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The Importance of Inflammatory Markers In Prediction Of Mortality In COVID-19 Patients

Year 2024, Volume: 19 Issue: 1, 17 - 26, 28.03.2024

Hacer Kandilcik Selçuk Nazik Fatma Gümüşer Selma Ateş

https://doi.org/10.17517/ksutfd.1174740

Abstract

Objective: COVID-19, which emerged in China at the end of December 2019, spread all over the world in a short time and was accepted as a pandemic by the World Health Organization on March 11, 2020. The pandemic is still up-to-date with its changing variants and number of cases. In this study, we aimed to determine the importance of hematological, inflammatory, and biochemical markers measured on the 1st and 5th days in inpatients with a diagnosis of COVID-19 in predicting mortality.

Material And Methods: The research was designed as a retrospective and cross-sectional study. The study included 200 patients over the age of 18 who were admitted to Kahraman-maraş Sütçü İmam University Hospital between 1 November 2020 and 30 April 2021 with suspected symptoms of COVID-19, and the diagnosis was confirmed by the RT-PCR test. The patient's age, gender, comorbid diseases, 1st and 5th-day laboratory parameters, and out-come were recorded. The patients were divided into two groups discharged and deceased.

Results: Of the 200 patients included in the study, 75% (n=150) were discharged and 25% (n=50) died within 28 days. 63.5% (n=127) of the patients were male and 36.5% (n=73) were female. The mean age of the patients was 63±17.2 years. Of the patients, 50.5% had mild, 31% moderate, and 18.5% severe clinical. Logistic regression analysis was performed to determine the factors affecting the prognosis of COVID-19 patients. Factors associated with prognosis were found to be male gender, presence of DM, presence of chronic obstructive pulmonary disease, presence of hypertension, fever, shortness of breath, and cough. Lymphocyte (lymphopenia), CRP (C-Reactive Protein), PCT (Procalcitonin), NLR (Neutrophil lymphocyte ratio), PLR (Procalcitonin lymphocyte ratio), D-Dimer values measured on the 1st and 5th days of the patients were found to be a predictor of mortality at the time of diagnosis and during follow-ups (p<0.005).
Conclusion: In our study, it was determined that leukocyte, lymphocyte, NLR, PLR, CRP, PCT, ferritin, D-Dimer, and LDH values measured in COVID-19 patients were important parameters in predicting mortality at admission and during hospitalization. We think that these parameters will help the clinician in the follow-up of patients with COVID-19.

Keywords

COVID-19 prognosis CRP PCT hematological parameters

References

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COVID-19 Hastalarında Mortaliteyi Öngörmede İnflamatuvar Belirteçlerin Önemi

Year 2024, Volume: 19 Issue: 1, 17 - 26, 28.03.2024

Hacer Kandilcik Selçuk Nazik Fatma Gümüşer Selma Ateş

https://doi.org/10.17517/ksutfd.1174740

Abstract

Amaç: Çin’de 2019 Aralık ayı sonunda ortaya çıkan COVID-19 kısa sürede tüm dünyaya yayılarak Dünya Sağlık Örgütü tarafından 11 Mart 2020’de pandemi olarak kabul edilmiştir. Pandemi hala değişen varyantlarıyla ve vaka sayılarıyla güncelliğini korumaktadır. Bu çalışmada COVID-19 tanılı yatan hastalarda 1. ve 5. gün bakılan hematolojik, inflamatuvar ve biyokimyasal belirteçlerin mortaliteyi öngörmede önemini belirlemeyi amaçladık.
Gereç ve Yöntemler: Araştırma retrospektif ve kesitsel çalışma olarak tasarlanmıştır. Çalışmaya 1 Kasım 2020-30 Nisan 2021 tarihleri arasında Kahramanmaraş Sütçü İmam Üniversitesi Hastanesi’ne COVID-19 şüpheli semptomları ile başvuran COVID-19 RT-PCR testi ile tanısı doğrulanarak yatışı yapılan 18 yaş üstü 200 hasta dahil edilmiştir. Hastaların yaş, cinsiyet, eşlik eden komorbid hastalıkları, 1. ve 5. gün laboratuvar parametreleri ve sonlanım durumları kaydedildi. Hastalar taburcu ve ölen şeklinde iki gruba ayrıldı.
Bulgular: Çalışmaya alınan 200 hastanın %75’i (n=150) taburcu olan, %25’i ise (n=50) 28 gün içinde ölen hastalardan oluşmaktaydı. Hastaların %63.5’i (n=127) erkek, %36.5’i (n=73) kadındı. Hastaların yaş ortalaması 63±17.2 yıldı. Hastaların %50.5’i hafif, %31’i orta, %18.5’i ise ağır klinik tabloya sahipti. COVID-19 hastalarının prognozunu etkileyen faktörleri belirlemek amacıyla lojistik regresyon analizi yapıldı. Prognoz ile ilişkili faktörler erkek cinsiyet, diyabetes mellitus, kronik obstrüktif akciğer hastalığı, hipertansiyon varlığı, ateş, nefes darlığı ve öksürük olarak bulundu. Hastaların 1. ve 5.gün bakılan lenfosit (lenfopeni), C-Reaktif Protein (CRP), Prokalsitonin (PCT), nötrofil/lenfosit oranı (NLO), platelet /lenfosit oranı (PLO), D-Dimer değerleri tanı anında ve takiplerde mortalite öngörücüsü olarak tespit edildi (p<0.05).
Sonuç: Çalışmamızda COVID-19 hastalarında bakılan lökosit, lenfosit, NLO, PLO, CRP, PCT, ferritin, D-Dimer ve LDH değerlerinin başvuru sırasında ve yatış takiplerinde mortaliteyi öngörmede önemli parametreler olduğu saptandı. Bu parametrelerin COVID-19 hasta takibinde klinisyene yardımcı olacağını düşünmekteyiz.

Keywords

COVID-19 prognoz CRP PCT hematolojik parametreler

References

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  • Fan, Yi; Zhao, Kai; Shi, Zheng-Li; Zhou, Peng. "Bat Coronaviruses in China." Viruses 2019; 11, no. 3: 210 PMC 6466186. PMID 30832341.
  • Ciotti, Marco, et al. "COVID-19 outbreak: an overview." Chemotherapy 64.5-6 2019: 215-223.
  • Tan W, Zhao W, Ma X, et al. A Novel Coronavirus Genome Identified in a Cluster of Pneumonia Cases Wuhan, China 2019−2020, Notes from the Field, China CDC Weekly.
  • World Health Organization. Coronavirus disease (COVID-19) situation dashboard. 2020. Accessed April, 2.
  • Doruk ÖG, Örmen M, Tuncel P. COVID-19’da biyokimyasal ve hematolojik parametreler. DEU Tıp Derg 2021;35(Özel Sayı 1): 71-80.
  • DO W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18): 1708-1720. Doi: 10.1056/nejmoa2002032.
  • Temgoua MN, Endomba FT, Nkeck JR, Kenfack GU, Tochie JN, Essouma M. Coronavirus Disease 2019 (COVID-19) as a Multi-Systemic Disease and its Impact in Low and Middle-Income Countries (LMICs). SN Compr Clin Med. Published online July 2020: 1-11. doi: 10.1007/s42399-020-00417-7.
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  • Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med.2020;180(7): 934-943.
  • Arslan B, Dinçel AS. Biyokimya laboratuvarında COVID-19: Klinik araştırmadan rutine inflamatuvar belirteçler. Yücel D, editör. COVID-19 Pandemisinde Tıbbi Biyokimyanın Artan Rolü. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.13-8.
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  • Li, J., Huang, D. Q., Zou, B., Yang, H., Hui, W. Z., Rui, F., & Nguyen, M. H. (2021). Epidemiology of COVID‐19: a systematic review and meta‐analysis of clinical characteristics, risk factors, and outcomes. Journal of medical virology, 93(3), 1449-1458.
  • Albitar, O., Ballouze, R., Ooi, J. P., & Ghadzi, S. M. S. (2020). Risk factors for mortality among COVID-19 patients. Diabetes research and clinical practice, 166, 108293.
  • Jaillon, S., Berthenet, K., & Garlanda, C. (2019). Sexual dimorphism in innate immunity. Clinical reviews in allergy & immunology, 56(3), 308-321.
  • Acar, E., Demir, A., Yıldırım, B., Kaya, M. G., & Gökçek, K. (2021). The role of hemogram parameters and Creactive protein in predicting mortality in COVID‐19 infection. International journal of clinical practice, 75(7), e14256.
  • Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis. 2021;31(3):745-755. Doi: 10.1016/j.numecd.2020.12.009.
  • Semenzato L, Botton J, Drouin J, Cuenot F, Dray-Spira R, Weill A, Zureik M. Chronic diseases, health conditions and risk of COVID-19-related hospitalization and in-hospital mortality during the first wave of the epidemic in France: a cohort study of 66 million people. Lancet Reg Health Eur. 2021 Sep; 8:100158. Doi: 10.1016/j.lanepe.2021.100158. Epub 2021 Jul 16. PMID: 34308411; PMCID: PMC8282330.
  • The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (2020). The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) China, 2020. China CDC weekly, 2(8), 113–122.
  • Della Salute, M. (2020). Covid-19-Situazione in Italia. Roma, I: Governo-Repubblica Italiana. Retrieved, 3(11), 2020.
  • Al Mutair A, Al Mutairi A, Alhumaid S, Maaz Abdullah S, Zia Zaidi AR, Rabaan AA, Al-Omari A. Examining and investigating the impact of demographic characteristics and chronic diseases on mortality of COVID-19: Retrospective study. PLoS One. 2021 Sep 10;16(9): e0257131. Doi: 10.1371/journal.pone.0257131. PMID: 34506551; PMCID: PMC843275
  • Li L. Q., Huang T., Wang Y. Q., Wang Z. P., Liang Y., Huang T. B., et al. (2020). COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. Journal of medical virology, 92(6), 577–583. pmid:32162702.
  • Goodman KE, Magder LS, Baghdadi JD, Pineles L, Levine AR, Perencevich EN, Harris AD. Impact of Sex and Metabolic Comorbidities on Coronavirus Disease 2019 (COVID-19) Mortality Risk Across Age Groups: 66 646 Inpatients Across 613 U.S. Hospitals. Clin Infect Dis. 2021 Dec 6;73(11): 4113-4123. Doi: 10.1093/cid/ciaa1787. PMID: 33337474; PMCID: PMC7799326.
  • Atalla E, Zhang R, Shehadeh F, Mylona EK, Tsikala-Vafea M, Kalagara S, Henseler L, Chan PA, Mylonakis E. Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April-June 2020. Pathogens. 2020 Dec 24;10(1):8. doi: 10.3390/pathogens10010008. PMID: 33374131; PMCID: PMC7824344.
  • Struyf, T., Deeks, J. J., Dinnes, J., Takwoingi, Y., Davenport, C., Leeflang, M. M., & COVID, C. (2021). Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID‐19. Cochrane Database of Systematic Reviews, (2).
  • Nasserie, T., Hittle, M., & Goodman, S. N. (2021). Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: a systematic review. JAMA network open, 4(5), e2111417-e2111417.
  • Yang, M. (2020). Cell pyroptosis, a potential pathogenic mechanism of 2019-nCoV infection. Available at SSRN 3527420.
  • Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, Liu XY, Liu HM, Guo Z, Ren H, Wang Q. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020 Sep;92(9):1533-1541. Doi: 10.1002/jmv.25767. Epub 2020 Mar 26. PMID: 32181903; PMCID: PMC7228291.
  • Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med. 2021 Apr; 42:60-69. doi: 10.1016/j.ajem.2021.01.006. Epub 2021 Jan 9. PMID: 33453617; PMCID: PMC7832118.
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Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Araştırma Makaleleri
Authors

Hacer Kandilcik 0000-0002-5708-3447

Selçuk Nazik 0000-0003-0587-0104

Fatma Gümüşer 0000-0003-1103-4962

Selma Ateş 0000-0002-2515-8758

Early Pub Date March 28, 2024
Publication Date March 28, 2024
Submission Date September 14, 2022
Acceptance Date November 1, 2022
Published in Issue Year 2024 Volume: 19 Issue: 1

Cite

AMA Kandilcik H, Nazik S, Gümüşer F, Ateş S. COVID-19 Hastalarında Mortaliteyi Öngörmede İnflamatuvar Belirteçlerin Önemi. KSU Medical Journal. March 2024;19(1):17-26. doi:10.17517/ksutfd.1174740
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