Predictive Values of Inflammation Indexes in Predicting Mortality in Patients with COVID 19 Hospitalized in General Intensive Care Unit
Öz
Objective: Causing a global pandemic, the coronavirus disease 2019 (COVID-19) has caused millions of people to become infected and many more to die. In this study we aimed to investigate whether routinely evaluated clinical and laboratory values can predict the mortality of patients with COVID-19 disease.
Materials and Methods: In our study, routine laboratory parameters of 89 patients hospitalized in the general intensive care unit with the diagnosis of COVID 19 were retrospectively analyzed. The aggregate index of systemic inflammation (AISI) and other inflamatuar values were calculated from blood tests in patients with positive COVID-19 polymerase chain reaction test and with ground-glass opacity on lung tomography. Patients were divided into two groups as those who died (non-survivors) and those who were discharged (survivors) during the intensive care follow-ups.
Results: In our study, in 48 patients who died during follow-up, the indexes of AISI, other inflamatuar paramaters and the biochemical parameters such as troponin I, d-dimer, ferritin and procalcitonin were significantly higher than in discharged patients. Hypertension and higher AISI and ferritin levels were statistically associated with reduced survival in Cox regression analysis (Hazard ration (HR): 3.176; 95% Confident interval (CI): 1.122-8.991, p=0.03, HR: 1.114; 95% CI: 1.060-1.348, p=0.042, HR=1.072;95% CI: 1.014-1.242, p=0.011, respectively.
Conclusion: Inflammation indexes derived from blood tests and acute phase reactants such as ferritin can guide us in planning the treatment strategy and risk stratification in patients with COVID-19 in intensive care follow-ups.
Anahtar Kelimeler
blood parameters coronavirus 2019 disease inflammation pandemic
Kaynakça
- Güner B, Sivritepe R, Basat SU. The Relationship between Malnutrition Risk and Prognosis in Geriatric Patients Hospitalized for COVID19. Online Türk Sağlık Bilimleri Dergisi 2021;6(3):382-390. doi: 10.26453/otjhs.892552
- Wu Z, McGoogan JM. Characteristics of and ımportant lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi: 10.1001/jama.2020.2648.
- He F, Deng Y, Li W. Coronavirus disease 2019: What we know? J Med Virol. 2020;92(7):719-725. doi: 10.1002/jmv.25766.
- Aksel G, Ademoğlu E, İslam MM, et al. Which COVID-19 patients should be recommended for home isolation and which should be hospitalized? Predictors of disease progression for mild COVID-19 patients. J Exp Clin Med 2021; 38(4): 490-495 doi: 10.52142/omujecm.38.4.17
- Rodriguez-Morales AJ, Cardona-Ospina JA. Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623.doi: 10.1016/j.tmaid.2020.101623.
- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi: 10.1016/S2213-2600(20)30079-5.
- Korkmaz C, Demirbas S, Vatansev H, et al. The Association of Neutrophil/Lymphocyte Ratio, Lymphocyte/Monocyte Ratio, Platelet/Lymphocyte Ratio and Hematological Parameters with Severity and Prognosis in Hospitalized Patients with COVID-19. Online Türk Sağlık Bilimleri Dergisi 2021;6(2):251-261. doi: 10.26453/otjhs.876015
- Peng J, Qi D, Yuan G, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross-sectional study. J Clin Lab Anal. 2020;34(10):e23475. doi: 10.1002/jcla.23475.
- Yang AP, Liu JP, Tao WQ, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. doi: 10.1016/j.intimp.2020.106504.
- Li T, Qiu Z, Zhang L,et al. Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome. J Infect Dis. 2004;189(4):648-651. doi: 10.1086/381535.
- Liu Y, Sun W, Li J, et al. Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019. MedRxiv. 2020. doi: 10.1101/2020.02.17.20024166.
- Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med. 2020;58(7):1131-1134. doi: 10.1515/cclm-2020-0198.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet.2020;395(10223):497–506.doi: 10.1016/S0140-6736(20)30183-5.
- Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422. doi: 10.1016/S2213-2600(20)30076-X.
- Tan M, Liu Y, Zhou R, et al. Immunopathological characteristics of coronavirus disease 2019 cases in Guangzhou, China. Immunology. 2020;160(3):261-268. doi:10.1111/imm.13223.
- Liu J, Li S, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763. doi: 10.1016/j.ebiom.2020.102763.
- Wang F, Nie J, Wang H, Zhao, et al. Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia. J Infect Dis. 2020;221(11):1762-1769. doi: 10.1093/infdis/jiaa150.
- Diao B, Wang C, Tan Y, et al. Reduction and functional exhaustion of t cells in patients with coronavirus disease 2019 (COVID-19). Front Immunol. 2020;11:827. doi: 10.3389/fimmu.2020.00827.
- Wen W, Su W, Tang H, et al. Immune cell profiling of COVID-19 patients in the recovery stage by single-cell sequencing. Cell Discov. 2020;6:31. doi: 10.1038/s41421-020-0168-9.
- Thevarajan I, Nguyen THO, Koutsakos M, et al. Breadth of concomitant immune responses prior to patient recovery: A case report of non-severe COVID-19. Nat Med. 2020;26(4):453-455. doi: 10.1038/s41591-020-0819-2.
- Chan AS, Rout A. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12(7):448-453. doi: 10.14740/jocmr4240.
- 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;180(7):934-943.doi:10.1001/jamainternmed.2020.0994.
- Paliogiannis P, Zinellu A, Scano V, et al. Laboratory test alterations in patients with COVID-19 and non COVID-19 interstitial pneumonia: A preliminary report. J Infect Dev Ctries. 2020;14(7):685-690. doi: 10.3855/jidc.12879.
- Sayar MS, Bulut D, Çelik S, et al. The impact and relationship of inflammatory markers and radiologic involvement in the COVID-19 patients. J Health Sci Med 2021; 4(4): 416-421. doi: 10.32322/jhsm.904196
- Hong X, Cui B, Wang M, et al. systemic ımmune-inflammation ındex, based on platelet counts and neutrophil-lymphocyte ratio, ıs useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med. 2015;236(4):297-304. doi: 10.1620/tjem.236.297.
- Hirahara N, Matsubara T, Fujii Y, et al. Comparison of the prognostic value of immunoinflammation-based biomarkers in patients with gastric cancer. Oncotarget. 2020;11(27):2625-2635. doi: 10.18632/oncotarget.27653.
- Aksu E, Avcı D, Çelik E, Öztürk B, Bozan MB, Göçer K, et al. New predictors in determining the need for invasive treatment in NSTEMI during the COVID-19 pandemic? A retrospective study. Koşuyolu Heart J 2021;24(1):1-7. doi: 10.51645/khj.2021.44
- Küçük U, Çeviker SA, Şener A. Relationship between in-Hospital Mortality and Inflammation Markers in Covid-19 Patients with the Diagnosis of Coronary Artery Disease. J Contemp Med 2021;11(3):267-271. doi 10.16899/jcm.869095
Genel Yoğun Bakım Ünitesinde Yatan COVID 19 Hastalarında Mortaliteyi Öngörmede İnflamasyon İndekslerinin Prediktif Değerleri
Öz
Amaç: Küresel bir pandemiye neden olan koronavirüs hastalığı 2019 (COVID-19), milyonlarca insanın enfekte olmasına ve birçok insanın ölmesine neden oldu. Bu çalışmada rutin olarak değerlendirilen klinik ve laboratuvar değerlerinin COVID-19 hastalığı olan hastaların mortalitesini tahmin edip edemeyeceğini araştırmayı amaçladık.
Materyal ve Metot: Çalışmamızda COVID 19 tanısı ile genel yoğun bakım ünitesinde yatırılan 89 hastanın rutin laboratuvar parametreleri retrospektif olarak incelendi. Sistemik inflamasyonun agregat indeksi (AISI) ve diğer infalamatuar değerler COVID-19 polimeraz zincir reaksiyonu testi pozitif olan ve akciğer tomografisinde buzlu cam opasitesi olan hastalarda yapılan kan testlerinden hesaplandı. Hastalar yoğun bakım takiplerinde ölenler (sağ kalamayanlar) ve taburcu olanlar (sağ kalanlar) olarak iki gruba ayrıldı.
Bulgular: Çalışmamızda takipte ölen 48 hastada AISI, diğer inflamatuar parametreler, ferritin, troponin I, d-dimer ve prokalsitonin gibi biyokimyasal paramtereler taburcu edilen hastalardan anlamlı derecede yüksekti. Hipertansiyon ve daha yüksek AISI ve ferritin seviyeleri, Cox regresyon analizinde azalmış sağkalım ile istatistiksel olarak ilişkiliydi (Sırasıyla: Risk oranı (RO)=3,176;%95 Güven aralığı (GA), 1,122-8,991,P=0,03, RO=1,114; %95 GA, 1,060-1,348, P=0,042 ve RO=1,072;95% GA,1,014-1,242, P=0,011).
Sonuç: Kan testlerinden elde edilen inflamasyon indeksleri ile ferritin gibi akut faz reaktanları, yoğun bakım takiplerinde COVID-19'lu hastalarda tedavi stratejisini ve risk sınıflandırmasını planlamada bize yol gösterebilir.
Anahtar Kelimeler
koronavirüs 2019 hastalığı pandemi inflamasyon kan parametreleri
Kaynakça
- Güner B, Sivritepe R, Basat SU. The Relationship between Malnutrition Risk and Prognosis in Geriatric Patients Hospitalized for COVID19. Online Türk Sağlık Bilimleri Dergisi 2021;6(3):382-390. doi: 10.26453/otjhs.892552
- Wu Z, McGoogan JM. Characteristics of and ımportant lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi: 10.1001/jama.2020.2648.
- He F, Deng Y, Li W. Coronavirus disease 2019: What we know? J Med Virol. 2020;92(7):719-725. doi: 10.1002/jmv.25766.
- Aksel G, Ademoğlu E, İslam MM, et al. Which COVID-19 patients should be recommended for home isolation and which should be hospitalized? Predictors of disease progression for mild COVID-19 patients. J Exp Clin Med 2021; 38(4): 490-495 doi: 10.52142/omujecm.38.4.17
- Rodriguez-Morales AJ, Cardona-Ospina JA. Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623.doi: 10.1016/j.tmaid.2020.101623.
- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi: 10.1016/S2213-2600(20)30079-5.
- Korkmaz C, Demirbas S, Vatansev H, et al. The Association of Neutrophil/Lymphocyte Ratio, Lymphocyte/Monocyte Ratio, Platelet/Lymphocyte Ratio and Hematological Parameters with Severity and Prognosis in Hospitalized Patients with COVID-19. Online Türk Sağlık Bilimleri Dergisi 2021;6(2):251-261. doi: 10.26453/otjhs.876015
- Peng J, Qi D, Yuan G, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross-sectional study. J Clin Lab Anal. 2020;34(10):e23475. doi: 10.1002/jcla.23475.
- Yang AP, Liu JP, Tao WQ, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. doi: 10.1016/j.intimp.2020.106504.
- Li T, Qiu Z, Zhang L,et al. Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome. J Infect Dis. 2004;189(4):648-651. doi: 10.1086/381535.
- Liu Y, Sun W, Li J, et al. Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019. MedRxiv. 2020. doi: 10.1101/2020.02.17.20024166.
- Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med. 2020;58(7):1131-1134. doi: 10.1515/cclm-2020-0198.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet.2020;395(10223):497–506.doi: 10.1016/S0140-6736(20)30183-5.
- Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422. doi: 10.1016/S2213-2600(20)30076-X.
- Tan M, Liu Y, Zhou R, et al. Immunopathological characteristics of coronavirus disease 2019 cases in Guangzhou, China. Immunology. 2020;160(3):261-268. doi:10.1111/imm.13223.
- Liu J, Li S, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763. doi: 10.1016/j.ebiom.2020.102763.
- Wang F, Nie J, Wang H, Zhao, et al. Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia. J Infect Dis. 2020;221(11):1762-1769. doi: 10.1093/infdis/jiaa150.
- Diao B, Wang C, Tan Y, et al. Reduction and functional exhaustion of t cells in patients with coronavirus disease 2019 (COVID-19). Front Immunol. 2020;11:827. doi: 10.3389/fimmu.2020.00827.
- Wen W, Su W, Tang H, et al. Immune cell profiling of COVID-19 patients in the recovery stage by single-cell sequencing. Cell Discov. 2020;6:31. doi: 10.1038/s41421-020-0168-9.
- Thevarajan I, Nguyen THO, Koutsakos M, et al. Breadth of concomitant immune responses prior to patient recovery: A case report of non-severe COVID-19. Nat Med. 2020;26(4):453-455. doi: 10.1038/s41591-020-0819-2.
- Chan AS, Rout A. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12(7):448-453. doi: 10.14740/jocmr4240.
- 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;180(7):934-943.doi:10.1001/jamainternmed.2020.0994.
- Paliogiannis P, Zinellu A, Scano V, et al. Laboratory test alterations in patients with COVID-19 and non COVID-19 interstitial pneumonia: A preliminary report. J Infect Dev Ctries. 2020;14(7):685-690. doi: 10.3855/jidc.12879.
- Sayar MS, Bulut D, Çelik S, et al. The impact and relationship of inflammatory markers and radiologic involvement in the COVID-19 patients. J Health Sci Med 2021; 4(4): 416-421. doi: 10.32322/jhsm.904196
- Hong X, Cui B, Wang M, et al. systemic ımmune-inflammation ındex, based on platelet counts and neutrophil-lymphocyte ratio, ıs useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med. 2015;236(4):297-304. doi: 10.1620/tjem.236.297.
- Hirahara N, Matsubara T, Fujii Y, et al. Comparison of the prognostic value of immunoinflammation-based biomarkers in patients with gastric cancer. Oncotarget. 2020;11(27):2625-2635. doi: 10.18632/oncotarget.27653.
- Aksu E, Avcı D, Çelik E, Öztürk B, Bozan MB, Göçer K, et al. New predictors in determining the need for invasive treatment in NSTEMI during the COVID-19 pandemic? A retrospective study. Koşuyolu Heart J 2021;24(1):1-7. doi: 10.51645/khj.2021.44
- Küçük U, Çeviker SA, Şener A. Relationship between in-Hospital Mortality and Inflammation Markers in Covid-19 Patients with the Diagnosis of Coronary Artery Disease. J Contemp Med 2021;11(3):267-271. doi 10.16899/jcm.869095
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2022 |
| Gönderilme Tarihi | 18 Ağustos 2021 |
| Kabul Tarihi | 22 Aralık 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 7 Sayı: 1 |
Cited By
Hematological indices as indicators of inflammation induced by exposure to pesticides
Environmental Science and Pollution Research
https://doi.org/10.1007/s11356-022-23509-4
