Inflammatory response and morphometric parameters of the spleen in COVID-19 in patients with diabetes mellitus

The aim: to study the severity of the inflammatory response and morphometric parameters of the spleen in patients with COVID-19 and diabetes mellitus. Materials and methods: The study included 98 patients who were treated at the State Budgetary Healthcare Institution “Infectious Diseases Hospital of the Kaliningrad Region” from March 2020 to December 2022 with a diagnosis of “Coronavirus infection caused by the SARS-CoV-2 virus”. Upon admission, patients were divided into two groups: “Diabetes mellitus (DM)”, n = 50 and “Hyperglycaemia”, n = 48. The dynamics of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), interleukin-6 (IL) and IL-8 were studied, and the neutrophil-lymphocyte index (NLR) was calculated. An ultrasound examination of the spleen was performed, and the mass and spleen mass ratio (SMR) were calculated. Results: On admission to hospital, patients in the “DM” group had statistically significantly lower levels of CRP, LDH and NLR compared to those in the “Hyperglycaemia” group (21.6 [10.0; 82.0] mg/L, (491.6 ± 154.1) U/L and 3.5 [2.5; 4.8]; 32.5 [12.0; 114.6] mg/L, (623.1 ± 270.2) U/L and 4.5 [2.6; 8.3], respectively) (p 0.05). In the acute period of COVID-19, microspleen was detected in patients in the “DM” group, the spleen weight was (122.0 ± 50.3) g, the IMR was (1.4 ± 0.6), in 10 (20 %) observations a critical decrease in the spleen was recorded, a decrease in IMR was less than 1.0. In the “Hyperglycaemia” group, the spleen weight was (162.6 ± 60.9) g, KMS (2.0 ± 0.5) (p 0.001). By the 5th day in the “DM” group, CRP was 6.5 [1.2; 10.2] mg/l, in the “Hyperglycaemia” group – 2.3 [0.7; 5.9] mg/l (p = 0.741), ferritin, respectively, 131.2 [61.4; 410.5] μg/l and 345.2 [193.1; 542.8] μg/l (p = 0.01), LDH (509.8 ± 177.5) U/l and (536.5 ± 167.3) (p = 0.582). NLR in patients in the “DM” group increased by the 5th day of treatment and was 4,3 [2,7; 5,4], in the “Hyperglycaemia” group it also increased by the 3rd day, but by the 5th day it decreased to 4.4 [3.3; 7.9]. No statistically significant differences were found between the groups (p 0.05). Conclusion: The course of coronavirus infection in patients with diabetes mellitus is characterized by a less pronounced inflammatory response and a decrease in the size of the spleen, which can be regarded as a state of immune imbalance.