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Original article
Comparison of inflammation markers and severity of illness among patients with COVID-19, acute psychiatric disorders and comorbidity
Özgecan Tunaa,
Corresponding author
ozgecantuna@gmail.com

Corresponding author.
, Cagatay Ermisb, Asli Enez Darcinc, Ekin Dagistand, Serdar Salmand
a Department of Psychiatry, Kanuni Sultan Süleyman Training and Research Hospital, Turkey
b Department of Child and Adolescent Psychiatry, Diyarbakır Childrens' Hospital, Turkey
c İstanbul Ayvansaray University, Turkey
d Department of Psychiatry, Istanbul Bakirkoy Prof Dr. Mazhar Osman Ruh Mental and Nervous Diseases Training and Research Hospital, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Introduction</span><p id="para0001" class="elsevierStylePara elsevierViewall">The COVID-19 outbreak caused by SARS-CoV-2 continues&#44; with more than 200 million people getting infected and more than 5 million deaths as of December 2021&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> People infected with SARS-CoV-2 experience the infection with different severity levels&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Studies have shown that factors such as advanced age&#44; presence of comorbidities&#44; severe dyspnea&#44; fever&#44; abnormalities in biochemical measurements are related to disease severity&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> In the previous studies&#44; it has been reported that high levels of alanine aminotransferase &#40;ALT&#41;&#44; creatinine&#44; lactate dehydrogenase &#40;LDH&#41;&#44; C &#8208; reactive protein &#40;CRP&#41;&#44; neutrophil&#47;lymphocyte ratio &#40;NLR&#41;&#44; D-dimer&#44; and fibrinogen indicate higher severity of COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2-5</span></a></p><p id="para0002" class="elsevierStylePara elsevierViewall">Another interesting issue is the question of whether the prognosis of COVID-19 would be poorer among individuals with mental disorders&#46; In the study conducted by Nemani et&#160;al&#46; &#40;2021&#41; to investigate COVID-19-related mortality&#44; 7348 patients with a positive SARS-CoV-2 Polymerase Chain Reaction &#40;PCR&#41; test result were re-evaluated after 45 days&#46; Results showed that mortality is associated with schizophrenia spectrum diagnoses but not with anxiety disorders and mood disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Lee et&#160;al &#40;2020&#41; also reported patients with a severe mental illness had a worse prognosis of COVID-19 when compared with patients without a history of mental illness&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">Cytokines increased by inflammatory stimuli or infections may cause systemic symptoms&#44; especially during acute inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> This acute phase response includes some clinical and pathological changes such as fever and elevated acute-phase proteins &#40;CRP&#44; fibrinogen&#44; ferritin&#44; serum amyloid A protein&#44; procalcitonin&#44; etc&#46;&#41; as well as an increase in neutrophils&#44; platelets&#44; and NLR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> These inflammation markers increase in those having infections such as MERS&#44; SARS&#44; SARS-CoV-2&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> On the other hand&#44; the increase in inflammation markers also has been shown in those with severe mental illnesses such as schizophrenia and bipolar disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0012"><span class="elsevierStyleSup">12-14</span></a> As seen in the previous pandemics&#44; increased rates of acute psychiatric conditions and acute exacerbations of remitted patients have been reported in the COVID-19 epidemic&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">15-17</span></a> These reports attract the attention of researchers&#44; giving rise to further efforts to investigate the relationship between mental disorders and pandemics&#46; It is known that both psychosocial and immune factors play a role in the etiopathogenesis of psychiatric illness&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a></p><p id="para0004" class="elsevierStylePara elsevierViewall">According to the hypothesis of Raony et&#160;al&#46; &#40;2020&#41;&#44; changes in cytokine levels can be considered as a link between immune system alterations and mental health disorders during COVID-19 infection&#44; as they play a possible role in disrupting neurotransmitter metabolism&#44; leading to behavioral changes&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> A meta-analysis of 16 studies by Wang et&#160;al&#46; &#40;2018&#41; reported that Cerebrospinal fluid levels of several interleukins &#40;IL&#41; such as IL-1&#946;&#44; IL-6&#44; and IL-8 were significantly increased in patients with schizophrenia compared to controls&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> It is also assumed that Human Coronaviruses &#40;HCoVs&#41; enter the central nervous system by retrograde neuronal routes &#40;via the olfactory nerve and enteric nervous system&#41; and hematogenous spread &#40;via infected leukocytes that cross the blood-brain barrier&#44; carrying the virus to the brain and&#47;or by the direct infection of angiotensin-converting enzyme 2 expressing brain microvascular endothelial cells&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Severance et&#160;al&#46; &#40;2011&#41; also suggested that immunoglobulin G response against human coronavirus &#40;NL63&#41; is associated with psychotic symptoms&#44; and exposure to coronaviruses may be a comorbid risk factor in people with severe mental disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">Although the SARS-CoV-2 infection and associated immune alterations could lead to psychotic exacerbations&#44; the laboratory assessment of COVID-19 patients treated for a mental disorder was not investigated&#44; especially considering cardiovascular or metabolic burden and morbidity of psychiatric disorders&#46; Moreover&#44; given the immune system disturbances shown in COVID-19 infection might have mental health outcomes&#44; the laboratory assessments of individuals treated for both COVID-19 and having a severe psychiatric disorder were not compared with those suffering from COVID-19&#46; Most clinicians need further knowledge about complications and the treatment of patients having both COVID-19 and a severe mental disorder&#46; These acutely-ill individuals suffering from dual health conditions could be at risk for more severe complications than seen in COVID-19 itself&#46; Therefore&#44; in this study&#44; we aimed to evaluate the inflammatory markers and the rates of complications among inpatients treated for a severe mental disorder along with COVID-19 by comparing with other inpatients with COVID-19 and without a psychiatric disorder&#46; Secondly&#44; we assessed the inflammatory markers of peripheral blood within inpatients with COVID-19 and a psychiatric disorder&#46; Finally&#44; we aimed to demonstrate the clinical outcomes of COVID-19 and the blood markers of the inflammation in an acutely-ill psychiatric population treated in the psychiatric ward for COVID-19 &#40;for those having both clinical conditions&#41; by comparing with patients treated in the regular psychiatry services and regular COVID-19 inpatient units&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Materials and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Study design</span><p id="para0006" class="elsevierStylePara elsevierViewall">As a response to the hospitalization needs of patients with acute psychiatric conditions accompanying COVID-19&#44; a special ward was designed at Kanuni Sultan S&#252;leyman Training and research hospital in April 2020&#46; The hospital was also declared as the main treatment center for COVID-19&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">The study was designed as a retrospective cohort study&#46; Three patient groups aged between 18-65 years from different units were consecutively included in the study&#58; i&#41; COVID-19 and psychiatric disorder group &#40;COVID-19&#43;PD&#41;&#58; The group was composed of patients hospitalized in the COVID-19 special psychiatry unit&#46; These patients were having acute psychiatric disorders together with COVID-19&#46; The diagnosis of COVID-19 was confirmed by PCR testing&#46; ii&#41; COVID-19 group&#58; The group was composed of patients hospitalized in the COVID-19 unit&#46; They were diagnosed with COVID-19 and had no psychiatric diagnoses&#46; The diagnosis of COVID-19 was confirmed by PCR testing&#46; iii&#41; Psychiatric disorder group &#40;PD&#41;&#58; The group involved patients hospitalized with an acute psychiatric disorder in the psychiatric ward of the hospital&#46; They didn&#39;t have COVID-19&#46; These patients had no COVID-19 related symptoms and it&#39;s confirmed by PCR testing that patients do not have COVID-19&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">All participants were inpatients from the same hospital at the same time interval&#46; By screening electronic patient files between May-August 2020&#44; sociodemographic information&#44; inflammation- and COVID-19-related inflammation markers&#44; clinical diagnoses&#44; treatments&#44; and complications were collected&#46;</p><p id="para0012" class="elsevierStylePara elsevierViewall">All patients were admitted to both psychiatry and COVID-19 wards from the emergency room&#46; The diagnosis of COVID-19 was confirmed by PCR testing&#46; The COVID-19 treatment was determined in line with the national treatment guideline available at that time&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> Patients in psychiatry wards were hospitalized for suicide risk&#44; aggression&#44; exacerbation of existing psychotic disorder&#44; non-compliance with oral or intramuscular treatment&#46; Participants recruited from psychiatric wards suffered from a diagnosis of schizophrenia&#44; bipolar disorder&#44; major depression&#44; psychosis spectrum disorders&#44; or severe anxiety disorder&#44; and were hospitalized for a median of 3 weeks&#46; Psychiatric diagnoses and treatments were organized by experienced psychiatry consultants according to their best choices&#46; All psychiatric disorders were treated with psychotropic medications and electroconvulsive therapy was not used&#46; Most patients were treated with first- or second-generation antipsychotics and mood stabilizers&#46; For all study groups&#44; patients with autoimmune diseases&#44; immune deficiency&#44; autoinflammatory illnesses&#44; active malignancy&#44; treated with oral corticosteroids&#44; immunosuppressive drugs&#44; or biological agents were excluded&#46; Likewise&#44; mental retardation&#44; autism spectrum disorders&#44; were not included in the study&#46; The complications were periodically recorded during the clinical follow-up&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">The official approval of the study was received from the Institutional Review Board and Ministry of Health &#40;COVID-19 Scientific Research Platform&#41;&#46; Also&#44; the Local Ethics Committee reviewed and approved the study protocol and waived the requirement of obtaining informed consent due to the retrospective nature of the study&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Laboratory procedures</span><p id="para0014" class="elsevierStylePara elsevierViewall">On the first day of the hospitalization&#44; blood samples were routinely collected at 7 am after overnight fasting&#46; Absolute neutrophil count &#40;ANC&#41;&#44; CRP&#44; platelet counts&#44; lymphocyte counts&#44; ALT&#44; creatinine&#44; ferritin&#44; NLR parameters are measured as indicators of the inflammatory response&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> D-dimer&#44; fibrinogen&#44; LDH&#44; CRP&#44; lymphocyte counts&#44; ALT&#44; NLR values &#8203;&#8203;have been previously shown as values &#8203;&#8203;indicating the prognosis of COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2-5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> Electrocardiograms in the patient files were used to calculate the corrected QT interval of hospitalized subjects&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">CALL score &#40;C&#160;&#61;&#160;co-morbidity&#44; A&#160;&#61;&#160;age&#44; L&#160;&#61;&#160;lymphocyte count&#44; L&#61; LDH&#41; was determined by Ji et&#160;al&#46; &#40;2020&#41; to predict the progression risk in patients with COVID-19 pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> The CALL score ranges between 4-13 points and is calculated as using &#40;Comorbidity&#160;&#61;&#160;1-4 points&#44; Age&#160;&#61;&#160;1 - 3 points&#44; Lymphocyte counts&#61; 1 - 3 points&#44; LDH&#61; 1 -3 points&#41;&#46; Systemic Immune-Inflammation Index &#40;SII&#41; was defined by Hu et&#160;al&#46; &#40;2014&#41; to reflect the degree of systemic inflammation and immune response&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> It was calculated based on peripheral lymphocyte&#44; neutrophil&#44; and platelet counts &#40;SII&#160;&#61;&#160;Platelet counts x Neutrophil counts &#47; Lymphocyte counts&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Statistical analysis</span><p id="para0016" class="elsevierStylePara elsevierViewall">Continuous variables were demonstrated as means and standard deviations and categorical variables were shown as frequencies&#46; Continuous variables were compared using the independent sample t-test and the one-way ANOVA test as per the number of groups involved in the analysis&#46; Categorical variables were compared by the chi-square test&#46; When cell size was equal to or less than 5&#44; Fisher&#39;s exact test was applied&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">To compare laboratory parameters&#44; ANCOVA models controlled for age and gender effects were implemented&#46; Laboratory values were the dependent outcomes of ANCOVA models&#46; The significance levels were obtained from posthoc tests&#46; In posthoc analyses&#44; the Bonferroni test was preferred to reduce the likelihood of type-I error&#46; The alpha level was set at 0&#46;05 for each comparison&#46; The Statistical Package for Social Sciences version 24 &#40;IBM Corporation&#44; Armonk&#44; NY&#41; was used for data analyses&#44;</p></span></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Results</span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Sociodemographic characteristics and medical comorbidities</span><p id="para0018" class="elsevierStylePara elsevierViewall">Sociodemographic&#44; clinic&#44; and treatment characteristics of the study groups were shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46; The study groups differed significantly for the mean age &#40;F&#61;24&#46;6&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#46; There were no significant differences regarding gender and the duration of education&#46; CALL scores of both COVID-19 groups were similar&#46; Additionally&#44; smoking status significantly differed among study groups &#40;&#935;<span class="elsevierStyleSup">2</span>&#61; 20&#46;7&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#46; Smoking was less common in the COVID-19 group than those found in the COVID-19&#43;PD and PD groups&#46; Other medical comorbidities were similar across study groups&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Laboratory paratmeters &#38; inflammation markers</span><p id="para0019" class="elsevierStylePara elsevierViewall">The comparison of laboratory parameters of the three groups was demonstrated in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#46; ALT and creatinine levels were similar across study groups&#46; Both COVID-19 groups also had similar D-dimer levels&#46; SII values were significantly higher in the COVID-19&#43;PD group compared to the other two groups &#40;F&#61;5&#46;3&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;007&#41;&#46; Besides&#44; LDH values were found to be lower in the COVID-19&#43;PD group compared to the COVID-19 group and lower in the PD group compared to both groups &#40;F&#61;15&#46;9&#44; <span class="elsevierStyleItalic">p</span>&#60; 0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0020" class="elsevierStylePara elsevierViewall">The COVID-19&#43;PD group had higher ANC levels than the COVID-19 group &#40;F&#61;7&#46;4&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#46; Although the ANC value in PD group was between both groups&#44; it was not significantly different from the two groups&#46; NLR ratio was higher in COVID-19&#43;PD group than PD group &#40;F&#61;9&#46;8&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#46; Finally&#44; ferritin and CRP levels were found higher in both COVID-19 groups than the PD group &#40;for ferritin&#44; F&#61;6&#46;3&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;003&#59; for CRP&#44; F&#61;8&#46;5&#44; <span class="elsevierStyleItalic">p</span>&#60; 0&#46;001&#41;&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Prognosis and complications</span><p id="para0021" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a> provides the cardiovascular complications of the COVID-19 during their hospitalizations&#46; Study groups did not statistically differ for a particular complication&#46; When all cardiovascular complications were assessed together&#44; the COVID-19&#43;PD group more frequently showed a cardiovascular incident than that of the COVID-19 group &#40;21&#46;1&#37; vs&#46; 3&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;035&#41;&#46; Cardiovascular arrest&#44; respiratory failure&#44; and death were not observed in the study population&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0022" class="elsevierStylePara elsevierViewall">Finally&#44; Table S1 shows that the COVID-19 group more commonly received favipiravir treatment than the COVID-19&#43;PD group and other medical treatments were similar between COVID-19 inpatient groups&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Discussion</span><p id="para0023" class="elsevierStylePara elsevierViewall">The results of our study showed that the severity of COVID-19&#44; assessed by the CALL score was similar between study groups with COVID-19&#46; Results also showed ANC and SII levels were higher and LDH and fibrinogen levels were lower in the COVID-19&#43;PD patient group compared to the COVID-19 inpatients&#46; Third&#44; when compared to psychiatric inpatients without COVID-19&#44; the COVID-19&#43;PD group had higher SII&#44; NLR&#44; ferritin&#44; and CRP levels&#46;</p><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Prognostic factors of COVID-19 in the psychiatric sample</span><p id="para0024" class="elsevierStylePara elsevierViewall">In the previous literature&#44; D-dimer&#44; fibrinogen&#44; NLR&#44; LDH&#44; CRP&#44; and low lymphocyte count were found as poor prognostic factors in COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> In our study&#44; fibrinogen and LDH values were found to be lower in the COVID-19&#43;PD group compared to the COVID-19 group&#46; Also&#44; there was no significant difference was found between COVID-19 groups in terms of D-dimer&#44; NLR&#44; CRP&#44; and lymphocyte counts&#46; These results of our study suggested the COVID-19&#43;PD group did not have a higher illness severity and a worse prognosis than the COVID-19 inpatients without a psychiatric disorder&#46; Besides&#44; the total CALL scores of the COVID-19 groups were similar&#44; indicating similar infection severity in both groups&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Cardiac complication rates were also similar and other severe complications of COVID-19 &#40;e&#46;g intensive care unit admission&#44; respiratory failure&#44; and so on&#41; were not seen in our sample&#46; While these results indicate a favorable prognosis of the COVID-19 in our study compared to previous literature with higher mortality and morbidity rates&#44; our results could suggest that the presence of exacerbated psychiatric disorders does not adversely affect the course of COVID-19&#46; On the other hand&#44; it should be taken into account that patients with severe mental disorders have disadvantages and difficulties in reaching health services during pandemic periods&#44; leading to low treatment compliance&#44; and are susceptible to drug interactions&#44; especially when receiving both neuroleptic drugs and the treatment of the infection&#46; These disadvantageous situations should be kept in mind while interpreting these results related to mental disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Inflammation markers</span><p id="para0025" class="elsevierStylePara elsevierViewall">In our study&#44; ANC and SII were found higher in the COVID-19&#43;PD group compared to the COVID-19 patient group&#46; Neutrophil&#44; NLR&#44; SII are the markers that can be obtained via routine blood work&#44; showing systemic inflammatory response&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> This result somewhat supported the notion that there was a more systemic inflammatory response to SARS-CoV-2 in acutely-ill patients with severe psychiatric disorders&#46; Epidemiological studies conducted during epidemic periods have shown that infections could also trigger psychiatric diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Debates over the role of inflammatory responses as a trigger of severe psychiatric disorder remained inconclusive and the exact etiopathogenesis of such effect has not been elucidated yet&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a></p><p id="para0026" class="elsevierStylePara elsevierViewall">Several mechanisms explain the neural effects of the inflammatory response&#46; A current hypothesis suggests that the activation of brain microglial cells causes the increased production of pro-inflammatory cytokines and free radicals&#46; This may lead to neuronal degeneration&#44; white matter abnormalities&#44; and decreased neurogenesis&#44; which are associated with the pathophysiology of schizophrenia&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> Cytokines can also directly alter the activity of enzymes involved in tryptophan catabolism&#46; Induction of the enzyme indoleamine 2&#44;3-dioxygenase by pro-inflammatory cytokines results in the increased production of kynurenine&#44; which is also converted to kynurenic acid and quinolinic that modulate glutamatergic N-methyl D-aspartate receptors in the brain&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Although there are several links between the development of mental disorders triggered by immunologic responses&#44; the underlying effects of immune mechanisms on neurochemical processes of the brain still require further exploration&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">On the other hand&#44; ANC in the PD group did not differ from those of the other study groups and SII in the PD group was significantly lower compared to the COVID-19&#43;PD group&#46; Moreover&#44; higher SII values in the COVID&#43;PD group suggest that patients with psychiatric disorders might be prone to an excessive inflammatory response to COVID-19&#46; The similarity between COVID-19 and PD groups in terms of ANC and SII values was also somewhat surprising&#46; Accordingly&#44; patients with psychiatric disorders seem to have some similarities in inflammatory markers to those seen in individuals with COVID-19&#46; However&#44; these preliminary results should be further investigated and tested by larger studies&#46;</p></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">The relationship between COVID-19 and psychiatric disorders</span><p id="para0028" class="elsevierStylePara elsevierViewall">During the COVID-19 pandemic&#44; clinicians reported serious cases with exacerbated mental illness such as first-episode psychosis&#44; mood swings&#44; and suicide attempts&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> In a study including patients with COVID-19&#44; NLR was positively related to patients&#39; self-perceived illness severity&#46;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> In the same study&#44; IL levels such as IL-1&#946;&#44; IL-6&#44; IL-8&#44; IL-10&#44; tumor necrosis factor-&#945;&#44; high-sensitive CRP&#44; and blood cell counts &#40;e&#46;g white blood cells&#44; neutrophils&#44; lymphocytes&#41; were also related to mental health&#46;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> Our results extended previous findings by demonstrating the increase in ANC and SII in the COVID-19&#43;PD group&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">In a recent study conducted in Italy&#44; results have shown that neutrophil counts and NLR in patients with COVID-19 are associated with self-reported depression levels&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> Previous literature also reported higher NLR in COVID-19 cases who developed psychosis&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Mazza et&#160;al&#46; &#40;2020&#41; re-evaluated the depression and anxiety levels of 402 patients hospitalized for COVID-19 at the first month of the hospital discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> Their findings showed that SII measured during hospitalization was positively associated with depression and anxiety scores during the follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> According to the results of our study&#44; the higher levels of SII and ANC in the COVID-19&#43;PD group compared to the COVID-19 group contributed to our current understanding of the potential immunological mechanisms of acute infections&#44; which might have a possible role in the newly emerging mental disorders&#46; Considering cytokines in the blood cannot be measured in clinical practice&#44; SII and ANC could be cheap&#44; accessible&#44; and quick tools that can be used in clinical practice&#46; Therefore&#44; both laboratory measurements could be indicative of future psychopathology&#46; patients with COVID-19 with elevated SII and ANC may be more likely to develop psychiatric disorders&#46; Clinicians should be careful about mental disorders that can be triggered by the infection&#46;</p></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Prognosis and complications</span><p id="para0030" class="elsevierStylePara elsevierViewall">In our study&#44; there was no significant difference between the COVID-19 groups regarding cardiac complications such as arrhythmias&#44; QT prolongation&#44; and acute coronary syndrome&#46; Besides&#44; taken together&#44; total rates of cardiac complications were higher in the COVID-19&#43;PD group&#46; It has been reported that drugs used in the treatment of COVID-19 can prolong the QT interval on EKG and could pose a risk for sudden cardiac death&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> Neuroleptic drugs use in patients with severe mental disorders may cause similar changes in electrocardiograms and cause serious cardiac events&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> Although this information raises suspicion over the potential cardiac risks of the coexistence of COVID-19 and severe mental illness&#44; in the study sample&#44; no life-threatening outcome or mortality was observed&#46; Nevertheless&#44; multi-center and larger cohorts are needed to predict cardiac risks of patients suffering from both health conditions&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Clinical implications</span><p id="para0031" class="elsevierStylePara elsevierViewall">In our study&#44; the COVID-19&#43;PD group differed from the other two groups regarding increased SII&#46; Also&#44; the COVID-19&#43;PD group had higher NLR&#44; CRP&#44; ferritin&#44; and lower lymphocyte counts than acute psychiatric inpatients without COVID-19&#46; Increased SII seems to be a marker of SARS-CoV-2 infection in psychiatric wards&#46; The inpatient units of mental health hospitals are at risk for the spread of infection&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Many cases with COVID-19 were diagnosed in the inpatient units of mental health hospitals throughout the pandemic and it was emphasized that almost all patients rapidly caught COVID-19 after the detection of the first cases in psychiatric wards&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a> Many cases with COVID-19 could be asymptomatic or showed no apparent severe symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> Likewise&#44; many cases can transmit the disease to others during the prodromal stage when they are asymptomatic&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> In this context&#44; screening the biochemical alterations of these patients and the early recognition of asymptomatic patients in psychiatric wards could be life-saving in many aspects&#46; Considering that COVID-19 PCR tests do not seem feasible to be routinely performed for screening within inpatient psychiatric units with limited sources&#59; blood count measurements can be a cheaper and easier way to detect those requiring gold-standard PCR tests especially for asymptomatic cases&#46; Elevated SII could alert the clinician for COVID-19 like elevated NLR&#44; CRP&#44; and ferritin&#46; Similarly&#44; despite being nonspecific&#44; these inflammatory markers could be considered to rule out a possible infection in psychiatric wards&#44; especially when a negative PCR test result could not exclude possible COVID-19 cases in psychiatry services&#46;</p></span><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Limitations and strengths</span><p id="para0032" class="elsevierStylePara elsevierViewall">The limitations of the study have to be considered&#46; The age difference among study groups might affect the results&#46; This finding was consistent with the previous literature regarding the effect of age on the severity of COVID-19&#44; especially when considering that patients were consecutively included in the study&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> To keep this variable constant&#44; we implemented ANCOVA models adjusted for age and gender&#46; Second&#44; the small sample size was associated with lower rates of severe complications&#46; The cross-sectional assessment of biochemical parameters was not able to show the changes during the clinical course&#46; Additionally&#44; COVID-19 treatments were administered according to the guidelines of the period in which the study was conducted and the treatments of that period became outdated&#46; Finally&#44; favipiravir use was different between COVID-19 groups&#44; which could play a confounding role in study results&#46; Given that the patients with psychiatric comorbidities using multiple psychotropic medications are susceptible to drug interactions&#44; we assume clinicians could be hesitant about using favipiravir for the treatment of COVID-19&#44; which ultimately may have had an impact on the study results&#46; Despite all these limitations&#44; our research provided a unique contribution to existing knowledge and demonstrated the clinical severity&#44; prognosis&#44; and outcomes of patients with COVID-19 together with an acute psychiatric disorder&#46;</p></span></span><span id="sec0017" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Conclusions</span><p id="para0033" class="elsevierStylePara elsevierViewall">Patients with both an acute severe mental disorder and COVID-19 are a special group to be treated carefully in clinical practice&#46; In our study&#44; the global severity of the illness&#44; inflammatory markers&#44; and clinical outcomes of these patients were not markedly worse than those suffering from COVID-19&#46; NLR&#44; SII&#44; CRP&#44; ferritin&#44; and lower lymphocyte counts could be helpful for clinicians in the early diagnosis of possible COVID-19 infection to prevent the spread of infection in psychiatric wards&#46; Future studies should focus on specific diagnostic categories as well as medications used in the treatment of affective and psychotic disorders&#46;</p></span></span>"
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          "titulo" => "Materials and methods"
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              "titulo" => "Sociodemographic characteristics and medical comorbidities"
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          "titulo" => "Abbreviations"
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          "palabras" => array:11 [
            0 => "Absolute neutrophil count"
            1 => "Alanine aminotransferase"
            2 => "Comorbidity"
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            4 => "C-reactive protein"
            5 => "Interleukin"
            6 => "Lactate dehydrogenase"
            7 => "Neutrophil&#47;lymphocyte ratio"
            8 => "Polymerase Chain Reaction"
            9 => "Psychiatric disorder group"
            10 => "Systemic immune-inflammation index"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001a">Background and objectives</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Neutrophil&#44; lymphocyte counts&#44; lactate dehydrogenase &#40;LDH&#41;&#44; D-dimer&#44; fibrinogen&#44; and comorbid illness are associated with the course and prognosis of COVID-19&#46; However&#44; the course of acute severe psychiatric disorders overlapping with COVID-19 infection was not investigated and remained as an unclarified research area&#46; This study aimed to demonstrate inflammatory markers and the course of patients suffering from both conditions&#46;</p></span> <span id="abss0001a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001b">Methods</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Thirty-eight inpatients with COVID-19 and comorbid acute psychiatric disorders &#40;COVID-19&#43;PD&#41;&#44; 31 inpatients with COVID-19&#44; and 38 inpatients with an acute psychiatric disorder &#40;PD&#41; were included in the study&#46; Neutrophil&#44; lymphocyte counts&#44; serum ferritin&#44; lactate dehydrogenase &#40;LDH&#41;&#44; D-dimer&#44; fibrinogen&#44; Systemic immune-inflammation index &#40;SII&#41;&#44; neutrophil&#47;lymphocyte ratio &#40;NLR&#41;&#44; and C-reactive protein &#40;CRP&#41; were compared to evaluate inflammation levels&#46;</p></span> <span id="abss0002a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005b">Results</span><p id="spara010a" class="elsevierStyleSimplePara elsevierViewall">Patients with SARS-CoV-2 infection had older age compared to the PD group&#46; CALL &#40;Comorbidity&#44; age&#44; lymphocyte&#44; lactate dehydrogenase&#41; scores which predict the progression risk in patients with COVID-19 pneumonia&#44; of both COVID-19 groups were found similar&#46; The COVID-19&#43;PD had higher SII in the study sample&#46; Additionally&#44; the COVID-19&#43;PD group had higher NLR&#44; ferritin&#44; and CRP levels than those of the PD group&#46;</p></span> <span id="abss00021" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle00051">Conclusions</span><p id="spara011a" class="elsevierStyleSimplePara elsevierViewall">The prognosis of COVID-19 is not worse when accompanied by a psychiatric disorder&#46; Laboratory assessment can guide clinicians to distinguish those infected with SARS-CoV-2 within psychiatric inpatient units&#46; The biochemical assessment did not robustly support higher inflammatory levels in the comorbid COVID-19 and psychiatric disorder group compared to the COVID-19 group&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0001"
            "titulo" => "Background and objectives"
          ]
          1 => array:2 [
            "identificador" => "abss0001a"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abss0002a"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abss00021"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">CHD&#58; Coronary heart disease&#44; COPD&#58; Chronic obstructive pulmonary disease&#44; COVID-19&#61;Coronavirus disease-19&#44; COVID-19&#43;PD&#61;Coronavirus disease-19 and psychiatric disorder&#44; CVD&#58; Cardiovascular disease&#44; HBV&#58; Hepatitis B virus&#44; N&#47;A&#61; not applicable&#44; PD&#61;psychiatric disorder&#44; SD&#61;standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">COVID-19&#43;PD&#44; n &#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">COVID-19&#44; n&#61;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PD&#44; n&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Statistics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age&#44; years&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">45&#46;7 &#177; 13&#46;6 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&#46;8 &#177; 10&#46;2 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">32&#46;8 &#177; 8&#46;8 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">F&#61;24&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Gender&#44; female n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;28&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15 &#40;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span> &#61;2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;363&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Education&#44; years&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;4 &#177; 4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;6 &#177; 4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;1 &#177; 4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">F&#61;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Current smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20 &#40;52&#46;6&#41; <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;6&#46;5&#41; <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21 &#40;55&#46;3&#41; <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#61; 20&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Medical comorbidities&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;10&#46;5&#41; <span class="elsevierStyleSup">AB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7 &#40;22&#46;6&#41; <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41; <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;009</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypothyroidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>CHD or CVD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;375&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac illness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;165&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>HBV infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#61; 1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;561&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Epilepsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#935;<span class="elsevierStyleSup">2</span>&#160;&#61;&#160;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;419&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>CALL score <a class="elsevierStyleCrossRef" href="#tb1fn1"><span class="elsevierStyleSup">a</span></a>&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;6 &#177; 2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;2 &#177; 2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">t&#61;1&#46;2 <a class="elsevierStyleCrossRef" href="#tb1fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Total N<span class="elsevierStyleSup">o</span> of AP&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;1 &#177; 0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">t&#61; 1&#46;8 <a class="elsevierStyleCrossRef" href="#tb1fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tb1fn1"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0002">CALL scores were calculated for patients with COVID-19&#44; abiding by Ji et&#160;al &#40;2020&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tb1fn2"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0003">Independent sample t-test</p> <p class="elsevierStyleNotepara" id="notep0004">&#42;Different superscripts indicate statistical differences between two groups at p&#60;0&#46;05&#47;3 level&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic&#44; clinic&#44; and treatment characteristics of study participants&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">ALT&#58; Alanine transaminase&#44; ANC&#58; Absolute neutrophil count&#44; COVID-19&#61;Coronavirus disease-19&#44; COVID-19&#43; PD&#160;&#61;&#160;Coronavirus disease-19 and psychiatric disorder&#44; CRP&#58; C &#8208; reactive protein&#44; LDH&#58; Lactate dehydrogenase&#44; NLR&#58; Neutrophil to lymphocyte ratio&#44; PD&#61;psychiatric disorder&#44; QTc&#58; corrected QT interval&#44; SD&#58; standard deviation&#44; SII&#58; Systemic Immune-Inflammation Index&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0109"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variables at admission &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0110"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">COVID-19&#43;PD&#44; n &#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0111"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">COVID-19&#44; n&#61;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0112"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PD&#44; n&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0113"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">F <a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0114"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">ALT&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">23&#46;3 &#177; 18&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26&#46;2 &#177; 12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30&#46;8 &#177; 41&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;664&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">LDH&#44; U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">263 &#177; 96 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">324 &#177; 92 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">184 &#177; 41 <span class="elsevierStyleSup">C</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#60; 0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Creatinine&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9 &#177; 0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;8 &#177; 0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;8 &#177; 0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;419&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Ferritin&#44; ng&#47;mL <a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">241 &#177; 204 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">319 &#177; 245 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">76 &#177; 60 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">D-dimer&#44; mg&#47;L <a class="elsevierStyleCrossRef" href="#tb2fn3"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;3 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0141"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;8 &#177; 0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fibrinogen&#44; mg&#47;dL <a class="elsevierStyleCrossRef" href="#tb2fn3"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">387 &#177; 135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">471 &#177; 161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;016</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">ANC&#44; 10&#179;&#47;&#956;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;0 &#177; 2&#46;9 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;7 &#177; 1&#46;6 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;3 &#177; 1&#46;8 <span class="elsevierStyleSup">AB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0155"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lymphocyte&#44; 10&#179;&#47;&#956;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;7 &#177; 0&#46;7 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;6 &#177; 0&#46;7 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;7 &#177; 0&#46;6 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#60; 0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Platelets&#44; 10&#179;&#47;&#956;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">230 &#177; 83 <span class="elsevierStyleSup">AB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">217 &#177; 77 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">273 &#177; 63 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;025</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NLR ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;3 &#177; 3&#46;4 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;0 &#177; 1&#46;8 <span class="elsevierStyleSup">AB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;1 &#177; 1&#46;0 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#60; 0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CRP&#44; mg&#47;L <a class="elsevierStyleCrossRef" href="#tb2fn4"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0176"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">32&#46;4 &#177; 51&#46;0 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&#46;6 &#177; 52&#46;1 <span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;6 &#177; 6&#46;5 <span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">&#60; 0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">QTc interval&#44; ms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">420&#46;6 &#177; 23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">421&#46;0 &#177; 27&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">424&#46;7 &#177; 29&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;648&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SII&#44; 10&#179;&#47;&#956;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1047&#46;4 &#177; 176&#46;1<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">607&#46;2 &#177; 85&#46;8<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0190"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">572&#46;0 &#177;271&#46;1<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;007</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
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            0 => array:3 [
              "identificador" => "tb2fn1"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0006">Results were compared using ANCOVA models&#44; adjusted by age and gender&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tb2fn2"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0007">Values of 13 cases are missing in the PD group</p>"
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            2 => array:3 [
              "identificador" => "tb2fn3"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0008">Values of the PD group are missing&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tb2fn4"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0009">Values of 5 cases are missing in the PD group</p> <p class="elsevierStyleNotepara" id="notep0010">&#42;Different superscripts indicate statistical differences between two groups at p&#60;0&#46;05&#47;3 level&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Comparison of laboratory values using ANCOVA models&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:3 [
          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">COVID-19&#61;Coronavirus disease-19&#44; COVID-19&#43; PD&#160;&#61;&#160;Coronavirus disease-19 and psychiatric disorder&#44;</p><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">PD&#61;psychiatric disorder&#44; QTc&#58; corrected QT interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0193"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Cardiovascular complications&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0194"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">COVID-19&#43;PD&#44;n &#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0195"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">COVID-19&#44;n&#61;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0196"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Statistics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0197"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Bradycardia &#40;symptomatic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fisher&#39;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0203"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Tachycardia &#40;symptomatic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0204"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fisher&#39;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;622&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">QTc prolongation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0211"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fisher&#39;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;498&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0213"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Acute coronary syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fisher&#39;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0218"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">Arrhythmia <a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0220"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fisher&#39;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0222"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0223"></a><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0226"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">Fisher&#39;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;035</span>&nbsp;\t\t\t\t\t\t\n
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ISSN: 02136163
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos