HEMOGRAM INDICATORS IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA CAUSED BY COVID-19 DEPENDING ON THE CHARLSON COMORBIDITY INDEX

Homeliuk T. M., Marushchak M. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Introduction. Several studies have shown a higher incidence of severe cases and mortality among COVID-19 patients with comorbidities such as diabetes, high blood pressure, obesity, and cardiovascular disease compared to patients without comorbidities. This raises the question of how multimorbidity -the presence of 2 or more chronic comorbidities – may affect disease severity and mortality in patients with SARS-CoV-2 infection. The aim of our research was to investigate hemogram indicators in patients with community-acquired pneumonia caused by COVID-19 depending on the Charlson comorbidity index. Material and methods. A retrospective non-interventional cohort study was conducted on the medical records of 208 patients who were hospitalized for community-acquired pneumonia with a negative smear test for SARSCoV-2 between mid-January and the end of April 2021. The main group consisted of patients with identification of SARS-CoV-2 nucleic acid and signs of pneumonia on high-resolution computed tomography. According to the severity of pneumonia, patients were divided into three groups: II group – patients with pneumonia of category 2 of complexity (n=124), group III – patients with pneumonia of category 3 of complexity (n=68), group IV – patients with pneumonia of category 4 of complexity ( n=16). The severity of pneumonia was calculated according to the PORT scale. Comparison groups were made up of patients with identification of SARS-CoV-2 nucleic acid and manifestations of pneumonia on high-resolution computed tomography. The indicators of the general analysis (erythrocytes, hemoglobin, ESR, platelets) of blood were determined on the automatic hematology analyzer «Yumizen H500 CT». Patient data and information about concomitant diseases were collected from the patients’ medical records. The Charlson Comorbidity Index (Charlson Comorbidity Index) for overall mortality prediction was calculated using a special computer program. Statistical analysis of data was carried out using the “STATISTICA 7.0” software. Comparative analysis of absolute indicators was carried out using the parametric ANOVA test. The results. It was established that patients with community-acquired pneumonia caused by SARS-CoV-2 of 4 complexity categories had the lowest indicators of erythrocytes, hemoglobin, platelets, and the highest erythrocyte sedimentation rate, compared to the data of patients of 2 and 3 complexity categories and the comparison group. At the same time, the ESR was probably lower by 10.20% in the II group compared to the data of the III group, but it remained probably higher compared to the values of the comparison group. Comparing the obtained data of the Charlson comorbidity index in patients with community-acquired pneumonia caused by SARS-CoV-2 with respect to the comparison group, it was found that its indicators were probably higher in the III (by 57.89%) and IV (by 167.67%) observation groups. Kruskel-Wallis analysis of rank variations showed the presence of statistically significant differences in the individual studied indicators of the hemogram in patients with community-acquired pneumonia of different categories of complexity depending on the comorbidity index. The probable influence of a high comorbid burden (CCI ≥3 points) on the level of erythrocytes and ESR in patients with pneumonia of the 4th complexity category in relation to the comparison, as well as the influence of a low comorbid burden (CCI 0-2 points) on the level of the color index and ESR in patients with pneumonia of the 2nd category of complexity compared to the comparison group. It is worth noting that among patients with a low comorbidity index, the ESR indicator was probably higher in all studied groups compared to the comparison group, while with a high SSI, this indicator in the IV group was probably higher than the similar indicator in the II group by 47.06%. When establishing the relationship between the studied parameters of the hemogram and the comorbidity index in community-acquired pneumonia caused by SARS-CoV-2, probable weak negative associations were found between the growth of SSI and a decrease in the level of erythrocytes, hemoglobin, color index and platelets. Conclusions. The results of this study indicate the lowest indicators of erythrocytes, hemoglobin, platelets and the highest erythrocyte sedimentation rate in patients with community-acquired pneumonia caused by SARS-CoV-2 of 4 severity categories in relation to data in patients of 2 and 3 severity categories and the comparison group. At the same time, a probable influence of a high comorbid burden (CCI ≥3 points) on the level of erythrocytes and ESR in patients with pneumonia of the 4th category of complexity in relation to the comparison group is revealed, as well as an influence of a low comorbid burden (CCI 0-2 points) on the level of color index and ESR in patients with pneumonia of 2 severity categories compared to the comparison group.

SARS-CoV-2,pneumonia,Charlson comorbidity index,hemogram

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«Bulletin of problems biology and medicine» Issue 1 (168), 2023 year, 161-170 pages, index UDK 616.24-002-06:616.98:578.834.1]-074

10.29254/2077-4214-2023-1-168-161-170