Öz
Amaç: Çalışmamızda covid-19 ilişkili pnömoninin şiddetine bağlı olarak koagulasyon parametrelerinde oluşan değişim ile mortalitenin öngörülebilmesi araştırıldı.
Gereç ve Yöntem: Çalışmaya toplam 137 covid-19 nedenli pnömonisi bulunan hasta dahil edildi. Pnömoni şiddetine göre hastalar hafif, orta ve şiddetli olarak üç gruba ayrıldı. Pnömoni şiddetine göre tam kan sayımındaki parametreler ile biyokimyasal parametrelerin düzeyleri gruplar arasında karşılaştırıldı. Mortaliteye göre kan parametreleri incelenerek bu parametrelerin mortalite üzerine net etkisini belirlemek için ROC analizleri ve regresyon analizleri yapıldı.
Bulgular: Pnömoni şiddeti Protrombin zamanı (PTZ), International normalized ratio (INR) ve Aktive parsiyel tromboplastin zamanı (aPTT) değerlerinde artış kaydedilmiş olup PTZ ve INR değerlerinde gruplar arasında istatistiksel olarak anlamlı farklılık belirlenmiştir. Mortal seyreden olgularda PTZ, INR ve aPTT düzeylerinin daha yüksek olduğu belirlendi. Koagulasyon parametresinin (aPTT+PTZ) >45,1 saniye (sn) cut-off değerine göre 93,5% duyarlılık ve 97,5% özgüllükle belirlendi.
Sonuç: Covid-19 ilişkili pnömoni şiddetinin artışına ikincil olarak düzeyi yükselen koagulasyon parametresinin (aPTT+PTZ) mortalitenin öngörülmesinde başarılı sonuçlar sunduğu belirlenmiş olup klinik kullanımda önerebileceğimiz bir parametre olabilir.
Anahtar Kelimeler
Kaynakça
- 1. WHO coronavirus disease (COVID-19) dashboard. Geneva: World Health Organization, 2020. Available online: https://covid19.who.int/ (last cited: [2020, November 30]).
- 2. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786.
- 3. Li D, Wang D, Dong J, Wang N, Huang H, Xu H, et al. False-Negative Results of Real-Time Reverse-Transcriptase Polymerase Chain Reaction for Severe Acute Respiratory Syndrome Coronavirus 2: Role of Deep-Learning-Based CT Diagnosis and Insights from Two Cases. Korean J Radiol. 2020 Apr;21(4):505-508. doi: 10.3348/kjr.2020.0146.
- 4. Pekçevik Y, Belet Ü. Patient Management in the Radiology Department, the Role of Chest Imaging During the SARS-CoV-2 Pandemic and Chest CT Findings Related to COVID-19 Pneumonia. Tepecik Eğit ve Araşt Hast Dergisi 2020;30(Ek sayı):195-212. doi: 10.5222/terh.2020.13549.
- 5. Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L, et al. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP). MedRxiv 2020. doi:10.1101/2020.02.10.20021832 (preprint).
- 6. Yang Y, Shen C, Li J, Yuan J, Yang M, Wang F, et al. Exuberant elevation of IP-10, MCP-3 and IL-1ra during SARS-CoV-2 infection is associated with disease severity and fatal outcome. MedRxiv 2020.doi:10.1101/2020.03.02.20029975 (preprint).
- 7. Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020;8(3):48.doi:10.21037/atm.2020.02.06.
- 8. Hojyo S, Uchida M, Tanaka K, Hasebe R, Tanaka Y, Murakami M, et al. How COVID-19 induces cytokine storm with high mortality. Hojyo et al. Inflamm Regen (2020)40:37. https://doi.org/10.1186/s41232-020-00146-3.
- 9. Ramana CV, DeBerge MP, Kumar A, Alia CS, Durbin JE, Enelow RI. Inflammatory impact of IFN‐γ in CD8+T cellmediated lung injury is mediated by both Stat1‐dependent and‐independent pathways. Am J Physiol Lung Cell Mol Physiol 2015;308(7):L650‐L657.doi:10.1152/ajplung.00360.2014.
- 10. Schwarze J, Cieslewicz G, Joetham A, Ikemura T, Hamelmann E, Gelfand EW. CD8 T cells are essential in the development of respiratory syncytial virus-induced lung eosinophilia and airway hyperresponsiveness. J Immunol 1999; 162: 4207-11. PMID:10201948.
- 11. Musher DM, Abers MS, Corrales-Medina VF. Acute Infection and Myocardial Infarction. N Engl J Med 2019; 380:171-176. doi: 10.1056/NEJMra1808137.
- 12. Lv X, Wang H. Pathophysiology of sepsis-induced myocardial dysfunction. Military Med Res (2016) 3:30. doi: 10.1186/s40779-016-0099-9.
- 13. Simmons J, Pittet J-F. The Coagulopathy of Acute Sepsis. Curr Opin Anaesthesiol. 2015 April;28(2): 227–236. doi:10.1097/ACO.0000000000000163.
- 14. Lee AYY, Connors JM, Kreuziger LB, Murphy M, Gernsheimer T, Lin Y, et al. COVID-19 and Coagulopathy: Frequently Asked Questions (Version 7.0; last updated January 29, 2021). Amerıcan Society of Hematology. 2021. Available at; https://www.hematology.org/covid-19/covid-19-and-coagulopathy.
- 15. Yazici O, Bozkuş F, Demirci N, Gülhan PY, Coşkun F. Coagulopathy and COVID-19. Eurasian J Pulmonol 2020;22(Suppl S1):67-9. doi: 10.4103/ejop.ejop_49_20.
- 16. Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020;13(11):1265-1275. doi: 10.1080/17474086.2020.1831383.
- 17. Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS One. 2020 Aug 21;15(8):e0238160. doi: 10.1371/journal.pone.0238160.
Öz
Purpose: In the present study, the possibility of predicting mortality with the change in coagulation parameters depending on the severity of Covid-19-associated pneumonia was investigated.
Materials and Methods: A total of 137 patients with Covid-19-associated pneumonia were included in the study. The patients were divided into three groups according to the severity of pneumonia as mild, moderate and severe. According to the severity of pneumonia, the parameters of complete blood count and the levels of biochemical parameters were compared between the groups. By examining blood parameters according to mortality, ROC analysis and regression analysis were performed to determine the net effect of these parameters on mortality.
Results: As the severity of pneumonia increased, Prothrombin time (PT), International normalized ratio (INR) and Activated partial thromboplastin time (aPTT) values were also increased, and a statistically significant difference was found between the groups in PT and INR values. PT, INR and aPTT levels were higher in cases with mortality. Mortality can be predicted with 93.5% sensitivity and 97.5% specificity. according to the >45.1 seconds(sec) cut-off value of the coagulation parameter (aPTT+PT.
Conclusion: The coagulation parameter (aPTT + PT), whose level increases secondarily to the increase in Covid-19-associated pneumonia severity, provides successful results in predicting mortality, and may be a parameter that we can recommend in clinical use.
Anahtar Kelimeler
Kaynakça
- 1. WHO coronavirus disease (COVID-19) dashboard. Geneva: World Health Organization, 2020. Available online: https://covid19.who.int/ (last cited: [2020, November 30]).
- 2. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786.
- 3. Li D, Wang D, Dong J, Wang N, Huang H, Xu H, et al. False-Negative Results of Real-Time Reverse-Transcriptase Polymerase Chain Reaction for Severe Acute Respiratory Syndrome Coronavirus 2: Role of Deep-Learning-Based CT Diagnosis and Insights from Two Cases. Korean J Radiol. 2020 Apr;21(4):505-508. doi: 10.3348/kjr.2020.0146.
- 4. Pekçevik Y, Belet Ü. Patient Management in the Radiology Department, the Role of Chest Imaging During the SARS-CoV-2 Pandemic and Chest CT Findings Related to COVID-19 Pneumonia. Tepecik Eğit ve Araşt Hast Dergisi 2020;30(Ek sayı):195-212. doi: 10.5222/terh.2020.13549.
- 5. Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L, et al. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP). MedRxiv 2020. doi:10.1101/2020.02.10.20021832 (preprint).
- 6. Yang Y, Shen C, Li J, Yuan J, Yang M, Wang F, et al. Exuberant elevation of IP-10, MCP-3 and IL-1ra during SARS-CoV-2 infection is associated with disease severity and fatal outcome. MedRxiv 2020.doi:10.1101/2020.03.02.20029975 (preprint).
- 7. Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020;8(3):48.doi:10.21037/atm.2020.02.06.
- 8. Hojyo S, Uchida M, Tanaka K, Hasebe R, Tanaka Y, Murakami M, et al. How COVID-19 induces cytokine storm with high mortality. Hojyo et al. Inflamm Regen (2020)40:37. https://doi.org/10.1186/s41232-020-00146-3.
- 9. Ramana CV, DeBerge MP, Kumar A, Alia CS, Durbin JE, Enelow RI. Inflammatory impact of IFN‐γ in CD8+T cellmediated lung injury is mediated by both Stat1‐dependent and‐independent pathways. Am J Physiol Lung Cell Mol Physiol 2015;308(7):L650‐L657.doi:10.1152/ajplung.00360.2014.
- 10. Schwarze J, Cieslewicz G, Joetham A, Ikemura T, Hamelmann E, Gelfand EW. CD8 T cells are essential in the development of respiratory syncytial virus-induced lung eosinophilia and airway hyperresponsiveness. J Immunol 1999; 162: 4207-11. PMID:10201948.
- 11. Musher DM, Abers MS, Corrales-Medina VF. Acute Infection and Myocardial Infarction. N Engl J Med 2019; 380:171-176. doi: 10.1056/NEJMra1808137.
- 12. Lv X, Wang H. Pathophysiology of sepsis-induced myocardial dysfunction. Military Med Res (2016) 3:30. doi: 10.1186/s40779-016-0099-9.
- 13. Simmons J, Pittet J-F. The Coagulopathy of Acute Sepsis. Curr Opin Anaesthesiol. 2015 April;28(2): 227–236. doi:10.1097/ACO.0000000000000163.
- 14. Lee AYY, Connors JM, Kreuziger LB, Murphy M, Gernsheimer T, Lin Y, et al. COVID-19 and Coagulopathy: Frequently Asked Questions (Version 7.0; last updated January 29, 2021). Amerıcan Society of Hematology. 2021. Available at; https://www.hematology.org/covid-19/covid-19-and-coagulopathy.
- 15. Yazici O, Bozkuş F, Demirci N, Gülhan PY, Coşkun F. Coagulopathy and COVID-19. Eurasian J Pulmonol 2020;22(Suppl S1):67-9. doi: 10.4103/ejop.ejop_49_20.
- 16. Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020;13(11):1265-1275. doi: 10.1080/17474086.2020.1831383.
- 17. Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS One. 2020 Aug 21;15(8):e0238160. doi: 10.1371/journal.pone.0238160.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Solunum Hastalıkları |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2021 |
| Kabul Tarihi | 19 Şubat 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 46 Sayı: 2 |
