Comparison between Acute Phase Reactant in COVID-19 Pneumonia And Bacterial pneumonia

INTRODUCTION

In the Chinese city of Wuhan, province of Hubei, multiple instances of pneumonia of unidentified cause were recorded in December 2019.¹

This pathogen was discovered as severe acute respiratory disorder coronavirus in January 2020. (SARS-CoV-2). ¹ Due to its rapid spread, SARS-CoV-2 has infected more than 183 nations and territories in a short period of time, prompting the WHO to declare a pandemic in March 2020.²   

Streptococcus pneumoniae, Staphylococcus aureus, Group A Streptococcus, Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, anaerobes, and gram-negative organisms are the most common bacteria that induce pneumonia. Unlike atypical organisms, these organisms can be readily cultivated on normal medium and identified using Gram stain.³

Acute phase reactants (APRs) are inflammatory bioindicators that show considerable variations in serum levels during inflammation induced by infectious and noninfectious disorders. APRs are utilized for early detection, to differentiate infectious from noninfectious diseases, and to assess treatment response.³

The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), fibrinogen, ferritin, procalcitonin, D-dimer, and Troponin are some of the most relevant APRs.¹

During inflammation, the concentrations of all of these positive (APRs) rise in the serum.^{4, 5}

An acute inflammatory reaction is triggered by bacterial infections of the lower respiratory tract. In bacterial pneumonia, a complicated interplay between immune cells and inflammatory cytokines regulates the inflammatory response.¹

The study aimed to determine the value of measurement of Acute Phase Reactants (APRs) in Differentiation between Covid-19 pneumonia and Bacterial pneumonia.

PATIENTS AND METHODS

This cross-sectional research took place at Al- Hussein University Hospital from October 2021 to April 2022, and included sixty participants: Thirty patients with pneumonia (diagnosed on clinical , radiological , PCR , culture & sensitivity & laboratory basis), and another thirty patients with Covid-19 (diagnosed on clinical , radiological , PCR , culture & sensitivity &  laboratory basis).

Exclusion criteria: The research excluded patients with underlying lung disorders such as TB, lung cancer, or other chronic lung conditions.

Inclusion criteria: Patients presented to the emergency room with symptoms such as fever, dry cough, weakness, chest discomfort, tachypnea, vomiting, disorientation, and headache, and were admitted to the hospital after undergoing a chest CT scan. 

At the time of admittance to the emergency department at EL-Hussein university hospital, school of medicine, Al-Azhar university, All of the individuals in the research had just been diagnosed and had not yet been treated. All patients' medical records were obtained and examined; APR levels (CBC, ESR, CRP, D-dimer, S-ferrittin, and Fibrinogen) and chest CT data were acquired on admission to the hospital for each patient before treatment.

Methods: The Ethics Committee of Al-Azhar University's Faculty of Medicine gave its approval to the research. Every patient signed a written or verbal agreement for participation in this research after being informed about the procedure. If the patient was conscious or by relatives if the patient was unconscious. All patients underwent the following: Full history and clinical examination, routine laboratory tests CBC , ESR, CRP, D-dimer, S-ferrittin, LDH, Fibrinogen, sputum culture and examination, chest X-ray, C.T chest & PCR of COVID-19.

Statistical analysis: The Statistical Program for Social Science (SPSS) version 24 was used to examine the data. To represent quantitative data, the mean and standard deviation were utilized. To express qualitative data, frequency and percentage were utilized. The center value of a discrete collection of numbers, namely the sum of values divided by the number of values, is called the mean (average). The standard deviation (SD) is a measure of a collection of values' dispersion. A low SD implies that the values are spread out across a larger range, while a high SD shows that the values are near to the set's mean. When comparing non-parametric data, the Chi-square test was utilized. Kruskal Willis test was used to compare between quantitative data as regard vitamin D status. For data correlation, the Pearson correlation coefficient was applied. P-values < 0.05 were deemed substantial, P-values < 0.001 were regarded very substantial, and P-values > 0.05 were considered insignificant.

RESULTS

The participants in this research were separated into two groups of sixty people. Thirty patients were assigned to the COVID-19 pneumonia group and another thirty to the Bacterial pneumonia group.

Table 1: Demographic data in all studied patients

the mean age of COVID-19 pneumonia group was 51.2 ± 16.1 years while it was 46.7 ± 16.9 in pneumonia group. As regard sex, there were 14 males (46.7%) and 16 females (53.3%) in COVID-19 pneumonia group while there were 17 males (56.7%) and 13 females (43.3%) in Bacterial pneumonia group. As regard smoking, there were 11 smokers (36.7%) in COVID-19 pneumonia group and 16 smokers (53.3%) in Bacterial pneumonia group. and there were 7 DM patients (23.3%) in COVID-19 pneumonia group and 11 DM patients (36.7%) in Bacterial pneumonia group. As regard HTN, there were 17 HTN patients (56.7%) in COVID-19 pneumonia group and 22 HTN patients (73.3%) in Bacterial pneumonia group.

Table 2: Clinical symptoms in all studied patients

Symptoms in all studied patients were revealed increased percentage of productive cough in bacterial pneumonia group (30 patients, 100%) when compared with COVID-19 pneumonia group (3 patients, 10%), increase duration of fever in bacterial pneumonia group (5.5 ± 1.1) when compared with COVID-19 pneumonia group (3.2 ± 1.01) and also increased percentage of dyspnea in bacterial pneumonia group (26 patients, 86.7%) when compared with COVID-19 pneumonia group (10 patients, 33.3%). No statistical substantial variance (p-value > 0.05) between investigated groups (COVID-19 pneumonia and bacterial pneumonia groups) as regard presence of cough, fever, fatigue and DCL(Disturbed Conscious level).

Table 3: Comparison between laboratory data in all studied patients

This table shows: Statistically substantial (p-value = 0.034) increased CRP in COVID-19 pneuonia group (68.8 ± 51.7mg/L) when compared with bacterial pneumonia group (42.8 ± 31.0mg/L). Highly statistical significant (p-value < 0.001) increased D-Dimer in COVID-19 pneumonia group (1276.7 ± 553.8ng/ml) when compared with bacterial pneumonia group (643.3 ± 171.1ng/ml). Highly statistical significant (p-value < 0.001) increased ferritin in COVID-19 pneumonia group (521 ± 361.8ng/ml) when compared with bacterial pneumonia group (254.3 ± 60.5ng/ml). Highly statistical significant (p-value < 0.001) increased WBCs in bacterial pneumonia group (22.3 ± 5.1/mm3) when compared with COVID-19 pneumonia group (8.5 ± 5.3/mm3). Highly statistical significant (p-value < 0.001) increased Neutrophil in bacterial pneumonia group (18.4 ± 5.7/mm3) when compared with COVID-19 pneumonia group (7.4 ± 5.4/mm3). Highly statistical significant (p-value < 0.001) decreased Lymphocytes in COVID-19 pneumonia group (1.1 ± 0.3/mm3) when compared with bacterial pneumonia group (3.9 ± 1.6/mm3). No statistical substantial variance (p-value > 0.05) between studied groups (COVID-19 pneumonia and bacterial pneumonia groups) as regard ESR, LDH and fibrinogen.