Analysis of indicators of endogenous intoxication in patients with communityacquired pneumonia associated with COVID-19

Aim. To assess the prognostic significance of hematological parameters of endogenous intoxication syndrome at the stage of routing patients with pneumonia associated with COVID-19.

Materials and methods. 146 case histories of patients were analyzed, divided into 2 groups: patients who were referred for treatment to intensive care units based on the results of routing in the admission and diagnostic department (ADD) and patients referred for treatment to pulmonology departments. Upon admission of patients to the hospital, according to the case histories at the stage of ADD, an assessment of the clinical blood test was made, the calculation of hematological indicators of intoxication. Based on the data obtained, a ROC analysis was performed to determine the prognostic significance of hematological indicators of intoxication.

Results. In patients who were in intensive care units, at the stage of sorting in the ADD, the concentration of leukocytes and the percentage of neutrophils were higher by 25.9 and 16.2%, respectively, in comparison with patients referred for treatment to the pulmonology departments, however, the percentage of lymphocytes and the quantitative concentration of erythrocytes was lower by 26.6 and 8.3%, respectively. The integral indicator of intoxication in patients in intensive care was higher by 38.6%, the leukocyte index of intoxication by 74.3% and the index of the ratio of neutrophils to lymphocytes by 81.5%. In patients of the same group, the index of the ratio of neutrophils to monocytes was lower by 28.7%, the index of the ratio of lymphocytes to monocytes by 44.9%. The sensitivity of the integral indicator of intoxication was 73.3%, the specificity was 51.2%; in the leukocyte index of intoxication – 57.3 and 51.2%, respectively; the sensitivity of the index of the ratio of neutrophils to monocytes was 57.3%, the specificity was 59.1%; the same figures for the index of the ratio of neutrophils to lymphocytes were 68 and 60%, respectively.

Conclusion. It can be concluded that there is a rather high clinical prognostic value in the routing of patients with community-acquired pneumonia caused by COVID- 19 at the stage of initial examination in the ADD, such hematological parameters of intoxication as the integral index of intoxication and the index of the ratio of neutrophils to lymphocytes. We believe that hematological indicators of intoxication can complement prognostic scales and be used as another criterion in determining the routing of patients in ADD.

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