Seasonal Distribution of Viral Pneumonia After COVID-19 and the Role of Hematological Markers in Assessing Pneumonia Severity: A Case-Control Study.

Abstract

Background: Various studies have shown that viral pneumonia pathogens display distinct inflammatory profiles, and hematological indices, such as the Neutrophil/Lymphocyte Ratio (NLR), Lymphocyte/Monocyte Ratio (LMR), and Platelet/Lymphocyte Ratio (PLR), can serve as accessible markers of disease severity. Moreover, the seasonal distribution of respiratory viruses appears to have shifted during the COVID-19 pandemic.

Methods: This retrospective case-control study was conducted on patients diagnosed with PCR-confirmed viral pneumonia in the emergency department of a tertiary care center between 1 January and 31 December 2024. The control group comprised age- and sex-matched individuals without viral pneumonia. Subjects with comorbidities or ongoing treatments potentially affecting hematological indices were excluded. Seasonal distribution of viral pathogens was recorded. Hematological and inflammatory parameters at admission-including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR)-were evaluated. The associations between these biomarkers, Pneumonia Severity Index (PSI) scores, and hospitalization status were statistically analyzed.

Results: In this study, it was determined that Influenza A/B was more common in winter (67.3%) and SARS-CoV-2 in summer (70.7%). The relationship between the Pneumonia Severity Index and hemogram parameters was examined in determining the severity of pneumonia. In SARS-CoV-2, leukocyte and neutrophil counts were positively correlated (R: 0.392, p: 0.003; R: 0.466, p: <0.001), while in Influenza A/B, lymphocyte, platelet, and monocyte counts showed a negative correlation (R: -0.402, p: 0.005; R: -0.331, p: 0.021; R: -0.327, p: 0.023). Correlations were found between inflammation parameters and the Pneumonia Severity Index, except for the Lymphocyte/Monocyte Ratio, between SARS-CoV-2 and Influenza A/B (p < 0.05).

Conclusions: The seasonal distribution of viral pneumonia pathogens has been revealed following the COVID-19 pandemic. Due to differences in inflammation patterns in viral infections, different leukocyte subgroups have been suggested as biomarkers.