Relationships of the neutrophil-lymphocyte and CRP-albumin ratios with the duration of hospitalization and fatality in geriatric patients with COVID-19.

OBJECTIVE: The aim of this study was to determine the associations of the neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP)-albumin ratio (CAR) with the duration of hospital stay and fatality rate in geriatric patients with coronavirus disease 2019 (COVID-19). METHODS: Patients older than 65 years with polymerase chain reaction-positive COVID-19 were included. Neutrophil, lymphocyte, CRP, albumin, and demographic data and the duration of hospitalization were recorded. RESULTS: The mean length of stay was 15 days. NLR and CAR were significantly higher in patients who died than in those who survived. The cutoffs predictive of mortality were 4.02 (area under the curve [AUC] = 0.717) for NLR and 23 for CAR (AUC = 0.781). The fatality rate among patients who required inpatient treatment was 33%. CONCLUSION: NLR and CAR, which can be calculated inexpensively and quickly at the first admission to the hospital, are extremely useful for estimating the duration of hospitalization and risk of mortality in geriatric patients with COVID-19. Using these data, treatment can quickly be intensified when needed.

Chanarin-Dorfman syndrome.

Chanarin Dorfman syndrome is a multisystem, very rare, autosomal recessive lipid storage disorder, characterized by the accumulation of lipid vacuoles in neutrophils, and was first described by Dorfman in 1974. Due to a mutation in the ABHD5 gene of the short arm of chromosome 3, lipid is stored in the granulocytes at various sites in the human body, such as the muscle, liver, eye, ear, central nervous system, and bone marrow. Clinically, the disease is presented with ichthyosis, hearing loss, hepatomegaly, splenomegaly, cirrhosis, cataract, keratopathy, myopathy, and mental retardation. A 38-year-old male patient was referred to our Internal Medicine Clinic for consultation with laboratory findings as follows: high aspartate aminotransferase (AST; 203 U/L), alanine aminotransferase (ALT; 151 U/L), gamma-glutamyl transferase (GGT; 167 U/L), creatine kinase (CK; 1127 U/L) levels and low platelet levels (108000). After ultrasonography and gastroscopy, the patient was diagnosed with liver cirrhosis. Bilateral mixed-type hearing loss on audial tests and bilateral punctuate keratopathy, ectropion, and cataract in the left eye on ophthalmological tests were found. For the definitive diagnosis of Chanarin Dorfman syndrome, peripheral blood was examined, which revealed lipid accumulation in the neutrophils (Jordan's anomaly). We emphasize that if a patient has unusual findings, such as ichthyosis, hearing loss, hepatomegaly, splenomegaly, cirrhosis, cataract, keratopathy, myopathy, and mental retardation, the possibility of Chanarin Dorfman syndrome should be considered.

Serum Angiopoietin-like peptide 4 levels in patients with hepatic steatosis.

OBJECTIVES: Angiopoietin-like peptide 4 (ANGPTL-4) plays an important role in lipid metabolism by inhibiting the enzyme lipoprotein lipase. This effect of ANGPTL-4 results in suppression of the release of plasma triglyceride-derived fatty acids. Increase in fatty acid levels entering to the liver and abnormalities in their secretion is one of the main mechanisms in pathogenesis of hepatic steatosis. In this study, we aimed to investigate the role of ANGPTL-4 in pathogenesis of hepatic steatosis by determining its levels in patients with fatty liver disease. METHODS: Totally 51 patients (age: 37.9 ±â€¯9.9 years, M/F) diagnosed with grade 2-3 hepatic steatosis with ultrasound and 30 healthy volunteers (age: 34.8 ±â€¯9.5 years, M/F) were included in the study. In both groups, routine biochemical tests including fasting blood glucose, fasting insulin levels, triglyceride, total cholesterol, LDL- cholesterol, HDL-cholesterol, AST, ALT, ALP, GGT levels were measured together with the ANGPTL-4 levels. In determination of ANGPTL-4 levels, ELISA was performed. RESULTS: When compared with the control group, ANGPTL-4 levels were determined to be decreased in patients with hepatic steatosis (369 ±â€¯243 vs 303 ±â€¯286 ng/mL, p = 0.014). There was a negative weak correlation observed between ANGPTL-4 and triglyceride levels (r = -0.246, p = 0.027). Among all groups, when patients with and without insulin resistance were compared; ANGPTL-4 levels were determined to be similar. While fasting blood glucose levels were similar between 2 groups; fasting insulin and triglyceride levels were determined to be increased in hepatic steatosis group (Insulin 17.7 ±â€¯12 vs 7.4 ±â€¯3.3 µIU/mL, p < 0.001, triglyceride 158 ±â€¯46.4 vs 118 ±â€¯59.8 mg/dL p < 0.001). CONCLUSIONS: We have determined lower serum ANGPTL-4 levels in patients with hepatic steatosis. ANGPTL-4 that is regulating LPL activity plays an important role in fatty liver disease pathogenesis via free fatty acid metabolism and peroxisome proliferator-activated receptor-delta (PPAR-δ). We believe that the results of this study would elucidate the investigations about the mechanism of fatty liver disease development and treatments targeting ANGPTL-4.