The Spanish Society of Laboratory Medicine organized the panel discussion "Contribution of laboratory medicine in the COVID-19 pandemic"
Since the beginning of the pandemic, laboratory medicine has played an essential role, being key in the risk stratification and monitoring of COVID-19 patients, thus contributing to their management. Dr Luis García de Guadiana Romualdo, president of the Commission of Biological Magnitudes related to Medical Emergencies of the SEQCML, insisted that laboratory tests, in combination with other clinical data, contribute to the identification of low-risk patients and also those who have a high risk of progression to the most serious forms of the disease. These tests are very useful for the establishment of outpatient treatment strategies, thus reducing patient care load in hospitals and monitoring of the course of the disease.
Along the same lines, Dr Antonio Buño, vice president of the SEQCML, stressed that from the first moment the clinical laboratory has been a key element in the correct organization of care. Starting with the diagnosis of the infection by detecting the virus in respiratory tract samples to the tests needed for correct follow-up, prognosis and help in making therapeutic decisions, the clinical laboratory is an absolutely fundamental piece in the complicated puzzle of this new situation.
Both experts, together with Dr Daniel Morell García, member of the Evidence-Based Laboratory Medicine Commission of the SEQCML, participated in the panel organized by the Society titled “Contribution of laboratory medicine in the COVID-19 pandemic” at the 2nd National Multidisciplinary COVID-19 Congress of Scientific Societies in Spain that was held between April 12 and 16 in virtual format.
The BIOCOVID registry is an example of the work and involvement of laboratory professionals in Spain during the pandemic. As explained by Dr Morell García, this registry is an initiative of the laboratory medicine professionals in our country which arose from the idea of identifying which of the numerous laboratory tests that were included from the beginning of the pandemic in analytical patient profiles were really useful in the early identification of patients at higher risk. In addition, a second objective was also proposed: to convey to physicians the importance of knowing the analytical methods used to measure these tests, given the variability that can occur depending on the test used to measure a given analytical parameter.
The BIOCOVID study has yielded important results for the management of COVID-19. Thus, it has established as useful 4 common laboratory parameters (creatinine, troponin, C-reactive protein, and platelet count) to establish the prognosis of COVID-19 patients. Likewise, a sub-study has made it possible to demonstrate the possible utility of the use of cut-off points, stratified by sex, for troponin, in order to increase the ability to detect myocardial damage associated with a worse prognosis. In addition, a final objective was to obtain a classification using machine-learning techniques, combining laboratory tests and other variables, in order to establish a prognosis for the COVID-19 patient admitted to the Emergency Service.
New markers for the prognosis of the COVID-19 patient
There are numerous studies that have tried to find new useful biomarkers for risk stratification in patients infected with SARS-CoV-2. Initial data from the second wave have shown that some markers that proved useful in the first wave, such as D-dimer or interleukin 6 (IL-6), did not behave in the same way in the second wave, and it is probably necessary, in the opinion of Dr García de Guadiana, to have available new markers that precede inflammation and thrombosis, characteristics of the most serious forms of the disease. He believes that markers such as MR-proADM or suPAR, related to endothelial damage, a characteristic finding in severe COVID-19, may be useful in establishing the prognosis of these patients; their measurement has been recommended in a recent document by the Spanish Society of Urgent and Emergency Medicine (SEMES), although the initial data will probably have to be confirmed in larger cohorts.
In addition, he believes that laboratory medicine must be able to offer tools that allow for the assessment of the evolution of COVID-19 patients once the acute phase has passed. In this sense, markers such as KL-6 (Krebs von den Lugen), with known prognostic value in interstitial lung disease, may be useful in detecting pulmonary fibrosis, a possible consequence of the disease.
Laboratory Service in "field hospitals"
The organization and adaptation in record time, and with enormous difficulties, of "field hospitals" that have been created to support existing ones is another clear example of the involvement of clinical laboratory professionals in this health crisis.
This is the case of the IFEMA hospital, created as an emergency service in the third week of March 2020 to address a pressing situation in the first wave, which was affecting the Community of Madrid. Dr Buño explained that the coronavirus epidemic had exploded in a very short period of time and the capacity to attend patients in the emergency services was overwhelmed, despite the fact that most of the centres had already taken all the measures that were within their reach. At that time, they were at their limit with more than 2,500 patients pending admission.
It was possible, in record time, to put the COVID-19 IFEMA Hospital, with 1,300 beds, into service. To meet the needs of laboratory tests and for the sake of the urgency with which everything had to be organized, it was decided to have an on-site infrastructure that would allow the samples to be organized, receive the requests, and send them to the La Paz University Hospital laboratory, located about 8 km away. An agile and secure transport of samples was organized and it was possible to guarantee a response time of less than 2 hours for scheduled requests and less than one hour for urgent requests. Likewise, 9 multiparameter blood gas analysers were installed, whose determinations were made as point-of-care-testing connected to the POCT network of Hospital La Paz.
During the entire period that the COVID-19 IFEMA Hospital was open, a total of 4,933 analyses were performed on 1,985 patients with a total of 88,022 tests in addition to 1,151 POCT blood gas tests.
There are many similarities with the IFEMA field hospital in the organizational model of the Nurse Isabel Zendal Emergency and Pandemic Hospital, which has treated more than 4,000 patients, although there are also many differences. Dr Buño stated that with regard to the laboratory, the organizational model is the same-- that is, the samples once extracted are received in a preanalytical area and are prepared to be sent to the Hospital La Paz laboratories. Through scheduled shipments they are transported, analysed, and the results are entered into hospital information systems. In addition, there were blood gas analysers connected to the POCT network of Hospital La Paz, where they were monitored and tasks related to quality assurance could be carried out.
These are two examples of hospitals that have supported the rest of the health centres of the Community of Madrid in different scenarios of this pandemic. In both cases, the laboratory has had to organize and adapt quickly to cover the needs of patients, emphasized the vice president of the Spanish Society of Laboratory Medicine.
In fact, according to Dr Buño, laboratory medicine has suffered a major impact from the COVID-19 pandemic, having to face important challenges such as readjusting circuits, protocols and templates, while also dealing with a staff reduction due to the infection of many colleagues. It was also necessary to review safety procedures in the laboratory and in some cases learn to use specific personal protective equipment; increase training in this new nosological entity; help interpret lab test results and expand lab areas to service increased demand; or actively participate in bringing the laboratory closer to the patient's bedside, known as point-of-care-testing, especially with the deployment of gasometers in different hospital units.