Laboratory medicine played an essential role during the pandemic, Has been key in patient risk stratification and monitoring infected by SARS-CoV-2 , so as to contribute to their management. This topic will be discussed at the table ‘Contribution of laboratory medicine in the COVID-19 pandemic’, in the framework of the 2nd National Multidisciplinary COVID-19 Congress of Scientific Societies in Spain.
As explained by Dr. Luis García de Guadiana Romualdo, President of the Committee on Biological Magnitudes in the Medical Emergency Department Spanish Society for Laboratory Medicine (SEQCML), “Laboratory tests, in combination with other clinical data, contribute to the identification of low-risk patients and those at high risk of progression to the most severe forms of the disease.”
“They are also used to establish outpatient treatment strategies, thereby reducing hospital care pressures and controlling the course of the disease,” adds Guadiana Romualdo.
In the same sense, Dr. emphasizes. Antonio Buño, Vice-President of the Spanish Society for Laboratory Medicine, how from the first moment the clinical laboratory has been an important piece in the proper organization of care, “From the diagnosis of infection by detecting the virus in airway samples to the tests needed for proper monitoring, prognosis and assistance in making therapeutic decisions,” he says.
Both experts, along with Drs. Daniel Morell García, member of the Evidence-Based Laboratory Medicine Commission of the SEQCML, will take part in the table organized by the Society at the congress, which will take place from 12 to 16 April.
De BIOCOVID register is an example of the work and involvement of laboratories in Spain during the pandemic.
As explained by Dr. Morell García this register is an initiative of the professionals of laboratory medicine in our country. It came up with the idea of ”identifying which of the number of laboratory tests that have been included in the laboratory profiles of these patients since the beginning of the pandemic, were really useful in identifying the patients at higher risk earlier”.
In addition, a second objective was raised, to convey to physicians the importance of the analytical methods used to measure these tests. The variability that can occur depending on the test used to measure a particular analytical parameter is a factor to consider.
The BIOCOVID study provided significant results for the management of COVID-19. Thus, he described four common laboratory parameters (creatinine, troponin, C-reactive protein, and platelets) as useful in determining the prognosis of COVID-19 patients.
Similarly, a substudy has made it possible to demonstrate the potential interest in the use of cut-off points stratified by sex for troponin to increase the ability to detect myocardial damage associated with a worse prognosis.
In addition, a definitive objective is to obtain a classification using techniques of machine learning, combine laboratory tests and other variables, to establish the COVID-19 patient’s prognosis to the Emergency Service.
New markers for the prognosis of the COVID-19 patient
Numerous studies are attempting to find new useful biomarkers for risk stratification in patients infected with SARS-CoV-2. Initial data from the second wave showed that some markers that were useful in the first wave, such as D-dimer or interleukin 6 (IL-6), did not behave in the same way in the second. It is probably necessary to have new markers that precede inflammation and thrombosis, characteristics of the most serious forms, “says Dr. García de Guadiana.
In this sense, “markers such as MR-proADM or suPAR, related to endothelial damage, a phenomenon that is being observed in these patients, may be useful in establishing the prognosis of these patients. The measurement is even recommended in a recent document of ‘ the Spanish Society of Emergency and Emergency Medicine (SEMES), although initial data are likely to need to be confirmed in larger cohorts, “he adds.
“In addition, laboratory medicine should be able to offer tools that allow evaluating the evolution of COVID-19 patients when the acute phase is over,” says this expert. To these lines, markers such as KL-6 (Krebs von den Lugen), with known prognostic value in interstitial lung disease, may be useful in detecting pulmonary fibrosis as a possible continuation of the disease.
Laboratory service at IFEMA Hospital
It is worth noting the organization and adaptation in record time and with enormous difficulties of professionals in clinical laboratory to provide coverage in the “field hospitals” created during the health crisis.
This is the case of the IFEMA hospital, created as an emergency device to overcome an urgent situation in the first wave that affected the community of Madrid in the third week of March 2020.
In record time, it was possible to start up the COVID-19 IFEMA Hospital, with 1,300 beds. In order to meet the needs of laboratory tests and the urgency with which everything had to be organized, it was decided to have an infrastructure on site that would allow the organization of samples, receive requests and send them to the Hospital laboratory. La Peace University.
An agile and safe transport of samples was organized. It was possible to guarantee a response time of less than two hours for scheduled requests and less than one hour for urgent requests. Similarly, nine multiparameter blood gas analyzers were installed, the determinations of which were made as point-of-care testing connected to the POCT network of La Paz Hospital.
During the entire period that COVID-19 IFEMA Hospital was open, a total of 4,933 analyzes were performed on 1,985 patients with a total of 88,022 tests in addition to 1,151 POCT blood gases.
The case of Emergency and Pandemic Hospital Nurse Isabel Zendal
“There are many similarities in the organizational model of the Nurse Isabel Zendal Emergency and Pandemic Hospital, which has already treated more than 4,000 patients, with the IFEMA field hospital, although they also have many differences,” explains Dr. Good.
“As far as the laboratory is concerned, the organizational model is the same. That is, the samples once extracted are received in a pre-analytical area and are ready to be sent to the laboratories of La Paz Hospital. Through scheduled shipments, they are transported, analyzed and the results are integrated into hospital information systems. In addition, we have connected blood gas analyzers to the POCT network of La Paz Hospital from where they can be checked and we can perform the tasks related to quality assurance, ”adds Dr. Good morning.
These are two examples of hospitals that have supported the rest of the health centers in the Community of Madrid in various scenarios of this pandemic. “In both cases, the laboratory had to be quickly organized and adapted to meet the needs of patients,” notes the vice-president of the Spanish Society of Laboratory Medicine.
Laboratory medicine has been severely affected by the COVID-19 pandemic. They had to “face important challenges such as reorganizing circuits, protocols and templates, as well as witnessing the decline due to contamination of our colleagues. Try laboratory safety procedures and learn in some cases to use specific personal protective equipment. Increase training in this new nosological entity, help interpret the results of laboratory tests and expand laboratory areas to serve the increase of existing demand “, concludes Dr. Good.