Is macrocytic erythrocyte a new prognostic parameter in critical COVID-19 disease?

Abstract

Introduction: In critical COVID- 19 patients, we aimed to examine the relationship mortality between the parameters and the macrocytic/microcytic erythrocyte population that are routinely evaluated in each patient admitted to the intensive care unit. Material and Method: It is a retrospective cross-sectional study and was conducted in Kastamonu University, Faculty of Medicine, a tertiary hospital intensive care units located in the North of Turkey .198 nonanemic critical COVID-19 patients treated between November 2020 and February 2021 were evaluated. The patients were divided into two groups as survival and non survival. Apache II score, saps II score and routine blood examinations of the patients were evaluated. Results: Among the groups; APACHE II score (p<0.001), SAPS II score (p<0.001), CRP (p<0.001), ferritin (p<0.001), d-dimer (p<0.001), platelet distribution width (p<0.009), mean platelet volume (p=0.005) and large platelet ratio (p=0.02) values ​​were higher, platelet counts (p=0.02) were lower, and these parameters were statistically significant between the two groups. There was no difference in erythrocyte distribution volume and microcytic erythrocyte percentage between the groups, but according to the cox regression analysis, each unit increase in macrocytic erythrocyte percentage was associated with a 1.203-fold increase in mortality. Conclusion: Routine procedures performed in every patient admitted to the intensive care unit can provide information about mortality. Macrocytic erythrocyte percentage, which is not generally considered in non-anemic patients, may be a new marker for mortality.

Keywords

• Macrocytic Erythrocyte Population
• Intensive Care Unit
• Covid 19
• Complete Blood Count
• Mortality

References

1. Zhou P, Yang XL, Wang XG. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579: 270–3.
2. World Health Organization; 2020. Coronavirus disease (COVID -2019) Situation Reports. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311- sitrep-51-COVID-19.pdf?sfvrsn=1ba62e57_10 (Accessed on 3/11/2020).
3. Murthy S, Archambault PM, Atique A, et al. Characteristics and outcomes of patients with COVID -19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study. CMAJ Open 2021; 9: E181-8.
4. Estella Á, Garcia Garmendia JL, de la Fuente C, et al. Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study. Med Intensiva. 2021; S0210-5691: 00033-4.
5. Li H Luo S, Zhang Y, Xiao X, Liu H. Longitudinal chest CT features in severe/critical COVID-19 cases and the predictive value of the ınitial CT for mortality. J Inflamm Res 2021; 14: 1111-24.
6. Chen R, Sang L, Jiang M, et al. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. J Allergy Clin Immunol 2020; 146: 89-100.
7. Qin C, Zhou L, Hu Z, et al. Dysregulation of ımmune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis 2020; 71: 762-8.
8. Lanini S, Montaldo C, Nicastri E, et al. COVID-19 disease-Temporal analyses of complete blood count parameters over course of illness, and relationship to patient demographics and management outcomes in survivors and non-survivors: A longitudinal descriptive cohort study. PLoS One 2020; 15: e0244129.

9. Ashorobi D, Munakomi S. Myelophthisic Anemia. (Updated 2021 May 1). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541103/
10. World Health Organization, 1968. Nutritional anaemias: report of a WHO scientific group (meeting held in Geneva from 13 to 17 March 1967).
11. Republic of Turkey Ministry of Health; Available from: (Accessed on 5/07/2021)
12. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients ınfected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323: 1574-81.
13. Vogels Y, Pouwels S, van Oers J, Ramnarain D. Characteristics and risk factors associated with mortality in critically ill patients with COVID-19. Cureus 2021; 13: e14442.
14. Rapp JL, Tremblay D, Alpert N, et al. Red cell distribution width is associated with mortality in non-anemic patients with COVID-19. J Med Virol 2021; 93: 4130-2.
15. Kokoszka-Bargieł I, Cyprys P, Rutkowska K, Madowicz J, Knapik P. Intensive care unit admissions during the first 3 months of the COVID-19 pandemic in Poland: a single-center, cross-sectional study. Med Sci Monit 2020; 26: e926974.
16. Armstrong RA, Kane AD, Cook TM. Outcomes from intensive care in patients with COVID -19: a systematic review and meta-analysis of observational studies. Anaesthesia 2020; 75: 1340-9.
17. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID -19-related death using OpenSAFELY. Nature 2020; 584: 430-6.
18. Xie J, Wu W, Li S, et al. Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Med 2020; 46: 1863-72.
19. Qu R, Hu L, Ling Y, et al. C-reactive protein concentration as a risk predictor of mortality in intensive care unit: a multicenter, prospective, observational study. BMC Anesthesiol 2020; 20: 292.
20. Larcher R, Besnard N, Akouz A, et al. Admission high-sensitive cardiac troponin t level ıncrease ıs ındependently associated with higher mortality in critically ill patients with COVID-19: a multicenter study. J Clin Med 2021; 10: 1656.
21. Duclos G, Bazalguette F, Allaouchiche B, et al. Can thoracic ultrasound on admission predict the outcome of critically ill patients with SARS-CoV-2? a French multi-centric ancillary retrospective study. Adv Ther 2021; 38: 2599-612.
22. Mahat RK, Panda S, Rathore V, Swain S, Yadav L, Sah SP. The dynamics of inflammatory markers in coronavirus disease-2019 (COVID -19) patients: A systematic review and meta-analysis. Clin Epidemiol Glob Health 2021; 11: 100727.
23. Adam EH, Zacharowski K, Miesbach W. A comprehensive assessment of the coagulation profile in critically ill COVID-19 patients. Thromb Res 2020; 194: 42–4.
24. Horton S, Fleming KA, Kuti M, et al. The top 25 laboratory tests by volume and revenue in five different countries. Am J Clin Pathol 2019; 151: 446-51.
25. Mousavi SA, Rad S, Rostami T, et al. Hematologic predictors of mortality in hospitalized patients with COVID -19: a comparative study. Hematology 2020; 25: 383-8.
26. Ouyang SM, Zhu HQ, Xie YN, et al. Temporal changes in laboratory markers of survivors and non-survivors of adult inpatients with COVID-19. BMC Infect Dis 2020; 20: 952.
27. Güçlü E, Kocayiğit H, Okan HD, et al. Effect of COVID -19 on platelet count and its indices. Rev Assoc Med Bras (1992) 2020; 66: 11227.
28. Bommenahalli Gowda S, Gosavi S, Ananda Rao A, et al. Prognosis of COVID-19: Red cell distribution width, platelet distribution width, and C-reactive protein. Cureus 2021; 13: e13078.
29. Lee JJ, Montazerin SM, Jamil A, et al. Association between red blood cell distribution width and mortality and severity among patients with COVID-19: A systematic review and meta-analysis. J Med Virol 2021; 93: 2513-22.
30. Horne BD, Muhlestein JB, Bennett ST, et al. Extreme erythrocyte macrocytic and microcytic percentages are highly predictive of morbidity and mortality. JCI Insight 2018; 3: e120183.
31. Brecher G, Stohlman F jr. Reticulocyte size and erythropoietic stimulation. Proc Soc Exp Biol Med 1961; 107: 887-91.