Diagnostic Value of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Patients with Severe COVID-19 — 7 PLADs, China, January 21–February 10, 2020

Ma, Yan; Zhu, Dongshan; Shi, Nannan; Zhang, Lei; Chen, Guangkun; Ge, Youwen; Zhang, Zelei; Chen, Renbo; Liu, Sihong; Fan, Yipin; Zhang, Huamin; Wang, Yanping

doi:10.46234/ccdcw2022.047

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Increased NLR levels has been observed in patients with Covid-19 in Johannesburg, South Africa but this parameter was not significantly related to prolonged LOS ( 35 ). The NLR has been shown to be useful in identifying young patients with severe Covid-19 (≤40 years) ( 36 ). The NLR, but not the SII, had a significant predictive value for Covid-19 mortality in a study of 108 hospitalized patients from Timisoara, Romania ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Linear and non‑linear indices of vagal nerve in relation to sex and inflammation in patients with Covid‑19

Hunakova,

Sabaka,

Zvarik

et al. 2023

Biomed Rep

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Hyperinflammation is one of the most important pathophysiological risk factors for poor prognosis in patients with coronavirus disease-2019 (Covid-19). Low vagal neuro-immune modulation can lead into this kind of immune dysregulation. The association between vagal activity, sex and inflammatory markers were investigated in patients with Covid-19. A total of 19 patients with Covid-19 were included in the present study. Vagus nerve activity was indexed by heart rate variability (HRV) derived from electrocardiogram at hospital admission. Linear HRV parameters included the root mean square of successive RR interval differences (RMSSD) and high-frequency HRV (HF-HRV), while non-linear parameters included 2 UV%. Immune/inflammatory parameters included C-reactive protein (CRP), interleukin-6 (IL-6), neutrophil/lymphocyte ratio (NLR), systemic inflammatory index (SII), and procalcitonin (PCT). It has been revealed that both linear HRV indices HF-HRV and RMSSD, are significantly negatively correlated with CRP and IL-6, independent of age. The non-linear index of 2 UV% is significantly negatively correlated with NLR and SII, which reflect subtle changes in the response of immunocompetent cells. Patients that received high-flow nasal oxygen therapy had significantly higher IL-6 and CRP levels and lower levels of HF-HRV and RMSSD. These patients also had a significantly longer length of stay in hospital (LOS) than patients receiving low-flow oxygen therapy. Men had higher plasma PCT levels and longer LOS in hospital than women, and PCT statistically explained (mediated) the association between sex and LOS. The present study showed different correlations of linear and non-linear vagal indexes of HRV and inflammatory markers in patients with Covid-19. Significant sex differences in certain inflammatory markers were also observed, which may very well verify previous findings of poor prognosis in men with Covid-19. HRV reflects a continuous interaction between the sympathetic and parasympathetic autonomic nervous systems, which are affected by mental or physical stress, and certain disease states. The increased sympathetic and decreased parasympathetic vagal tone contribute to a higher risk of diseases associated with inflammation, cardiovascular disease, cancer, pulmonary diseases and other pathologies, including infectious diseases such as Covid-19. The present study showed that higher RMSSD (a marker of vagal activity) in Covid-19 patients is associated with lower levels of inflammatory biomarkers, a lower need for treatment and is negatively correlated with intensive care unit admission, leading to a shorter hospital stay. These findings support the idea that activation of vagus nerve may help certain Covid-19 patients by reducing the cytokine storm and excessive inflammation.

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Section: Discussionmentioning

confidence: 99%

Linear and non‑linear indices of vagal nerve in relation to sex and inflammation in patients with Covid‑19

Hunakova,

Sabaka,

Zvarik

et al. 2023

Biomed Rep

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“…24,25 The role of neutrophils is also relevant; a high neutrophil/lymphocyte ratio has been proposed to be a predictor of more severe COVID-19. 26,27 The interrelationship of oxidative stress and inflammation in COVID-19 occurs and several mediators contribute. Among others, IL-1beta, IL6, TNF-alpha, and a kappa B (κB-α)/nuclear factor kappa B (NF-κB)-independent pathway, that mediates the redox-dependent regulation of inflammatory cytokines.…”

Section: Discussionmentioning

confidence: 99%

Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19

Izquierdo

Soriano

González³

et al. 2022

Science Progress

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Infection by SARS-CoV-2 causing coronavirus disease 2019 (COVID-19) can be associated with serious and life-threatening conditions, including acute respiratory distress syndrome (ARDS). Severity and mortality have been related to a cytokine storm, an imbalance of oxidative stress, and a pro-thrombotic state. We conducted an observational retrospective cohort study from a community-based large population of hospitalized COVID-19 PCR + patients admitted from March 01, 2020, to January 24, 2021, with integrated primary to tertiary care information in Castilla la Mancha, Spain. We explored the potential benefits of the antioxidant, anti-inflammatory and anti-thrombotic drug N-acetylcysteine (NAC) administered orally in high doses (600 mg every 8 h), added to standard of care in COVID-19 patients by using the free text information contained in their electronic health records (EHRs). Out of 19,208 patients with a diagnosis of COVID-19 hospitalized, we studied 2071 (10.8%) users of oral NAC at high doses. COVID-19 patients treated with NAC were older, predominantly male, and with more comorbidities such as hypertension, dyslipidemia, diabetes, and COPD when compared with those not on NAC (all p < 0.05). Despite greater baseline risk, use of NAC in COVID-19 patients was associated with significantly lower mortality (OR 0.56; 95%CI 0.47–0.67), a finding that remained significant in a multivariate analysis adjusting by baseline characteristics and concomitant use of corticosteroids. There were no significant differences with the use of NAC on the mean duration of hospitalization, admission to the intensive care unit or use of invasive mechanical ventilation. The observed association signaling to better relevant outcomes in COVID-19 patients treated with NAC at high doses should be further explored in other settings and populations and in randomized controlled trials.

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“…A high incidence of lymphopenia, ranging from 67-75%, has been consistently reported among COVID-19 patients who have a severe illness; it may correlate with an increased quantity of cytokines such as IL-6, IL-10 or TNF (tumor necrosis factor) [82,83]. These cytokines and TNF may have a direct impact on the T-cell population [84] and might have an indirect impact on other types of cells, including neutrophils and dendritic cells [85,86].…”

Section: Lymphopeniamentioning

confidence: 99%

Pathological Effects of SARS-CoV-2 Associated with Hematological Abnormalities

Shama,

Mahmood,

Mehmood

et al. 2023

CIMB

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The SARS coronavirus 2 (SARS-CoV-2) is the causative agent of the 2019 coronavirus disease (COVID-19) pandemic that has claimed the lives of 6.9 million people and infected over 765 million. It has become a major worldwide health problem and is also known to cause abnormalities in various systems, including the hematologic system. COVID-19 infection primarily affects the lower respiratory tract and can lead to a cascade of events, including a cytokine storm, intravascular thrombosis, and subsequent complications such as arterial and venous thromboses. COVID-19 can cause thrombocytopenia, lymphopenia, and neutrophilia, which are associated with worse outcomes. Prophylactic anticoagulation is essential to prevent complications and death rates associated with the virus’s effect on the coagulation system. It is crucial to recognize these complications early and promptly start therapeutic anticoagulation to improve patient outcomes. While rare, COVID-19-induced disseminated intravascular coagulation (DIC) exhibits some similarities to DIC induced by sepsis. Lactate dehydrogenase (LDH), D-dimer, ferritin, and C-reactive protein (CRP) biomarkers often increase in serious COVID-19 cases and poor prognosis. Understanding the pathophysiology of the disease and identifying risk factors for adverse outcomes is critical for effective management of COVID-19.

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Diagnostic Value of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Patients with Severe COVID-19 — 7 PLADs, China, January 21–February 10, 2020

Cited by 4 publications

References 8 publications

Linear and non‑linear indices of vagal nerve in relation to sex and inflammation in patients with Covid‑19

Linear and non‑linear indices of vagal nerve in relation to sex and inflammation in patients with Covid‑19

Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19

Pathological Effects of SARS-CoV-2 Associated with Hematological Abnormalities

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