Neutrophils, lymphocytes and their ratio as predictors of outcome in patients with COVID-19

Актуальность. До сих пор в литературе практически не существует работ, в которых бы описывались на ранних стадиях COVID-19 простые методы исследования, позволяющие прогнозировать исход этого коварного заболевания. Вместе с тем, наличие предикторов благоприятного и летального исходов при COVID-19 имеет важное значение, так как своевременно позволяет клиницисту вмешаться в тактику лечения больного. Цель исследования - разработка простых и доступных предикторов, позволяющих с большой долей вероятности на ранних стадиях заболевания COVID-19 прогнозировать его исход. Методика. Исследования проведены на 125 больных COVID-19, у которых на 1-, 5-, 7-, 10-, 14-е и 21-е сут пребывания в стационаре определялось число лейкоцитов, нейтрофилов, лимфоцитов и отношение нейтрофилы/лимфоциты (NEU/LYM). Для расчета пороговых значений выживаемости и летальности, имеющих предиктивную ценность, проводился ROC-анализ. Для оценки значимости роста AUC в динамике заболевания сопоставление ROC кривых производили попарно (1-5, 5-7, 7-10, 10-14 и 14-е - 21-е сут с использованием непараметрического алгоритма E.R. DeLong. Результаты. Установлено, что между числом лейкоцитов, нейтрофилов, лимфоцитов и отношением NEU/LYM у больных с благоприятным исходом и больных впоследствии умерших существуют значительные различия. Наиболее значимыми предикторами исхода заболевания при COVID-19 являются число нейтрофилов и особенно индекс NEU/LYM, при повышении которого резко возрастает вероятность летального исхода. С помощью ROC-анализа установлено, что уже в 1-е сут заболевания предсказательная способность (AUC) для отношения NEU/LYM в качестве предиктора исхода заболевания соответствовала 79%, к 5-м сут 84%, начиная с 10-х сут и до окончания исследования баланс качества этого теста превышал 90%. При высоких значениях показателей возможного летального исхода необходимо вводить иммуномодуляторы. Мы рекомендуем с этой целью применять комплекс полипептидов вилочковой железы - тималин, хорошо зарекомендовавший себя при лечении больных со среднетяжелым и тяжелым течением COVID-19. Заключение. Предиктором тяжелого течения и неблагоприятного исхода COVID-19 с высокой чувствительностью и специфичностью является отношение нейтрофилы/лимфоциты (индекс NEU/LYM). Background. There have been practically no reports that describe, in early stages of COVID-19, simple methods to predict the outcome of this insidious disease. At the same time, predictors of favorable or fatal COVID-19 outcome are important, since they would allow clinicians to adjust treatment in a timely manner. Aim. To develop simple and affordable predictors that are highly likely to forecast outcome at early stages of COVID-19. Methods. The study was conducted in 125 patients with COVID-19, in whom the number of leukocytes, neutrophils, lymphocytes, and the neutrophil/lymphocyte ratio (NEU/LYM) were determined on days 1, 5, 7, 10, 14, and 21 of hospitalization. To calculate predictive threshold values of survival and mortality, ROC analyses were performed. To assess the significance of changes in the areas under the ROC curves (AUC) in the illness dynamics, the ROC curves were compared in pairs (1-5, 5-7, 7-10, 10-14, 14-21 days) using the DeLong nonparametric algorithm. Results. There were significant differences between the number of leukocytes, neutrophils, lymphocytes, and the NEU/LYM ratio in patients with a favorable outcome and those that later died. The most significant outcome predictors were the number of neutrophils and, especially, the NEU/LYM index, with an increase in which, the likelihood of death sharply increased. The ROC-analysis showed that on day 1, the outcome predictive ability of AUC for the NEU/LYM ratio was 79%; by day 5, it increased to 84%; from day 10 to day 21, it exceeded 90 %. In the presence of high indicators for potentially lethal outcomes, it is necessary to administer immunomodulators. For this purpose, we recommend using a complex of polypeptides from the thymus gland, i.e., thymalin, which has proven beneficial for treatment of patients with moderate to severe COVID-19. Conclusion. The neutrophil/lymphocyte ratio predicts of the outcome of severe COVID-19 with high sensitivity and specificity.

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

Family therapy for adolescent anorexia nervosa (FT-AN) is the first line treatment for the disorder, but little is known about who the treatment works for, or how it works. This thesis investigates the potential value of the constructs of attachment and mentalization as predictors of outcome in family therapy for adolescent AN. The thesis presents a systematic review of attachment and mentalization and their association with child and adolescent eating pathology in which 22 relevant studies were found. In keeping with the evidence base for adults with eating disorders, both attachment and mentalization were found to be correlates of eating pathology in childhood and adolescence. However, evidence for these constructs in the process of treatment in child and adolescent eating disorders is scarce. In a second systematic review, the psychometric properties of attachment measures in middle childhood and adolescence were investigated across 53 studies. The overall conclusion of the study is that there is a lack of evidence of adequate psychometric properties for attachment measures in this age group.In the main study, attachment and mentalization were investigated as predictors of outcome in a sample of adolescents and their parents (n = 192) receiving FT-AN across three specialist outpatient eating disorder services. Mentalization, but not attachment, was found to predict poor clinical outcome at nine months after starting of treatment, with the strongest predictive effect being excessive certainty about mental states as assessed in parents. Therapeutic alliance scores at one month were predictive of outcome but did not play a mediating role in relation to baseline attachment or mentalization. In a further empirical study, definitions of eating disorder recovery were investigated through a qualitative analysis of comments on recovery-focused social media forums. Two super-ordinate themes emerged: firstly, recovery was defined as encompassing broad psychosocial domains of wellbeing; secondly, recovery was understood to be an ongoing process. Social connectedness to others was regarded as important both to the process and definition of eating disorder recovery. The final chapter of the thesis integrates findings from across the studies with emerging theoretical developments in the fields of attachment and mentalization. It is argued that attachment and mentalization represent worthwhile constructs for further FT-AN research, with a particular emphasis on the need to better understand the mechanisms by which excessive mental state certainty might lead to poor clinical outcomes.