The relationship between mortality and inflammatory markers and the systemic immune inflammatory index in patients in the intensive care unit with a pneumothorax as a complication of COVID-19 disease

Abstract

Background A pneumothorax is common in patients admitted to the intensive care unit (ICU) with coronavirus disease (COVID-19) when non-invasive or invasive mechanical ventilation is performed to maintain adequate oxygenation. The aim of the present study was to investigate the effects of elevated inflammatory markers and an elevated systemic immune inflammatory index (SII) on mortality in this patient population. Materials and methods Between March 2020 and May 2021, 124 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reacion positviity who were admitted to the ICU in our hospital and diagnosed with and treated for a pneumothorax were evaluated retrospectively. Interleukin-6 (IL-6), C-reactive protein, neutrophil, lymphocyte, platelet and white blood cell levels were measured. These parameters were used to calculate the neutrophil–lymphocyte ratio (NLR) and SII, and the association of these parameters with pneumothorax-related mortality was examined. Results This study included 39 female (31.5%) and 85 male (68.5%) patients. The mean age was 65.3 ± 12.6 years. Non-invasive mechanical ventilation was performed in 13 (10.5%) patients, and 111 (89.5%) patients received invasive mechanical ventilation. Tube thoracostomy was performed in 113 patients (91.1%), and 11 patients (8.9%) were treated with oxygen therapy. The factors affecting mortality in the pneumothorax patients were the Charlson Comorbidity Index (four or higher), IL-6 level and NLR. The IL-6 level was 53.4 in those who died versus 24.6 in those who survived ( p = 0.017). The NLR in the patients who died was 16.9 as compared to 12.5 in those who survived ( p = 0.011). Conclusion Elevated markers of infection were associated with an increased risk of mortality in pneumothorax patients with COVID-19 who received invasive or non-invasive mechanical ventilation in the ICU. In this patient population, high levels of positive end-expiratory pressure should be avoided, and inflammatory marker levels and the SII should be closely monitored.

Oxidative stress and inflammatory markers in patients with COVID-19: Potential role of RAGE, HMGB1, GFAP and COX-2 in disease severity

“…A wide range of biomolecules associated with the inflammatory and immune cell response, which are used as predictors of organ failure and severity in other diseases, are also being studied in patients with COVID-19 [38] , [39] . It has been found that several inflammatory and oxidative mediators are misregulated in COVID-19 and are associated with multiorgan damage and poor disease prognosis [40] , [41] .…”

Effects of PM2.5 Exposure on the ACE/ACE2 Pathway: Possible Implication in COVID-19 Pandemic

“…Furthermore, many inflammatory and oxidative stress mediators are known to be impaired in COVID-19 and are associated with multi-organ damage and poor disease prognosis [56,57].…”

Association of lactate/albumin ratio with in-hospital mortality in ICU patients with acute respiratory failure: A retrospective analysis based on MIMIC-IV database

“…In recent years, researchers have focused on developing systemic inflammatory biomarkers to predict the prognosis of critical illnesses, including RDW, [ 16 ] NLR, [ 17 ] MLR, [ 18 ] PLR, [ 19 ] SII, [ 20 ] SIRI, [ 21 ] AISI, [ 22 ] etc. LAR has been applied as a predictive tool for in-hospital mortality in patients with necrotizing fasciitis, [ 23 ] moderate to severe traumatic brain injury, [ 24 ] sepsis, [ 25 ] acute kidney injury, [ 26 ] and severe community-acquired pneumonia.…”