ABSTRACT
INTRODUCTION: The COVID-19 pandemic has changed the immunological status of the population, indicating increased activation. The aim of the study was to compare the degree of inflammatory activation in patients admitted for surgical revascularization in the period before and during the COVID-19 pandemic. MATERIALS AND METHODS: This retrospective analysis included an analysis of inflammatory activation assessed on the basis of whole blood counts in 533 patients (435 (82%) male and 98 (18%) female) with a median age of 66 (61-71) years who underwent surgical revascularization, including 343 and 190 patients operated on in 2018 and 2022, respectively. RESULTS: The compared groups were matched by propensity score matching analysis, obtaining 190 patients in each group. Significantly higher values of preoperative monocyte count (p = 0.015), monocyte-to-lymphocyte ratio (p = 0.004) and systemic inflammatory response index (p = 0.022) were found in the during-COVID subgroup. The perioperative and 12-month mortality rates were comparable, with 1% (n = 4) in 2018 vs. 1% (n = 2) in 2022 (p = 0.911), and 5.6 % (n = 11 patients) vs. 7% (n = 13 patients) (p = 0.413), in the pre-COVID and during-COVID subgroups, respectively. CONCLUSIONS: Simple whole blood analysis in patients with complex coronary artery disease performed before and during the COVID-19 pandemic indicates excessive inflammatory activation. However, the immune variation did not interfere with one-year mortality rate after surgical revascularization.
ABSTRACT
The COVID-19 pandemic revealed a breakdown of the system of DFU patient care. This retrospective national cohort study analyses the epidemiological status of DFU patients in relation to urgent and elective hospitalizations, amputation rates, and deaths in Poland from 2017 to 2019, and during 2020 when the COVID-19 pandemic began. The data were obtained from national medical records gathered by the National Health Fund (NHF). Discharge diagnoses were categorized according to ICD-10 and ICD-9 codes. Analysis of the data showed a statistically significant decrease in elective hospital admissions (from 29.6% to 26.3%, p = 0.001). There was a decrease in the percentage of hospitalizations related to limb-salvage procedures (from 79.4% to 71.3%, p = 0.001). The opposite tendency was observed among urgent hospital admissions (from 67.0% to 73.2%, p = 0.01), which was related to a significant increase in the number of minor amputations (from 3146 to 4269, p = 0.017). This rise was in parallel with the increase in the percentage of patients who died during hospitalization due to DFU (from 3.9% to 4.8%, p = 0.03). The number of deaths has not changed significantly (from 590.7 to 668.0, p = 0.26). The results of the conducted analyses confirm the negative tendencies in the medical care of patients with DFU during the first year of the pandemic in Poland. Changes in therapy schemes and stronger patient support following this period are necessary to avoid further complications in patients with DFU.
ABSTRACT
Objective The aim was to compare the metabolic control of patients with type 2 diabetes mellitus (DM2) before and during the COVID-19 pandemic in Poland and assess its impact on cardiovascular risk. Methods Patients with DM2, treated with metformin and/or insulin were analysed with Pearson and ANOVA correlations. Blood levels of metabolic control biomarkers were checked throughout the first pandemic wave were compared to the results obtained before the 4th of March, 2020 (1st confirmed case in Poland). Results 598 patients cases with mean weight 87.07 kg (±19.54) were analysed. 22.41% (n=134) were treated solely with insulin, 42.64% (n=255) with metformin and 28.6% (n=171) were prescribed a combination of those. The baseline HbA1c and creatinine levels were at 7.33% (±1.39) and 1.16mg/dl (±0.76) respectively and rose by 0,19% (p=0.02) and 0.07mg/dl (p=0.004). The patient attendance for blood testing decreased by 42.18% in comparison to the pre-pandemic period. All patients have shown a rise in creatinine levels, but those treated only with metformin rose by 0,01mg/dl, which was a significantly smaller increase. Conclusions The increase in levels of creatinine and HbA1c, which may have an impact on cardiovascular risk, suggests that lockdown and its consequences resulted in a deterioration of metabolic control. Stronger support of patients and preparations for upcoming pandemic waves are necessary to avoid further complications in patients with DM2. The improvement of renal parameters in the group of patients treated only with metformin confirms its nephroprotective effect and it still should be used as first-line treatment..