Determining Serum Asymmetric Dimethylarginine (ADMA) level in Covid-19 Pneumonia and its relation with thrombosis and mortality

Abstract

Purpose: Covid-19 can cause widespread inflammation in the endothelial cell. Asymmetric dimethylarginine (ADMA) is a molecule recognized as one of the important markers of vascular endothelial dysfunction. The aim of this study was to determine serum ADMA level during the course of Covid pneumonia, and to determine the relationship between serum ADMA level and susceptibility to thrombosis and mortality. An other purpose of this study is to identify mortality-associated risk factors, and to investigate the effectiveness of different sepsis scores, laboratory measurements and prognostic markers. Materials and Methods: The data of 60 patients with the diagnosis of Covid-19 pneumonia were analyzed. Blood samples for ADMA were taken in the morning in the first 3 days after symptom onset from Covid-19 pneumonia, and 60 healthy volunteers. Results: Mean serum ADMA level of inpatients with Covid pneumonia was 95.35±223.8 ng/mL. Mean serum ADMA level measured in the control group was 266.56±606.14 ng/mL. ADMA value measured in Covid patients was found to be significantly lower with respect to the control group.(p₌0.042) The inpatient mortality rate was 21%. Mortality was significantly associated with higher SOFA, qSOFA, on admission. Conclusion: The serum ADMA concentration measured in the early period of hospitalization was found to be significantly lower in patients with Covid-19 pneumonia with respect to the control group. It must be kept in mind that cases with a SOFA score≥3, qSOFA score≥1, CRP/Albumin ratio≥30 and Neutrophil/Lymphocyte Ratio≥5 have a high risk of mortality and require early intervention.

Keywords

• Covid-19 pneumonia
• Asymmetric dimethylarginine
• ADMA
• SOFA
• qSOFA
• Neutrophil/Lymphocyte ratio
• CRP/albümin ratio

Covid-19 Pnömonisinde Serum Asimetrik Dimetilarjinin (ADMA) Düzeyinin Tespiti ve Tromboz, Mortalite ile İlişkisinin Belirlenmesi

Abstract

Amaç: Covid-19, endotel hücrelerinde yaygın inflamasyona neden olabilir. Asimetrik dimetilarjinin (ADMA), vasküler endotel disfonksiyonunun önemli belirteçlerinden olarak kabul edilen bir moleküldür. Bu çalışmanın amacı, Covid pnömonisinin seyri sırasında serum ADMA düzeyini saptayıp, serum ADMA düzeyi ile tromboza yatkınlık ve mortalite arasındaki ilişkiyi belirlemektir. Çalışmanın diğer bir amacı da mortaliteyle ilişkili risk faktörlerini belirlemek ve farklı sepsis skorlarının, laboratuvar ölçümlerinin ve prognostik belirteçlerin etkinliğini araştırmaktır. Gereç ve Yöntemler: Covid-19 pnömonisi tanısı alan 60 hastanın verileri analiz edildi. ADMA için kan örnekleri, pnömonisi olan hastalarda semptom başlangıcından sonraki ilk 3 gün sabah saatlerinde ve 60 sağlıklı gönüllüden alındı. Bulgular: Hastaneye yatan covid pnömonili hastaların ortalama serum ADMA düzeyi 95,35±223,8 ng/mL idi. Kontrol grubunda ölçülen ortalama serum ADMA düzeyi 266,56±606,14 ng/mL idi. Covid hastalarında ölçülen ADMA değerinin kontrol grubuna göre anlamlı derecede düşük olduğu görüldü. (p₌0,042) Yatan hastalardaki ölüm oranı %21 idi. Ölüm oranı, başvuru anında daha yüksek düzeyde saptanan SOFA ve qSOFA düzeyleri ile ilişkiliydi. Sonuç: Hastaneye yatışın erken döneminde ölçülen serum ADMA konsantrasyonunun Covid-19 pnömonisi olan hastalarda kontrol grubuna göre anlamlı derecede düşük olduğu belirlendi. SOFA skoru≥3, qSOFA skoru≥1, CRP/Albümin oranı≥30 ve Nötrofil/Lenfosit Oranı ≥5 olan vakaların mortalite riskinin yüksek olduğu ve erken müdahale gerektirdiği unutulmamalıdır.

Keywords

• Covid-19 pnömonisi
• Asimetrik dimetilarjinin
• ADMA
• SOFA
• qSOFA
• Nötrofil/Lenfosit oranı
• CRP/albümin oranı

Ethical Statement

This study was submitted to the Izmir Katip Celebi University Hospital Non-Interventional Scientific Research Ethics Committee and approved by the decision dated 22.04.2021 and numbered 2021-48

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