Monocytosis in patients with coronavirus pneumonia after treatment with glucocorticoids

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Features of variation of peripheral blood leukocyte formula parameters in 86 patients with coronavirus pneumonia with leukocytosis with a background of glucocorticoid treatment were investigated. All patients were divided into 2 groups. Group 1 was 22 individuals who showed clinical signs of the bacterial infection (purulent sputum cough in combination with neutrophilic leukocytosis at hospital the admission). The 2nd group was made up of 64 patients with the glucocorticoids developed against the background of treatment with glucocorticoids (dexamethasone 20 mg/day or prednisolone 150 mg/day, intravenously for 3 days) leukocytosis >10 ×109/l without signs of a bacterial infection. It was found that in patients of the 1st group compared to the 2nd group, levels of the white blood cells and neutrophils significantly (p < 0.001) exceeded the reference values in the absence of a significant change in the number of monocytes. In patients of the 2nd group after a three-day intravenous application of the glucocorticoids on the 4th day of hospitalization, a statistically significant (p <0.001) increase in the number of neutrophils and monocytes was established. When comparing the quantitative parameters of the leukocyte formula between the 2nd group on the 4th day of the hospitalization and the 1st group at admission, there were no differences in the level of leukocytes and neutrophils. Number of monocytes in group 2 (1.11 (0.90; 1.34) × 109/l), on the contrary, statistically significantly (p < 0.001) exceeded their level in the 1st group (0.59 (0.50; 0.77) × 109/l). Thus, an indicator of the number of monocytes in the peripheral blood could be a promising differential diagnostic criterion for the genesis of the leukocytosis in patients with the COVID-19. This parameter may be one of the factors influencing the decision to prescribe the antibacterial therapy.

Full Text

Restricted Access

About the authors

Maxim I. Shperling

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Author for correspondence.
Email: mersisaid@yandex.ru
ORCID iD: 0000-0002-3274-2290
SPIN-code: 7658-7348
Scopus Author ID: 57215661145
ResearcherId: ABC-3170-2021

intern

Russian Federation, Saint Petersburg

Alexey V. Kovalev

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: kovalev.mmeda@yandex.ru
SPIN-code: 3478-3858

intern

Russian Federation, Saint Petersburg

Vitaliy S. Sukachev

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: dr.sukachev@gmail.com
SPIN-code: 4140-6250
Scopus Author ID: 54890504800
ResearcherId: H-6303-2016

candidate of medical sciences

Russian Federation, Saint Petersburg

Andrey A. Vlasov

33rd Central Research Test Institute

Email: vlasovandrej@mail.ru
SPIN-code: 2801-1228

candidate of medical sciences

Russian Federation, Volsk-18

Alexey S. Polyakov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: doctorpolyakov@gmail.com
ORCID iD: 0000-0001-9238-8476
SPIN-code: 2700-2420
Scopus Author ID: 56583551700
ResearcherId: M-4229-2016

candidate of medical sciences

Russian Federation, Saint Petersburg

Yaroslav A. Noskov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: dady-08@mail.ru
SPIN-code: 1645-2231

candidate of medical sciences

Russian Federation, Saint Petersburg

Alexandr D. Morozov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: m14232@mail.ru
ORCID iD: 0000-0002-2258-5914
SPIN-code: 3874-8152

candidate of medical sciences

Russian Federation, Saint Petersburg

Victor S. Merzlyakov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: sidmma@yandex.ru
SPIN-code: 5098-0700

cadet

Russian Federation, Saint Petersburg

Dmitry P. Zvyagintsev

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: zvyagintsev321@mail.ru
SPIN-code: 9937-6852

cadet

Russian Federation, Saint Petersburg

Konstantin V. Kozlov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: kosttiak@mail.ru
ORCID iD: 0000-0002-4398-7525
SPIN-code: 7927-9076
Scopus Author ID: 56924908500
ResearcherId: H-9944-2013

doctor of medical sciences, professor

Russian Federation, Saint Petersburg

Konstantin V. Zhdanov

Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation

Email: zhdanovkv.vma@gmail.com
SPIN-code: 7895-2075
Scopus Author ID: 6602691874

doctor of medical sciences, professor

Russian Federation, Saint Petersburg

References

  1. Surveillances V The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19). Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–151. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003
  2. Zaytsev AA, Chernov SA, Kryukov EV, et al. Practical experience of managing patients with new coronavirus infection COVID-19 in hospital (preliminary results and guidelines). Lechaschi Vrach. 2020;(6):74–79. (In Russ.). doi: 10.26295/OS.2020.41.94.014
  3. Teuwen LA, Geldhof V, Pasut A, et al. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020;20(7):389–391. doi: 10.1038/s41577-020-0343-0
  4. Azkur AK, Akdis M, Azkur D, et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. 2020;75(7):1564–1581. doi: 10.1111/all.14364
  5. Minnullin TI, Stepanov AV, Chepur SV, et al. Immunological aspects of SARS-CoV-2 coronavirus damage. Bulletin of the Russian Military Medical Academy. 2021;23(2):187–198. (In Russ.). doi: 10.17816/brmma72051
  6. Wang J, Jiang M, Chen X, et al. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol. 2020;108(1):17–41. doi: 10.1002/JLB.3COVR0520-272R
  7. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266–275. doi: 10.1016/j.jinf.2020.05.046
  8. Youngs J, Wyncoll D, Hopkins P, et al. Improving antibiotic stewardship in COVID-19: Bacterial co-infection is less common than with influenza. J Infect. 2020;81(3):e55–e57. doi: 10.1016/j.jinf.2020.06.056
  9. Crotty MP, Akins R, Nguyen A, et al. Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients. мedRxiv. 2020;2:1–19. doi: 10.1101/2020.05.29.20117176
  10. Vazzana N, Dipaola F, Ognibene S. Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes. Acta Clin Belgica Int J Clin Lab Med. 2020:1–5. doi: 10.1080/17843286.2020.1824749
  11. Zaitsev AA, Chernov SA, Stets VV, et al. Algorithms for the management of patients with a new coronavirus COVID-19 infection in a hospital. Guidelines. Consilium Medicum. 2020;22(11):91–97. (In Russ.). doi: 10.26442/20751753.2020.11.200520
  12. Lee H. Procalcitonin as a biomarker of infectious diseases. Korean J Intern Med. 2013;28(3):285–291. doi: 10.3904/kjim.2013.28.3.285
  13. Shoenfeld Y, Gurewich Y, Gallant LA, et al. Prednisone-induced leukocytosis. Am J Med. 1981;71(5):773–778. doi: 10.1016/0002-9343(81)90363-6
  14. Martinez FO, Combes TW, Orsenigo F, et al. Monocyte activation in systemic Covid-19 infection: Assay and rationale. EBioMedicine. 2020;59:(102964):1–7. doi: 10.1016/j.ebiom.2020.102964
  15. Zaitsev AA, Golukhova EZ, Mamalyga ML, et al. Efficacy of methylprednisolone pulse therapy in patients with COVID-19. Clinical Microbiology and Antimicrobial Chemotherapy. 2020;22(2):88–91. (In Russ.). doi: 10.36488/cmac.2020.2.88-91
  16. Dubinski D, Won SY, Gessler F, et al. Dexamethasone-induced leukocytosis is associated with poor survival in newly diagnosed glioblastoma. J Neurooncol. 2018;137(3):503–510. doi: 10.1007/s11060-018-2761-4
  17. Liles WC, Dale DC, Klebanoff SJ Glucocorticoids inhibit apoptosis of human neutrophils. Blood. 1995;86(8):3181–3188.
  18. Burton JL, Kehrli ME, Kapil S, et al. Regulation of l-selectin and CD18 on bovine neutrophils by glucocorticoids: effects of cortisol and dexamethasone. J Leukoc Biol. 1995;57(2):317–325. doi: 10.1002/jlb.57.2.317
  19. Ehrchen JM, Roth J, Barczyk-Kahlert K. More Than Suppression: Glucocorticoid Action on Monocytes and Macrophages. Front Immunol. 2019;10:2028. doi: 10.3389/fimmu.2019.02028
  20. Gómez-Rial J, Rivero-Calle I, Salas A. Role of Monocytes/Macrophages in COVID-19 Pathogenesis: Implications for Therapy. Infect Drug Resist. 2020;13:2485–2493. doi: 10.2147/IDR.S258639
  21. Qin C, Zhou L, Hu Z, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762–768. doi: 10.1093/cid/ciaa248
  22. Solinas C, Perra L, Aiello M, et al. A critical evaluation of glucocorticoids in the management of severe COVID-19. Cytokine Growth Factor Rev. 2020;54:8–23. doi: 10.1016/j.cytogfr.2020.06.012
  23. Liu B, Dhanda A, Hirani S, et al. CD14++CD16+ Monocytes Are Enriched by Glucocorticoid Treatment and Are Functionally Attenuated in Driving Effector T Cell Responses. J Immunol. 2015;194(11):5150–5160. doi: 10.4049/jimmunol.1402409
  24. Solomay TV, Semenenko TA, Filatov NN, et al. Reactivation of Epstein – Barr virus (Herpesviridae: Lymphocryptovirus, HHV-4) infection during COVID-19: epidemiological features. Problems of Virology. 2021;66(2):152–161 (In Russ.). doi: 10.36233/0507-4088-40
  25. Blinov DV, Akarachkova ES, Orlova AS, et al. New framework for the development of clinical guidelines in Russia. Farmakoekonomika. Modern Pharmacoeconomics and Pharmacoepidemiology. 2019;12(2):125–144. (In Russ.). doi: 10.17749/2070-4909.2019.12.2.125-144

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Number of monocytes, neutrophils, and white blood cells in patients of both groups prior to the start of glucocorticoid therapy

Download (190KB)
Indexing metadata
3. Fig. 2. Number of peripheral blood monocytes in the study groups

Download (261KB)
Indexing metadata

Copyright (c) 2021 Shperling M.I., Kovalev A.V., Sukachev V.S., Vlasov A.A., Polyakov A.S., Noskov Y.A., Morozov A.D., Merzlyakov V.S., Zvyagintsev D.P., Kozlov K.V., Zhdanov K.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 77762 от 10.02.2020.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies