Dynamics of laboratory indicators against the background of antibacterial therapy regimens that included fluoroquinolones in the treatment of critically ill COVID-19 patients depending on their age and doses of hormonal drugs

Abstract

The article provides a review of the literature on the dynamics of blood counts in patients with the new coronavirus di­sease 19 and provides data from our own researches. It was found that patients of all age groups on the background of fluoroquinolone and dexamethasone treatment demonstrated an increase in leukocyte count, and in people over 60 years of age, its increase to the highest levels was observed. Individuals under 60 compared to patients over 60 years who received only antibiotics with the inclusion of fluoroquinolones, without the use of dexamethasone, had a slightly lower level of lymphocytes (р > 0.05) at the beginning of hospitalization, but already from day 4 their growth was observed. At the same time, in people over 60 years old, on the contrary, indicators decreased. In patients under 60 years of age who received antibiotics with the inclusion of fluoroquinolones and 16 mg of dexamethasone during treatment, their gra­dual increase with normalization was observed; this did not happen when 8 mg were used. In patients over 60 years of age who received antibiotics with the inclusion of fluoroquinolones, 8 and 16 mg dexamethasone and who recovered, fluctuations were observed at reduced numbers with a slight tendency towards normalization, as it was observed in younger people. In patients over 60 who received antibiotics without the use of dexamethasone and died, there was a decrease in lymphocyte level during treatment. In people over 60 who recovered, greater fluctuations in the level of lymphocytes to normal values were observed when using 8 mg of dexamethasone, while against the background of 16 mg of dexamethasone, the former showed a decrease in their level with a tendency to increase. At the same time, those who died, on the contrary, had a more significant decrease without a tendency towards normalization. Among patients under 60 and over 60 who have recovered, the former have a more rapid decrease in the le­vel of granulocytes with a tendency to normalize. In people under 60 years of age, when 16 mg of dexamethasone were prescribed, a slightly faster decrease in granulocyte level was observed. Also, a tendency to a more rapid decrease in the level of granulocytes was observed in patients older than 60 years against the background of the use of 16 mg of dexamethasone. In the age group over 60 years old against the background of 16 mg of dexamethasone, those who recovered demonstrated a decrease in granulocytes, and those who died, on the contrary, their increase. In people older than 60 years who recovered, when using 8 mg of dexamethasone and antibiotics with the inclusion of fluoroquinolones in the treatment regimen, the level of band neutrophils was slightly higher than in people younger than 60 years, and a period of its normalization was longer. Against the background of 16 mg of dexamethasone, people over 60 years of age who recovered, had lower indicators of band neutrophils in the first three days and a longer period of their normalization compared to those under 60 years of age. Patients over 60 years old who died, in comparison with those who reco­vered, already from the beginning of hospitalization demonstrated higher levels of band neutrophils and their gradual increase, while those who recovered, on the contrary, had a decrease. In patients under 60 years of age who, in addition to antibiotics, received 8 mg of dexamethasone, in the first three days after hospitalization the level of C-reactive protein (CRP) was lower than in people over 60 years of age who recovered. In both groups of patients, a tendency towards a decrease in the level of CRP was observed. Recovered patients over 60 years of age who received fluoroquinolones and 16 mg of dexamethasone had hig­her CRP content in the first three days than younger patients, and almost the same rates as those who died at the age of 60 years and older. Patients over 60 years old and those who recovered against the background of the use of 16 mg dexamethasone, had a more rapid decrease in the level of CRP; at the same time, in those who died, its slower decrease was observed. Also, the dynamics of ala­nine aminotransferase, aspartate aminotransferase, urea, creatinine, glucose, creatine phosphokinase, lactate dehydrogenase was established depending on the doses of hormones, age and the consequences of the disease course.