Sitokin Fırtınası Nedeniyle Tosilizumab ile Tedavi Edilen Covid-19 Hastalarında Nötrofil/Lenfosit Oranı ve Trombosit/Lenfosit Oranının Değerlendirilmesi
Öz
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
Kaynakça
- Karahan S, Katkat F. Impact of Serum 25(OH) Vitamin D Level on Mortality in Patients with COVID-19 in Turkey. J Nutr Health Aging 2021; 25:189-196.
- Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.
- Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020;12:6049-6057.
- Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Med 2020;8:420-422.
- T.C. Sağlık Bakanlığı COVID-19 Erişkin Hasta Tedavisi Rehberi [İnternet]. Ankara: T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. [erişim 05 Aralık 2021]. https://covid19.saglik.gov.tr/Eklenti/42169/0/ covid-19rehberieriskinhastayonetimivetedavi20122021v6pdf.pdf
- Koseoglu HI, Altunkas F, Kanbay A, Doruk S, Etikan I, Demir O. Platelet–lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. J Thromb Thrombolysis 2015;39:179‐185.
- Yu S, Arima H, Bertmar C, Clarke S, Herkes G, Krause M. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci 2018;387:115-118.
- Lian J, Jin C, Hao S, Zhang X, Yang M, Jin X, et al. High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: a multicenter retrospective study. Aging (Albany NY) 2020;12:13849-13859.
- Zhang JJ, Cao YY, Tan G, Dong X, Wang BC, Lin J, et al. Clinical, radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients. Allergy 2021;76:533-550. 10. Rabinowich H, Cohen R, Bruderman I, Steiner Z, Klajman A. Functional analysis of mononuclear cells infiltrating into tumors: lysis of autologous human tumor cells by cultured infiltrating lymphocytes. Cancer Res 1987;47:173-177.
- Menges T, Engel J, Welters I, Wagner RM, Little S, Ruwoldt R, et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications, Crit Care Med 1999;27:733-740.
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 Patients. Int Immunopharmacol 2020;84:106504.
- Soy M, Keser G, Atagündüz P, Tabak F, Atagündüz I, Kayhan S. Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol 2020;39: 2085-2094.
- Al-Samkari H, Berliner N. Hemophagocytic lymphohistiocytosis. Annu Rev Pathol 2018;13:27-49.
- Ding C, Jones G. Anti-interleukin-6 receptor antibody treatment in inflammatory autoimmune diseases. Rev Recent Clin Trials 2006;1:193-200.
- Hartog NL, Davis AT, Prokop JW, Walls A, Rajasekaran S. Monitoring neutrophil-to-lymphocyte ratio in patients with coronavirus disease 2019 receiving tocilizumab. Ann Allergy Asthma Immunol 2021;126:306-308.
- Haagmans BL, Al Dhahiry SH, Reusken CB, Raj VS, Galiano M, Myers R, et al. Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation, Lancet Infect Dis 2014;14:140-145.
- Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-402.
- Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264-266.
- Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al; COVID-19 Lombardy ICU Network. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. Intern Med 2020;180:1345-1355.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323:1061-1069.
- Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020; 201:1430-1434.
- Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al; the Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020:323:2052-2059.
- Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California. JAMA 2020:323:2195-2198.
- Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. COVID-19 in critically ill patients in the Seattle region-case series. N Engl J Med. 2020:382:2012-2022.
- Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020:323:1612-1614.
- Okuyucu M, Ozturk O, Atay MH, Gullu YT, Temocin F, Terzi O. Clinical Evaluation of Patients with COVID-19 Within the Framework of Comorbidities. Med Bull Sisli Etfal Hosp 2022;56:311–317.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054-1062.
Evaluation of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Covid-19 Patients Treated with Tocilizumab Due to Cytokine Storm
Öz
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.
Anahtar Kelimeler
Kaynakça
- Karahan S, Katkat F. Impact of Serum 25(OH) Vitamin D Level on Mortality in Patients with COVID-19 in Turkey. J Nutr Health Aging 2021; 25:189-196.
- Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.
- Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020;12:6049-6057.
- Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Med 2020;8:420-422.
- T.C. Sağlık Bakanlığı COVID-19 Erişkin Hasta Tedavisi Rehberi [İnternet]. Ankara: T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. [erişim 05 Aralık 2021]. https://covid19.saglik.gov.tr/Eklenti/42169/0/ covid-19rehberieriskinhastayonetimivetedavi20122021v6pdf.pdf
- Koseoglu HI, Altunkas F, Kanbay A, Doruk S, Etikan I, Demir O. Platelet–lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. J Thromb Thrombolysis 2015;39:179‐185.
- Yu S, Arima H, Bertmar C, Clarke S, Herkes G, Krause M. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci 2018;387:115-118.
- Lian J, Jin C, Hao S, Zhang X, Yang M, Jin X, et al. High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: a multicenter retrospective study. Aging (Albany NY) 2020;12:13849-13859.
- Zhang JJ, Cao YY, Tan G, Dong X, Wang BC, Lin J, et al. Clinical, radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients. Allergy 2021;76:533-550. 10. Rabinowich H, Cohen R, Bruderman I, Steiner Z, Klajman A. Functional analysis of mononuclear cells infiltrating into tumors: lysis of autologous human tumor cells by cultured infiltrating lymphocytes. Cancer Res 1987;47:173-177.
- Menges T, Engel J, Welters I, Wagner RM, Little S, Ruwoldt R, et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications, Crit Care Med 1999;27:733-740.
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 Patients. Int Immunopharmacol 2020;84:106504.
- Soy M, Keser G, Atagündüz P, Tabak F, Atagündüz I, Kayhan S. Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol 2020;39: 2085-2094.
- Al-Samkari H, Berliner N. Hemophagocytic lymphohistiocytosis. Annu Rev Pathol 2018;13:27-49.
- Ding C, Jones G. Anti-interleukin-6 receptor antibody treatment in inflammatory autoimmune diseases. Rev Recent Clin Trials 2006;1:193-200.
- Hartog NL, Davis AT, Prokop JW, Walls A, Rajasekaran S. Monitoring neutrophil-to-lymphocyte ratio in patients with coronavirus disease 2019 receiving tocilizumab. Ann Allergy Asthma Immunol 2021;126:306-308.
- Haagmans BL, Al Dhahiry SH, Reusken CB, Raj VS, Galiano M, Myers R, et al. Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation, Lancet Infect Dis 2014;14:140-145.
- Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-402.
- Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264-266.
- Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al; COVID-19 Lombardy ICU Network. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. Intern Med 2020;180:1345-1355.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323:1061-1069.
- Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020; 201:1430-1434.
- Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al; the Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020:323:2052-2059.
- Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California. JAMA 2020:323:2195-2198.
- Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. COVID-19 in critically ill patients in the Seattle region-case series. N Engl J Med. 2020:382:2012-2022.
- Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020:323:1612-1614.
- Okuyucu M, Ozturk O, Atay MH, Gullu YT, Temocin F, Terzi O. Clinical Evaluation of Patients with COVID-19 Within the Framework of Comorbidities. Med Bull Sisli Etfal Hosp 2022;56:311–317.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054-1062.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Göğüs Hastalıkları |
| Bölüm | Original Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 23 Ekim 2023 |
| Yayımlanma Tarihi | 25 Ekim 2023 |
| Gönderilme Tarihi | 27 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 33 Sayı: 5 |
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