COVİD-19’lu İleri Yaşlı Hastalarda Hiperferritinemi Hastalık Şiddeti Yönünden Güvenilir midir?

Yıl 2023, Cilt: 33 Sayı: 6, 649 - 655, 31.12.2023

Muhammet Özbilen Şeyda Tuba Savrun Celali Kurt Yeliz Kaşko Arıcı

https://doi.org/10.54005/geneltip.1199803

Öz

Amaç: Covid-19’a yakalanmış yaşlı hastalarda ferritin düzeylerinin çeşitli hastalık şiddeti göstergelerinden daha üstün olup olmadığını belirlemek.
Yöntem: Eylül 2020 ile Ocak 2021 tarihleri arasında Covid-19 şüphesi veya tanısı ile Ordu Üniversitesi Eğitim ve Araştırma Hastanesi acil servisine başvuran hastalar retrospektif ve kesitsel olarak incelendi. Temel dahil etme kriterleri hastaların 18 yaş ve üzeri olması ve glomerüler filtrasyon hızının 30 ml/ dk/1,73 m2 idi. Hastalara ait kronik hastalık öyküsü, mortalite durumu, hemogram, kan gazı, ferritin, c-reaktif protein ve vital bulgularına ilişkin veriler ile Covid-19 tanısı için yapılan test ve tetkiklere ilişkin veriler kaydedilmiştir. Veri seti iki bölüme ayrılmıştır: <65 yaş ≥65 yaş.
Bulgular: Kriterleri karşılayan 416 hasta çalışmaya dahil edilmiştir. Toplam hasta sayısının 321’i 65 yaşın altında, 95’i ise 65 yaş ve üzerindeydi. Yaş ortalamaları 65 yaş altı grup için 42.50±12.73, yaşlı hasta grubu için 77.89±7.34 idi. Ortalama ferritin düzeyi, 65 yaş ve üzeri hastalarda (249.59±261.45 ng/mL) 65 yaş altı hastalara (169.76±210.44 ng/mL) göre anlamlı düzeyde yüksekti (p=0.001). Ferritin düzeyleri sadece mortalite yönünden iki grup arasında farklılaştı (p<0.037). Yaşlı hastalara ait mortal seyreden alt grupta ferritine ait AUC değeri 0.700 (%95 GA, 0.482-0.919) ve cut-off değeri 231.55 ng/mL idi (duyarlılık=%67.7, özgüllük=%67.4) ve tüm biyobelirteçler içinde yalnızca ferritin seviyeleri anlamlı olarak farklılaşma gösterdi.
Sonuç: C-reaktif protein de dahil olmak üzere iyi bilinen şiddetli hastalık serum belirteçleri, yaşlı hastaların Covid-19 yönünden mortalite tahmininde ferritin kadar değerli değildir. Ferritin, yaşlı Covid-19 hastalarında en güçlü mortalite belirleyicisi olabilir.

Anahtar Kelimeler

Covid-19, yaş, yaşlı, ferritin, hiperferritinemi, hastalık şiddeti, mortalite

Is Hyperferritinemia Reliable in Determining the Severity of COVID-19 in Older Patients?

Öz

Aim: To determine whether ferritin levels among elderly patients inflicted with Covid-19 are superior to several types of disease severity indicators.
Methods: A retrospective and cross-sectional analysis was conducted on patients who were admitted to the emergency department of Ordu University Training and Research Hospital between September 2020 and January 2021, with a suspected or confirmed diagnosis of Covid-19. Patients had to be 18 years of age or older and have a glomerular filtration rate greater than 30 ml/min/1.73 m2 in order to meet the basic inclusion criteria. In addition, the data pertaining to the patients’ chronic diseases, mortality status, hemogram, blood gas, ferritin, c-reactive protein, and vital signs were recorded alongside the information regarding the tests and examinations conducted for the diagnosis of Covid-19. The data set is divided into two parts: <65 years ≥65 years.
Results: Four hundred sixteen patients were identified as meeting the criteria for the study. Out of the total number of patients, 321 were under the age of 65, while 95 were 65 years of age or older. The under-65 group’s mean age was 42.50±12.73 while the older group was 77.89±7.34 years. The mean ferritin of patients 65 and older (249.59±261.45 ng/mL) was significantly more than the patients under 65 (169.76±210.44 ng/mL) (p=0.001). Only mortality differed between older and younger patients (p=0.049). The AUC value of ferritin in older patients was 0.700 (95% CI, 0.482-0.919), and the cut-off value was 231.55 ng/mL in the mortal group (sensitivity=66.7%, specificity=67.4%). Only ferritin levels were significant in older patients’ AUC scores of mortality stats among the other biomedical markers.
Conclusions: Some well-known severe disease blood markers, including c-reactive protein, are not as significant as ferritin in older patient mortality ROC curve analyses. Ferritin may be the strongest mortality predictor in older Covid-19 patients.

Anahtar Kelimeler

Covid-19, age, older, ferritin, illness severity, hyperferritinemia, mortality

Kaynakça

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