Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. METHODS: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. RESULTS: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p=0.003, 36.6% vs 10.8%, p<0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. CONCLUSION: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection? ¿Puede el índice de inflamación inmunitaria sistémica al ingreso predecir la mortalidad hospitalaria al ingreso de pacientes con enfermedad renal crónica e infección por SARS-CoV-2?

Background and aim Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. Methods 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts × neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. Results CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p = 0.003, 36.6% vs 10.8%, p < 0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. Conclusion We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

COVID-19 HASTALARINDA ANTÍFOSFOLÍPÍD ANTÍKOR (AFA) VARLIĞI

Objective: In our study, we aimed to show whether there is a relationship between antiphospholipid antibody (aPL) positivity and complications of COVID-19. Material and Methods: Eighty-three patients who were diagnosed with COVID-19 infection and hospitalized in the intensive care unit (ICU) of Bakirkoy Dr. Sadi Konuk Research and Training Hospital were included in our study as the case group and 79 healthy volunteers as the control group. Only patients with a positive Polymerase Chain Reaction (PCR) test were included in the case group. Serum antiphospholipid antibodies (aPL IgM/G), C-Reactive Protein (CRP), ferritin, procalcitonin (PCT), plasma D-Dimer levels, prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were analyzed by routine laboratory methods. Results: Both groups were found statistically similar in terms of gender (χ2 test, p=0.236). The mean age of the case group and control group was 60.54±16.86 and 51.47±14.64 years, respectively. When aPL positivity was evaluated between the case and control groups, a statistically remarkable difference was found between the groups (p=0.046). The case group showed an aPL positivity of 7.5% and the control group 1%. The correlation between D-Dimer, PT, INR, aPTT levels, and aPL IgM/G positivity in the case group was significant. Conclusion: Our results revealed that aPL positivity in patients with COVID-19 infection relate to the severity of the disease, in dependent from age and gender. To confirm the result of this study further studies with participation of larger patient groups from national and international hospitals are required. (English) [ FROM AUTHOR] Amaç: Çalışmamızda antifosfolipid antikor (AFA) pozitifliği ile COVID-19 komplikasyonları arasında bir ilişki olup olmadığını göstermeyi amaçladık. Gereç ve Yöntem: Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi yoğun bakım servisinde yatan COVID-19 enfeksiyonu tanısı almış 83 hasta olgu grubu olarak, 79 sağlıklı gönüllü de kontrol grubu olarak çalışmamıza dahil edildi. Olgu grubuna sadece Polimeraz Zincir Reaksiyon (PZR) test sonucu pozitif olan hastalar alındı. Serum antifosfolipid antikorları (AFA IgM/G), C-Reaktif Protein (CRP), ferritin, prokalsitonin (PCT) ve plazma D-Dimer seviyeleri, protrombin zamanı (PT) ve uluslararası normalleştirilmiş oran (INR), aktive parsiyel tromboplastin zamanı (aPTT), rutin laboratuvar yöntemleriyle analiz edildi. Bulgular: Her iki grup cinsiyet açısından istatistiksel olarak benzer bulundu (χ2 testi, p=0,236). Olgu grubu ve kontrol grubunun yaş ortalaması sırasıyla 60,54±16,86 ve 51,47±14,64 yıl idi. Olgu ve kontrol grupları arasında AFA pozitifliği değerlendirildiğinde, gruplar arasında istatistiksel olarak anlamlı fark bulundu (p=0,046). Olgu grubu %7,5 ve kontrol grubu %1 AFA pozitifliği gösterdi. Olgu grubunun D-Dimer, PT, INR, aPTT seviyeleri ile AFA IgM/G pozitifliği arasındaki korelasyon anlamlı bulundu. Sonuç: Sonuçlarımız, COVID-19 enfeksiyonu olan hastalarda AFA pozitifliğinin yaş ve cinsiyetten bağımsız olarak hastalığın şiddeti ile ilişkili olduğunu ortaya koydu. Bu çalışmanın sonucunu doğrulamak için ulusal ve uluslararası hastanelerden daha geniş hasta gruplarının katılımıyla daha ileri çalışmalara ihtiyaç vardır. (Turkish) [ FROM AUTHOR] Copyright of Istanbul Tip Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Respiratory viral infections in otherwise healthy humans with inherited IRF7 deficiency.

Autosomal recessive IRF7 deficiency was previously reported in three patients with single critical influenza or COVID-19 pneumonia episodes. The patients' fibroblasts and plasmacytoid dendritic cells produced no detectable type I and III IFNs, except IFN-ß. Having discovered four new patients, we describe the genetic, immunological, and clinical features of seven IRF7-deficient patients from six families and five ancestries. Five were homozygous and two were compound heterozygous for IRF7 variants. Patients typically had one episode of pulmonary viral disease. Age at onset was surprisingly broad, from 6 mo to 50 yr (mean age 29 yr). The respiratory viruses implicated included SARS-CoV-2, influenza virus, respiratory syncytial virus, and adenovirus. Serological analyses indicated previous infections with many common viruses. Cellular analyses revealed strong antiviral immunity and expanded populations of influenza- and SARS-CoV-2-specific memory CD4+ and CD8+ T cells. IRF7-deficient individuals are prone to viral infections of the respiratory tract but are otherwise healthy, potentially due to residual IFN-ß and compensatory adaptive immunity.

Risk factors and the impact of vaccination on mortality in COVID-19 patients.

INTRODUCTION: The novel coronavirus disease (COVID-19) pandemic has had a profound global impact economically, socially, and in many other areas. As vaccines are developed and introduced, their effect on the disease on both, the global and individual scale is a subject of intense curiosity. This study aimed to evaluate the relationship between risk factors for hospitalization, disease severity, and vaccination status in COVID-19 inpatients in a pandemic hospital. METHODOLOGY: Patients hospitalized for COVID-19 between June and September 2021 were retrospectively analyzed in three groups: unvaccinated, incompletely vaccinated, and fully vaccinated. Disease severity was classified as moderate, severe, or critical according to World Health Organization criteria, and mortality risk factors and the prognostic effect of vaccination were analyzed. RESULTS: The study included 486 patients, 228 women (46.9 %) and 258 men (53.1 %), with a mean age of 55.4 ± 16.5 years. Of these, 264 patients (54.3 %) were unvaccinated, 147 (30.2 %) were incompletely vaccinated, and 75 (15.4 %) were fully vaccinated. Older age, higher Charlson Comorbidity Index, greater disease severity, and being unvaccinated or incompletely vaccinated were associated with higher mortality. CONCLUSIONS: The results of our study indicate that age, disease severity, comorbidities, and vaccination status were factors affecting COVID-19 mortality. Our findings support that full vaccination reduces COVID-19 -related mortality rates, disease severity, and length of hospital stay. However, large-scale studies with larger patient populations are needed (Tab. 2, Ref. 22).

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

Background and aim: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. Methods: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts × neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. Results: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p = 0.003, 36.6% vs 10.8%, p < 0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. Conclusion: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Antecedentes y objetivo: Los pacientes con enfermedad renal crónica (ERC) son susceptibles a la infección por SARS-CoV-2 y más propensos a desarrollar una enfermedad grave. Es importante conocer los predictores de los malos resultados para optimizar las estrategias de atención. Métodos: Se incluyeron en el estudio 93 pacientes con ERC y 93 pacientes sin ERC, emparejados por edad y sexo. Los datos sobre las características demográficas, clínicas, índices hematológicos y resultados, se anotaron y compararon entre los grupos. La proporción de neutrófilos a linfocitos (NLR), la proporción de plaquetas a linfocitos (PLR), el índice de inflamación inmunitaria sistémica (SII) (recuentos de plaquetas × recuentos de neutrófilos/recuentos de linfocitos) y la proporción de linfocitos a PCR (LCR) se calcularon en el momento de la admisión y se identificó la asociación de estos marcadores con la mortalidad por enfermedad en pacientes con ERC. Resultados: Los pacientes con ERC tuvieron un mayor riesgo de enfermedad grave y mortalidad en comparación con los pacientes sin ERC (72% vs 50,5%, p = 0,003, 36,6% vs 10,8%, p < 0,001, respectivamente) y tuvieron más probabilidades de tener valores más altos de índices inmuno inflamatorios (recuento de leucocitos, neutrófilos, NLR, SII y proteína C reactiva, etc.) y niveles más bajos de linfocitos y LCR. Además, se observaron niveles más altos de NLR, SII, PLR y un nivel más bajo de LCR en pacientes con ERC que murieron en comparación con los recuperados. En un análisis de la curva de características operativas del receptor, el área NLR, SII, PLR y LCR bajo la curva de mortalidad hospitalaria de pacientes con ERC fueron de 0,830, 0,811, 0,664 y 0,712, respectivamente. Entre todos los parámetros, NLR y SII se dió a conocer la mejor manera de distinguir a los pacientes con mayor riesgo de muerte. Con base en el valor de corte de 1180,5, se encontró que la sensibilidad y especificidad del SII, para predecir la mortalidad hospitalaria, fue del 67,5% y 79,6%, respectivamente. La sensibilidad y especificidad correspondientes del NLR fueron del 85,2% y 66,1%, respectivamente, en el valor de corte de 5,1.El análisis de regresión logística escalonada hacia adelante mostró que el NLR (≥5,1), SII (≥1180,5) y LCR (≤9) fueron predictores de mortalidad hospitalaria. Conclusión: Informamos, por primera vez, que el SII es capaz de distinguir pacientes con ERC infectados por COVID-19 de peor supervivencia y, en este sentido, es tan poderoso como el NLR. Como el SII se cuantifica fácilmente a partir de los datos de las muestras de sangre, puede ayudar a la identificación temprana y el manejo oportuno de los pacientes con ERC con peor supervivencia.

Investigation of SARS-CoV-2 in tear and conjunctival secretions of hospitalized patients with clinically-confirmed COVID-19 pneumonia.

BACKGROUND: The aim of this study was to demonstrate the presence of the virus in tear and conjunctival secretions of clinically-confirmed COVID-19 pneumonia patients. METHODS: This prospective study was conducted at Bakirkoy Dr. Sadi Konuk Training and Research Hospital (2020/190). Nasopharyngeal and ocular samples were obtained by swab technique and investigated by RT-PCR. RESULTS: A total of 83 patients were included. The mean age was 61.88 ± 16.04 years. 28.92% of the patients had mild, 65.06% moderate and 6.02% severe pneumonia radiologically. RT-PCR was positive in 31 (37.35%) patients in the first nasopharyngeal swabs and in 19 (22.89%) in the second swabs. 17 of 19 patients had positive both first and second nasopharyngeal swabs; only the second swabs of two patients were positive. The first conjunctival swabs RT-PCR were positive in 5 out of 83 clinically-confirmed patients or 33 laboratory-confirmed patients (rates: 6.02% and 15.15%). There were no positives detected in the second conjunctival swabs. CONCLUSIONS: SARS-CoV-2 can be detected in the conjunctival swabs of patients with COVID-19 pneumonia.

Investigation of the relationships between perceived causes of COVID-19, attitudes towards vaccine and level of trust in information sources from the perspective of Infodemic: the case of Turkey.

BACKGROUND: The main purpose in this study carried out from the perspective of infodemic was to investigate the relationships between individuals' perceived causes of COVID-19, their attitudes towards vaccine and their levels of trust in information sources in terms of various descriptive characteristics. METHODS: In this cross-sectional and correlational study conducted with 1216 individuals from different provinces of Turkey, the Perception of Causes of COVID-19 (PCa-COVID-19) Scale was used. In addition, a questionnaire including the participants' descriptive characteristics, their attitudes towards vaccine and their level of trust in information sources about Covid-19 was used. RESULTS: The mean age of the participants was 35.9 ± 12.3 years. Of them, 62.5% were women, 59.0% were married, and 62.1% were university graduates. As for their view of having the Covid-19 vaccine, 54.1% thought to have it, 16.2% did not think, and 29.7% were undecided. Although the correlation was not significant, of the participants, those who considered having vaccination mostly trusted YouTube as their source of information. Of the participants, those whose level of trust in government institutions and health professionals was high displayed significantly more favorable attitudes towards vaccine. The participants obtained the highest mean score from the Conspiracy Theories subscale of the PCa-COVID-19 scale. There was a positive and low-level relationship between attitudes towards COVID-19 vaccine, and the Conspiracy Theories (r: 0.214) and Faith Factors (r: 0.066) sub-dimensions of the PCa-COVID-19 Scale. CONCLUSIONS: The level of vaccine hesitancy in Turkey is at an alarming level, and the virus is defined by moderate conspiracy theories. In this context, in the fight against infodemic, it is critical to implement mechanisms that can reveal misinformation and to plan initiatives that can increase the health literacy levels of societies.

Annual influenza vaccination effect on the susceptibility to COVID-19 infection.

OBJECTIVES: We aimed to study the effect of seasonal influenza (flu) vaccination on the susceptibility to coronavirus disease 2019 (COVID-19). METHODS: A total of 203 healthcare workers of a pandemic centre of Istanbul, Turkey, were included in this retrospective study. According to the presence or absence of flu vaccination, participants were divided into group 1 and group 2. A comparison of the rate of COVID-19 was done between these two groups. Also, the mean age and the sex ratio of females/males were evaluated and compared between these two groups. RESULTS: Group 1 participants (n = 65) were older than participants in group 2 (n = 138) (p < 0.05). Despite of this, interestingly, the COVID-19 infection rate was lower in the 1st group (in comparison to the 2nd group) (p < 0.05). CONCLUSION: Our study results showed that, even if low, the flu vaccination may have a protective effect on the susceptibility to COVID-19 infection. Using this beneficial adjuvant effect of the vaccine may help us in this unpredictable battle with the COVID-19 pandemic. Further studies are needed to confirm this assumption.