PMC:7553377 / 11033-20122 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7553377","sourcedb":"PMC","sourceid":"7553377","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7553377","text":"Clinical and laboratory findings\nOut of consecutive 408 patients who had positive RT-PCR tests, a total of 27 patients who met the inclusion criteria were identified. The flowchart of the study is shown in Fig. 2. There were 7 patients [4 men, 3 women; median age: 41 years (29–65 years)] in the non-progressive group and 20 patients [8 men, 12 women; median age: 57 years (23–81) years] in the progressive group. Table 1 demonstrates the clinical characteristics of the two groups of patients.\nFig. 2 The flowchart of the study\nTable 1 Patient demographics and clinical characteristics of the two groups of COVID-19 patients\nParameter Non-progressive group (n = 7) Progressive group (n = 20) p\nAge 41 (29–65) 57 (23–81) 0.653\nSex 0.662\n Male 4 (57.1%) 8 (40%)\n Female 3 (42.8%) 12 (60%)\nComorbidities 3 (42.8%) 11(55%)\n Hypertension 1 (14.3%) 9 (45%) 0.204\n Diabetes mellitus 3 (42.9%) 2 (10%) 0.091\n Chronic renal failure 0 (0) 1 (5%) 1.000\n Malignancy 1 (14.3%) 1 (5%) 0.459\nTreatment\n Hydorxychloroquine 6 (85.7%) 18 (90%) 1.000\n Azithromycin ± or other antibiotics 4 (57.1%) 11 (55%) 1.000\n Oseltamivir 3 (42.9%) 7 (35%) 1.000\n Favipiravir 1 (14.3%) 9 (45%) 0.204\n LMWH 0 (0) 6 (30%) 0.155\nLength of hospital stay (day) 5 (0–17) 12.5 (0–29) 0.035\nICU admission 0 (0) 6 (30%) 0.155\nSurvival 1.000\n Dead 0 (0) 1 (5%)\n Alive 7 (100%) 19 (95%)\nData are n (%) or median (minimum–maximum)\nICU intensive care unit, LMWH low-molecular-weight heparin\nThree (42.8%) patients in the non-progressive group and 11 (55%) patients in the progressive group had comorbidites. Six (85.7%) patients in the non-progressive group and 18 (90%) patients in the progressive group received hydroxychloroquine therapy. Nine (45%) patients in the progressive group had favipiravir treatment while it was started in 1 (14.3%) patient in the non-progressive group. No significant differences of comorbidities and treatment were found between the two groups of patients (p \u003e 0.05).\nPatients in the progressive group had a significantly longer hospital stay than the patients in the non-progressive group (p = 0.035). Six (30%) patients who had increased lung CT scores were admitted to intensive care unit (ICU) whereas none of the patients with decreased or stable lung CT scores had ICU admission. One (5%) patient in progressive group died while none of the patients in the non-progressive group died.\nLaboratory parameters of the patients obtained at the time corresponding to the dates of the two chest CTs are detailed in Table 2. By using Brunner and Langer method, it was found that changes of parameters obtained at the time of hospital admission and follow-up were different between the two groups of patients for the following tests; AST, ALT, creatinine, and CRP. Δ values for each variable (differences between the values that were obtained at the time of the first chest CT and the second chest CT) were compared for the two groups of patients. Among these parameters, Δ ALT values were found to be statistically significantly different between the two groups (p = 0.03). Additionally, patients with elevated lung CT scores had a significant change in Δ ALT values (p = 0.02). No significant difference was found for Δ AST values between the two groups.\nTable 2 Laboratory characteristics of the two groups of patients with COVID-19\nNon-progressive group (n = 7) Progressive group (n = 20) Between group comparison (p) Hospital admission and follow-up comparison (p)\nParameter At hospital admission Follow-up At hospital admission Follow-up\nAST*\n Increased (n, %) 19 (10–28)\n0 (0) 17 (12–20)\n0 (0) 18 (7–51)\n2 (10) 22 (5–97)\n5 (25) 0.825a 0.071b 0.149c 0.141d\nALT*\n Increased (n, %) 18 (5–58)\n2 (28.6) 19 (6–50)\n1 (14.3) 16 (6–50)\n1 (5) 29 (9–127)\n5 (25) 0.471a 0.030b 0.344c 0.020d\nALP\n Increased (n, %) 61 (39–109)\n1 (14.3) 60 (39–248)\n1 (14.3) 60 (36–98)\n0 (0) 55.5 (30–124)\n1 (5) 0.725 0.246\nGGT\n Increased (n, %) 20.5 (11–39)\n1 (14.3) 21 (7–63)\n2 (28.6) 17.5 (7–81)\n2 (10) 24 (10–177)\n6 (30) 0.950 0.148\nTotal bilirubin\n Increased (n,%) 0.2 (0.1–0.4)\n0 (0) 0.3 (0.1–0.4)\n0 (0) 0.3 (0.01–1.3)\n1 (5) 0.4 (0.2–1.2)\n2 (10) 0.063 0.006\nCreatinine*\n Increased (n, %) 0.7 (0.4–0.9)\n0 (0) 0.8 (0.4–1)\n0 (0) 0.8 (0.1–3.7)\n2 (10) 0.7 (0.5–2.7)\n1 (5) 0.234a 0.009b 0.027c 0.098d\nUrea\n Increased (n, %) 29 (14–33)\n0 (0) 25 (13–34)\n0 (0) 30 (12–235)\n2 (10) 27 (16–221)\n2 (10) 0.376 0.035\nCRP*\n Increased (n, %) 4.4 (0.3–135.6)\n3 (42.8) 0.8 (0.3–211)\n1 (14.3) 12.6 (0.5–310.9)\n14 (70) 37.7 (1–176)\n18 (90) 0.439a 0.105b 0.249c 0.039d\nLDH\n Increased (n, %) 194 (132–384)\n2 (28.6) 182 (166–376)\n3 (42.8) 204 (138–300)\n5 (25) 211 (117–364)\n7 (35) 0.949 0.700\nD-dimer\n Increased (n, %) 275 (169–1355)\n2 (28.6) 248 (168–1413)\n3 (42.8) 647.5 (169–1919)\n11 (55) 643.5 (169–2733)\n8 (40) 0.114 0.856\nWBC\n Increased (n, %)\n Decreased (n,%) 8.3 (4.3- 13.9)\n1 (14.3)\n1 (14.3) 8.5 (5.1–13.2)\n1 (14.3)\n0 (0) 4.9 (0.6–8.9)\n0 (0)\n7 (35) 5.1 (0.5–12.1)\n1 (5)\n6 (30) 0.000e 0.088\nNeutrophil\n Increased (n, %)\n Decreased (n,%) 4.7 (2–7.6)\n1 (14.3)\n0 (0) 5.3 (2.4–10.3)\n1 (14.3)\n0 (0) 3 (0.4–6.7)\n0 (0)\n5 (25) 3.3 (0.3–9.7)\n1 (5)\n3 (15) 0.037e 0.208\nLymphocyte\n Increased (n, %)\n Decreased (n,%) 2.4 (1.3–4.7)\n2 (28.6)\n0 (0) 2.3 (1.5–3.6)\n0 (0)\n0 (0) 1.4 (0.08–2.1)\n0 (0)\n6 (30) (0.1–2)\n0 (0)\n4 (20) 0.000e 0.777\nMonocyte\n Increased (n, %) 0.9 (0.3–1.3)\n4 (57.1) 0.8 (0.4–1)\n2 (28.6) 0.5 (0.1–0.9)\n2 (10) 0.5 (0.07–1)\n2 (10) 0.009e 0.731\nNLR 1.6 (0.8–5) 2 (0.9–6.1) 2.2 (1–4.8) 2.7 (0.9–14.9) 0.267 0.299\nHb\n Decreased (n,%) 11.3 (8.2–16.2)\n3 (42.8) 11.5 (7.4–16.1)\n3 (42.8) 13.3 (1.9–17)\n3 (15) 12.7 (4.5–16.4)\n3 (15) 0.475 0.050\nPlatelet\n Increased (n, %)\n Decreased (n,%) 253 (203–399)\n0 (0)\n0 (0) 285 (191–409)\n0 (0)\n0 (0) 190 (68–247)\n0 (0)\n2 (10) 219 (86–336)\n0 (0)\n2 (10) 0.000e 0.084\nA p value of \u003c 0.05 was considered to be statistically significant in bold\nData are median (minimum–maximum). ALP alkaline phosphatase (35–104 U/L), ALT alanine aminotransferase (normal limits, \u003c 45 U/L), AST aspartate amino transferase (normal limits, \u003c 35 U/L), creatinine (0.6–1.1 mg/dL), CRP C-reactive protein (0–5 mg/L), d-dimer (\u003c 550 µg/L FEU), GGT gamma-glutamyltransferase (normal limits, \u003c 38 U/L), Hb hemoglobin (11.7–16 g/dL), LDH lactate dehydrogenase (normal limits, \u003c 225 IU/L), lymphocyte count (1–3.38 × 103/µL), monocyte count (0–0.8 × 103/µL), neutrophil count (2.02–7.46 × 103/µL), NLR neutrophil / lymphocyte ratio, platelet count (150–450 × 103/µL) total bilirubin (0.1-1 mg/dL), urea (10–50 mg/dL), WBC white blood cells (4.5–11 × 103/µL)\n*Interactions were found for these variables. Interactions represent that the changes of laboratory parameters obtained at hospital admission and follow-up were different between the two groups\naComparison of the parameters between progressive and non-progressive groups at the time of hospital admission\nbComparison of Δ parameters between the progressive and non-progressive groups\ncComparison of differences of the parameters obtained at the time of follow-up and hospital admission in the non-progressive group\ndComparison of differences of the parameters obtained at the time of follow-up and hospital admission in the progressive group\neStatistically significant difference was found between progressive and non-progressive groups in terms of laboratory parameters at hospital admission\nIn the progressive group, 14 (70%) patients and 18 (90%) of patients had elevated CRP levels at hospital admission and follow-up, respectively. The comparison of the two time intervals for CRP was significantly different in the progressive group (p = 0.039).\nThere were statistically significant differences between the two groups of patients in terms of WBC, neutrophil, lymphocyte, monocyte, and platelet counts that were obtained at hospital admission (p \u003c 0.05). ROC analysis was used to determine cut-off values of the laboratory parameters obtained at the time of the first chest CT to predict the changes in the lung CT scores. Patients with a WBC count \u003c 6 × 103/µL, neutrophil count \u003c 3.3 × 103/µL, lymphocyte count \u003c 1.7 × 103/µL, monocyte count \u003c 0.55 × 103/µL, and platelet count \u003c 230 × 103/µL, which were obtained correspondingly at the time of the first chest CT, were predicted to have elevated lung CT scores in the consecutive scan (Table 3).\nTable 3 Predictors at hospital admission for the progression of lung CT score\nParameter Cut-off valuea AUC 95% confidence interval Sensitivity (%) Specificity (%) PPV (%) NPV (%) Std. Error p\nLower Upper\nWBC count 6 0.850 0.651 1 85 85.7 94.4 66.7 0.102 0.007\nNeutrophil count 3.3 0.757 0.531 0.983 75 71.4 88.2 50 0.115 0.046\nLymphocyte count 1.7 0.843 0.654 1 90 71.4 90.5 83.3 0.096 0.008\nMonocyte count 0.55 0.757 0.510 1 70 57.1 82.4 40 0.126 0.046\nPlatelet count 230 0.929 0.813 1 95 85.7 95 85.7 0.059 0.001\naCut-off value is given as (× 103/µL). AUC area under curve, lymphocyte count (1–3.38 × 103/µL), monocyte count (0–0.8 × 103/µL), neutrophil count (2.02–7.46 × 103/µL), NPV negative predictive value, platelet count (150–450 × 103/µL), PPV positive predictive value, WBC white blood cells 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