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Ana Maria Caetano de Fariahttp://lattes.cnpq.br/2268635568464108Andréa Teixeira de CarvalhoOlindo Assis Martins FilhoLuis Henrique Francohttp://lattes.cnpq.br/0894429078369153Cecília Horta Ramalho pinto2023-09-28T16:13:30Z2023-09-28T16:13:30Z2023-05-16http://hdl.handle.net/1843/58992https://orcid.org/0000-0002-0499-620XNovos medicamentos antivirais para a COVID-19, como Paxlovid e Molnupiravir, são mais eficazes se administrados nos primeiros cinco dias após o início dos sintomas, ajudando os pacientes com alto risco de desenvolver a forma grave de COVID-19 a evitar a hospitalização. Assim, quanto mais cedo os pacientes que podem se beneficiar dessas drogas forem identificados, melhores serão suas chances de sobrevivência. Embora a infecção por SARS-CoV-2 já tenha alguns grupos de risco estabelecidos, como indivíduos do sexo masculino, idosos e pessoas com comorbidades, ainda é necessário encontrar biomarcadores de desfechos da doença para estratificar o risco dos pacientes e aprimorar o manejo clínico. O hemograma pode ser uma opção viável, eficiente e acessível para encontrar biomarcadores que predizem o prognóstico da doença, uma vez que essa infecção viral pode alterar diversos parâmetros sanguíneos. Portanto, o objetivo do presente estudo foi identificar uma possível associação entre parâmetros hematológicos e diferentes formas clínicas de COVID-19 e usá-los como preditores de desfechos da doença. Para isso, realizamos hemograma em amostras de sangue de 297 indivíduos tratados em serviço de saúde de referência em Belo Horizonte/MG, Brasil, e observamos que, nos primeiros 4 dias de sintomas, as alterações hematológicas clássicas da COVID-19, como a linfopenia, ainda não são perceptíveis. No entanto, o percentual de monócitos (MON%) e a razão entre os números de granulócitos e linfócitos (GLR) já se apresentavam diminuídos e elevados, respectivamente, nesse período em pacientes que apresentavam sintomas leves e que, posteriormente, progrediram para a forma grave da doença e necessitaram de internação hospitalar. Também observamos que durante esse período, a razão entre o número de plaquetas e linfócitos (PLR) foi capaz de diferenciar pacientes com COVID-19 de indivíduos com síndrome gripal ou controles negativos. Realizamos curvas ROC e TG-ROC, bem como algoritmos de Árvore de Decisão, para avaliar a acurácia desses preditores hematológicos e estabelecer seus valores de corte. Assim, nossos achados demonstraram que pacientes com COVID-19 com valores de MON% menor que 7,7% e GLR maior que 8,75 são atribuídos ao grupo hospitalizado com uma precisão de 86%. Isso sugere que esses índices hematológicos podem ser biomarcadores importantes na predição de desfechos de doenças e podem ser utilizados para discriminar pacientes na admissão hospitalar e conduzir abordagens terapêuticas, como antivirais, no início da infecção.Novel antiviral COVID-19 medications, such as Paxlovid and Molnupiravir, are most effective if administered within the first five days of symptoms, helping patients with a high risk of developing the severe form of COVID-19 to avoid hospitalization. Hence, the sooner patients who may benefit from these drugs are identified, the better their chances of survival. Although the SARS-CoV-2 infection already has some established risk groups, such as men, elderly people, and people with comorbidities, it is still necessary to find biomarkers of disease outcomes to stratify patients' risk and improve clinical management. The complete blood count (CBC) can be a viable, efficient, and affordable option to find biomarkers able to predict the prognosis of the disease, since this viral infection can alter various blood parameters. Therefore, the goal of the present study was to identify a possible association between hematological parameters and different clinical forms of COVID-19 and use them as predictors of disease outcomes. We performed a CBC in blood samples from 297 individuals treated in Belo Horizonte, Brazil, and observed that in the first 4 days of symptoms the classic hematological COVID-19 alterations, such as lymphopenia, are not yet perceptible. However, the percentage of monocytes (MON%) and the granulocyte-to-lymphocyte ratio (GLR) were already reduced and increased, respectively, during this period in patients who presented mild symptoms and who later progressed to the severe form of the disease and required hospitalization. We also observed that during this period, the platelet-to-lymphocyte ratio (PLR) was able to differentiate COVID-19 patients from individuals with flu-like symptoms or negative controls. We performed ROC and TG-ROC Curves, as well as Decision Tree algorithms, to evaluate the accuracy of these hematological predictors and to establish their cutoff values. Thus, our findings demonstrated that patients with COVID-19 with MON% values lower than 7.7% and GLR values greater than 8.75 are assigned to the hospitalized group with a precision of 86%. This suggests that these variables can be important biomarkers in predicting disease outcomes and could be used to discriminate patients at hospital admission and manage therapeutic approaches, such as antivirals, in the beginning of infection.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorporUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Bioquímica e ImunologiaUFMGBrasilICB - DEPARTAMENTO DE BIOQUÍMICA E IMUNOLOGIABioquímica e imunologiaCovid-19BiomarcadoresContagem de Células SanguíneasMonócitosHemogramaPreditoresCOVID-19GLRMonócitosParâmetros hematológicos como fatores de predição precoce do desfecho da COVID-19Hematological parameters as early predictive factors for COVID-19 outcomeinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALRepositório - Dissertação - Cecília Horta.pdfRepositório - Dissertação - Cecília Horta.pdfapplication/pdf6253917https://repositorio.ufmg.br/bitstream/1843/58992/1/Reposito%cc%81rio%20-%20Dissertac%cc%a7a%cc%83o%20-%20Ceci%cc%81lia%20Horta.pdf0076190a6be5020d6ae1ae2517127c19MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/58992/2/license.txtcda590c95a0b51b4d15f60c9642ca272MD521843/589922023-09-28 13:13:30.803oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-09-28T16:13:30Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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