt™ 2.0 analysis software were used. ROC curve and other statistical relationships were performed with IBM SPSS™ v. 25 software. RESULTS: Patients were divided as moderate (not intubated, n = 41) and severe (intubated, n = 35). From the median total leukocyte, neutrophil and lymphocyte counts and their subsets, we define the cutoff values with the highest correlation with hospital discharge. Patients with lymphocyte counts higher than 489/μL, CD4 counts higher than 326 and CD8 counts higher than 121 had a greater chance of evolving with a better prognosis (p < 0.001). Patients who had neutrophil-to-lymphocyte ratio (NLR) higher than 15.2 showed greater correlation with worse prognosis. Patients with lymphopenia below cutoff values are 40 to 55% more likely to be intubated and 50 to 63% to progress to death. Patients with NLR higher than 15.2 have 53.1% more chances of being intubated and 78.1% of evolving to death. DISCUSSION: Laboratory evaluation is essential in the follow-up of patients with Covid-19. In addition to routinely used biochemical markers, cellular analysis can provide valuable information about the clinic and its progression. Lymphopenia and neutrophilia are common parameters in patients with severe disease, so NLR analysis presents itself as an objective scale for stratification of infected patients with a high correlation with possible outcomes. Associated with this, assessment of the immune profile with low levels of T-cells and especially low levels of positive CD4 cells has been associated with worse prognosis in patients with severe Covid-19. CONCLUSION: We conclude that analysis of the neutrophil/lymphocyte ratio routinely obtained from the complete blood count may provide relevant prognostic information for patients with Covid-19. In addition, flow cytometry analysis of CD4 and CD8 T-lymphocytes can complement the screening of patients with Covid-19 by providing information on the immune profile of the disease. Published by Elsevier Editora Ltda. 2021-10 2021-10-22 /pmc/articles/PMC8530580/ http://dx.doi.org/10.1016/j.htct.2021.10.083 Text en Copyright © 2021 Published by Elsevier Editora Ltda. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Oliveira, DC Schluga, YC Justus, JLP Martins, EA Rocha, MTL Azambuja, AP LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 |
title | LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 |
title_full | LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 |
title_fullStr | LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 |
title_full_unstemmed | LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 |
title_short | LABORATORY MARKERS FOR PREDICTING AGGRAVATION AND POOR PROGNOSIS IN PATIENTS WITH COVID-19 |
title_sort | laboratory markers for predicting aggravation and poor prognosis in patients with covid-19 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530580/ http://dx.doi.org/10.1016/j.htct.2021.10.083 |
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