ABSTRACT
Background and Aims: Many reviews show impaired response of metabolic and immune systems in patient with diabetes that leads to more severe clinical course of COVID-19. One of such early predictors could be neutrophil indices that derives from hemogram. Our study aims to investigate the predictive value of neutrophil ratios in a diabetic cohort hospitalized with COVID-19. Method(s): We retrospectively examined data from 229 diabetic patients with COVID-19 hospitalized at the regional clinical hospital of Karaganda between May and August 2021. We analyzed the relationship between inflammation markers (neutrophil- lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), neutrophil-platelets ratio (NPR), systemic immune-inflammation index (SII)), disease severity, and early outcomes. Result(s): In multivariate regression analysis, patients with high NLR (p = 0.018), NPR (p = 0.006), and SII (p = 0.022) had more severe COVID-19, an increase in NLR (p = 0.0001), NPR (p = 0.0001) and SII (p = 0.001) was associated with the development of early mortality. The role of PLR in predicting COVID- 19 was not significant (p = 0.388).The ROC curve result showed that higher NLR (AUC = 0.637, 95% CI = 0.554-0.719, p = 0.002) and NPR (AUC = 0.674, 95%CI = 0.600-0.749, p = 0.0001) scores predicted the COVID-19 severity and mortality (NLR: AUC= 0.687, 95% CI = 0.587-0.787, p = 0.0001 and NPR: AUC= 0.703, 95% CI = 0.614-0.791, p = 0.0001), increasing of SII predicted only early mortality (AUC = 0.652, 95% CI = 0.541-0.764, p = 0.004). Conclusion(s): NLR and NPR can be considered as optimal and readily available parameters for predicting the severity and early mortality among diabetic patients with COVID-19.
ABSTRACT
Background: Infectious complications remain as a serious problem for hematological hospitals. Despite the fact that COVID-19 is a viral infection, the pandemic could have affected the development of antibiotic resistance. In Kazakhstan, at the beginning of 2020, the fear of bacterial complications, the emergence of available information about the possibility of using antibiotics in the treatment of patients with COVID 19 led to an increase in the consumption of antibacterial drugs, primarily azithromycin, ceftriaxone. This could negatively affect the selection and development of antibiotic-resistant microorganisms in the departments where patients are especially exposed to infectious agents. There are no data on monitoring of the etiological structure of bacterial pathogens and the level of antibiotic resistance during a pandemic among patients of hematology departments in Kazakhstan. Aims: To analyze the etiological structure and assess the level of resistance to antimicrobial drugs before and during a pandemic COVID 19. Methods: A retrospective analysis of the etiological structure and sensitivity to antimicrobial drugs of pathogens isolated from 108 patients in the hematology department of Karaganda for the period before the pandemic (from January 2019 to March 20, 2020) and 181 patients after the introduction of a lockdown due to the COVID 19 pandemic (from March 20, 2020 to 02/01/2021). The study included positive bacteriological cultures from 9 biotopes (blood, urine, sputum, catheters etc.). The bacteriological study was carried out by standard bacteriological methods with identification by time-of-flight mass spectrometry (Microflex-LT, Biotyper System, Bruker Daltonics, Germany), the determination and interpretation of sensitivity to antimicrobial drugs was carried out in accordance with the recommendations of CLSI M100-24. Statistical processing of the data obtained was carried out on an online platform for the analysis and exchange of antibiotic resistance data (AMRcloud, version: Beta, 01/27/2021). Results: The results of the study showed that in the structure of microorganisms isolated from patients of the hematology department for the entire period of the study, gram-negative flora prevailed. Significant differences in the structure of bacteria before and during the pandemic period were noted: increased Pseudomonas aeurogenosa strains from 29.7% to 55.3% (p = 0.022) and drastically decreased in the growth of Enterococcus faecalis, from 40.5% to 10.6% (p = 0.001). The appearance of P. aeurogenosa strains carbapenemase producers up to 30.4% (p = 0.01) during a pandemic was noted. Despite the fact that the ratio of gram-negative and gram-positive flora did not statistically change, after the lockdown the percentage of methicillin-resistant Staphylococcus aureus (MRSA) increased from 11.8% to 35%. Summary/Conclusion: During the COVID 19 pandemic, in non-infection departments, like hematology, the frequency of MRSA excretion increased by 3 times and a third of Pseudomonas aeurogenosa strains were resistant to carbapenems. Stricter infection control is needed, as well as monitoring the growth of opportunistic flora, which is often resistant to antibiotics and thus aggravates the condition of patients in the hematological compartments.