Gizem KARATAŞ KILIÇCIOĞLU, Tezcan KAYA, Kubilay İŞSEVER, Ertuğrul GÜÇLÜ, Oğuz KARABAY

COVID-19 hastalarında koagülopati için C-reaktif protein/albumin oranının tanısal doğruluğu

Amaç: Bu çalışma, COVİD-19'da D-dimer yüksekliğini öngörmede C-reaktif proteinin (CRP) albümine oranının (CAR) tanısal faydasını değerlendirmek amaçlamıştır. Gereç ve Yöntem: Bu retrospektif kohort çalışmasında, bir üniversite hastanesinde COVID-19 olduğu doğrulanmış 145 yatan hastadan veri topladık. Hastalar D-dimer düzeylerine göre D-dimer düzeyi yüksek olanlar ve D-dimer düzeyi normal olanlar olarak iki gruba ayrıldı. Hastaların tıbbi kayıtlarından demografik veriler, komorbiditeler, klinik semptomlar, CAR ve laboratuvar sonuçları elde edildi ve gruplar arasında kıyaslamalar yapıldı. Bulgular: Hastaların yaş ortalaması 52,9±17,9 yıl olup, 76'sı erkek idi. CAR medyanı, D-dimer değeri yüksek olanlarda anlamlı olarak daha yüksekti (134,1'e karşı 20,7,). D-dimeri yüksek hastalarda CRP, prokalsitonin, lökosit, nötrofil, laktat dehidrojenaz, ferritin ve fibrinojen daha yüksekti. CAR ve D-Dimer arasında oldukça anlamlı pozitif korelasyon vardı. Lojistik regresyon analizi, CAR'ın D-dimer yüksekliği için önemli bir belirleyici olduğunu ortaya koydu. ROC eğrisi altında kalan alan (AUC) CAR için 0,741 idi. COVİD-19 hastalarında D-dimer yüksekliğini öngörmek için CAR'ın doğrulanmış eşik değeri, %58 duyarlılık ve %70 özgüllük ile 81,8 idi. Sonuç: Çalışmamız, CAR'ın D-dimer ile önemli ölçüde korele olduğunu ve COVİD-19’u olan hastalarda D-dimer yüksekliğini öngörmek için kullanılabileceğini göstermiştir.

Diagnostic precision of C-reactive protein to albumin ratio for coagulopathy in patients with COVID-19

Purpose: This study aims to assess the diagnostic utility of C-reactive protein (CRP) to albumin ratio (CAR) for predicting elevated D-dimer levels in COVID-19. Materials and Methods: This retrospective cohort study collected data from 145 hospitalized patients with confirmed COVID-19 in a university hospital. Patients were divided into two groups based on their D-dimer levels, as elevated D‐dimer levels and normal D-dimer levels. Demographic data, comorbidities, clinical symptoms, CAR, and laboratory results were obtained from the patients’ medical records and compared between the groups. Results: The mean age of patients was 52.9±17.9 years, and 76 of them were male. The median of CAR was significantly higher in those with higher D-dimer (134.1 vs. 20.7). CRP, procalcitonin, leukocyte, neutrophil, lactate dehydrogenase, ferritin, and fibrinogen were higher in patients with elevated D-dimer levels. There was a highly significant positive correlation between CAR and D-Dimer. Logistic regression analysis revealed that CAR was a significant determinant for elevated D‐dimer levels . The area under the ROC curve (AUC) was 0.741 for CAR. The verified cut-off value of CAR for predicting elevated D‐dimer levels in patients with COVID-19 was 81.8, with a sensitivity of 58% and a specificity of 70%. Conclusion: Our study revealed that CAR was significantly correlated with D-dimer and can be used to predict elevated D‐dimer levels in patients with COVID-19.

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1. Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S et al. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J Community Hosp Intern Med Perspect. 2020;10:402-8.
2. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95:834-47.
3. Iba T, Levy JH, Levi M, Thachil J. Coagulopathy in COVID-19. J Thromb Haemost. 2020;18:2103-9.
4. Halaby R, Popma CJ, Cohen A, Chi G, Zacarkim MR, Romero G et al. D-Dimer elevation and adverse outcomes. J Thromb Thrombolysis. 2015;39:55-9.
5. Naymagon L, Zubizarreta N, Feld J, van Gerwen M, Alsen M, Thibaud S et al. Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19. Thromb Res. 2020;196:99-105.
6. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol. 2020;92:856-62.
7. Karakoyun I, Colak A, Turken M, Altin Z, Arslan FD, Iyilikci V et al. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients. Int Immunopharmacol. 2021;91:107285.
8. Li Y, Li H, Song C, Lu R, Zhao Y, Lin F et al. Early prediction of disease progression in patients with severe COVID-19 using c-reactive protein to albumin ratio. Dis Markers. 2021;3;6304189.
9. Xue G, Gan X, Wu Z, Xie D, Xiong Y, Hua L et al. Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID19. Int Immunopharmacol. 2020;89:107065.
10. World Health Organization. Clinical Management of COVID-19: Interim Guidance. Geneva, World Health Organization, 2020.
11. Feketea GM, Vlacha V. The diagnostic significance of usual biochemical parameters in coronavirus disease 19 (COVID-19): Albumin to globulin ratio and CRP to albumin ratio. Front Med (Lausanne). 2020;7:566591.
12. Violi F, Cangemi R, Romiti GF, Ceccarelli G, Oliva A, Alessandri F et al. Is albumin predictor of mortality in COVID-19? Antioxid Redox Signal. 2021;35:139-42.
13. Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with Creactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond). 2009;9:30-3.
14. Yang JR, Xu JY, Chen GC, Yu N, Yang J, Zeng DX et al. Post-diagnostic C-reactive protein and albumin predict survival in Chinese patients with non-small cell lung cancer: a prospective cohort study. Sci Rep. 2019;9:8143.
15. Kurokawa Y, Yamashita K, Kawabata R, Fujita J, Imamura H, Takeno A et al. Prognostic value of postoperative C-reactive protein elevation versus complication occurrence: a multicenter validation study. Gastric Cancer. 2020;23:937-43.
16. Tu H, Tua S, Gao S, Shao A, Shenget J. Current epidemiological and clinical features of COVID-19; a global perspective from China. J Infect. 2020;81:1-9.
17. Zheng Y, Xu H, Yang M, Zeng Y, Chen H, Liu R et al. Epidemiological characteristics and clinical features of 32 critical and 67 noncritical cases of COVID-19 in Chengdu. J Clin Virol. 2020;127:104366.
18. Shen Y, Zheng F, Sun D, Ling Y, Chen J, Li F et al. Epidemiology and clinical course of COVID-19 in Shanghai, China. Emerg Microbes Infect. 2020;9:1537-45.
19. Brufsky A. Distinct viral clades of SARS-CoV-2: Implications for modeling of viral spread. J Med Virol. 2020;92:1386-90.
20. Creel-Bulos C, Liu M, Auld SC, Gaddh M, Kempton CL, Sharifpour M et al. Trends and diagnostic value of D-dimer levels in patients hospitalized with coronavirus disease 2019. Medicine (Baltimore). 2020;99:e23186.
21. Varim C, Yaylaci S, Demirci T, Kaya T, Nalbant A, Dheir H et al. Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID19 ınfection. Rev Assoc Med Bras. 2020;21;66:77-81.
22. Palmieri L, Palmer K, Lo Noce C, Meli P, Giuliano M, Floridia M et al. Differences in the clinical characteristics of COVID-19 patients who died in hospital during different phases of the pandemic: national data from Italy. Aging Clin Exp Res. 2021;33:193-99.
23. Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care. 2020;24:360.
24. Ye W, Chen G, Li X, Lan X, Ji C, Hou M et al. Dynamic changes of D-dimer and neutrophillymphocyte count ratio as prognostic biomarkers in COVID-19. Respir Res. 2020;21:169.