Background Since December 2019, when COVID-19 emerged in Wuhan and rapidly spread worldwide, an overcrowding of health care facilities and limitations of medical resources have established. As a consequence of this, in order to improve the management of patients and optimize the use of resources, predictors of disease severity and lung complications after COVID-19 pneumonia urgently need to be found. Aim of the study This retrospective study aims to evaluate the significance of hematological values in patients hospitalized for COVID-19 pneumonia. The first goal is to investigate a possible association between serum values and the intensity of care that patients needed during hospitalization. The second goal is to explore the relationship between inflammatory markers (such as NLR, CRP, D-Dimer and eosinophils) and COVID-19 sequelae after discharge. Materials and methods In this study 327 patients, categorized in high intensity medicalcare group (HIMC, n=113) and low intensity medical care group (LIMC, n=214), are enrolled. For the whole population, clinical, radiological and demographics data are obtained at the hospital admission and at the first follow-up visit (3 months). A complete blood test in order to calculate biomarkers (NLR, LMR, CRP, Δ eosinophils) is also collected at admission and on discharge. Treatment during hospitalization is finally reported. Results In the univariate analysis age ≥ 62 years (p=0.002), a high degree of medical care (p=0.0001), NLR at admission ≥ 4,64 (p=0.02), neutrophils at admission ≥ 4.25 x109/L (p=0.002), CRP at admission ≥ 59.5 (mg/dl) (p=0.007), ferritin at admission ≥ 589 (ng/ml) (p=0.04), Δ eosinophils ≥ 0.05 (p=0.002) and oncological diseases (p=0.04) are associated with persistent radiological abnormalities at follow-up. In multivariate analysis, age ≥ 62 years (p=0.03) and Δ eosinophils ≥ 0.05 (p=0.03) are two independent predictor factors of radiological lung sequelae in the whole population. Moreover, NLR at admission and Δ eosinophils positively correlate with alveolar score (r=0.30, p=0.002; r=0.20, p=0.04; respectively) and interstitial score (r=0.22, p=0.02; r=0.27, p=0.003 respectively) at first CT scan after discharge (3 months). Similarly, a positive correlation has been observed between lung ultrasound score at first follow-up, NLR and Δ eosinophils (r=0.13, p=0.02; r=0.14, p=0.02 respectively). Conclusions Based on our findings, NLR at baseline and Δ eosinophils could be potential predictors of radiological sequelae in CT scan, even though further studies are needed to investigate the role of blood values in post COVID sequelae.
Background A partire da dicembre 2019, quando il COVID-19 ha fatto per la prima volta comparsa a Wuhan e si è rapidamente diffuso in tutto il mondo, si è verificato un sovraffollamento delle strutture sanitarie e una limitazione delle risorse mediche. Di conseguenza, al fine di migliorare la gestione dei pazienti e ottimizzare l’uso delle risorse, è necessario trovare urgentemente dei predittori di gravità di malattia e di complicazioni polmonari successive alla polmonite da COVID-19. Scopo dello studio Questo studio retrospettivo mira a valutare il significato dei parametri ematologici nei pazienti ricoverati per polmonite da COVID-19. Il primo obiettivo è quello di indagare una possibile associazione tra i valori sierici e l’intensità delle cure di cui i pazienti necessitano durante il ricovero. Il secondo obiettivo è quello di esplorare la relazione tra i marcatori infiammatori (come NLR, PCR, D-Dimero e Δ eosinofili) e le sequele del COVID-19 dopo la dimissione. Materiali e metodi In questo studio sono stati arruolati 327 pazienti, suddivisi in base al livello di cure in gruppo ad alta intensità di cure (HIMC, n = 113) e gruppo a bassa intensità di cure (LIMC, n = 214). Per l’intera popolazione, i dati clinici, radiologici e demografici vengono raccolti il giorno del ricovero ospedaliero e alla prima visita di controllo (3 mesi). Un emocromo completo per calcolare i biomarcatori (NLR, LMR, PCR e Δ eosinofili) viene raccolto sia al momento del ricovero che il giorno della dimissione. Viene inoltre riportata la terapia eseguita durante il ricovero. Risultati Nell’ analisi univariata età ≥ 62 anni (p=0.002), un alto grado di assistenza medica (p=0.0001), NLR al ricovero ≥ 4.64 (p=0.02), neutrofili al ricovero ≥ 4.25 x109/L (p=0.002), PCR al ricovero ≥ 59.5 (mg/dl) (p=0.007), ferritina al ricovero ≥ 589 (ng/ml) (p=0.04), Δ eosinofili ≥ 0.05 (p=0.002) e malattie oncologiche (p=0.04) sono associati alla persistenza di anomalie radiologiche al follow-up. Nell’analisi multivariata età ≥ 62 anni (p=0.03) e Δ eosinofili ≥ 0.05 (p=0.03) sono due predittori indipendenti di sequele radiologiche polmonari nell’intera popolazione di pazienti. Inoltre, NLR al ricovero e Δ eosinofili correlano positivamente con lo score alveolare (r = 0.30, p = 0.002; r = 0.20, p = 0.04; rispettivamente) e lo score interstiziale (r = 0.22, p = 0.02; r= 0.27, p = 0.003 rispettivamente) alla prima scansione TC al follow-up (3 mesi). Similmente è stata osservata una correlazione positiva tra score ecografico al primo follow-up, NLR e Δ eosinofili (r = 0.13, p = 0.02; r = 0.14, p = 0.02 rispettivamente). Conclusioni Sulla base dei nostri risultati, NLR al ricovero e Δ eosinofili potrebbero essere potenziali predittori di sequele radiologiche alla TC, anche se sono necessari ulteriori studi per indagare più approfonditamenteil ruolo dei parametri ematologici nelle sequele post COVID.
"Predictors of lung complications after COVID-19 pneumonia"
PASIN, DYLAN
2021/2022
Abstract
Background Since December 2019, when COVID-19 emerged in Wuhan and rapidly spread worldwide, an overcrowding of health care facilities and limitations of medical resources have established. As a consequence of this, in order to improve the management of patients and optimize the use of resources, predictors of disease severity and lung complications after COVID-19 pneumonia urgently need to be found. Aim of the study This retrospective study aims to evaluate the significance of hematological values in patients hospitalized for COVID-19 pneumonia. The first goal is to investigate a possible association between serum values and the intensity of care that patients needed during hospitalization. The second goal is to explore the relationship between inflammatory markers (such as NLR, CRP, D-Dimer and eosinophils) and COVID-19 sequelae after discharge. Materials and methods In this study 327 patients, categorized in high intensity medicalcare group (HIMC, n=113) and low intensity medical care group (LIMC, n=214), are enrolled. For the whole population, clinical, radiological and demographics data are obtained at the hospital admission and at the first follow-up visit (3 months). A complete blood test in order to calculate biomarkers (NLR, LMR, CRP, Δ eosinophils) is also collected at admission and on discharge. Treatment during hospitalization is finally reported. Results In the univariate analysis age ≥ 62 years (p=0.002), a high degree of medical care (p=0.0001), NLR at admission ≥ 4,64 (p=0.02), neutrophils at admission ≥ 4.25 x109/L (p=0.002), CRP at admission ≥ 59.5 (mg/dl) (p=0.007), ferritin at admission ≥ 589 (ng/ml) (p=0.04), Δ eosinophils ≥ 0.05 (p=0.002) and oncological diseases (p=0.04) are associated with persistent radiological abnormalities at follow-up. In multivariate analysis, age ≥ 62 years (p=0.03) and Δ eosinophils ≥ 0.05 (p=0.03) are two independent predictor factors of radiological lung sequelae in the whole population. Moreover, NLR at admission and Δ eosinophils positively correlate with alveolar score (r=0.30, p=0.002; r=0.20, p=0.04; respectively) and interstitial score (r=0.22, p=0.02; r=0.27, p=0.003 respectively) at first CT scan after discharge (3 months). Similarly, a positive correlation has been observed between lung ultrasound score at first follow-up, NLR and Δ eosinophils (r=0.13, p=0.02; r=0.14, p=0.02 respectively). Conclusions Based on our findings, NLR at baseline and Δ eosinophils could be potential predictors of radiological sequelae in CT scan, even though further studies are needed to investigate the role of blood values in post COVID sequelae.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/31014