The effect of thrombosis-related laboratory values on mortality in COVID-19 infection.

OBJECTIVE: COVID-19 may cause thrombosis in both venous and arterial systems. Familiarity with the signs and symptoms of thrombosis and its treatment is essential in treating COVID-19 infection and its complications. D-Dimer and mean platelet volume (MPV) are measurements related to the development of thrombosis. This study investigates whether MPV and D-Dimer values could be used to determine the risk of thrombosis and mortality in the COVID-19 early stages. PATIENTS AND METHODS: 424 patients who were COVID-19 positive, according to the World Health Organization (WHO) guidelines, were randomly and retrospectively included in the study. Demographic and clinical characteristics such as age, gender, and length of hospitalization were obtained from the digital records of participants. Participants were divided into living and deceased groups. The patients' biochemical, hormonal, and hematological parameters were analyzed retrospectively. RESULTS: White blood cells (WBC), neutrophils, and monocytes were significantly different in the two groups (p-value <0.001), and their values were lower in the living group than in the deceased group. MPV median values did not differ according to prognosis (p-value = 0.994). While the median value was 9.9 in the survivors, it was 10 in the deceased. Creatinine, procalcitonin, ferritin, and the number of hospitalization days in living patients were significantly lower than in patients who died (p-value <0.001). Median values of D-dimer (mg/L) differ according to prognosis (p-value <0.001). While the median value was 0.63 in the survivors, it was found as 438 in the deceased. CONCLUSIONS: Our results did not show any significant relationship between the mortality of COVID-19 patients and their MPV levels. However, a significant association between D-Dimer and mortality in COVID-19 patients was observed.

INFLAMMATORY CELL RATIOS IN THE PATIENTS WITH FIBROMYALGIA.

Fibromyalgia is a chronic disease with undefined aetiology which commonly results in muscle sensitivity, pain, and sensitivity at certain anatomical points. The pathogenesis and aetiology of fibromyalgia are not yet fully understood. The objective of this study was to assess the diagnostic value of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/ monocyte ratio (LMR) as simple systemic inflammatory response biomarker sin patients with fibromyalgia. A total of 489 patients with fibromyalgia (group1) and 227 healthy controls (group2) were included in the study. Demographic data, Body Mass Index (BMI) neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded. Baseline NLR, PLR, and LMR were calculated by dividing the absolute neutrophil, platelet and lymphocyte counts by the respective divisor absolute values. The NLR, PLR, and LMR levels of the two groups were then compared. There were no significant differences in gender and age between the two groups (p>0,05). BMI levels (29.6 vs 24.8 kg/m2), mean NLR (3.63 vs. 2.11) and PLR (222.55 vs. 114.28) values were found to be statistically higher (p <0.001), and mean LMR (2.73 vs. 3.85) values were found to be statistically lower, in the patient group (p <0.001). The present study showed that NLR, PLR, AND LMR levels can be used in the diagnosis of fibromyalgia and systemic inflammation may play a role in fibromyalgia.

CLINICAL CHARACTERISTICS OF BLOOD TRANSFUSION IN GERIATRIC PATIENTS.

In the presented study, the etiology was defined in geriatric patients who received transfusions with erythrocyte suspension due to anemia; the amount of transfusion was investigated and practical systems and methods to prevent the overuse of transfusions were developed. A retrospective patient records analysis was performed for a total of 328 patients aged ≥65 who received transfusions for any reason between July 2015 and 2018 at Sakarya Research and Training Hospital. Laboratory data at initial presentation, number of erythrocyte transfusions (NES), and total volume of erythrocyte suspension transfusions (TNES) performed during all admissions over the study period were recorded. Also recorded were the demographic data, concurrent conditions, and laboratory values. Patients were divided into two groups based on their age and hemoglobin levels. Age group A1 consisted of patients between 65 and 75 years of age (inclusive), while age group A2 consisted of patients over 75 years of age (exclusive). Based on the hemoglobin levels, the patients were identified as those with a hemoglobin <8 g/dl severe anemia (group H1), hemoglobin level ranging 8-9,5 g/dl moderate anemia (H2), and hemoglobin >9,5 g/dl - mild anemia (H3). The amount of transfusion and etiological factors responsible for anemia were examined. With respect to the incidence of iron deficiency, volume of transfused erythrocyte suspensions (ES), and total number of erythrocyte suspensions (TNES) were significantly higher in the H1 group, compared to the H2 group (p:0.012 and p:0.001, respectively). Comparing H2 and H3 groups, in terms of B12 deficiency, ES, and TNES were significantly higher in the H3 group than in the H2 group (p:.0001, p:.001, p:.001, respectively). In our study, transfusion indications in patients between 65 and 75 years of age and patients aged over 75 years differed significantly in terms of cardiac conditions and hypertension. The age groups were not significantly different in terms of transfusions performed for gastrointestinal bleeding. Also, the gender distribution across these two age groups was well balanced. No significant differences were noted related either to the age or to comorbid conditions between two groups. The higher average NES and TNES values in Group A2 (> 75 years) compared to Group A1 (65-75 y) were attributed to the need for achieving cardiovascular hemodynamic stability, and to the reduced tolerance of anemia due to accompanying comorbid conditions. Despite a wide array of etiological factors in anemic geriatric patients requiring transfusions, it is of utmost importance to develop a management plan for the underlying cause of anemia in order to reduce the indications for repeated transfusions. The anemia threshold for identifying the need for transfusion should be individualized based on the physiological status of each case.