Specificities of Correlation Indicators of the Hemostasis System and Leukocytic Index of Intoxication in Patients with Out-of-Hospital Pneumonia on the Background of COVID-19

ABSTRACT

Foreword Pneumonia remains an important medical and social problem at the beginning of the 21st century as well. This is due to its high prevalence, fairly high rates of disability and mortality, as well as significant economic expenditures for treatment. The incidence of pneumonia in different regions of the world ranges from 3.5 to 15 cases per 1 thousand population. The mortality rate from pneumonia in different countries of the world ranges from 2-3 to 25%. Pneumonia takes the first place among the causes of lethality and mortality from infectious diseases and the sixth one - among all the causes of death and the fourth - among causes of death in patients older than 65 years. Objective of research Find out the peculiarities of correlation indicators of the hemostasis system and leukocytic index of intoxication in patients with out-of-hospital pneumonia on the background of COVID-19. Materials and methods of research Based on NMMCC MMCH, a retrospective review analyzed 66 maps of inpatients with out-of-hospital pneumonia associated with COVID-19. The average age of the patients included in the study was 38.9 ± 0.7 years for males [66% (n = 37)] and 39.3 ± 0.83 for females [44% (n = 29)]. The leukocyte intoxication index (LII) was calculated and the severity of pneumonia was assessed according to the PSI scale (Pneumonia Severity Index, 2004). Results of the personal research After dividing the patients according to the level of LII and PSI stratification class, we identified three groups of patients with mild intoxication (n = 30, LII - 2.13 ± 0.09), which corresponded to class II on PSI (61.5 ± 6, 5);with intoxication of moderate severity (n = 31, LII - 4.83 ± 0.29), which corresponded to class III for PSI (79.4 ± 7.4);with severe intoxication (n = 5, LII - 10.11 ± 0.53), which corresponded to class IV PSI (110.4 ± 11.4). Assessing the severity of pneumonia on the PSI and LII scale [in the first group (LII - 2.13 ± 0.09, PSI - 61.5 ± 6.5), in the second group (LII - 4.83 ± 0.29, PSI - 79.4 ± 7.4), and in the third group (LII - 10.11 ± 0.53, PSI - 110.4 ± 11.4)], we found a direct strong credible Pearson's correlation (r = 0.56;p < 0.05) between the level of leukocyte intoxication index and the level of PSI. In addition, it was found that the increasing degree of intoxication significantly increases the value of LII (p < 0.05). When assessing changes in the coagulogram of patients depending on LII (in the first group of LII - 2.13 ± 0.09, PI,% - 91.3 ± 0.86, APTT, c - 33.38 ± 0.2, fibrinogen A, g\L - 3.37 ± 0.08, fibrinogen B, qualitatively - 1.6 ± 0.14, activated plasma recalcification time, c - 84.5 ± 1.64, in the second group of LII - 4.83 ± 0.29, PI,% - 84.6 ± 0.98, APTT, c - 31.96 ± 0.19, fibrinogen A, g\L - 3.69 ± 0.05, fibrinogen B, qualitatively - 2.48 ± 0.13, activated plasma recalcification time, c - 94.19 ± 1.31, in the third group LII - 10.11 ± 0.53, PI,% - 83 ± 2.0, APTT, c - 31, 42 ± 0.26, fibrinogen A, g\L - 3.93 ± 0.11, fibrinogen B, qualitatively - 3.0 ± 0.31, activated plasma recalcification time, c - 97.0 ± 4.63), it was found that with increasing degree of intoxication PI and APTT indicators decreased, while levels of fibrinogen A and B raised, as well as the rate of activated plasma recalcification (a significant difference between the data of groups I and II with p < 0.01;I and II with p < 0.001;I and III with p < 0.05;I and III with p < 0.001 was defined). Conclusion: (1) In assessment, the severity of pneumonia on the PSI scales and leukocyte intoxication index, we found a direct strong veracious correlation by Pearson's method (r = 0.56;p <0.05) between the level of leukocyte intoxication index and the level of PSI. (2) Characteristic features of changes in the leukocyte index of intoxication in patients with community-acquired pneumonia are the following with increasing degree of intoxication, the value of leukocyte index of intoxication increases significantly (p < 0.05). (3) When assessing changes in the coagulogram depending on LII and PSI scale, it was found that with increasing degree of intoxication PI and APTT indicators decreased but the levels of fibrinogen A and B increased, as well as the rate of the activated plasma recalcification.