Prognostic Value of Monocyte-to-High-Density Lipoprotein Cholesterol Ratio in COVID-19 Patients

Yıl 2024, Cilt: 14 Sayı: 6, 315 - 322, 30.11.2024

Celal Kilit , Türkan Paşalı Kilit , Sertaş Erarslan

https://doi.org/10.16899/jcm.1549415

Öz

Aims: A significant portion of individuals infected with COVID-19 experience severe illness and require intensive care. Especially in these cases, the disease may ultimately be fatal. Monocyte to high-density lipoprotein cholesterol ratio (MHR) has been reported to be a novel marker for major adverse outcomes in many diseases. In this study, we aimed to reveal the relationship of MHR with the prognostic markers of COVID-19 and its role in predicting the severity of disease and in-hospital mortality in COVID-19.
Materials and Methods: This single-center, retrospective, and cross-sectional study included 195 hospitalized patients diagnosed with COVID-19. The patients who were discharged from the hospital formed the survivor group, whereas those who were deceased were categorized as the non-survivor group. Clinical and biochemical data of patients were retrospectively collected from medical records.
Results: The age of the patients ranged from 19 to 92 years and the mean age was 57.0±16.3 years. Ninety-eight (50.3%) of the patients were female. Forty-one of the patients died during hospitalization due to COVID-19 and related complications. Median MHR was significantly higher in the non-survivor group than in the survivor group. MHR was significantly correlated with age, ferritin, uric acid, urea, and creatinine levels. Univariate logistic regression analysis demonstrated no significant association between MHR and in-hospital mortality (p=0.132).
Conclusion: MHR is increased in COVID-19 survivors compared to non-survivors and correlates with age, ferritin, uric acid, urea, and creatinine levels. However, MHR cannot be used as a prognostic marker to predict the severity of the disease and in-hospital mortality in COVID-19 patients.

Anahtar Kelimeler

COVID-19 virus disease, in-hospital mortality, monocyte, HDL cholesterol, prognostic factor

Etik Beyan

ETHICAL DECLARATIONS Ethics Committee Approval: The study was initiated with the approval of the Kütahya Health Sciences University Clinical Researches Ethics Committee (Date: 17 September 2020, Decision No: 2020/14-18). Informed Consent: Because the study was designed retrospectively, no written informed consent form was obtained from patients. Conflict of Interest Statement: The authors have no conflicts of interest to declare. Financial Disclosure: The authors declared that this study has no financial support. Author Contributions: All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version.

Destekleyen Kurum

None

Teşekkür

None

COVID-19 Hastalarında Monosit-Yüksek Yoğunluklu Lipoprotein Kolesterol Oranının Prognostik Değeri

Öz

Amaç: COVID-19'a yakalanan bireylerin önemli bir kısmı ağır hastalık geçirmekte ve yoğun bakıma ihtiyaç duymaktadır. Özellikle bu vakalarda hastalık nihayetinde ölümcül olabilir. Monosit-yüksek yoğunluklu lipoprotein kolesterol oranının (MHR) birçok hastalıkta önemli olumsuz sonuçlar için yeni bir belirteç olduğu bildirilmiştir. Bu çalışmada, MHR'nin COVID-19'un prognostik belirteçleriyle ilişkisini ve COVID-19'da hastalığın şiddetini ve hastane içi mortaliteyi tahmin etmedeki rolünü ortaya koymayı amaçladık.
Gereç ve Yöntem: Tek merkezli, retrospektif ve kesitsel çalışmaya COVID-19 tanısı almış ve hastaneye yatırılmış 195 hasta dahil edildi. Hastaneden taburcu edilen hastalar sağ kalan grubu oluştururken, hayatını kaybedenler ise sağ kalamayan grup olarak kategorize edildi. Hastaların klinik ve biyokimyasal verileri tıbbi kayıtlardan retrospektif olarak toplandı.
Bulgular: Hastaların yaşları 19 ile 92 arasında değişiyordu ve ortalama yaş 57,0±16,3 yıldı. Hastaların 98'i (%50,3) kadındı. Hastaların 41'i COVID-19 ve ilgili komplikasyonlar nedeniyle hastanede yatarken öldü. Medyan MHR, hayatta kalmayan grupta hayatta kalan gruba göre anlamlı şekilde daha yüksekti. MHR, yaş, ferritin, ürik asit, üre ve kreatinin seviyeleriyle anlamlı şekilde ilişkiliydi. Tek değişkenli lojistik regresyon analizi, MHR ile hastane içi mortalite arasında anlamlı bir ilişki olmadığını gösterdi (p=0,132).
Sonuç: MHR, COVID-19'dan sağ kurtulanlarda hayatta kalmayanlara göre artmıştır ve yaş, ferritin, ürik asit, üre ve kreatinin seviyeleriyle ilişkilidir. Ancak MHR, COVID-19 hastalarında hastalığın şiddetini ve hastane içi mortaliteyi tahmin etmek için prognostik bir belirteç olarak kullanılamaz.

Anahtar Kelimeler

COVID-19 virüs hastalığı, hastane içi mortalite, monosit, HDL kolesterol, prognostik faktör

Kaynakça

• 1) Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579(7798):270-3.
• 2) Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
• 3) Sun P, Qie S, Liu Z, Ren J, Li K, Xi J. Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis. J Med Virol 2020;92(6):612-7.
• 4) Oudit GY, Kassiri Z, Jiang C, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 2009;39(7):618-25.
• 5) Xu SW, Ilyas I, Weng JP. Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies. Acta Pharmacol Sin 2023;44(4):695-709.
• 6) Georgieva E, Ananiev J, Yovchev Y, et al. COVID-19 Complications: Oxidative Stress, Inflammation, and Mitochondrial and Endothelial Dysfunction. Int J Mol Sci 2023;24(19):14876.
• 7) Gadotti AC, Lipinski AL, Vasconcellos FT, et al. Susceptibility of the patients infected with Sars-Cov2 to oxidative stress and possible interplay with severity of the disease. Free Radic Biol Med 2021;165:184-90.
• 8) Bektemur G, Bozali K, Colak S, Aktas S, Guler EM. Oxidative stress, DNA damage, and inflammation in COVID-19 patients. North Clin Istanb 2023;10(3):335-40.
• 9) Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239-42.
• 10) Weber C, Shantsila E, Hristov M, et al. Role and analysis of monocyte subsets in cardiovascular disease. Joint consensus document of the European Society of Cardiology (ESC) Working Groups "Atherosclerosis & Vascular Biology" and "Thrombosis". Thromb Haemost 2016;116(4):626-37.
• 11) Li XP, Zhao SP, Zhang XY, Liu L, Gao M, Zhou QC. Protective effect of high density lipoprotein on endothelium-dependent vasodilatation. Int J Cardiol 2000;73(3):231-6.
• 12) Murphy AJ, Woollard KJ, Hoang A, et al. High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol 2008;28(11):2071-7.
• 13) Inonu Koseoglu H, Pazarli AC, Kanbay A, Demir O. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study. Clin Appl Thromb Hemost 2018;24(1):139-44.
• 14) Kanbay M, Solak Y, Unal HU, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2014;46(8):1619-25.
• 15) Zhou Y, Wang L, Jia L, et al. The Monocyte to High-Density Lipoprotein Cholesterol Ratio in the Prediction for Atherosclerosis: A Retrospective Study in Adult Chinese Participants. Lipids 2021;56(1):69-80.
• 16) Ganjali S, Gotto AM Jr, Ruscica M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol 2018;233(12):9237-46.
• 17) Sun M, Zhao D, Zhang Y, et al. Prognostic Utility of Monocyte to High-Density Lipoprotein Ratio in Patients With Acute Coronary Syndrome: A Meta-Analysis. Am J Med Sci 2020;359(5):281-6.
• 18) Gunay-Polatkan S, Caliskan S, Sigirli D. Association of atherogenic indices with myocardial damage and mortality in COVID-19. PLoS One 2024;19(5):e0302984.
• 19) Argun D, Argun F, Basim P, Bayraktaroglu M. Monocyte-to-High-Density Lipoprotein Cholesterol Ratio: a Candidate Parameter for a Risk Assessment Model in COVID-19. Clin Lab 2022;68(3):10.7754/Clin.Lab.2022.210755.
• 20) Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020;324(8):782-93.
• 21) de Bruin S, Bos LD, van Roon MA, et al. Clinical features and prognostic factors in Covid-19: A prospective cohort study. EBioMedicine 2021;67:103378.
• 22) Sigirci S, Ser ÖS, Keskin K, Yildiz SS, Gurdal A, Kilickesmez KO. Comparing the Prognostic Value of Hematological Indices in Patients With ST Segment Elevation Myocardial Infarction: "A Head to Head" Analysis. Angiology 2021;72(4):348-54.
• 23) Yakar HI, Kanbay A. Could monocyte level/HDL cholesterol ratio predict cardiovascular diseases in patients with COPD?. Niger J Clin Pract. 2020;23(4):450-55.
• 24) Güler B, Doğan E, Onbaşı K. The Relationship Between Monocyte Count to High-density Lipoprotein Ratio and Severity of Inflammation in Aggressive Periodontitis: A Retrospective Analysis. Meandros Med Dent J 2020;21(2):122-7.
• 25) Usta A, Avci E, Bulbul CB, Kadi H, Adali E. The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome. Reprod Biol Endocrinol 2018;16(1):34.
• 26) Efe TH, Arslan ED, Ertem AG, et al. The prognostic value of the monocyte/HDL ratio in predicting short-term mortality in patients with acute pulmonary embolism. Koşuyolu Heart J 2016;19(3):149-53.
• 27) Oylumlu M, Oylumlu M, Arik B, et al. Monocyte to high-density lipoprotein cholesterol and lymphocyte to monocyte ratios are predictors of in-hospital and long-term mortality in patients with acute coronary syndrome. Int J Clin Pract 2021;75(5):e13973.
• 28) Jakubzick CV, Randolph GJ, Henson PM. Monocyte differentiation and antigen-presenting functions. Nat Rev Immunol 2017;17(6):349-62.
• 29) Pirsalehi A, Salari S, Baghestani A, et al. Differential alteration trend of white blood cells (WBCs) and monocytes count in severe and non-severe COVID-19 patients within a 7-day follow-up. Iran J Microbiol 2021;13(1):8-16.
• 30) Thell R, Zimmermann J, Szell M, et al. Standard blood laboratory values as a clinical support tool to distinguish between SARS-CoV-2 positive and negative patients. Sci Rep 2021;11(1):9365.
• 31) El-Sadr WM, Mullin CM, Carr A, et al. Effects of HIV disease on lipid, glucose and insulin levels: results from a large antiretroviral-naive cohort. HIV Med 2005;6(2):114-21.
• 32) Marin-Palma D, Sirois CM, Urcuqui-Inchima S, Hernandez JC. Inflammatory status and severity of disease in dengue patients are associated with lipoprotein alterations. PLoS One 2019;14(3):e0214245.
• 33) Sun JT, Chen Z, Nie P, et al. Lipid Profile Features and Their Associations With Disease Severity and Mortality in Patients With COVID-19. Front Cardiovasc Med 2020;7:584987.
• 34) Wang G, Zhang Q, Zhao X, et al. Low high-density lipoprotein level is correlated with the severity of COVID-19 patients: an observational study. Lipids Health Dis 2020;19(1):204.
• 35) Hu X, Chen D, Wu L, He G, Ye W. Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection. Clin Chim Acta 2020;510:105-10.
• 36) Kim HJ, Park HA, Cho YG, et al. Gender Difference in the Level of HDL Cholesterol in Korean Adults. Korean J Fam Med 2011;32(3):173-81.
• 37. Davis CE, Williams DH, Oganov RG. Sex difference in high density lipoprotein cholesterol in six countries. Am J Epidemiol 1996;143(11):1100-6.
• 38) Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020;369:m1985.
• 39) Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584(7821):430-6.
• 40) Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-20.
• 41) Wang K, Zuo P, Liu Y, et al. Clinical and Laboratory Predictors of In-hospital Mortality in Patients With Coronavirus Disease-2019: A Cohort Study in Wuhan, China. Clin Infect Dis 2020;71(16):2079-88.
• 42) Zheng T, Liu X, Wei Y, et al. Laboratory Predictors of COVID-19 Mortality: A Retrospective Analysis from Tongji Hospital in Wuhan. Mediators Inflamm 2021;2021:6687412.