ABSTRACT
OBJECTIVE: Coronavirus disease 2019 is an ongoing disease with high morbidity and mortality. We aimed to investigate the relationship between demographics, lymphocytes, eosinophils, and the coronavirus disease 2019 severity at hospital admission. MATERIAL AND METHODS: A retrospective, observational cross-sectional study was carried out with 5828 coronavirus disease 2019 patients between March 11, 2020, and November 30, 2020. Patients were divided into 3 groups according to where they were followed up as an indicator of disease severity, namely outpatients, inpatients, and critically ill patients. The patients' demographics and hemogram values on admission were recorded. The predictive accuracies of lymphocyte count, lymphocyte percentage, eosinophil count, and eosinophil percentage for predicting severity were determined using receiver operating characteristic curves. Logistic regression analysis was used to predict intensive care unit demand according to lymphocyte and eosinophil values. RESULT(S): Of the 5828 coronavirus disease 2019 patients, 4050 were followed up as outpatients, 1581 were hospitalized in a ward, and 197 were hospitalized in the intensive care unit. Lymphocyte count and lymphocyte percentage were significantly different between the groups, but the difference for eosinophil count and eosinophil percentage was not significant as it was for lymphocytes. Cutoff values for lymphocyte count (1.0 x 109/L), lymphocyte percentage (22%), eosinophil count (0.052 x 109/L), and eosinophil percentage (0.08%) were found to indicate a high risk for intensive care unit admission. Coronavirus disease 2019 patients >55 years of age, with a lymphocyte count <1.0 x 109/L, a lymphocyte percentage <22%, and an eosinophil percentage <0.08% had a 2-fold higher risk of requiring intensive care unit management. CONCLUSION(S): Lymphocyte counts and percentages are quick and reliable biomarkers for predicting coronavirus disease 2019 severity and may guide physicians for proper management earlier.Copyright © Author(s).
ABSTRACT
Background: Primary immunodeficiency diseases (PID) are rare conditions that occur as a result of defects in one or more components of the immune system, which are clinically characterized by recurrent and/or severe infections, and may be accompanied with autoimmunity. Patients diagnosed with primary immunodeficiency were included in the high risk patient group for COVID-19 by the US Center for Disease Control (CDC). On the other hand, intravenous immunoglobulin (IVIG) therapy, which is used in the treatment of patients with PID, has been used as an immunomodulator in the treatment of COVID-19 patients in reducing hyperinflammation and associated cytokine storm syndrome. In our study, we wanted to present the clinical and laboratory characteristics of patients infected with COVID-19 and the course of the disease while receiving IVIG treatment with the diagnosis of PID. Method: 11 women 32 patients with an average age of 36.4 from 2 centers included in the study. Patients who were receiving IVIG/ subcutaneous IG due to PID have been screened for Covid-19 since March 2019. Results: It was found that Covid-19 developed in a total of 4 patients, 3 of the cases had common variable immune defficiency (CVID), and last one had Ataxia Telangiectasia. 3 of the cases were male and 1 female. All 4 patients had comorbid diseases accompanying primary immunodeficiency. Three of 4 patients had lymphopenia. Radiological findings consistent with interstitial pneumonia were observed in the thoracic CT's of all 4 patients, no patients required hospitalization. 3 of 4 patients received favipravir treatment, and 1 patient received hydroxychloroquine. Phenotypic and immunological data of the patients before Covid-19 and clinical laboratory presentation during Covid-19 infection are given in the table below. (Table 1) Conclusion: Coronavirus disease 2019 (COVID-19) has developed rapidly into a global pandemic. Patients with PID may be at risk of developing severe COVID-19 infection even though they recieve IVIG. On the other hand IVIG probably suppresses inflammatory reactions by a multi factorial mechanisms which leads alleviation of the symptoms caused by cytokine over-synthesis. Although patients have radiological and laboratory findings during Covid-19 infection, they have with milder symptoms.It was observed that Covid-19 infection was not mortal and morbidity was low in our patients with primary immunodeficiency (3 CVID, 1 Ataxia Telangiectasia) who were receiving IVIG and all of them recovered. (Table Presented).