Hazar HARBALIOĞLU, Ömer GENÇ, Abdullah YILDIRIM

COVİD-19 tanısı alan hastalarda yatarak tedavi görmeyi öngörmede 3 prediktör: yaş, laktat dehidrogenaz ve nötrofil/lenfosit oranı

Özet Amaç: Aralik 2019’da Çin’in Hubei eyaleti Wuhan’da nedeni bilinmeyen pnömoni salgını yaşandı ve bu hastalık Dünya Sağlık Örgütü (WHO) tarafından koronavirüs hastalığı (COVİD-19) olarak adlandırıldı. COVİD-19 hızlıca dünyaya yayıldı. Bu hastalık hastalarda farklı şiddette seyretmektedir. Bu nedenle hastalar yatarak tedavi veya ayaktan tedavi gibi farklı alternatifler ile tedavi edilmektedir. Bu çalışmada bizim amacımız biyokimyasal parametreler ile hastaların ayakta tedavi veya yatarak tedavi almasındaki ilişkiyi araştırmaktır. Gereç ve yöntem: Çok merkezli retrospektif kohort çalışmamızda hastalar iki gruba ayrıldı; yatan hastalar ve ayaktan tedavi alan hastalar. Yatarak tedavi alan 60 hasta olmak üzere 102 hasta çalışmaya alındı. Koronavirüs; WHO’nun kılavuzuna göre gerçek zamanlı polimeraz zincir reaksiyonu (PZR) yöntemiyle SARS-CoV-2 RNA saptanmasıyla belirlenmiştir. Kan parametrelerinde nötrofil/lenfosit oranı (NLR) hesaplanmıştır. Bulgular: Yatan hasta grubunda daha ileri yaş (32,0 (26,0-39,3); 54,0 (38,3-59,3), p<0,001), kan değerlerinde daha yüksek laktat dehidrogenaz (LDH) (195,0 (156,5-225,3); 248,5 (200,3-334,5), p<0,001) ve daha yüksek NLR (1,56 (1,08-2,62); 2,60 (1,65-4,90), p<0,001) görüldü. Sonraki adımda lojistik regresyon analizinde; ileri yaş (OR:1,072 95 % CI:1,031-1,115, p=0,001), yüksek LDH (OR:1,021 95 %CI:1,009-1,034, p=0,001) yüksek NLR (OR:1,402 95 % CI:1,049-1,874, p=0,023) yatarak tedavi almayı bağımsız olarak predikte etti. Sonuç: COVİD-19 hastalarında ileri yaş, yüksek LDH ve yüksek NLR değerleri hastanede yatarak tedavi almayı öngördürmüştür. Anahtar Kelimeler: Koronavirüs, laktat dehidrogenaz, nötrofil/lenfosit oranı (NLR) Abstract Purpose: In December 2019, an unknown pneumonia epidemic was detected in Wuhan, Hubei province, China which was subsequently designated coronavirus disease 2019 (COVID 2019) by WHO in February 2020. COVID- 19 continues to spread rapidly all over the world. Patients may experience the disease at different severity. Therefore, they can be treated by choosing alternative approaches including outpatient treatment or hospitalization. Our aim in the present study is to investigate the relationship between some biochemical parameters on admission and treatment location preference (inpatient or outpatient) Materials and methods: At our multi-center retrospective cohort study, we divided the study into 2 groups as inpatients and outpatients. A total of 102 patients, 60 of whom received inpatient treatment, were enrolled. Coronavirus was determined by detecting SARS-CoV-2 RNA with a real-time PCR method in accordance with the WHO guide. Blood parameters were recorded and NLR was calculated. Results: Inpatient group was older (32.0 (26.0-39.3) vs 54.0 (38.3-59.3), p<0.001) and had significantly higher level of LDH (195.0 (156.5-225.3) vs 248.5 (200.3-334.5), p<0.001) and NLR (1.56 (1.08-2.62) vs 2.60 (1.65-4.90), p<0.001) in blood samples. In forward stepwise logistic regression analysis; advanced age (OR:1.072 95 % CI:1.031-1.115, p=0.001), high LDH (OR:1.021 95 %CI:1.009-1.034, p=0.001) and NLR (OR:1.402 95 % CI:1.049-1.874, p=0.023) were shown as independent predictors of hospitalization Conclusion: Advanced age, high LDH, and NLR level predicted hospitalization in patients with COVID-19. Keywords: Coronavirus, laktate dehydrogenase, neutrophil/ lymphocyte ratio (NLR)

Anahtar Kelimeler:

Koronavirüs, laktat dehidrogenaz, nötrofil/lenfosit oranı (NLR), yaş

3 predictors of hospitalization patients with coronavirus (Covid-19): old age, lactate dehydrogenase and neutrophil/lymphocyte ratio

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1. Lu H, Stratton C.W., Tang Y. Outbreak of pneumonia of unknown etiology in Wuhan China: The mystery and the miracle. J Med Virol 2020;92:401-402. doi: 10.1002/jmv.25678.
2. Lu R, Zhao X, Li J, Niu P, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: Implications for virüs origins and receptor binding. Lancet 2020;395:565-574. doi: 10.1016/S0140-6736(20)30251-8.
3. Su S, Wong G, Shi W, et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol 2016;24:490-502. doi: 10.1016/j.tim.2016.03.003.
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. doi: 10.1016/S0140-6736(20)30183-5.
5. Li W, Shi Z, Yu M, et al. Bats are natural reservoirs of SARS-like coronaviruses. Science 2005;310:676-9. doi: 10.1126/science.1118391.
6. Corman VM, Ithete NL, Richards LR, et al. Rooting the phylogenetic tree of Middle East respiratory syndrome coronavirus by characterization of a conspecific virus from an African bat. J Virol 2014;88:11297-303. doi: 10.1128/JVI.01498-14.
7. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-273. doi: 10.1038/s41586-020-2012-7.
8. Yang Y, Peng F, Wang R, et al. The deadly coronaviruses: The 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China. J Autoimmun 2020;109:102434. doi: 10.1016/j.jaut.2020.102434.
9. N. Chen, M. Zhou, X. Dong, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-513. doi: 10.1016/S0140-6736(20)30211-7.
10. https://covid19.who.int/. Erişim Tarihi 6 Mayıs 2020
11. https://www.who.int/publications/i/item/laboratory-testing-of-2019-novel-coronavirus-(-2019-ncov)-in-suspected-human-cases-interim-guidance-17-january-2020. Erişim tarihi 6 Mayıs 2020
12. Tian S, Hu N, Lou J, et al. Characteristics of COVID-19 Infection in Beijing. J Infect 2020;80:401-406. doi: 10.1016/j.jinf.2020.02.018.
13. Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for AntimicrobialTherapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci 2020;35:e112. doi: 10.3346/jkms.2020.35.e112.
14. CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:343-346. doi: 10.15585/mmwr.mm6912e2.
15. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020;e200950. doi: 10.1001/jamacardio.2020.0950.
16. Zhang JJ, Dong X, Cao Y, et al. Clinical Characteristics of 140 Patients infected with SARS-CoV-2 in Wuhan, China Allergy 2020 Feb 19. doi: 10.1111/all.14238.
17. Márquez EJ, Trowbridge J, Kuchel GA, Banchereau J, Ucar D. The lethal sex gap: COVİD-19. Immun Ageing 2020;17:13. doi: 10.1186/s12979-020-00183-z. eCollection 2020.
18. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368:m1091. doi: 10.1136/bmj.m1091.
19. Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in Northeast Chongqing. J MedVirol. 2020;10.1002/jmv.25783. doi: 10.1002/jmv.25783.
20. 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;e200994. doi: 10.1001/jamainternmed.2020.0994.
21. Zhang X, Cai H, Hu J, et al. Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings. Int J Infect Dis 2020;94:81-87. doi: 10.1016/j.ijid.2020.03.040.
22. Drent M, Cobben NA, Henderson RF, Wouters EF, Dieijen-Visser MV. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation Eur Respir J 1996;9:1736-42. doi: 10.1183/09031936.96.09081736.
23. Lott JA, Nemensanszky E. Lactate dehydrogenase. In: Lott JA, Wolf PL, editors. Clinical Enzymology, a case-orianted Aprroach. 1987. pp. 213–244.
24. Moss DW, Henderson AR. Enzymes. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 2nd edn. Philadelphia, Saunders Co. 1986; pp. 735–896.history. 2nd edn. Philadelphia, Saunders Co. 1986; pp. 735–896.
25. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017;39:529-539. doi: 10.1007/s00281-017-0629-x.
26. He Z, Zhao C, Dong Q, et al. Effects of severe acute respiratory syndrome (SARS) coronavirus infection on peripheral blood lymphocytes and their subsets. Int J Infect Dis 2005;9:323-330. doi: 10.1016/j.ijid.2004.07.014.
27. Al-Tawfiq JA, Hinedi K, Abbasi S, Babiker M, Sunji A, Eltigani M. Hematologic, hepatic, and renal function changes in hospitalized patients with Middle East respiratory syndrome coronavirus. Int J Lab Hematol 2017;39:272-278. doi: 10.1111/ijlh.12620.
28. Xia X, Wen M, Zhan S He J, Chen W. An increased neutrophil/lymphocyte ratio Is an early Warning signal of severe COVID-19.Nan Fang Yi Ke Da Xue Xue Bao 2020;40:333-336. doi: 10.12122/j.issn.1673-4254.2020.03.06.
29. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect 2020 ;81(1):e6-e12. doi: 10.1016/j.jinf.2020.04.002.
30. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020;ciaa248. doi: 10.1093/cid/ciaa248.