The role of inflammatory markers in the diagnosis of viral pneumonia in comorbid patients
Abstract
Introduction. The COVID-19 pandemic has posed significant challenges for healthcare systems, requiring the development of effective diagnostic and treatment methods for patients. One of the most common clinical manifestations of COVID-19 is bilateral viral pneumonia, often accompanied by systemic inflammation. It is important to consider the impact of comorbidities such as arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) on the course of the disease. In the pathogenesis of COVID-19, particular attention is given to inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), ferritin, and procalcitonin (PCT), which play an essential role in assessing disease severity, as well as in prognosis and therapy adjustment. The aim of this study is to investigate the role of pro-inflammatory markers in patients with viral pneumonia combined with AH and type 2 DM. Materials and methods. The study included 119 patients who were divided into three groups. The first group included patients with viral pneumonia without comorbidities, the second group included patients with viral pneumonia and AH, and the third group included patients with viral pneumonia and T2DM. Inflammatory markers such as CRP,
IL-6, ferritin, and PCT were assessed on admission to the hospital, 7 days after therapy initiation, and upon discharge. Results and discussion. All patients had a positive rapid test for COVID-19 and clinically confirmed moderate bilateral polisegmental viral pneumonia. In the AH group, a rise in blood pressure by 20–30 mm Hg from baseline was observed. In the T2DM group, disturbances in blood glucose control were noted. These changes required appropriate therapy adjustments. Clinical blood tests revealed leukocytosis, increased hematocrit, and elevated erythrocyte sedimentation rate (ESR) in all patients. Transaminases, creatinine, and urea concentrations remained within reference ranges, indicating normal liver and kidney function at the time of hospitalization. CRP, IL-6, ferritin, and PCT levels were associated with the intensity of the inflammatory process, as well as the presence of comorbidities such as AH and T2DM. Conclusions. Marker studies of pro-inflammatory factors play a key role in assessing the severity of COVID-19, particularly in patients with AH and T2DM. Monitoring CRP, IL-6, ferritin, and PCT levels is an important tool for disease prognosis and for timely adjustment of therapeutic strategies.
References
Ji D., Zhang D., Xu J., Chen Z., Yang T., Zhao P., Chen G., Cheng G., Wang Y., Bi J., Tan L., Lau G., Qin E. Prediction for Progression Risk in Patients With COVID-19 Pneumonia: The CALL Score. Clin Infect Dis. 2020;71(6):1393–1399. DOI: 10.1093/cid/ciaa414.
Semiz S. COVID19 biomarkers: What did we learn from systematic reviews? Front Cell Infect Microbiol. 2022;12:1038908. DOI: 10.3389/fcimb.2022.1038908.
Yang J., Zheng Y., Gou X., Pu K., Chen Z., Guo Q., Ji R., Wang H., Wang Y., Zhou Y. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91–95. DOI: 10.1016/j.ijid.2020.03.017.
Petrilli C.M., Jones S.A., Yang J., Rajagopalan H., O’Donnell L., Chernyak Y., Tobin K.A., Cerfolio R.J., Francois F., Horwitz L.I. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. DOI: 10.1136/bmj.m1966.
Adhikari S.P., Meng S., Wu Y.J., Mao Y.P., Ye R.X., Wang Q.Z., Sun C., Sylvia S., Rozelle S., Raat H., Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. 2020;9(1):29. DOI: 10.1186/s40249-020-00646-x.
Bornstein S.R., Dalan R., Hopkins D., Mingrone G., Boehm B.O. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020;16(6):297–298. DOI: 10.1038/s41574-020-0353-9.
Yong S.J., Halim A., Halim M., Liu S., Aljeldah M., Al Shammari B.R., Alwarthan S., Alhajri M., Alawfi A., Alshengeti A., Khamis F., Alsalman J., Alshukairi A.N., Abukhamis N.A., Almaghrabi F.S., Almuthree S.A., Alsulaiman A.M., Alshehail B.M., Alfaraj A.H., Alhawaj S.A., Mohapatra R.K., Rabaan A.A. Inflammatory and vascular biomarkers in post-COVID-19 syndrome: A systematic review and meta-analysis of over 20 biomarkers. Rev Med Virol. 2023;33(2):e2424. DOI: 10.1002/rmv.2424.
Wang G., Wu C., Zhang Q., Wu F., Yu B., Lv J., Li Y., Li T., Zhang S., Wu C., Wu G., Zhong Y. C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation. Open Forum Infect Dis. 2020;7(5):ofaa153. DOI: 10.1093/ofid/ofaa153.
Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332–334. DOI: 10.1016/j.medmal.2020.03.007.
Sayah W., Berkane I., Guermache I., Sabri M., Lakhal F.Z., YasmineRahali S., Djidjeli A., LamaraMahammed L., Merah F., Belaid B., Berkani L., Lazli N.Z., Kheddouci L., Kadi A., Ouali M., Khellafi R., Mekideche D., Kheliouen A., Hamidi R.M., Ayoub S., Raaf N.B., Derrar F., Gharnaout M., Allam I., Djidjik R. Interleukin-6, procalcitonin and neutrophil-to-lymphocyte ratio: Potential immune-inflammatory parameters to identify severe and fatal forms of COVID-19. Cytokine. 2021;141:155428. DOI: 10.1016/j.cyto.2021.155428.
Kumar A., Karn E., Trivedi K., Kumar P., Chauhan G., Kumari A., Pant P., Munisamy M., Prakash J., Sarkar P.G., Prasad K., Prasad A. Procalcitonin as a predictive marker in COVID-19: A systematic review and meta-analysis. PLoS One. 2022;17(9):e0272840. DOI: 10.1371/journal.pone.0272840.
Wei S., Wang L., Lin L., Liu X. Predictive values of procalcitonin for coinfections in patients with COVID-19: a systematic review and meta-analysis. Virol J. 2023;20(1):92. DOI: 10.1186/s12985-023-02042-x.
