Potential markers of COVID-19 severity found in patients with chronic airway disease



The results of a retrospective study revealed potential markers of the severity of COVID-19 in people with chronic obstructive pulmonary disease, asthma or chronic bronchitis.

Eosinopenia and elevation of lactate dehydrogenase (LDH) may serve as potential predictors of the severity of COVID-19 disease in patients with underlying chronic airway disease, according to the results of a study by retrospective cohort.

As COVID-19 has spread over the past 2 years, identifying severe cases early in the course of the disease has become crucial for the administration of effective care and treatment.

“Chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma are common respiratory diseases accompanied by chronic inflammation of the airways,” the authors explained. “Eosinophils, neutrophils, and macrophages in the innate immune response increase dramatically in the airways and lungs during the initial stage of inflammation.”

Lymphopenia and a decrease in circulating eosinophils have been reported in patients with COVID-19, leading researchers to hypothesize that patients with COPD, asthma, and chronic bronchitis under- could have different inflammatory states after infection with SARS-CoV-2, the virus that causes COVID. -19 — compared to those without chronic airway inflammation.

To test their hypothesis, investigators analyzed the medical records of 59 patients with lab-confirmed COVID-19 and underlying chronic airway inflammation who presented to a hospital in China between January and April 2020.

They compared the demographic, clinical and radiological characteristics and laboratory results of patients with severe and non-severe disease. Severe COVID-19 was defined as “respiratory distress with respiratory rate ≥ 30 per minute, pulse oximeter oxygen saturation ≤ 93% at rest; and oxygenation index (arterial partial pressure of oxygen / fraction of inspired oxygen) 300 mm Hg, ”the authors wrote.

Of the 1,888 patients admitted to hospital within the study window, 59 had COPD (0.95%), asthma (0.53%) or chronic bronchitis (1.64%). Twenty-six patients were classified as having severe COVID-19, and the median age of the patients was 71 years old. The majority of patients were male (71%) and had at least one comorbidity in addition to chronic respiratory disease (53%).

On admission, people with severe COVID-19 were more likely to have a decrease in lymphocyte count (0.6 × 10⁹ / L vs. 1.1 × 10⁹ / L; P P P P = 0.002) compared to those with non-severe COVID-19, the researchers found.

Univariate and multivariate models also found that eosinopenia and elevated LDH were significantly associated with disease severity, while “the number of eosinophils and the level of LDH tended to return to normal over time. in both groups after treatment and severe patients recovered more slowly than non-severe patients, especially in the number of eosinophils, ”the authors said. However, no difference was observed in patients with asthma, potentially due to the small sample size included.

Previous treatment regimens, including the use of inhaled corticosteroids, could contribute to the outcome of patients with COVID-19, although research on this topic is scarce and further studies are warranted. In addition, different asthma and COPD phenotypes could also play a role in COVID-19 outcomes.

Overall, “Our study reveals that eosinopenia and elevated LDH on admission are potential predictors of disease severity in adults with COVID-19 with underlying chronic airway disease.” , the researchers concluded. “In addition, the number of eosinophils could indicate the progression of the disease of COVID-19, thus revealing the effectiveness of the treatment. These predictors can help clinicians identify severe COVID-19 in patients with chronic bronchitis, COPD, and asthma. “

Reference:

Chen D, Zhang S, Feng Y et al. Decreased eosinophils and elevated lactate dehydrogenase predict severe COVID-19 in patients with underlying chronic airway disease. Postgrad Med J. Published online November 22, 2021. doi: 10.1136 / postgradmedj-2021-139704


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