Esra POLAT, Cengiz ŞABANOĞLU, Muhdedir CANER, Fatma Yekta URKMEZ, Fulden AKYÜZ İNANÇ, Ünal ÖZTÜRK, Hüseyin KANDEMİR, Gamze Yeter ARSLAN, Elif İlkay YÜCE, İbrahim Halil İNANÇ

COVID-19'un uzun dönem mortalitesinde C-reaktif protein/ albümin oranı ve sistemik immün inflamasyon indeksinin prediktif değeri

Amaç: Coronavirüs-19 hastalığının (COVID-19) kısa dönem prognozu ile biyobelirteçlerle ilgili bir çok çalışma yapılmıştır; ancak uzun dönem prognozu ile ilgili çalışmalar kısıtlıdır. Amacımız; sistemik inflamasyon indeksi (SII) ve C-reaktif protein/ albümin oranının (CAR) COVID-19 hastalığının hastane içi ve 1 yıllık takiplerinde prediktif değerini saptamaktır. Gereç ve Yöntemler: Primer sonuçlar hastane içi mortalite ve 1 yıllık mortalite idi. İkincil sonuçlar; yatışta yoğun bakım ünitesi (YBÜ) ihtiyacı ve sonrasında YBÜ'ye transfer olma durumu idi. Bulgular: Çalışmaya 449 (53.6 %) erkek ve 389 ( 46.4 %) kadın katıldı. Yaş ortalaması 53.8±18.5 idi. Önceden bilinen kalp yetmezliği (KY), COVID-19 ile ilişkili KY, akut böbrek yetmezliği (ABY), diyabetes mellitus (DM), hipertansiyon (HT), koroner arter hastalığı (KAH), kronik obstrüktif akciğer hastalığı (KOAH)/astım , yüksek CO-RADS skoru ( >4), düşük Ejeksiyon Fraksiyonu (EF), yüksek CAR ve SII, artmış hastane içi ve 1 yıllık mortalite ile ilişkilendirildi (p < 0.05). Çok değişkenli analiz sonucunda; CAR, SII, ABY ve DM hastane içi ve 1 yıllık mortalitenin bağımsız belirteçleri iken, KAH sadece 1 yıllık mortalitenin bağımsız bir öngörücüsüydü. ROC analizi ile sırasıyla 2.54 ve 2.23 CAR değerleri, hastane içi ve 1 yıllık mortaliteyi predikte etti (p <0.001). Sırasıyla 1274 ve 1191 SII değerleri, hastane içi ve 1 yıllık mortaliteyi predikte etti (p <0.001). Sonuç: CAR ve SII, COVID-19’da hem kısa dönemde hem uzun dönemde mortaliteyi tahmin etmek için değerli prognostik indeksler olarak kullanılabilir.

Anahtar Kelimeler:

Sistemik İmmün İnflamasyon İndeksi, SII, C-reaktif protein/albümin oranı, CAR, Uzun dönem mortalite, COVID-19

Predictive value of c-reactive protein to albumin ratio and systemic immune-inflammation index for the long-term mortality in COVID-19

Aim: Several studies have investigated the association between biomarkers and short-term prognosis in the coronavirus infectious disease 2019 (COVID-19). However, data on the long-term prognosis are limited. To determine the predictive value of systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) for in-hospital and 1-year outcomes during COVID-19. Material and Method: The primary outcomes were in-hospital and 1-year mortality. The secondary outcomes were the intensive care unit (ICU) need at admission and transfer to the ICU later on. Results: The study included 449 (53.6%) males and 389 (46.4%) females with a mean age of 53.8±18.5 years. Previously known heart failure (HF), COVID-19-related HF, acute renal failure (ARF), diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD)/asthma, high CO-RADS scores (>4), low ejection fraction (EF), higher CAR and SII were associated with an increased in-hospital and 1-year mortality (p<0.05). After multivariate analysis; CAR, SII, ARF, and diabetes mellitus were independent predictors of in-hospital and 1-year mortality,whereas CAD was only an independent predictor of 1-year mortality. After ROC analysis, CAR cut-off levels of 2.54 and 2.23 predicted in-hospital and 1-year mortality, respectively (p<0.001). The SII cut-off levels of 1274 and 1191 predicted in-hospital and 1-year mortality, respectively (p<0.001). Conclusion: CAR and SII can be used as valuable prognostic indexes to predict both the short-term and long-term mortality in COVID-19.

Keywords:

Systemic immune-inflammation index, SII, C-reactive protein to albumin ratio, CAR, long-term mortality, COVID-19,

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Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 update: a report from the American Heart Association. Circulation 2021; 143: e254-743.
Piombi-Adanza SN, Baretto MC, Echaide FA, et al. Analysis of oxygen blood saturation/respiratory rate index, NEWS2, CURB65, and quick sequential organ failure assessment scores to assess prognosis in patients with mild coronavirus disease 2019. Rev Invest Clin 2021; 73: 399-407.
Inanc IH, Bursa N, Gultepe A, Bayramoğlu M, Sabanoglu C, Inanc FA. Association among CO-RADS score, co-morbid diseases, and short-term prognosis in COVID-19 infection. Eur Rev Med Pharmacol Sci 2022; 26: 653-63.
Gaspar-Hernández J, Araiza-Garaygordobil D, Gopar-Nieto R, Martínez-Amezcua P, Arias-Mendoza A. impact of the coronavirus disease-19 pandemic on acute cardiovascular emergencies in a third level cardiology hospital: a call for action. Rev Invest Clin 2020; 72: 280-2.
Ramos-Araque ME, Siegler JE, Ribo M, et al. Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry. BMC Neurol 2021; 21: 43.
Inanc IH, Sabanoglu C. Autonomic dysfunction and metabolic disorders as the possible sequelae of COVID-19 infection. Eur Rev Med Pharmacol Sci 2022; 26: 5587-95.
Saylik F, Akbulut T, Kaya S. Can c-reactive protein to albumin ratio predict in-hospital death rate due to COVID-19 in patients with hypertension? Angiology 2021; 72: 947-52.
Fois AG, Paliogiannis P, Scano V, et al. The systemic inflammation index on admission predicts in-hospital mortality in COVID-19 patients. Molecules 2020; 25: 5725.
Li Y, Li H, Song C, et al. Early prediction of disease progression in patients with severe COVID-19 using c-reactive protein to albumin ratio. Dis Markers 2021; 2021: 6304189.
Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of systemic immune- inflammation index in cancer: a meta-analysis. J Cancer 2018; 9: 3295-302.
Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Shibuya N, Kubota K. Clinical significance of the c-reactive protein to albumin ratio for survival after surgery for colorectal cancer. Ann Surg Oncol 2016;23:900-7.
Özcan S, Dönmez E, Yavuz Tuğrul S, et al. The prognostic value of C-reactive protein/albumin ratio in acute pulmonary embolism. Rev Invest Clin 2022; 74: 97-103.
Denegri A, Obeid S, Raeber L, et al. Systemic immune-inflammation index predicts major adverse cardiovascular events in patients with ST-elevation myocardial infarction. Eur Heart J 2021; 42: ehab724-1353.
Prokop M, van Everdingen W, van Rees Vellinga T, et al. CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19-definition and evaluation. Radiology 2020; 296: E97-104.
Wiegers SE, Ryan T, Arrighi JA, et al. 2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography): a report of the ACC competency management committee. J Am Soc Echocardiogr 2019; 32: 919-43.
Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr 2021; 21: 199.
Di Bari M, Tonarelli F, Balzi D, et al. COVID-19, vulnerability, and long-term mortality in hospitalized and non-hospitalized older persons. J Am Med Dir Assoc 2022; 23: 414-20.
Carriazo S, Mas-Fontao S, Seghers C, et al. Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study. Clin Kidney J 2021; 15: 432-41.
Sproston NR, Ashworth JJ. Role of c-reactive protein at sites of inflammation and infection. Front Immunol 2018; 9: 754.
Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med 2018;52:8-12.
Karadeniz M, Duran M, Akyel A, et al. High-sensitive CRP level is associated with intermediate and high Syntax score in patients with acute coronary syndrome. Int Heart J 2015; 56: 377-80.
Lucijanić M, Stojić J, Atić A, et al. Clinical and prognostic significance of c-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients: data on 2309 patients from a tertiary center and validation in an independent cohort. Wien Klin Wochenschr 2022; 134: 377-84.
Manne BK, Denorme F, Middleton EA, et al. Platelet gene expression and function in patients with COVID-19. Blood 2020; 136: 1317-29.
Acar E, Demir A, Yıldırım B, Kaya MG, Gökçek K. The role of hemogram parameters and c-reactive protein in predicting mortality in COVID-19 infection. Int J Clin Pract 2021; 75: e14256.
Kudlinski B, Zgoła D, Stolińska M, et al. Systemic inflammatory predictors of in-hospital mortality in COVID-19 patients: a retrospective study. Diagnostics (Basel) 2022; 12: 859.
Ari A, Gunver F. Comparison of neutrophil-lymphocyte ratio and platelet- lymphocyte ratio in patients with thyroiditis and papillary tumors. J Int Med Res 2019; 47: 2077-83.
Xue G, Gan X, Wu Z, et al. Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID-19. Int Immunopharmacol 2020; 89: 107065.