ÖZET
Amaç:
Hospitalize Coronavirüs hastalığı-2019 (COVİD-19) olgularında nötrofil-lenfosit oranı (NLR), platelet-lenfosit oranı (PLR) ve enflamatuvar göstergelerin hastane yatış süresi (HYS) ve klinik seyirle olan ilişkisini araştırmaktır. Yöntemler: Çalışmaya dahil edilen olguların
Yöntemler:
Çalışmaya dahil edilen olguların total lökosit, nötrofil, lenfosit ve trombosit sayıları (/mm3), hemoglobin düzeyi (g/dL), ortalama trombosit hacmi, C-reaktif protein (CRP) (mg/L), ferritin (ng/mL), laktat dehidrogenaz (LDH) (U/L), kreatin kinaz (U/L), D-dimer (ng/mL), troponin-I (pg/mL), alanin aminotransferaz (U/L), aspartat aminotransferaz (U/L) ve serum kreatinin (mg/dL) sonuçları kaydedildi. NLR ve PLR hesaplandı. Uygulanmış olan antiviral tedaviler kaydedildi. Yoğun bakım ünitesi takibi ve mortalite oranları belirlendi. Biyokimyasal parametrelerin kendi aralarındaki korelasyon analizleri yapıldı ve parametrelerin HYS ve mortalite öngörüsü için duyarlılıkları analiz edildi.
Bulgular:
Toplam 171 hastanın (87 kadın, 84 erkek) verileri değerlendirildi. Ortalama yaş 57,9±14,6 yıl, ortalama HYS 8,83±6,4 gündü. NLR ile PLR pozitif yönde koreleydi (p<0,05). NLR ile CRP, LDH, ferritin, D-dimer ve troponin-I arasında pozitif yönde korelasyon vardı (p<0,05). HYS, artmış serum kreatinin, CRP, LDH, ferritin ve troponin-I olan olgularda daha uzundu (p<0,05). Yirmi beş olgu (%14,6) yoğun bakım ünitesinde takip edilmiş, 17 olgunun takibi (%9,9) mortalite ile sonuçlanmıştı. Tedavide Azitromisin ve Hidroksiklorokin kullanımı yüksek orandaydı. Favipravir ve Tociluzumab tedavileri uygulanan olgularda ileri yaş, uzamış yatış süresi ve artmış enflamatuvar göstergeler mevcuttu.
Sonuç:
COVİD-19 olgularında HYS’yi öngörmek için enflamatuvar parametreler kullanılabilir. Artmış NLR ve PLR kötü klinik seyirle ilişkili gözükmektedir.
References
1
Weifeng Shang, Junwu Dong, Yali Ren, Ming Tian, Wei Li, Jianwu Hu, Yuanyuan Li The Value of Clinical Parameters in Predicting the Severity of COVID-19 J Med Virol 2020; 21;10.1002/jmv.26031 Online ahead of print.
2
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323:1239.
3
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395:497‐506.
4
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 82:1708-20.
5
Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18:844–47.
6
Lin L, Lu L, Cao W, et al. Hypothesis for potential pathogenesis of SARS-CoV-2 infection—a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect. 2020; 9:1–1.
7
Zhang G, Zhang J, Wang B, et al. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res. 2020; 21:74.
8
Ai-Ping Yang, Jian-Ping Liu, Wen-Qiang Tao, Hui-Ming Li. The Diagnostic and Predictive Role of NLR, d-NLR and PLR in COVID-19 Patients Int Immunopharmacol 2020; 84:106504.
9
Yunbao Pan, Guangming Ye, Xiantao Zeng, et al. Can Routine Laboratory Tests Discriminate SARS-CoV-2-infected Pneumonia From Other Causes of Community-Acquired Pneumonia? Clin Transl Med2020; 10:161-8.
10
Dawei Wang, Bo Hu, Chang Hu et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China JAMA 2020; 323:1061-69.
11
Vinayak Mishra, Ajit Deo Burma, Sumit Kumar Das, Mohana Balan Parivallal, Senthil Amudhan, Girish N Rao. COVID-19-Hospitalized Patients in Karnataka: Survival and Stay Characteristics Indian J Public Health 2020; 64: 221-24.
12
Xiaofan Liu, Hong Zhou Yilu Zhou et al. Risk Factors Associated With Disease Severity and Length of Hospital Stay in COVID-19 Patients J Infect 2020; 81:95-97.
13
Center for Disease Control and Prevention. Interim clinical guidance for management of patients with confirmed coronavirus disease COVID-19 2020.
14
World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected 2020.
15
Pham Quang Thai, Do Thi Thanh Toa, Dinh Thai Son, et al. Factors Associated With the Duration of Hospitalisation Among COVID-19 Patients in Vietnam: A Survival Analysis Epidemiol Infect 2020; 10:e114.
16
Wise J. A third of COVID-19 patients admitted to UK hospitals die. British Medical Journal 2020; 30: m1794.
17
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention JAMA 2020: 323; 1239–42.
18
CDC (Centers for Disease Control and Prevention) Severe outcomes among patients with coronavirus disease 2019 (COVID-19) – United States, February 12–March 16, 2020. MMWR. Morbidity and Mortality Weekly Report 69, 343–346.
19
Xiaofan Liu, Hong Zhou, Yilu Zhou et al. Risk Factors Associated With Disease Severity and Length of Hospital Stay in COVID-19 Patients Comment J Infect 2020; ;81:95-97.
20
Ian Huang Raymond Pranata, Michael Anthonius Lim, Amaylia Oehadian, Bachti Alisjahbana C-reactive Protein, Procalcitonin, D-dimer, and Ferritin in Severe Coronavirus disease-2019: A Meta-Analysis Ther Adv Respir Dis 2020; 14:1753466620937175.
21
Alvaro Lorente-Ros, Juan Manuel Monteagudo Ruiz, Luis M Rincón,et al. Myocardial Injury Determination Improves Risk Stratification and Predicts Mortality in COVID-19 Patients Cardiol J 2020 Jun 26, Online ahead of print.
22
E. Afari, T. Bhat, Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update, Expert Rev. Cardiovasc. Ther 2016;14: 573–77.
23
Furong Zeng, Linfeng Li, Jiling Zeng, Yuhao Deng, Huining Huang, Bin Chen, Guangtong Deng Can We Predict the Severity of Coronavirus Disease 2019 With a Routine Blood Test? Pol Arch Intern Med 2020;130:400-6.
24
Ruchong Chen, Ling Sang, Mei Jiang, J et al Longitudinal Hematologic and Immunologic Variations Associated With the Progression of COVID-19 Patients in China Medical Treatment Expert Group for COVID-19 Allergy Clin Immunol. 2020; 146:89-100.
25
Rayes J, Bourne JH, Brill A, Watson SP. The dual role of platelet innate immune cell interactions in thrombo‐inflammation. Res Pract Thromb Haemost. 2019;4:23‐35.
26
Rong Qu,Yun Ling, Yi-Hui-Zhi Zhang J et al. Platelet-to-lymphocyte Ratio Is Associated With Prognosis in Patients With Coronavirus disease-19 Med Virol. 2020;17:10.
27
Du R-H, Liang L-R, Yang C-Q, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020; 55:2000524.
28
Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease2019: retrospective study. BMJ. 2020; 368:m1091.
29
Zhang C, Wu Z, Li J-W, et al. The cytokine release syndrome (CRS) of severe COVID-19 and interleukin-6 receptor (IL-6R) antagonist tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. 2020. 55:105954.
30
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62.
31
Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–34.
32
Wang D, Hu B, Hu C, et al. Clinical characteristics of138 hospitalized patients with 2019 novel coronavirus- infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–69.
33
Guan W-j, Ni Z-y, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–20.
34
World Health Organization. Coronavirus disease (COVID‐19): situation report—125. https://www.who.int/docs/default-source/ coronaviruse/situation-reports/20200524-covid-19-sitrep-125.pdf? sfvrsn=80e7d7f0-2.
35
Centers for Disease Control and Prevention, Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19), https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html.
36
Michael P McRae, Glennon W Simmons et al. Clinical Decision Support Tool and Rapid Point-of-Care Platform for Determining Disease Severity in Patients With COVID-19 medRxiv. 2020 22;04.16.20068411.
37
Morse JS, Lalonde T, Xu S, Liu WR. Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV. Chembiochem2020;21:730-8.
38
Savarino A, Boelaert JR, Cassone A, Majori G, Cauda R. 2003. Effects of chloroquine on viral infections: an old drug against today’s diseases? Lancet Infect Dis 3:722–7.
39
Gautret P, Lagier JP, Parola P, Hoang VT et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020; 20:105949.
40
Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020;2600: 30127-2.
41
Bryner J. 2020. Flu drug used in Japan shows promise in treating COVID-19. Live Science, New York, NY. https://www.livescience. com/flu-drug-could-treat-coronavirus.html.
42
Gov. Clinical trials on Favipiravir role in SARS-COV-2 infection. 2020 https://clinicaltrials.gov/ct2/results?cond=covid+19&term= Favipiravir+&cntry=&state=&city=&dist
43
Xu X, Han M, Li T et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc. Natl Acad. Sci. U S A 2020;117:10970-10975.
44
Org. Favipiravir Combined With Tocilizumab in the Treatment of novel coronavirus pneumonia (COVID-19) - A Multicenter, Randomized, Controlled Trial 2020 www.chictr.org.cn/showprojen.aspx?proj=51126
45
Chris R Triggle, Devendra Bansal, Elmoubasher Abu Baker Abd Farag, Hong Ding , Ali A Sultan COVID-19: Learning From Lessons To Guide Treatment and Prevention Interventions- Review mSphere2020;5:e00317-20.
46
Lo'ai Alanagreh, Foad Alzoughool, Manar Atoum. Review Pathogens The Human Coronavirus Disease COVID-19: Its Origin, Characteristics, and Insights Into Potential Drugs and Its Mechanisms Pathogens 2020; 29:331.
