Faysal DUKSAL, Cengiz BURNİK, Serkan YAVUZ, Mehmet MERMER

Sitokin Fırtınası Nedeniyle Tosilizumab ile Tedavi Edilen Covid-19 Hastalarında Nötrofil/Lenfosit Oranı ve Trombosit/Lenfosit Oranının Değerlendirilmesi

Giriş/Amaç: Sitokin fırtınasına giren şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2) hastalarında proinflamatuar sitokin seviyelerinde önemli bir artış vardır. Nötrofil-lenfosit oranı (NLO) ve platelet-lenfosit oranı (PLO), inflamatuar hastalıklarda da artar. Amaç, sitokin fırtınası nedeniyle tosilizumab (TCZ) alan koronavirüs hastalığı 2019 (COVID-19) hastalarının NLR ve PLR'sini değerlendirmektir. Gereç ve Yöntem: Mart ve Aralık 2020 tarihleri arasında yürütülen bu geriye dönük, kesitsel çalışmada, laboratuvar tarafından doğrulanmış COVID-19'lu yetişkin hastalar analiz edildi. Bulgular: Çalışmaya alınan 519 hastanın yaş ortalaması 61,6 ± 17,0 yıldı ve erkek ağırlıklıydı (%64,7). Hastaların %70,7'sinde en az bir tip komorbidite vardı ve en sık görülen komorbid durumlar kronik obstrüktif akciğer hastalığı (%45,9) ve astımdı (%28,7). TCZ verilen 399 hasta (grup 1) ve verilmeyen 120 hasta (grup 2) değerlendirildi. Grup 2'ye göre grup 1'de erkek ağırlığı daha fazlaydı ve daha yaşlıydılar (p<0.001). Grup 1'de %48,6 olarak saptanan ölüm oranı yoğun bakımda (YBÜ) yaklaşık iki kat daha yüksekti. Grup 1'de özellikle YBÜ hastalarında NLO ve PLO anlamlı olarak yüksekti ve lenfopeni grup 2'ye göre daha belirgindi (p<0.001). Sonuç: Yüksek NLO, PLO ve lenfopeni, kritik derecede hasta olan Covid-19 hastalarında daha yaygındı. Bu nedenle, kötü prognozu tahmin etmek için bir belirteç olarak kullanılabilirler. Bu hastaların başlangıç döneminde daha agresif tedavi edilmesi önerilebilir.

Anahtar Kelimeler:

Covid-19, inflamasyon, lenfopeni, NLO, PLO

Evaluation of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Covid-19 Patients Treated with Tocilizumab Due to Cytokine Storm

Background/Aims: There is a significant increase in proinflammatory cytokine levels in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients entering cytokine storm. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), also increase in inflammatory diseases. The aim was to evaluate the NLR and PLR of coronavirus disease 2019 (COVID-19) patients receiving tocilizumab (TCZ) due to cytokine storm. Materials and Methods: In this retrospective, cross-sectional study conducted in between March and December 2020, adult patients with laboratory-confirmed COVID-19 were analyzed Results; The mean age of 519 patients included in the study was 61.6 ± 17.0 years, with male predominance (64.7%). 70.7% of patients had at least one type of comorbidity and the most common comorbid conditions were chronic obstructive pulmonary disease (45.9%) and asthma (28.7%). 399 patients who were given TCZ (group 1) and 120 patients who were not given TCZ (group 2) were evaluated. Compared with group 2, group 1 had more male predominance and they were older (p<0.001). The mortality rate, which was found to be 48.6% in group 1, was approximately twice as high in the intensive care unit (ICU). NLR and PLR were significantly higher and lymphopenia was more prominent in group 1, especially in ICU patients than group 2 (p<0.001). Conclusion: High NLR, PLR and lymphopenia was more common in critically ill Covid-19 patients. Therefore, they may be used as a marker to predict poor prognosis. It can be suggested to treat these patients more aggressively in the initial period.

Keywords:

Covid-19, İnflammation, lymphopenia, NLR, PLR,

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