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Eozinopeni; Covid-19 tanısında, basit, hızlı ve güvenilir bir biyobelirteç olabilir mi?

Yıl 2020, Cilt: 42 Sayı: 4, 422 - 433, 31.12.2020

Muzaffer Katar , Osman Demir

https://doi.org/10.7197/cmj.822996
https://izlik.org/JA64ET92DN

Öz

Giriş
Covid-19 hastalığı moleküler, serolojik veya radyolojik yöntemlerle teşhis edilir. Bu tanı yöntemlerine ulaşılamadığı veya sonuçlanmasının çok zaman aldığı durumlarda, Covid-19 hastalarının basit ve kolay erişilebilir laboratuvar biyobelirteçleri ile etkin teşhisine ihtiyaç vardır.
Amaç
Covid-19' hastalığında 'eozinopeni'nin tanısal performansını araştırdık.
Materyal ve Yöntemler
Çalışmamız bir retrospektif vaka-kontrol çalışmasıdır. 15 Mart - 15 Haziran 2020 tarihleri arasında Covid-19 tanısı alan 30 hastanın kaydedilmiş klinik, laboratuvar ve radyolojik verileri uygun istatistiksel yöntemler kullanılarak 30 sağlıklı kişi ile karşılaştırıldı.
Bulgular
Hem hastalar hem de kontroller sırasıyla 57.2 ± 15.46 ve 60.07 ± 20.59 yaş ortalamaları ile 10 (% 33.3) kadın ve 200 (% 66.6) erkekten oluşuyordu. Hastaların başvuru sırasındaki eozinofil sayıları kontrollere göre anlamlı olarak düşüktü (p <0.001). Yatıştan bir hafta sonra eozinofil sayıları başvuru düzeylerine göre anlamlı olarak arttı (p = 0,004). Hastalarda yatış anında 'Eozinopeni'nin güvenilir bir göstergesi olan Nötrofil / Eozinofil oranı bir hafta sonrasına göre anlamlı derecede yüksekti (p: 0,041). Başvuru eozinofil sayımları,% 66,7 duyarlılık,% 93,3 özgüllük ve ≤0,04x103 / µL kesme seviyesi ile hasta ve kontrolleri ayırt etti. ROC analizi; (AUC): 0.856, p <0.001.
Sonuç
Covid-19 şüpheli hastaların benzer semptomları olan diğer hastalardan basit bir hemogram parametresi eozinofil sayımı ile hızlı bir şekilde izole edilmesi ve ampirik tedaviye başlanması halk sağlığı açısından büyük fayda sağlayacaktır.

Anahtar Kelimeler

Covid-19 Eozinopeni Lenfopeni Nötropeni Tanı

Kaynakça

  • 1. Zhu N, Zhang D, Wang W. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019 [published January 24, 2020]. N Engl J Med.
  • 2. Jebril N. World Health Organization declared a pandemic public health menace: A systematic review of the coronavirus disease 2019 “COVID-19”, up to 26th March 2020. Available at SSRN 3566298. 2020.
  • 3. Rothenberg ME, Hogan SP. The eosinophil. Annual review of immunology. 2006;24.
  • 4. Weller PF, Spencer LA. Functions of tissue-resident eosinophils. Nature Reviews Immunology. 2017;17(12):746-60.
  • 5. Busse W, Chupp G, Nagase H, Albers FC, Doyle S, Shen Q, et al. Anti–IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: Indirect treatment comparison. Journal of Allergy and Clinical Immunology. 2019;143(1):190-200. e20.
  • 6. Rodriguez C, Veciana C. ASTHMA AND COVID-19: THE EOSINOPHILIC LINK. Qeios. 2020.
  • 7. Akuthota P, Wang H, Spencer L, Weller P. Immunoregulatory roles of eosinophils: a new look at a familiar cell. Clinical & Experimental Allergy. 2008;38(8):1254-63.
  • 8. Nagase H, Okugawa S, Ota Y, Yamaguchi M, Tomizawa H, Matsushima K, et al. Expression and function of Toll-like receptors in eosinophils: activation by Toll-like receptor 7 ligand. The Journal of Immunology. 2003;171(8):3977-82.
  • 9. Bass DA, Gonwa TA, Szejda P, Cousart MS, DeChatelet LR, McCall CE. Eosinopenia of acute infection: production of eosinopenia by chemotactic factors of acute inflammation. The Journal of clinical investigation. 1980;65(6):1265-71.
  • 10. Echevarria C, Hartley T, Nagarajan T, Tedd H, Steer J, Gibson GJ, et al. 30 day mortality and eosinopenia in patients with pneumonia. European Respiratory Journal. 2014;44(Suppl 58).
  • 11. Savitskiy A, Rudnov V, Bagin V. Eosinopenia as a marker of sepsis and mortality in critically ill patients. Critical Care. 2015;19(1):1-201.
  • 12. Bass DA. Behavior of eosinophil leukocytes in acute inflammation. II. Eosinophil dynamics during acute inflammation. The Journal of clinical investigation. 1975;56(4):870-9.
  • 13. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420-2.
  • 14. Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study. American journal of respiratory and critical care medicine. 2020;201(11):1372-9.
  • 15. Zhang J-j, Dong X, Cao Y-y, Yuan Y-d, Yang Y-b, Yan Y-q, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020.
  • 16. Lindsley AW, Schwartz JT, Rothenberg ME. Eosinophil responses during COVID-19 infections and coronavirus vaccination. Journal of Allergy and Clinical Immunology. 2020.
  • 17. Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S. Covid-19 autopsies, oklahoma, usa. American Journal of Clinical Pathology. 2020;153(6):725-33.
  • 18. Li Y, Wu W, Yang T, Zhou W, Fu Y, Feng Q, et al. Characteristics of peripheral blood leukocyte differential counts in patients with COVID-19. Zhonghua nei ke za zhi. 2020;59:E003-E.
  • 19. Du Y, Tu L. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. 2020;201(11):1372-9.
  • 20. Riggioni C, Comberiati P, Giovannini M, Agache I, Akdis M, Alves-Correia M, et al. A compendium answering 150 questions on COVID-19 and SARS-CoV-2. Allergy. 2020:10-111.
  • 21. Yii A, Tay TR, Choo X, Koh M, Tee A, Wang DY. Precision medicine in united airways disease: A “treatable traits” approach. Allergy. 2018;73(10):1964-78.
  • 22. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406-7.
  • 23. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology. 2020.
  • 24. Yao X, Zeng Y, Tong Y, Tang X, Yin Z. Determination and analysis of blood eosinophil in 200 severe acute respiratory syndrome patients. Lab Med. 2004;5(19):444-45.
  • 25. Li Q, Ding X, Xia G, Chen H-G, Chen F, Geng Z, et al. Eosinopenia and elevated C-reactive protein facilitate triage of COVID-19 patients in fever clinic: a retrospective case-control study. EClinicalMedicine. 2020:100375.
  • 26. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020:100331.
  • 27. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
  • 28. Organization WH. Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎ nCoV)‎‎‎ infection is suspected: interim guidance, 25 January 2020. World Health Organization, 2020.

Could Eosinopenia be a simple, fast and reliable biomarker in diagnosis of Covid-19?

Yıl 2020, Cilt: 42 Sayı: 4, 422 - 433, 31.12.2020

Muzaffer Katar , Osman Demir

https://doi.org/10.7197/cmj.822996
https://izlik.org/JA64ET92DN

Öz

Objective: Monitoring CBC subsets, particularly eosinophils. and inflammation markers, during admission and treatment of severe COVID-19 patients, can reveal key indicators of disease progression and stage to provide a basis for diagnosis and treatment for clinicians.
Method: Our study is a retrospective case-control study. After taking aproval of Ministry of Health and Ethics Committee, the recorded clinical, laboratory and radiological data of 30 patients who were diagnosed with Covid-19, between 15 March and 15 June 2020, were compared with 30 healthy person by using appropriate statistical methods.
Results: Both patients and conrols included 10 (33.3%) females and 20 (66.6%) males with a mean age of 57.2 ± 15.46 and 60.07 ± 20.59 respectively. Eosinophil counts of the patients on admission were significantly lower than the controls (p <0.001). Eosinophil counts one week after admission were increased significantly compared to the admission levels (p= 0.004). Neutrophil/Eosinophil ratio, which is a reliable indicator of 'Eosinopenia' in patients on admission was significantly higher than that of one week later (p= 0.041). EO1, NE1, NE2, PLT2/LYM2, LYM1/CRP1 and LYM2/CRP2 were the most predictive indexes. The AUCs of them were; 0.856, 0.778, 0.719, 0.738, 0.747 and 0.702 respectively, the cut-off values were; 0.04, 3.32, 3.21, 144,59, 1.99 and 7.84 respectively, the sensitivity and specificity were 66.7% and 93.3% for EO1; 53.3% and 93.3% for NE1; 46.7% and 93.3% for NE2; and 80.1% and 80.5% for PLT2/LYM2; and 100% and 66.7% for LYM1/CRP1and 100% and 53.3% for LYM2/CRP2; respectively. 
Conclusions: Tracking of CBC subsets, particularly Eosinophil, and CBC indexes is helpful in the early screening, diagnosis, treatment and follow up of critical COVID-19 patients.

Anahtar Kelimeler

Covid-19 Diagnosis Eosinopenia Lymphopenia Neutropenia

Kaynakça

  • 1. Zhu N, Zhang D, Wang W. China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019 [published January 24, 2020]. N Engl J Med.
  • 2. Jebril N. World Health Organization declared a pandemic public health menace: A systematic review of the coronavirus disease 2019 “COVID-19”, up to 26th March 2020. Available at SSRN 3566298. 2020.
  • 3. Rothenberg ME, Hogan SP. The eosinophil. Annual review of immunology. 2006;24.
  • 4. Weller PF, Spencer LA. Functions of tissue-resident eosinophils. Nature Reviews Immunology. 2017;17(12):746-60.
  • 5. Busse W, Chupp G, Nagase H, Albers FC, Doyle S, Shen Q, et al. Anti–IL-5 treatments in patients with severe asthma by blood eosinophil thresholds: Indirect treatment comparison. Journal of Allergy and Clinical Immunology. 2019;143(1):190-200. e20.
  • 6. Rodriguez C, Veciana C. ASTHMA AND COVID-19: THE EOSINOPHILIC LINK. Qeios. 2020.
  • 7. Akuthota P, Wang H, Spencer L, Weller P. Immunoregulatory roles of eosinophils: a new look at a familiar cell. Clinical & Experimental Allergy. 2008;38(8):1254-63.
  • 8. Nagase H, Okugawa S, Ota Y, Yamaguchi M, Tomizawa H, Matsushima K, et al. Expression and function of Toll-like receptors in eosinophils: activation by Toll-like receptor 7 ligand. The Journal of Immunology. 2003;171(8):3977-82.
  • 9. Bass DA, Gonwa TA, Szejda P, Cousart MS, DeChatelet LR, McCall CE. Eosinopenia of acute infection: production of eosinopenia by chemotactic factors of acute inflammation. The Journal of clinical investigation. 1980;65(6):1265-71.
  • 10. Echevarria C, Hartley T, Nagarajan T, Tedd H, Steer J, Gibson GJ, et al. 30 day mortality and eosinopenia in patients with pneumonia. European Respiratory Journal. 2014;44(Suppl 58).
  • 11. Savitskiy A, Rudnov V, Bagin V. Eosinopenia as a marker of sepsis and mortality in critically ill patients. Critical Care. 2015;19(1):1-201.
  • 12. Bass DA. Behavior of eosinophil leukocytes in acute inflammation. II. Eosinophil dynamics during acute inflammation. The Journal of clinical investigation. 1975;56(4):870-9.
  • 13. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420-2.
  • 14. Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study. American journal of respiratory and critical care medicine. 2020;201(11):1372-9.
  • 15. Zhang J-j, Dong X, Cao Y-y, Yuan Y-d, Yang Y-b, Yan Y-q, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020.
  • 16. Lindsley AW, Schwartz JT, Rothenberg ME. Eosinophil responses during COVID-19 infections and coronavirus vaccination. Journal of Allergy and Clinical Immunology. 2020.
  • 17. Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S. Covid-19 autopsies, oklahoma, usa. American Journal of Clinical Pathology. 2020;153(6):725-33.
  • 18. Li Y, Wu W, Yang T, Zhou W, Fu Y, Feng Q, et al. Characteristics of peripheral blood leukocyte differential counts in patients with COVID-19. Zhonghua nei ke za zhi. 2020;59:E003-E.
  • 19. Du Y, Tu L. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. 2020;201(11):1372-9.
  • 20. Riggioni C, Comberiati P, Giovannini M, Agache I, Akdis M, Alves-Correia M, et al. A compendium answering 150 questions on COVID-19 and SARS-CoV-2. Allergy. 2020:10-111.
  • 21. Yii A, Tay TR, Choo X, Koh M, Tee A, Wang DY. Precision medicine in united airways disease: A “treatable traits” approach. Allergy. 2018;73(10):1964-78.
  • 22. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406-7.
  • 23. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology. 2020.
  • 24. Yao X, Zeng Y, Tong Y, Tang X, Yin Z. Determination and analysis of blood eosinophil in 200 severe acute respiratory syndrome patients. Lab Med. 2004;5(19):444-45.
  • 25. Li Q, Ding X, Xia G, Chen H-G, Chen F, Geng Z, et al. Eosinopenia and elevated C-reactive protein facilitate triage of COVID-19 patients in fever clinic: a retrospective case-control study. EClinicalMedicine. 2020:100375.
  • 26. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020:100331.
  • 27. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
  • 28. Organization WH. Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎ nCoV)‎‎‎ infection is suspected: interim guidance, 25 January 2020. World Health Organization, 2020.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Muzaffer Katar 0000-0002-6296-2390

Osman Demir 0000-0002-1322-2716

Kabul Tarihi 22 Aralık 2020
Yayımlanma Tarihi 31 Aralık 2020
DOI https://doi.org/10.7197/cmj.822996
IZ https://izlik.org/JA64ET92DN
Yayımlandığı Sayı Yıl 2020 Cilt: 42 Sayı: 4

Kaynak Göster

AMA 1.Katar M, Demir O. Could Eosinopenia be a simple, fast and reliable biomarker in diagnosis of Covid-19? CMJ. 2020;42(4):422-433. doi:10.7197/cmj.822996

Cited By

Dynamic inflammatory response among routine laboratory biomarkers and their predictive ability for mortality in patients with severe COVID-19
Frontiers in Medicine
https://doi.org/10.3389/fmed.2022.1047304