medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-234medsovet-10252Research ArticleCOVID-19Факторы риска развития тяжелого COVID-ассоциированного поражения легких у пациентов с хронической обструктивной болезнью легкихRisk factors for severe COVID-associated lung damage in patients with chronic obstructive pulmonary diseasehttps://orcid.org/0000-0002-2665-6214ГнеушеваТ. Ю.GneushevaT. Yu.

Гнеушева Татьяна Юрьевна - ассистент кафедры пульмонологии лечебного факультета.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Tatiana Yu. Gneusheva - Assistant Professor of the Department of Pulmonology, Faculty of Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119048

dr_tatjana@list.ruhttps://orcid.org/0000-0001-9928-926XГайнитдиноваВ. В.GaynitdinovaV. V.

Гайнитдинова Вилия Вилевна - д.м.н., профессор кафедры пульмонологии лечебного факультета.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Viliya V. Gaynitdinova - Dr. Sci. (Med.), Professor of the Department of Pulmonology, Faculty of Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119048

ivv_08@mail.ruhttps://orcid.org/0000-0001-9125-1873ПоздняковаА. А.PozdnyakovaA. A.

Позднякова Анна Алексеевна - к.м.н., доцент кафедры пульмонологии лечебного факультета.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Anna A. Pozdnyakova - Cand. Sci. (Med.), Associate Professor of the Department of Pulmonology, Faculty of Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119048

pozdniakovaaa@gmail.comhttps://orcid.org/0000-0001-7986-8010АйнетдиноваЕ. С.AynetdinovaE. S.

Айнетдинова Елизавета Сергеевна - аспирант кафедры пульмонологии лечебного факультета.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Elizaveta S. Aynetdinova - Postgraduate Student of the Department of Pulmonology, Faculty of Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119048

e-li1999@mail.ruВанЮ.WangYu.

Ван Юэ – студент.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Yue Wang – Student.

8, Bldg. 2, Trubetskaya St., Moscow, 119048

965802890@qq.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202614072026098696Copyright © Гнеушева Т.Ю., Гайнитдинова В.В., Позднякова А.А., Айнетдинова Е.С., Ван Ю., 20262026Гнеушева Т.Ю., Гайнитдинова В.В., Позднякова А.А., Айнетдинова Е.С., Ван Ю.Gneusheva T.Y., Gaynitdinova V.V., Pozdnyakova A.A., Aynetdinova E.S., Wang Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10252Введение

Введение. Сопутствующая хроническая обструктивная болезнь легких (ХОБЛ) является одним из наиболее важных факторов риска развития COVID-ассоциированного поражения легких.

Цель

Цель. Изучить факторы риска развития тяжелой формы COVID-ассоциированного поражения легких на фоне ХОБЛ.

Материалы и методы

Материалы и методы. Проведено ретроспективное одноцентровое сравнительное исследование. В исследование включены 154 пациента, госпитализированных по поводу COVID-19, из них 103 пациента с ХОБЛ. В группу сравнения вошли пациенты (n = 51) без ХОБЛ и без анамнеза курения по принципу «случай – контроль». Наличие COVID-19 подтверждалось лабораторными исследованиями и/или клинико-рентгенологически.

Результаты

Результаты. В группе пациентов с COVID-19 без ХОБЛ доля пациентов с поражением легких КТ-1–2 и КТ-3–4 составила 47% (18/38), в группе пациентов с COVID-19 и ХОБЛ – 38% (39/103); статистически значимых различий выявлено не было (p = 0,41). Поражение легких КТ-3–4 вне зависимости от наличия/отсутствия ХОБЛ статистически значимо ассоциировано с более старшим возрастом пациентов, более высоким индексом массы тела, наличием ишемической болезни сердца, повышенным уровнем артериального давления, частоты дыхания, уровня нейтрофилов, СРБ, АСТ, ЛДГ и пониженным уровнем SpO2. В группе пациентов с COVID-19 и ХОБЛ поражение легких КТ-3–4 ассоциировалось с более высокими значениями данных показателей по сравнению с группой пациентов с COVID-19 без ХОБЛ: пороговое значение уровня лейкоцитов в группе COVID-19 без ХОБЛ составило 5,6 × 109/л против 10,9 × 109/л у пациентов с COVID-19 и ХОБЛ, пороговое значение уровня нейтрофилов – 4,2 × 109/л и 9,3 × 109/л, пороговое значение соотношения нейтрофилов и лимфоцитов – 5,8 и 11,3. Поражение легких КТ-3–4 у пациентов с COVID-19 и ХОБЛ ассоциировано с более высокими баллами по шкале mMRC (отношение шансов [ОШ] составило 2,75 [95% ДИ: 1,09–6,92] для 3 баллов по сравнению с 2 баллами и 4,24 [95% ДИ: 1,26–14,3] для 4 баллов по сравнению с 2 баллами), более высокими значениями по шкале CAT (ОШ = 4,87; 95% ДИ: 1,88–13,53 при CAT выше 18 баллов) и смешанным фенотипом ХОБЛ (ОШ = 2,94; 95% ДИ: 1,10–8,07) по сравнению с бронхитическим фенотипом (p = 0,045).

Заключение

Заключение. Тяжелое COVID-ассоциированное поражение легких (КТ-3–4) развивается под влиянием общих факторов (возраст, ожирение, воспаление, гипоксемия), но у пациентов с ХОБЛ оно протекает на фоне более выраженного системного воспаления и отягощается симптомами основного заболевания.

Introduction

Introduction. Concomitant chronic obstructive pulmonary disease (COPD) is one of the most important risk factors for the development of COVID-associated lung damage.

Aim

Aim. To study risk factors for the development of severe COVID-associated lung damage in patients with COPD.

Materials and methods

Materials and methods. A retrospective single-center comparative study was conducted. The study included 154 patients hospitalized for COVID-19, of which 103 patients had COPD. The comparison group consisted of patients (n = 51) without COPD and smoking history on the case-control principle. The presence of COVID-19 was confirmed by laboratory tests and/or clinically and radiologically. The dynamics of clinical and laboratory-instrumental indicators were evaluated from the first to the seventh day of observation.

Results

Results. In the COVID-19 group without COPD, the proportion of patients with lung damage CT 1–2 and CT 3–4 was 47% (18/38), in the COVID-19 and COPD group – 38% (39/103); no statistically significant differences were found (p = 0.41). Lung damage CT 3–4 regardless of the presence/absence of COPD was statistically significantly associated with older age, higher body mass index, coronary artery disease, increased levels of blood pressure, respiratory rate, neutrophils, CRP, AST, LDH, and decreased SpO2 level. In the group of patients with COVID-19 and COPD, lung damage CT 3–4 was associated with higher values of these indicators than in the group of patients with COVID-19 without COPD: the threshold value of leukocytes in the COVID-19 group without COPD was 5.6 × 109/L versus 10.9 × 109/L in patients with COVID-19 and COPD, the threshold value of neutrophils – 4.2 × 109/L and 9.3×109/L, the threshold value of the neutrophil/lymphocyte ratio – 5.8 and 11.3. Lung damage CT 3–4 in patients with COVID-19 and COPD was associated with higher mMRC scores (odds ratio [OR] = 2.75 [95% CI: 1.09–6.92] for 3 points versus 2, OR = 4.24 [95% CI: 1.26–14.3] for 4 points versus 2), higher CAT scores (OR = 4.87; 95% CI: 1.88–13.53 for CAT above 18 points) and mixed COPD phenotype (OR = 2.94; 95% CI: 1.10–8.07) versus bronchitic (p = 0.045).

Conclusion

Conclusion. Severe COVID-associated lung damage (CT 3–4) develops under the influence of general factors (age, obesity, inflammation, hypoxemia), but in patients with COPD it occurs against the background of more pronounced systemic inflammation and is aggravated by symptoms of the underlying disease.

COVID-19хроническая обструктивная болезнь легкихпоражение легкихиндекс системного воспалениягипоксемияшкала mMRCшкала CATфенотипы хронической обструктивной болезни легкихCOVID-19chronic obstructive pulmonary diseaselung damagesystemic inflammation indexhypoxemiamMRC scaleCAT scalephenotypes of chronic obstructive pulmonary diseaseReferencesFeiereisz AI, Oprinca GC, Birlutiu V. Lung Volume Change Assessment in Moderate and Severe COVID-19 Using CT Volumetry. Diagnostics. 2025;15(12):1465. https://doi.org/10.3390/diagnostics15121465.Feiereisz AI, Oprinca GC, Birlutiu V. Lung Volume Change Assessment in Moderate and Severe COVID-19 Using CT Volumetry. Diagnostics. 2025;15(12):1465. https://doi.org/10.3390/diagnostics15121465.Авдеев СН, Адамян ЛВ, Алексеева ЕИ, Багненко СФ, Баранов АА, Баранова НН и др. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). М.; 2021. 236 с. Режим доступа: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/058/211/original/BMP-13.pdf.Авдеев СН, Адамян ЛВ, Алексеева ЕИ, Багненко СФ, Баранов АА, Баранова НН и др. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). М.; 2021. 236 с. Режим доступа: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/058/211/original/BMP-13.pdf.Su WL, Lu KC, Chan CY, Chao YC. COVID-19 and the lungs: A review. J Infect Public Health. 2021;14(11):1708–1714. https://doi.org/10.1016/j.jiph.2021.09.024.Su WL, Lu KC, Chan CY, Chao YC. COVID-19 and the lungs: A review. J Infect Public Health. 2021;14(11):1708–1714. https://doi.org/10.1016/j.jiph.2021.09.024.Montazersaheb S, Hosseiniyan Khatibi SM, Hejazi MS, Tarhriz V, Farjami A, Ghasemian Sorbeni F et al. COVID-19 infection: An overview on cytokine storm and related interventions. Virol J. 2022;19(1):92. https://doi.org/10.1186/s12985-022-01814-1.Montazersaheb S, Hosseiniyan Khatibi SM, Hejazi MS, Tarhriz V, Farjami A, Ghasemian Sorbeni F et al. COVID-19 infection: An overview on cytokine storm and related interventions. Virol J. 2022;19(1):92. https://doi.org/10.1186/s12985-022-01814-1.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. https://doi.org/10.1001/jama.2020.1585.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. https://doi.org/10.1001/jama.2020.1585.Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med. 2005;11(8):875–879. https://doi.org/10.1038/nm1267.Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med. 2005;11(8):875–879. https://doi.org/10.1038/nm1267.Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS ONE. 2020;15(5):e0233147. https://doi.org/10.1371/journal.pone.0233147.Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS ONE. 2020;15(5):e0233147. https://doi.org/10.1371/journal.pone.0233147.Aaron SD, Donaldson GC, Whitmore GA, Hurst JR, Ramsay T, Wedzicha JA. Time course and pattern of COPD exacerbation onset. Thorax. 2012;67(3):238–243. https://doi.org/10.1136/thoraxjnl-2011-200768.Aaron SD, Donaldson GC, Whitmore GA, Hurst JR, Ramsay T, Wedzicha JA. Time course and pattern of COPD exacerbation onset. Thorax. 2012;67(3):238–243. https://doi.org/10.1136/thoraxjnl-2011-200768.Williams NP, Ostridge K, Devaster JM, Kim V, Coombs NA, Bourne S et al. Impact of radiologically stratified exacerbations: insights into pneumonia aetiology in COPD. Respir Res. 2018;19:143. https://doi.org/10.1186/s12931-018-0842-8.Williams NP, Ostridge K, Devaster JM, Kim V, Coombs NA, Bourne S et al. Impact of radiologically stratified exacerbations: insights into pneumonia aetiology in COPD. Respir Res. 2018;19:143. https://doi.org/10.1186/s12931-018-0842-8.Hosseninia S, Ghobadi H, Garjani K, Hosseini SAH, Aslani MR. Aggregate index of systemic inflammation (AISI) in admission as a reliable predictor of mortality in COPD patients with COVID-19. BMC Pulm Med. 2023;23(1):107. https://doi.org/10.1186/s12890-023-02397-5.Hosseninia S, Ghobadi H, Garjani K, Hosseini SAH, Aslani MR. Aggregate index of systemic inflammation (AISI) in admission as a reliable predictor of mortality in COPD patients with COVID-19. BMC Pulm Med. 2023;23(1):107. https://doi.org/10.1186/s12890-023-02397-5.Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36. https://doi.org/10.1148/radiology.143.1.7063747.Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36. https://doi.org/10.1148/radiology.143.1.7063747.Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020;13(12):1833–1839. https://doi.org/10.1016/j.jiph.2020.07.014.Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020;13(12):1833–1839. https://doi.org/10.1016/j.jiph.2020.07.014.Schultze A, Walker AJ, MacKenna B, Morton CE, Bhaskaran K, Brown JP et al. Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform. Lancet Respir Med. 2020;8(11):1106–1120. https://doi.org/10.1016/S2213-2600(20)30415-X.Schultze A, Walker AJ, MacKenna B, Morton CE, Bhaskaran K, Brown JP et al. Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform. Lancet Respir Med. 2020;8(11):1106–1120. https://doi.org/10.1016/S2213-2600(20)30415-X.Avdeev SN, Pozdnakova AA, Gaynitdinova VV, Chikina SY, Vlasenko AE. Asthma in older adults with severe COVID-19: clinical outcomes and predictors of mortality. Ann Allergy Asthma Immunol. 2021;128(2):213–215. https://doi.org/10.1016/j.anai.2021.10.016.Avdeev SN, Pozdnakova AA, Gaynitdinova VV, Chikina SY, Vlasenko AE. Asthma in older adults with severe COVID-19: clinical outcomes and predictors of mortality. Ann Allergy Asthma Immunol. 2021;128(2):213–215. https://doi.org/10.1016/j.anai.2021.10.016.Гайнитдинова ВВ, Авдеев СН, Позднякова АА, Власенко АЕ, Байтимерова ИВ, Гнеушева ТЮ. Бронхиальная астма и COVID-19 у пожилых пациентов: особенности течения, выживаемость, предикторы летальности. Пульмонология. 2022;32(2):151–161. https://doi.org/10.18093/0869-0189-2022-32-2-151-161.Gaynitdinova VV, Avdeev NN, Pozdniakova AA, Vlasenko AYe, Baytimerova IV, Gneusheva TV. Asthma and COVID-19 in the elderly: course, survival, predictors of mortality. Pulmonologiya. 2022;32(2):151–161. (In Russ.) https://doi.org/10.18093/0869-0189-2022-32-2-151-161.Gómez Antúnez M, Muiño Míguez A, Bendala Estrada AD, Maestro de la Calle G, Monge Monge D, Boixeda R et al. Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2. Int J Chron Obstruct Pulmon Dis. 2020;15:3433–3445. https://doi.org/10.2147/COPD.S276692.Gómez Antúnez M, Muiño Míguez A, Bendala Estrada AD, Maestro de la Calle G, Monge Monge D, Boixeda R et al. Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2. Int J Chron Obstruct Pulmon Dis. 2020;15:3433–3445. https://doi.org/10.2147/COPD.S276692.Beltramo G, Cottenet J, Mariet AS, Georges M, Piroth L, Tubert-Bitter P et al. Chronic respiratory diseases are predictors of severe outcome in COVID-19 hospitalised patients: a nationwide study. Eur Respir J. 2021;58(6):2004474. https://doi.org/10.1183/13993003.04474-2020.Beltramo G, Cottenet J, Mariet AS, Georges M, Piroth L, Tubert-Bitter P et al. Chronic respiratory diseases are predictors of severe outcome in COVID-19 hospitalised patients: a nationwide study. Eur Respir J. 2021;58(6):2004474. https://doi.org/10.1183/13993003.04474-2020.Aveyard P, Gao M, Lindson N, Hartmann-Boyce J, Watkinson P, Young D et al. Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. Lancet Respir Med. 2021;9(8):909–923. https://doi.org/10.1016/S2213-2600(21)00095-3.Aveyard P, Gao M, Lindson N, Hartmann-Boyce J, Watkinson P, Young D et al. Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. Lancet Respir Med. 2021;9(8):909–923. https://doi.org/10.1016/S2213-2600(21)00095-3.Bloom CI, Drake TM, Docherty AB, Lipworth BJ, Johnston SL, Nguyen-Van-Tam JS et al. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. Lancet Respir Med. 2021;9(7):699–711. https://doi.org/10.1016/S2213-2600(21)00013-8.Bloom CI, Drake TM, Docherty AB, Lipworth BJ, Johnston SL, Nguyen-Van-Tam JS et al. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. Lancet Respir Med. 2021;9(7):699–711. https://doi.org/10.1016/S2213-2600(21)00013-8.Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R et al. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and metaanalysis of cohort studies in Europe. Eur Respir Rev. 2022;31(166):220098. https://doi.org/10.1183/16000617.0098-2022.Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R et al. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and metaanalysis of cohort studies in Europe. Eur Respir Rev. 2022;31(166):220098. https://doi.org/10.1183/16000617.0098-2022.Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S et al. Severe COVID-19 infection: An institutional review and literature overview. PLoS ONE. 2024;19(8):e0304960. https://doi.org/10.1371/journal.pone.0304960.Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S et al. Severe COVID-19 infection: An institutional review and literature overview. PLoS ONE. 2024;19(8):e0304960. https://doi.org/10.1371/journal.pone.0304960.Rovina N, Koutsoukou A, Koulouris NG. Inflammation and immune response in COPD: where do we stand? Mediators Inflamm. 2013;2013:413735. https://doi.org/10.1155/2013/413735.Rovina N, Koutsoukou A, Koulouris NG. Inflammation and immune response in COPD: where do we stand? Mediators Inflamm. 2013;2013:413735. https://doi.org/10.1155/2013/413735.Гайнитдинова ВВ, Авдеев СН. Хроническая обструктивная болезнь легких с легочной гипертензией: особенности течения, выживаемость, предикторы летальности. Пульмонология. 2017;27(3):357–365. https://doi.org/10.18093/0869-0189-2017-27-3-357-365.Gaynitdinova VV, Avdeev SN. Chronic obstructive pulmonary disease and pulmonary hypertension: clinical course, survival and mortality predictors. Pulmonologiya. 2017;27(3):357–365. (In Russ.) https://doi.org/10.18093/0869-0189-2017-27-3-357-365.Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020;8(6):e46–e47. https://doi.org/10.1016/S2213-2600(20)30216-2.Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020;8(6):e46–e47. https://doi.org/10.1016/S2213-2600(20)30216-2.Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Med Rev. 2021;55:101382. https://doi.org/10.1016/j.smrv.2020.101382.Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Med Rev. 2021;55:101382. https://doi.org/10.1016/j.smrv.2020.101382.Zhu B, Feng X, Jiang C, Mi S, Yang L, Zhao Z et al. Correlation between white blood cell count at admission and mortality in COVID-19 patients: a retrospective study. BMC Infect Dis. 2021;21(1):574. https://doi.org/10.1186/s12879-021-06277-3.Zhu B, Feng X, Jiang C, Mi S, Yang L, Zhao Z et al. Correlation between white blood cell count at admission and mortality in COVID-19 patients: a retrospective study. BMC Infect Dis. 2021;21(1):574. https://doi.org/10.1186/s12879-021-06277-3.Ghobadi H, Mohammadshahi J, Javaheri N, Fouladi N, Mirzazadeh Y, Aslani MR. Role of leukocytes and systemic inflammation indexes (NLR, PLR, MLP, dNLR, NLPR, AISI, SIR-I, and SII) on admission predicts inhospital mortality in non-elderly and elderly COVID-19 patients. Front Med. 2022;9:916453. https://doi.org/10.3389/fmed.2022.916453.Ghobadi H, Mohammadshahi J, Javaheri N, Fouladi N, Mirzazadeh Y, Aslani MR. Role of leukocytes and systemic inflammation indexes (NLR, PLR, MLP, dNLR, NLPR, AISI, SIR-I, and SII) on admission predicts inhospital mortality in non-elderly and elderly COVID-19 patients. Front Med. 2022;9:916453. https://doi.org/10.3389/fmed.2022.916453.Ghobadi H, Mokhtari S, Aslani MR. Serum levels of visfatin, sirtuin-1, and interleukin-6 in stable and acute exacerbation of chronic obstructive pulmonary disease. J Res Med Sci. 2021;26:17. https://doi.org/10.4103/jrms.JRMS_626_19.Ghobadi H, Mokhtari S, Aslani MR. Serum levels of visfatin, sirtuin-1, and interleukin-6 in stable and acute exacerbation of chronic obstructive pulmonary disease. J Res Med Sci. 2021;26:17. https://doi.org/10.4103/jrms.JRMS_626_19.Tong X, Cheng A, Yuan X, Zhong X, Wang H, Zhou W et al. Characteristics of peripheral white blood cells in COVID-19 patients revealed by a retrospective cohort study. BMC Infect Dis. 2021;21(1):1236. https://doi.org/10.1186/s12879-021-06899-7.Tong X, Cheng A, Yuan X, Zhong X, Wang H, Zhou W et al. Characteristics of peripheral white blood cells in COVID-19 patients revealed by a retrospective cohort study. BMC Infect Dis. 2021;21(1):1236. https://doi.org/10.1186/s12879-021-06899-7.Filippenko Y, Zagurovskaya M, Abdrakhmanova A, Kassenova S, Zhakenova Z, Aimakhanova A, Zholdybay Z. Impact of COPD on clinical and CT characteristics of COVID-19-associated pneumonia: single tertiary center experience. Egypt J Radiol Nucl Med. 2022;53(1):245. https://doi.org/10.1186/s43055-022-00932-8.Filippenko Y, Zagurovskaya M, Abdrakhmanova A, Kassenova S, Zhakenova Z, Aimakhanova A, Zholdybay Z. Impact of COPD on clinical and CT characteristics of COVID-19-associated pneumonia: single tertiary center experience. Egypt J Radiol Nucl Med. 2022;53(1):245. https://doi.org/10.1186/s43055-022-00932-8.

The authors declare that there are no conflicts of interest present.