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      Impact of age to ferritin and neutrophil‐lymphocyte ratio as biomarkers for intensive care requirement and mortality risk in COVID‐19 patients in Makassar, Indonesia

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          Abstract

          Inflammation plays a substantial role in COVID‐19 pathophysiology. Ferritin and neutrophil‐lymphocyte ratio (NLR) are significant prognostic biomarkers used in COVID‐19 patients, although they are affected by other factors such as comorbidities and age. Aging changes the immune system through immunosenescence and inflammaging; however, there are limited number of studies evaluating its effect on ferritin and NLR as part of the complete assessment for intensive care requirement and mortality risk. A single‐center retrospective cohort study of 295 COVID‐19 patients was performed at the Siloam Hospitals Makassar, South Sulawesi, Indonesia from April to August 2020. After admission, all patients were followed up for clinical outcomes. Patients were grouped into strata based on age (<50 years vs. ≥50 years) and risk groups (low‐risk ferritin vs. high‐risk ferritin; low‐risk NLR vs. high‐risk NLR). The endpoints of the study were the intensive care requirements and mortality. Among the 295 COVID‐19 patients, 264 survived and 31 deceased. Ferritin and NLR had higher area under curve (AUC) values than other inflammatory parameters and had significantly different outcomes in both mortality and intensive care requirement groups. The combination of ferritin and NLR showed higher AUC values for intensive care requirement and mortality (AUC, 0.783; 95% confidence interval, 0.703–0.864). Multivariate analysis showed that both endpoints were strongly affected by age, ferritin level, and NLR. Age significantly multiplied clinical endpoints in low‐risk group patients but not in high‐risk group patients. The combination of ferritin and NLR had a better predictive value for intensive care requirement and mortality risk. However, age strongly affects clinical outcome in low‐risk groups of both ferritin and NLR groups; hence, it should be considered as an early predictive factor of COVID‐19 disease progression.

          Abstract

          Combination of both ferritin and NLR had a better predictive value of intensive care requirement and mortality risk. However, age strongly affect clinical outcome in low‐risk groups (both ferritin and NLR groups), hence should be considered as early predictive factor of COVID‐19 disease progression.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

            Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.
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              Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

              Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
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                Author and article information

                Contributors
                haeraniabdurasyid@yahoo.com
                Journal
                Physiol Rep
                Physiol Rep
                10.1002/(ISSN)2051-817X
                PHY2
                physreports
                Physiological Reports
                John Wiley and Sons Inc. (Hoboken )
                2051-817X
                27 May 2021
                May 2021
                : 9
                : 10 ( doiID: 10.1002/phy2.v9.10 )
                : e14876
                Affiliations
                [ 1 ] Department of Internal Medicine Faculty of Medicine Hasanuddin University Makassar Indonesia
                [ 2 ] Department of Internal Medicine Siloam Hospitals Makassar Makassar Indonesia
                [ 3 ] Siloam Hospitals Makassar Makassar Indonesia
                Author notes
                [*] [* ] Correspondence

                Haerani Rasyid, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Jl. Perintis Kemerdekaan Km.10, Makassar 90245, South Sulawesi, Indonesia.

                Email: haeraniabdurasyid@ 123456yahoo.com

                Author information
                https://orcid.org/0000-0001-7404-2973
                https://orcid.org/0000-0002-1658-558X
                https://orcid.org/0000-0002-9731-5193
                https://orcid.org/0000-0001-7684-4531
                Article
                PHY214876
                10.14814/phy2.14876
                8157771
                34042296
                722b42ae-c6ec-4106-9350-e00c17a8947b
                © 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 April 2021
                : 29 December 2020
                : 17 April 2021
                Page count
                Figures: 5, Tables: 3, Pages: 10, Words: 5415
                Categories
                Original Article
                ORIGINAL ARTICLES
                Themed article: The Pathophysiology of COVID‐19 and SARS‐CoV‐2 Infection
                Custom metadata
                2.0
                May 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:27.05.2021

                age,covid‐19,ferritin,neutrophil‐lymphocyte ratio
                age, covid‐19, ferritin, neutrophil‐lymphocyte ratio

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