ABSTRACT
Background: COVID-19 a multisystemic disorder caused by the SARS-CoV-2 virus with deleterious and often fatal effects on respiratory function. Many therapeutic but expensive options have been presented. Unfractionated heparin is widely available and has been shown to have antiviral properties in vitro (by inhibiting the interaction of the spike protein of the coronavirus with ACE2), as well as anti-inflammatory, mucolytic and anticoagulant effects. Objective: To conduct a retrospective cohort study on COVID-19 patients admitted to an isolation ward in Jamaica to determine if nebulized unfractionated heparin delivered to patients with severe COVID-19 pneumonitis would influence the derived neutrophil to lymphocyte ratio (dNLR), a predictor of infection severity that was routinely measured. Methods: Study participants were hospitalized with COVID-19 pneumonitis, confirmed by polymerase chain reaction, between August 4, 2021 and November 13, 2021 and managed by anaesthesiologists. All had SpO2 < 92% on room air at admission. Patients received a standard COVID-19 care management protocol, as per the national guidelines of Jamaica. Seventeen patients with median (range)age 53 (35-67) years received nebulized unfractionated heparin (the study group); and seventeen patients with median (range) age 53 (38-67) years were not given nebulized unfractionated heparin (the control group). Derived neutrophil to lymphocyte ratios were observed daily over a 15-day period and tabulated and charted using stacked line graphs and box plots to compare changes in the variable between the groups. Results: The demographics and illness severity were comparable for the groups. Stacked line graphs of the dNLR in each group indicated a more rapid decline in the group treated with nebulized unfractionated heparin than in the control group. Univariate analysis using box plots of serial dNLR changes showed larger interquartile ranges, longer whiskers, higher means and medians in the control group than in the study group. Conclusions: Participants treated with nebulized unfractionated heparin had a sharper decline in dNLR than patients who did not receive this therapy. There was a less varied, more predictable serial dNLR response in the study group than in the control group. Larger studies should explore the clinical implications of this finding.