Covid-19 Hastalarında D-dimer ve Eritrosit Dağılım Genişliği Arasındaki İlişkinin Klinik Önemi

Giriş: Eritrosit dağılım genişliği (RDW), sistemik inflamasyon varlığında ve tromboembolik durumu değerlendirmede kullanılabilen bir belirteçtir. Bu çalışmada, Coronavirus hastalığı 2019'da (COVID-19) advers olaylarla ilişkili olduğu bilinen D-dimer düzeyi ile RDW arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntemler: Bu çalışmaya yaş ve cinsiyet açısından uyumlu 122 COVID-19'lu hasta ve 62 sağlıklı birey dahil edildi. Hastalar D-dimer düzeylerinin değerlendirilmesine göre iki gruba ayrıldı. Birinci grup D-dimer düzeyi daha yüksek olan 45 hastayı, ikinci grup ise normal D-dimer düzeyi olan 77 hastayı içeriyordu. Bulgular: D-dimer düzeyi yüksek olan Covid-19 hastalarındaki RDW değerleri, D-dimer düzeyi normal olan Covid-19 hastaları ve kontrol grubuna göre daha yüksek bulundu. Bu sonuçlar istatistiksel olarak anlamlıydı (sırasıyla P=0,006 ve P=0,013). COVID-19 hastaları arasında RDW ile D-dimer düzeyi arasında pozitif bir korelasyon gözlendi (r=0.270, P=0.003). Çok değişkenli lojistik regresyon analizlerinde yüksek D-dimer ile ilişkili çeşitli değişkenler arasında RDW’nin, D-dimerin yüksek olduğu Covid-19 hastalarında bağımsız bir belirteç olduğu saptandı (%95 CI: CI: CI:0.322-0.979, P=0.042). Sonuç: Sonuçlar, COVID-19 hastalığı olan hastalarda yüksek RDW değerlerinin D-dimer gibi hastaların klinik takibinde bir belirteç olarak kullanılabileceğini göstermiştir

Anahtar Kelimeler:

Eritrosit dağılım genişliği, D-dimer, belirteç

Clinical Significance of the Relationship Between D-dimer and Erythrocyte Distribution Width in Covid-19 Patients

Introduction: Red cell distribution width (RDW) is a marker that can be used in the presence of systemic inflammation and evaluating thromboembolic condition.We aimed to evaluate the relationship between RDW and the level of D-dimer known as related to adverse events in Coronavirus disease 2019 (COVID-19) in this study. Methods: One hundred twenty two patients with COVID-19 and 62 healthy individuals with age and sex-matched were enrolled in the present study. The patients were divided into two groups based on evaluating their D-dimer level. The first group contained 45 patients with higher D-dimer level whereas the second group contained 77 patients with normal D-dimer level. Results: RDWvalues were found to be higher in patients with COVID-19 and higher D-dimer level than patients with normal D-dimer level and control group. These results were found to be statistically significant (P=0.006 and P=0.013, respectively). Among patients with COVID-19, a positive correlation was observed between RDW and D-dimer level (r=0.270, P=0.003). Among the various variables associated with higher D-dimer in multivariate logistic regression analyses, RDW detected an independent predictor of higher D-dimer in COVID-19 patients (95% CI: CI:0.322-0.979, P=0.042). Conclusion: The results indicated that high RDW values in patients with COVID-19 disease could be used as a marker in clinical follow-up of patients as D-dimer.

Keywords:

red cell distribution witdh, D-dimer, marker,

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References 1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb;395(10223):497–506.
2. Tu Y-F, Chien C-S, Yarmishyn AA, et al. A Review of SARS-CoV-2 and the Ongoing Clinical Trials. Int J Mol Sci. 2020 Apr 10;21(7):2657.
3. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727–33.
4. Iba T, Levy JH, Levi M, Connors JM, Thachil J. Coagulopathy of Coronavirus Disease 2019. Crit Care Med. 2020 May 27;Publish Ah.
5. Beun R, Kusadasi N, Sikma M, Westerink J, Huisman A. Thromboembolic events and apparent heparin resistance in patients infected with SARS‐CoV‐2. Int J Lab Hematol. 2020 Jun 15;42(S1):19–20.
6. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020 Jun;7(6):e438–40.
7. Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003 Sep 25;349(13):1227–35.
8. Frater JL, Zini G, D’Onofrio G, Rogers HJ. COVID‐19 and the clinical hematology laboratory. Int J Lab Hematol. 2020 Jun 15;42(S1):11–8.
9. Uslu AU, Yonem O, Aydin B, et al. Red cell distribution width is associated with albuminuria in adults with familial Mediterranean fever. Kaohsiung J Med Sci. 2016;32(4):216–20.
10. Ozsu S, Abul Y, Gunaydin S, Orem A, Ozlu T. Prognostic Value of Red Cell Distribution Width in Patients With Pulmonary Embolism. Clin Appl Thromb Hemost. 2014 May 8;20(4):365–70.
11. Pehlivanlar Küçük M, Öztuna F, Abul Y, et al. Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism. Adv Respir Med. 2019 Apr 30;87(2):69–76.
12. Sunnetcioglu A, Sertogullarindan B, Ozbay B, Asker S, Ekin S. Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism. Clin (Sao Paulo). 2015 Jun 24;70(6):441–5.
13. Celik A, Ozcan IT, Gündes A, et al. Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism. Kaohsiung J Med Sci. 2015 Mar;31(3):145–9.
14. Pan F, Yang L, Li Y, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci. 2020;17(9):1281–92.
15. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Jun 4;135(23):2033–40.
16. Kollias A, Kyriakoulis KG, Dimakakos E, et al. Thromboembolic risk and anticoagulant therapy in COVID‐19 patients: emerging evidence and call for action. Br J Haematol. 2020 Jun 4;189(5):846–7.
17. Zhang L, Yan X, Fan Q, et al. D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19. J Thromb Haemost. 2020 Jun 4;18(6):1324–9.
18. Eichinger S, Minar E, Bialonczyk C, et al. D-dimer levels and risk of recurrent venous thromboembolism. JAMA [Internet]. 2003 Aug 27;290(8):1071–4.
19. García Suquia A, Alonso-Fernández A, de la Peña M, et al. High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea. Eur Respir J. 2015 Dec;46(6):1691–700.
20. Hasegawa M, Wada H, Yamaguchi T, et al. The Evaluation of D-Dimer Levels for the Comparison of Fibrinogen and Fibrin Units Using Different D-Dimer Kits to Diagnose VTE. Clin Appl Thromb Hemost. 2018 May 8;24(4):655–62.
21. Tamburello A, Bruno G, Marando M. COVID-19 and Pulmonary Embolism: Not a Coincidence. Eur J Case Rep Intern Med. 2020;7(6):001692.
22. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Hear J. 2020 May 14;41(19):1858–1858.
23. Poggiali E, Bastoni D, Ioannilli E, Vercelli A, Magnacavallo A. Deep Vein Thrombosis and Pulmonary Embolism: Two Complications of COVID-19 Pneumonia? Eur J Case Rep Intern Med. 2020 Apr 8;7(5):1.
24. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J Med Virol. 2020 Jul 10;92(7):791–6.
25. Leonard-Lorant I, Delabranche X, Severac F, et al. Acute Pulmonary Embolism in COVID-19 Patients on CT Angiography and Relationship to D-Dimer Levels. Radiology. 2020 Apr 23;201561.
26. Uslu AU, Aydin B, Inal S, et al. The relationship between red cell distribution width and homozygous M694V mutation in familial Mediterranean fever patients. Ann Saudi Med. 2015 Mar;35(2):151–6.
27. Shahrbanoo Kheirkham-Sabetghadam, Yaser Jenab, Seyed-Mohammad Ghoreyshi-Hefzabad, et al. Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism. Turk J Med Sci. 2018 Apr 30;48(2).
28. Yčas JW, Horrow JC, Horne BD. Persistent increase in red cell size distribution width after acute diseases: A biomarker of hypoxemia? Clin Chim Acta. 2015 Aug;448:107–17.
29. Bulut C, Kato Y. Epidemiology of COVID-19. Turk J Med Sci. 2020 Apr 21;50(SI-1):563–70.