A novel haemocytometric COVID-19 prognostic score developed and validated in an observational multicentre European hospital-based study

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Abstract

COVID-19 induces haemocytometric changes. Complete blood count changes, including new cell activation parameters, from 982 confirmed COVID-19 adult patients from 11 European hospitals were retrospectively analysed for distinctive patterns based on age, gender, clinical severity, symptom duration, and hospital days. The observed haemocytometric patterns formed the basis to develop a multi-haemocytometric-parameter prognostic score to predict, during the first three days after presentation, which patients will recover without ventilation or deteriorate within a two-week timeframe, needing intensive care or with fatal outcome. The prognostic score, with ROC curve AUC at baseline of 0.753 (95% CI 0.723–0.781) increasing to 0.875 (95% CI 0.806–0.926) on day 3, was superior to any individual parameter at distinguishing between clinical severity. Findings were confirmed in a validation cohort. Aim is that the score and haemocytometry results are simultaneously provided by analyser software, enabling wide applicability of the score as haemocytometry is commonly requested in COVID-19 patients.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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

Fei Zhou, Ting Yu, Ronghui Du … (2020)

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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Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

Chaomin Wu, Xiaoyan Chen, Yanping Cai … (2020)

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

Andre J van der Ven:

ORCID: https://orcid.org/0000-0003-1833-3391

Anurag Agrawal: Role: Reviewing Editor

Mone Zaidi: Role: Senior Editor

Journal

Journal ID (nlm-ta): eLife

Journal ID (iso-abbrev): Elife

Journal ID (publisher-id): eLife

Title: eLife

Publisher: eLife Sciences Publications, Ltd

ISSN (Electronic): 2050-084X

Publication date (Electronic, pub): 26 November 2020

Publication date Collection: 2020

Volume: 9

Electronic Location Identifier: e63195

Affiliations

[1 ]Sysmex Europe GmbH HamburgGermany

[2 ]Amphia Hospital BredaNetherlands

[3 ]Elisabeth-Tweesteden Hospital TilburgNetherlands

[4 ]Hospital Papa Giovanni XXIII BergamoItaly

[5 ]Erasmus MC, University Medical Center RotterdamNetherlands

[6 ]Leiden University Medical Center LeidenNetherlands

[7 ]Albert Schweitzer Hospital DordrechtNetherlands

[8 ]Canisius Wilhelmina Hospital NijmegenNetherlands

[9 ]Catharina Hospital EindhovenNetherlands

[10 ]University Hospital Antwerp AntwerpBelgium

[11 ]University Medical Center Groningen, University of Groningen GroningenNetherlands

[12 ]Zuyderland Medical Center Sittard-GeleenNetherlands

[13 ]Radboud University Medical Center NijmegenNetherlands

CSIR Institute of Genomics and Integrative Biology India

Icahn School of Medicine at Mount Sinai United States

CSIR Institute of Genomics and Integrative Biology India

Nantong University China

University of Oklahoma Health Science Center United States

Author information

Simone van der Sar-van der Brugge http://orcid.org/0000-0001-6462-075X

Lucas Joost Van Pelt http://orcid.org/0000-0001-5538-1806

Andre J van der Ven https://orcid.org/0000-0003-1833-3391

Article

Publisher ID: 63195

DOI: 10.7554/eLife.63195

PMC ID: 7732342

PubMed ID: 33241996

SO-VID: 7cf77bf7-ae50-4e0b-98a8-c6b4d75bde14

License:

This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited.

History

Date received : 17 September 2020

Date accepted : 25 November 2020

Funding

Sysmex Europe GMBH provided free of charge reagents for the study. No monetary payments were made to any of the investigators. Joachim Linssen, Jarob Saker and Marion Münster are full-time employees of Sysmex Europe GMBH and Andre van der Ven has an ad hoc consultancy agreement with Sysmex Europe GMBH.

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Author impact statement Distinct haemocytometric parameters, including cell activation markers, combined in a prognostic score may support early identification of COVID-19 patients likely to deteriorate and thus may benefit from ICU admission.

ScienceOpen disciplines: Life sciences

Keywords: covid-19,prognostic score,haemocytometry,complete blood count,intensive care,human

Data availability:

ScienceOpen disciplines: Life sciences

Keywords: covid-19, prognostic score, haemocytometry, complete blood count, intensive care, human

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A novel haemocytometric COVID-19 prognostic score developed and validated in an observational multicentre European hospital-based study

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Novel Coronavirus Disease COVID-19

Most cited references 52

Clinical Characteristics of Coronavirus Disease 2019 in China

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

Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

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