Kumar Yogesh, Kumari Amita, Kumar Tribhuwan, Jha Kamlesh, Zabihullah Md
Physiology, All India Institute of Medical Sciences, Patna, Patna, IND.
Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND.
Cureus. 2023 Sep 14;15(9):e45276. doi: 10.7759/cureus.45276. eCollection 2023 Sep.
Introduction Human coronaviruses, identified in the 1960s, are known culprits of respiratory infections. Classified into alpha, beta, gamma, and delta subgroups, these viruses have the capacity to transition from animal reservoirs to causing severe respiratory ailments in humans. Notable outbreaks like the 2003 severe acute respiratory distress syndrome (SARS) epidemic and the ongoing coronavirus disease 2019 (COVID-19) pandemic underscore the recurring emergence of novel coronaviruses with severe human infection potential. COVID-19, driven by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly become a leading global cause of severe acute respiratory syndrome. Immune system disruptions and cytokine imbalances contribute to severe cases, necessitating early diagnosis and precise severity assessment. Methodology This retrospective cross-sectional study encompassed 211 COVID-19 patients admitted to AIIMS Patna from May to July 2020. Clinical and hematological parameters, including neutrophils, eosinophils, basophils, lymphocytes, monocytes, red and white blood cell counts, platelet count, C-reactive protein (CRP), serum ferritin, and d-dimer, were meticulously recorded. Patients were categorized into non-severe and severe groups using the National Early Warning Score (NEWS) 2. Results Our findings underscore the pivotal role of hematological markers in gauging COVID-19 severity. Notably, markers such as neutrophil-to-lymphocyte ratio (NLR), derived NLR, lymphocyte monocyte ratio, platelet lymphocyte ratio, d-dimer, CRP, and serum ferritin exhibited notable elevation in severe cases. Survival analysis further established the predictive potential of these markers in assessing disease progression and mortality risk. We advocate for the integration of these markers into existing severity assessment frameworks to foster objective clinical evaluations. Conclusion In conclusion, our study unravels the intricate connection between COVID-19 severity and hematological parameters. We emphasize the early warning capabilities of NLR, derived NLR, platelet lymphocyte ratio, and other markers in predicting disease progression. This research underscores the imperative need to incorporate hematological markers into the evaluation of COVID-19 severity, thereby providing invaluable insights for enhancing clinical practice and patient outcomes.
引言
人类冠状病毒于20世纪60年代被发现，是呼吸道感染的已知病原体。这些病毒分为α、β、γ和δ亚组，有能力从动物宿主传播并导致人类严重的呼吸道疾病。2003年严重急性呼吸综合征（SARS）疫情和正在发生的2019冠状病毒病（COVID-19）大流行等重大疫情凸显了具有严重人类感染潜力的新型冠状病毒的反复出现。由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发的COVID-19已迅速成为严重急性呼吸综合征的主要全球病因。免疫系统紊乱和细胞因子失衡导致病情严重，因此需要早期诊断和精确的严重程度评估。
方法
这项回顾性横断面研究涵盖了2020年5月至7月在巴特那全印医学科学研究所住院的211例COVID-19患者。精心记录了临床和血液学参数，包括中性粒细胞、嗜酸性粒细胞、嗜碱性粒细胞、淋巴细胞、单核细胞、红细胞和白细胞计数、血小板计数、C反应蛋白（CRP）、血清铁蛋白和D-二聚体。使用国家早期预警评分（NEWS）2将患者分为非重症组和重症组。
结果
我们的研究结果强调了血液学标志物在衡量COVID-19严重程度方面的关键作用。值得注意的是，中性粒细胞与淋巴细胞比率（NLR）、衍生NLR、淋巴细胞单核细胞比率、血小板淋巴细胞比率、D-二聚体、CRP和血清铁蛋白等标志物在重症病例中显著升高。生存分析进一步证实了这些标志物在评估疾病进展和死亡风险方面的预测潜力。我们主张将这些标志物纳入现有的严重程度评估框架，以促进客观的临床评估。
结论
总之，我们的研究揭示了COVID-19严重程度与血液学参数之间的复杂联系。我们强调NLR、衍生NLR、血小板淋巴细胞比率和其他标志物在预测疾病进展方面的早期预警能力。这项研究强调了将血液学标志物纳入COVID-19严重程度评估的迫切需要，从而为改善临床实践和患者预后提供宝贵的见解。
