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Kılıc J, Ebik B, Bacaksız F, Ekin N, Kalın BS. IS LYMPHOPENIA A PREDICTOR OF MORTALITY IN PATIENTS WITH COVID-19? Acta Clin Croat 2023; 62:82-87. [PMID: 38304379 PMCID: PMC10829944 DOI: 10.20471/acc.2023.62.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/24/2022] [Indexed: 02/03/2024] Open
Abstract
In this study, we evaluated the relation between the presence of lymphopenia and the need of intensive care unit (ICU) or mortality. A total of 1670 COVID-19 patients were divided according to the severity of lymphopenia developing at the time of COVID-19 infection. According to the symptoms and need of ICU, the infection was classified as mild or severe. The rates of severe infection, ICU admission, and mortality were evaluated between the groups. Among 1670 patients, 576 (34.4%) patients had severe disease and 1094 (65.6%) patients had a mild form of the disease; 213 (12.7%) patients with severe COVID-19 died. The severe form of COVID-19 was more common in patients with low lymphocyte levels (<500) than in those with normal lymphocytes count (64.7% vs. 5.2%; p<0.001). The odds ratio of lymphopenic patients was 2.4 (1.8-3.0; p=0.001). The risk of severe COVID-19 infection and mortality was 8.9 and 12.4 times higher in patients with low lymphocyte count compared to patients with normal lymphocyte count subsequently. ROC analysis showed that lymphocyte counts lower than 615 lym/mcL had 96.4% sensitivity for severe disease (AUC:0.89 (0.842-0.938); p<0.001). There was a significant negative correlation between lymphocyte count and mortality rate and severe COVID-19 disease (for severe COVID-19 r=-0.590; p<0.001and for mortality r=-0.511; p=0.001). In conclusion, we found a strong correlation between lymphopenia and COVID-19 outcomes. Lymphopenia in patients with COVID-19 was a prognostic factor in the course of the disease. Lymphopenia is an easy and inexpensive prognostic factor that can be used in the management of COVID-19 patients.
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Affiliation(s)
- Jehat Kılıc
- SBÜ Diyarbakır Gazi Yaşargil EAH, Internal Medicine Department, Diyarbakır, Turkey
| | - Berat Ebik
- SBÜ Diyarbakır Gazi Yaşargil Education Hospital, Department of Gastroenterology, Diyarbakır, Turkey
| | - Ferhat Bacaksız
- SBÜ Diyarbakır Gazi Yaşargil Education Hospital, Department of Gastroenterology, Diyarbakır, Turkey
| | - Nazım Ekin
- SBÜ Diyarbakır Gazi Yaşargil Education Hospital, Department of Gastroenterology, Diyarbakır, Turkey
| | - Burhan Sami Kalın
- SBÜ Diyarbakır Gazi Yaşargil Education Hospital, Department of Intensive Care, Diyarbakır, Turkey
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Gokce A, Hatipoglu M, Akboga SA, Sezen AI, Bektas SG, Akkas Y, Kocer B. THE EFFECT OF COVID-19 VACCINES ON PNEUMOTHORAX IN GERIATRIC PATIENTS HOSPİTALIZED IN INTENSIVE CARE UNIT DUE TO COVID-19. Acta Clin Croat 2022; 61:655-660. [PMID: 37868181 PMCID: PMC10588389 DOI: 10.20471/acc.2022.61.04.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/31/2022] [Indexed: 10/24/2023] Open
Abstract
In our study, we examined the effect of COVID-19 vaccination on the incidence of pneumothorax in intensive care patients over age 65. COVID-19 intensive care patients that presented to our department between April 2020 and May 2021 during the COVID-19 pandemic were evaluated retrospectively. Patients were divided into two main groups, i.e., before and after the vaccination period. Patients were evaluated retrospectively for the following parameters: gender, age, side of pneumothorax, mortality, discharge, comorbidity, and additional pleural complications. The total number of patients was 87, i.e., 66 patients before vaccination and 21 patients after vaccination. When patients in the pre- and post-vaccination period were compared, there was a significant difference in the incidence of pneumothorax between the two groups (p<0.05). Pneumothorax was less common after vaccination. When patients with pneumothorax and tube thoracostomy were evaluated according to pre- and post-vaccination mortality, mortality was significantly higher (89%) in the pre-vaccination period (p<0.05). We consider that COVID-19 vaccines used in patients aged over 65 reduced the incidence of pleural complications, especially pneumothorax. We think that mortality due to pneumothorax in patients over 65 years of age was lower during the vaccination period. In addition, we think that bilateral pneumothorax was more common in the non-vaccinated period. As a result, we think that life-threatening pneumothorax and similar complications could be reduced by increasing the number of vaccines made in the COVID-19 pandemic and spreading it around the world.
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Affiliation(s)
- Anil Gokce
- University of Health Sciences, Ankara City Hospital, Department of Thoracic Surgery, Bilkent, Ankara, Turkey
| | - Merve Hatipoglu
- University of Health Sciences, Ankara City Hospital, Department of Thoracic Surgery, Bilkent, Ankara, Turkey
| | - Suleyman Anil Akboga
- University of Health Sciences, Ankara City Hospital, Department of Thoracic Surgery, Bilkent, Ankara, Turkey
| | - Aysegul Inci Sezen
- Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Infectious Diseases, Istanbul, Turkey
| | - Serife Gokbulut Bektas
- University of Health Sciences, Ankara City Hospital, Department of Intensive Care Unit, Bilkent, Ankara, Turkey
| | - Yucel Akkas
- University of Health Sciences, Ankara City Hospital, Department of Thoracic Surgery, Bilkent, Ankara, Turkey
| | - Bulent Kocer
- University of Health Sciences, Ankara City Hospital, Department of Thoracic Surgery, Bilkent, Ankara, Turkey
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Delen LA, Gok A, Kasapoglu US, Cagasar O, Gok Z, Berber N, Derya S, Tetik B. EFFECTS OF HYDROXYCHLOROQUINE PLUS FAVIPIRAVIR TREATMENT ON THE CLINICAL COURSE AND BIOMARKERS IN HOSPITALIZED COVID-19 PATIENTS WITH PNEUMONIA. Acta Clin Croat 2022; 61:403-411. [PMID: 37492367 PMCID: PMC10364115 DOI: 10.20471/acc.2022.61.03.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/25/2021] [Indexed: 07/27/2023] Open
Abstract
Background The novel coronavirus disease 2019 (COVID-19) has a broad spectrum of clinical manifestations, the most common serious clinical manifestation of the coronavirus infection being pneumonia. Unfortunately, the optimal treatment approach is still uncertain. However, many studies have been conducted on the effectiveness of several medications in the treatment of COVID-19 infection. The aim of this study was to evaluate the effectiveness of the hydroxychloroquine (HCQ) + favipiravir (FAV) treatment regimen and HCQ alone by comparing the patient's clinical response and laboratory results on the fifth day of treatment in patients hospitalized due to COVID-19 infection. Patients and methods This retrospective cohort study was conducted in Malatya Training and Research Hospital between March 2020 and July 2020. The study included 69 patients with confirmed COVID-19 with pneumonia. The patients were divided into 2 groups, those receiving HCQ alone and those receiving the HCQ + FAV combination. Results A total of 69 patients were included in the study, and the mean age was 60.09±15.56 years. A statistically significant decrease was observed in C-reactive protein (CRP) levels, at the end of the fifth day, in patients who received HCQ + FAV treatment (p=0.002), whereas there was no decrease in CRP levels in patients who received HCQ treatment alone. In addition, an increase in lymphocyte count and a better fever response was observed at the end of the fifth day in patients who received HCQ + FAV (p=0.008). However, there was no statistical difference between both treatment regimens in terms of hospital stay and treatment results (p=0.008, p=0.744, p=0.517). Conclusion Although the combination of HCQ + FAV treatment was observed to be effective on CRP levels and fever response in patients with COVID-19 pneumonia, there was no difference in terms of hospital stay and discharge.
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Affiliation(s)
- Leman Acun Delen
- Department of Anesthesiology and Reanimation, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Abdullah Gok
- Department of Anesthesiology and Reanimation, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Umut Sabri Kasapoglu
- Department of Critical Care Medicine, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ozlem Cagasar
- Department of Infectious Diseases and Clinical Microbiology, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Zarife Gok
- Department of Ophthalmology, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Nurcan Berber
- Department of Chest Diseases, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Serdar Derya
- Department of Traumatology and Emergency Medicine, Turgut Ozal University, Malatya Training and Research Hospital, Malatya, Turkey
| | - Bora Tetik
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
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Işık ME, Korkusuz R, Şahingöz GE, Işık AC, Karagöz A, Işıksaçan N, Taş SK, Yaşar KK. PENTRAXIN 3 LEVELS CORRELATE WELL WITH DISEASE SEVERITY AT ADMISSION IN COVID-19 PATIENTS. Acta Clin Croat 2022; 61:303-310. [PMID: 36818928 PMCID: PMC9934037 DOI: 10.20471/acc.2022.61.02.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/19/2022] [Indexed: 02/10/2023] Open
Abstract
Pentraxin 3 (PTX3), a long pentraxin, is not only released from dendritic cells and neutrophils but also from epithelial and endothelial cells such as alveolar epithelium. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initially activates the innate immune system, causing a complex immune response. Clinical and experimental studies suggest that PTX3, a locally and systemically secreted marker, can be used as a predictor of the severity and mortality in respiratory infections. In the current study, serum PTX3 levels in patients hospitalized with COVID-19 were found to be significantly increased at admission and showed significant association with the disease severity.
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Affiliation(s)
- Mehmet Emirhan Işık
- University of Health Sciences, Koşuyolu High Specialization Research and Training Hospital, Department of Infectious Diseases, Istanbul, Turkey
| | - Ramazan Korkusuz
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Department of Infectious Diseases, Istanbul, Turkey
| | - Gülçin Erdal Şahingöz
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Arzu Cennet Işık
- University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Ali Karagöz
- University of Health Sciences, Koşuyolu High Specialization Research and Training Hospital, Department of Cardiology, Istanbul, Turkey
| | - Nilgün Işıksaçan
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Department of Biochemistry, Istanbul, Turkey
| | - Sevgi Kalkanlı Taş
- University of Health Sciences, Department of Immunology, Istanbul, Turkey
| | - Kadriye Kart Yaşar
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Department of Infectious Diseases, Istanbul, Turkey
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Ferenc T, Vilibić-Čavlek T. COMMON VARIABLE IMMUNODEFICIENCY: PREDISPOSING OR PROTECTIVE FACTOR FOR SEVERE COMPLICATIONS OF COVID-19? Acta Clin Croat 2022; 61:107-114. [PMID: 36398083 PMCID: PMC9616023 DOI: 10.20471/acc.2022.61.01.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/06/2021] [Indexed: 08/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The usual presentation of the disease is a common cold-like illness but it can present with more severe and sometimes fatal manifestations. Immunocompromised patients such as those with common variable immunodeficiency (CVID) also are among the infected population. A limited number of reports have been published concerning CVID patients with COVID-19. The main reported symptoms were fever, cough, dyspnea and fatigue while the median duration of illness was 19 (interquartile range 14-26.5) days. Total recovery rate was 88.4%. It is still unknown whether primary immunodeficiency interacts as a predisposing or protective factor against the severe forms of COVID-19. Substitute immunoglobulin (IG) therapy is the only treatment option for CVID. Some reports suggest that early administration of intravenous IGs or convalescent plasma infusion may positively influence the outcome of COVID-19 in these patients.
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Affiliation(s)
- Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
| | - Tatjana Vilibić-Čavlek
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia
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Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res 2022; 11:102. [PMID: 35340277 PMCID: PMC8921693 DOI: 10.12688/f1000research.108667.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 08/26/2024] Open
Abstract
Background: iron and calcium dysmetabolism, with hyperferritinemia, hypoferremia, hypocalcemia and anemia have been documented in the majority of COVID-19 patients at later/worse stages. Furthermore, complementary to ACE2, both sialic acid (SA) molecules and CD147 proved relevant host receptors for SARS-CoV-2 entry, which explains the viral attack to multiple types of cells, including erythrocytes, endothelium and neural tissue. Several authors advocated that cell ferroptosis may be the core and final cell degenerative mechanism. Methods: a literature research was performed in several scientific search engines, such as PubMed Central, Cochrane Library, Chemical Abstract Service. More than 500 articles were retrieved until mid-December 2021, to highlight the available evidence about the investigated issues. Results: based on COVID-19 literature data, we have highlighted a few pathophysiological mechanisms, associated with virus-based cation dysmetabolism, multi-organ attack, mitochondria degeneration and ferroptosis. Our suggested elucidated pathological sequence is: a) spike protein subunit S1 docking with sialylated membrane glycoproteins/receptors (ACE2, CD147), and S2 subunit fusion with the lipid layer; b) cell membrane morpho-functional changes due to the consequent electro-chemical variations and viroporin action, which induce an altered ion channel function and intracellular cation accumulation; c) additional intracellular iron concentration due to a deregulated hepcidin-ferroportin axis, with higher hepcidin levels. Viral invasion may also affect erythrocytes/erythroid precursors, endothelial cells and macrophages, through SA and CD147 receptors, with relative hemoglobin and iron/calcium dysmetabolism. AB0 blood group, hemochromatosis, or environmental elements may represent possible factors which affect individual susceptibility to COVID-19. Conclusions: our literature analysis confirms the combined role of SA molecules, ACE2, CD147, viroporins and hepcidin in determining the cation dysmetabolism and final ferroptosis in the cells infected by SARS-CoV-2. The altered ion channels and electrochemical gradients of the cell membrane have a pivotal role in the virus entry and cell dysmetabolism, with subsequent multi-organ immune-inflammatory degeneration and erythrocyte/hemoglobin alterations.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, AP, 63074, Italy
| | | | - Emidio Troiani
- Cardiology Unit, Social Security Institute, State Hospital, Cailungo, 47893, San Marino
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division,, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
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Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res 2022; 11:102. [PMID: 35340277 PMCID: PMC8921693 DOI: 10.12688/f1000research.108667.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background: iron and calcium dysmetabolism, with hyperferritinemia, hypoferremia, hypocalcemia and anemia have been documented in the majority of COVID-19 patients at later/worse stages. Furthermore, complementary to ACE2, both sialic acid (SA) molecules and CD147 proved relevant host receptors for SARS-CoV-2 entry, which explains the viral attack to multiple types of cells, including erythrocytes, endothelium and neural tissue. Several authors advocated that cell ferroptosis may be the core and final cell degenerative mechanism. Methods: a literature research was performed in several scientific search engines, such as PubMed Central, Cochrane Library, Chemical Abstract Service. More than 500 articles were retrieved until mid-December 2021, to highlight the available evidence about the investigated issues. Results: based on COVID-19 literature data, we have highlighted a few pathophysiological mechanisms, associated with virus-based cation dysmetabolism, multi-organ attack, mitochondria degeneration and ferroptosis. Our suggested elucidated pathological sequence is: a) spike protein subunit S1 docking with sialylated membrane glycoproteins/receptors (ACE2, CD147), and S2 subunit fusion with the lipid layer; b) cell membrane morpho-functional changes due to the consequent electro-chemical variations and viroporin action, which induce an altered ion channel function and intracellular cation accumulation; c) additional intracellular iron concentration due to a deregulated hepcidin-ferroportin axis, with higher hepcidin levels. Viral invasion may also affect erythrocytes/erythroid precursors, endothelial cells and macrophages, through SA and CD147 receptors, with relative hemoglobin and iron/calcium dysmetabolism. AB0 blood group, hemochromatosis, or environmental elements may represent possible factors which affect individual susceptibility to COVID-19. Conclusions: our literature analysis confirms the combined role of SA molecules, ACE2, CD147, viroporins and hepcidin in determining the cation dysmetabolism and final ferroptosis in the cells infected by SARS-CoV-2. The altered ion channels and electrochemical gradients of the cell membrane have a pivotal role in the virus entry and cell dysmetabolism, with subsequent multi-organ immune-inflammatory degeneration and erythrocyte/hemoglobin alterations.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, AP, 63074, Italy
| | | | - Emidio Troiani
- Cardiology Unit, Social Security Institute, State Hospital, Cailungo, 47893, San Marino
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division,, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
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