COVID-19 hastalarında dalak boyutu ve hematolojik parametrelerinin klinik önemi

Amaç: Şiddetli akut solunum sendromu koronavirüs 2'nin (SARS-CoV-2) neden olduğu COVID-19, sistemik tutuluma neden olur ve dalak hedef organlardan biri olabilir. Bu çalışmamızda COVID-19 hastalarının hastane başvurusu sırasında çekilen bilgisayarlı tomografi (BT) kesitlerindeki dalak boyutu ve laboratuvar parametrelerinin COVID-19'un sonlanımı üzerine etkisini değerlendirmeyi amaçladık.Materyal-Metot: Bu retrospektif kohort çalışmasına Nisan ve Aralık 2020 tarihleri arasında hastanemize başvuran 644 COVID-19 hastası alındı. Hastaların medikal kayıtları toplandı ve başvuru anında çekilen Toraks BT kesitlerinde dalağın tümünün değerlendirilebildiği Toraks BT’ler gözden geçirildi.Bulgular: Çalışma popülasyonu, medyan yaşı 59 (45 – 69 yıl) olan 644 hastayı (387 erkek, 57 kadın) içermektedir. COVID-19 ile ilişkili en yaygın üç sistemik hastalık hipertansiyon (%28), diabetes mellitus (%22.2) ve kalp hastalığıydı (%18.6). Başvuru sırasında en sık görülen aktif şikayet nefes darlığı (%57,5) ve öksürükdü (%46). 644 hastann 109’u mortal seyretti. Başvuru sırasında, mortalitesi olan hastalarda medyan lökosit sayısı daha yüksek olmasına rağmen (8.9'a karşı 6.5, p<0.001), lenfosit sayısı (1.3'e karşı 1.0, p<0.001) ve trombosit sayısı (200'e karşı 187, p= 0.035) mortalitesi olmayan hastalarda daha yüksekti. Çalışma popülasyonunun 173'ünde (%26,9) splenomegali vardı ve mortalitesi olmayan hastalarda splenomegali oranı oldukça yüksekti (%31'e karşı %6,4, p<0,001). Sonuç: COVID-19 özellikle erken dönemde akciğer tutulumu ile kendini gösterse de sistemik tutuluma da neden olur ve hedefteki organlarından biri dalak olabilir. Ayrıca hastaların başvuru anındaki lenfosit, monosit ve trombosit sayıları COVID-19'un ilerlemesini öngörebilir. Çalışmamızın sonuçları dalak boyutu artışının COVID-19 sonlanımı açısından dikkate alınması gereken bir belirteç olabileceğini düşündürmektedir.

Anahtar Kelimeler:

SARS-CoV-2, dalak boyutu, Laboratuvar, CT-SS, pandemi

Clinical Significance of Spleen Size and Hematological Parameters in COVID-19 Patients

Objective: COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes systemic involvement and the spleen may be one of the target organs. In this study, we aimed to evaluate the effect of spleen size and laboratory parameters in computed tomography (CT) sections taken during hospital admission of COVID-19 patients on the outcome of COVID-19.Material-Method: This retrospective cohort study included 644 COVID-19 patients admitted to our hospital between April and December 2020. The medical records of the patients were collected, and the thorax CT scans in which the entire spleen could be evaluated in the thorax CT sections taken at the time of admission were reviewed.Results: The study population included 644 patients (387 men, 257 women) with a median age of 59 (45 – 69 years). The three most common systemic diseases associated with COVID-19 were hypertension (28%), diabetes mellitus (22.2%), and heart disease (18.6%). The most common active complaints at admission were shortness of breath (57.5%) and cough (46%). 109 of 644 patients were mortal. At admission, patients with mortality had higher median leukocyte count (8.9 vs 6.5, p<0.001), lymphocyte count (1.3 vs 1.0, p<0.001) and platelet count (187 vs 200, p=0.001). 0.035) was higher in patients without mortality. Of the study population, 173 (26.9%) had splenomegaly, and the rate of splenomegaly was significantly higher in patients without mortality (31% vs. 6.4%, p<0.001).Conclusion: Although COVID-19 manifests itself with lung involvement especially in the early period, it also causes systemic involvement and one of the target organs may be the spleen. In addition, the lymphocyte, monocytes and platelet counts of the patients at the time of admission can predict the progression of COVID-19. The results of our study suggest that increased spleen size may be a marker that should be considered in terms of COVID-19 outcome.

Keywords:

SARS-CoV-2, spleen size, Laboratory, CT-SS, pandemic,

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