Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of COVID-19 patients: a retrospective cohort study

ABSTRACT BACKGROUND: Quick and accurate identification of critically ill patients ensures appropriate and correct use of medical resources. In situations that threaten public health, like pandemics, rapid and effective methods are needed for early disease detection among critically ill patients. OBJECTIVE: To determine the relationship between the neutrophil-to-lymphocyte ratio (NLR) of coronavirus disease-19 (COVID-19) patients upon admission to the emergency department (ED) and these patients' prognosis. DESIGN AND SETTING: Retrospective cohort study among COVID-19 patients in the ED of a tertiary-level hospital. METHODS: Data on patients' age, gender, vital signs, chronic diseases, laboratory tests and clinical outcomes were collected from electronic medical records. Receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) was used to assess the accuracy of NLR for predicting in-hospital mortality risk and intensive care unit (ICU) requirement. The Youden J index (YJI) was used to determine optimal threshold values. RESULTS: 1,175 patients were included. Their median age was 63 years (IQR, 48-75). With an NLR cutoff value of 5.14, the sensitivity, specificity, PPV, AUC and YJI for ICU requirement were calculated as 77.87%, 74.08%, 92.4%, 0.811 and 0.5194, respectively. With the same cutoff value, the sensitivity, specificity, AUC and YJI for in-hospital mortality were 77.27%, 75.82%, 0.815 and 0.5309, respectively. In addition, advanced age, leukocytosis, anemia and lymphopenia were found to be associated with poor prognosis. CONCLUSION: The NLR, which is a widely available simple parameter, can provide rapid insights regarding early recognition of critical illness and prognosis among COVID-19 patients.

Comparison of C-reactive protein and C-reactive protein-to-albumin ratio in predicting mortality among geriatric coronavirus disease 2019 patients

SUMMARY OBJECTIVE: The aim of this study was to evaluate and compare C-reactive protein and C-reactive protein-to-albumin ratio performances in predicting mortality of geriatric patients who visited the emergency department. METHODS: The data of patients with COVID-19 and aged 65 years and above, who visited emergency department during the study period, were retrospectively analyzed. The data were obtained from an electronic-based hospital information system. The area under the receiver operating characteristic curve and the area under the curve were used to assess each cutoff value discriminatory for predicting mortality. RESULTS: The mean age of the population included in this study was 76 (71-82) years, while 52.7% were males. The sensitivity, specificity, and area under the curve values for C-reactive protein in terms of mortality were calculated as 71.01, 52.34, and 0.635%, respectively, while the sensitivity, specificity, and area under the curve values for C-reactive protein-to-albumin ratio were calculated as 75.74, 47.66, and 0.645%, respectively (p<0.001). In the pairwise comparison for the receiver operating characteristic curves of C-reactive protein and C-reactive protein-to-albumin ratio, no statistically significant difference was found. CONCLUSIONS: Geriatric patients are the "most vulnerable" patient group against the COVID-19. In this study, both C-reactive protein and C-reactive protein-to-albumin ratio were found to be successful in predicting mortality for geriatric COVID-19 patients.

Investigation of the antioxidant effects of pheniramine maleate and nebivolol on testicular damage in rats with experimentally induced testis torsion

Abstract Purpose: To investigate the biochemical, histopathologic, and spermatogenetic changes in the detorsionated testicle after experimental torsion and to study the antioxidant effects of pheniramine maleate and nebivolol. Methods: Twenty-four Sprague-Dawley male rats were divided into 4 groups: Group 1: Sham; Group 2: Torsion/Detorsion (T/D); Group 3: T/D + Pheniramine maleate (PM); Group 4: T/D + Nebivolol (NB) group. Paroxanase (PON), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stres index (OSI) were measured, and spermatogenetic and histopathologic evaluation was performed in tissue and blood samples. Results: The evaluation of tissue TAS indicated no statistically significant difference in Group 3 compared to Group 2. A statistically significant increase was detected in Group 4 compared to Group 2. Serum PON levels revealed a statistically significant increase in Groups 3 and 4 compared to Groups 1 and 2. The Johnsen testicular biopsy score decreased in Groups 3 and 4, but the decrease was not statistically significant. Conclusions: Pheniramine maleate and nebivolol have antioxidant effects against ischemia-reperfusion damage. They also support tissue recovery, which is more significantly observed by nebivolol.

Interleukin-8 levels in children with bacterial, tuberculous and aseptic meningitis.

OBJECTIVE: lnterleukin-8 (IL-8) is produced in monocytes and vascular endothelial cells in response to stimulation with bacteria or lipopolysaccharides, and is released from these cells into blood stream or tissue fluid. METHODS: Cerebrospinal fluid (CSF) levels of interleukin-8 in 56 children with nonbacterial, bacterial and tuberculous meningitis (TBM), and in 15 control subjects were analyzed to evaluate the involvement of this cytokine in the pathogenesis acute bacterial meningitis and their discriminative value between different etiologies of meningitis. The kinetics of IL-8 concentrations during the course of bacterial meningitis was also evaluated in patients. IL-8 levels were significantly higher in bacterial and TBM than in aseptic meningitis and in control subjects (p < 0.0001). RESULTS: There was no difference in the levels of IL-8 between the non-bacterial meningitis and control groups. The analysis of the kinetics of production of IL-8 in patients with bacterial meningitis showed that the SSF concentrations of this cytokine decreased to undetectable values in recovery stage. Conversely in patients with TBM the concentrations of IL-8 were elevated in two weeks after beginning the specific treatment. CONCLUSION: The results suggest that determining IL-8 levels may be useful in the differential diagnosis.