Elevated eosinophil count is related with lower anti-factor Xa activity in COVID-19 patients

Behavior of Eosinophil Counts in Recovered and Deceased COVID-19 Patients over the Course of the Disease

Knowledge about the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, particularly regarding the function of eosinophils, has been steadily emerging recently. There exists controversy regarding the implications of eosinophils in the coronavirus disease 2019 (COVID-19)’s pathology. We report a retrospective cohort study including the comparison of leukocyte counts in COVID-19 patients, considering the outcomes of recovery (n = 59) and death (n = 60). Among the different types of leukocytes, the eosinophil counts were those that showed the greatest difference between recovered and deceased patients. Eosinopenia (eosinophil count < 0.01 × 10⁹/L) was more frequently observed in deceased than recovered patients (p = 0.0012). The eosinophil counts more rapidly increased and showed a greater proportion over the course of the disease in the recovered than deceased patients. Furthermore, the estimated survival rate was greater in patients without eosinopenia than in patients with eosinopenia (p = 0.0070) during hospitalization. Importantly, recovered but not deceased patients showed high negative correlations of the eosinophils with the neutrophil-to-lymphocyte ratio (NLR) and neutrophil counts at Day 9 of the onset of clinical symptoms (p ≤ 0.0220). Our analysis suggests that eosinopenia may be associated with unfavorable disease outcomes and that the eosinophils have a beneficial function in COVID-19 patients, probably contributing by controlling the exacerbated inflammation induced by neutrophils.

Coronavirus infection: An immunologists' perspective

Coronavirus infections are frequent viral infections in several species. As soon as the severe acute respiratory syndrome (SARS) appeared in the early 2000s, most of the research focused on pulmonary disease. However, disorders in immune response and organ dysfunctions have been documented. Elderly individuals with comorbidities exhibit worse outcomes in all the coronavirus that cause SARS. Disease severity in SARS-CoV-2 infection is related to severe inflammation and tissue injury, and effective immune response against the virus is still under analysis. ACE2 receptor expression and polymorphism, age, gender and immune genetics are factors that also play an essential role in patients' clinical features and immune responses and have been partially discussed. The present report aims to review the physiopathology of SARS-CoV-2 infection and propose new research topics to understand the complex mechanisms of viral infection and viral clearance.

Can a modified-simplified pulmonary embolism severity index (m-sPESI) be used to predict the need for intensive care in hospitalized COVID-19 patients?

Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been considered a pandemic by the World Health Organization (WHO). Clinical manifestations of COVID-19 disease may differ, most cases are mild, but a significant minority of patients may develop moderate to severe respiratory symptoms, with the most severe cases requiring intensive care and/or mechanical ventilatory support. In this study, we aimed to identify validity of our modified scoring system for foreseeing the approach to the COVID-19 patient and the disease, the treatment plan, the severity of morbidity and even the risk of mortality from the clinician's point of view. In this single center study, we examined the patients hospitalized with the diagnosis of COVID-19 between 01/04/2020 and 01/06/2020, of the 228 patients who were between 20 and 90 years of age, and whose polymerase chain reaction (PCR) tests of nasal and pharyngeal swab samples were positive. We evaulated 228 (92 male and 136 female) PCR (+) patients. Univariate analysis showed that advanced age (p < 0.001), hemoglobin (p < 0.001), troponin-I (p < 0.001), C-reactive protein (CRP) (p < 0.001), fibrinogen (p < 0.001), HT (p = 0.01), CAD (p = 0.001), DM (p < 0.001), history of malignancy (p = 0.008), along with m-sPESI scores (p < 0.001) were significantly higher in patients that needed intensive care due to COVID-19 infection. In the multivariable logistic regression analysis, only the m-sPESI score higher than ≥ 2 was found to be highly significant in terms of indicating the need for ICU admission (AUC 0.948; 84.6% sensitivity and 94.6% specificity) (p < 0.001). With an increasing number of hospitalized patients, healthcare providers are confronting a deluge of lab results in the process of caring for COVID-19 patients. It is imperative to identify risk factors for mortality and morbidity development. The modified sPESI scoring system, which we put forward, is successful in predicting the course of the disease at the presentation of the patient with COVID-19 disease and predicting the need for intensive care with high specificity and sensitivity, can detect the need for intensive care with high specificity and sensitivity.