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C-reaktif protein/albümin oranı COVID-19 pnömonisi olan hastalarda artan mortalite riski ile ilişkilidir

Year 2021, Volume: 46 Issue: 4, 1449 - 1458, 30.12.2021
https://doi.org/10.17826/cumj.977050

Abstract

Amaç: Bu retrospektif gözlemsel çalışmanın amacı, COVID-19 pnömonisi nedeniyle hastaneye yatırılan 18 yaş üstü hastalarda mortaliteyi öngörme açısından acil serviste bakılan C-reaktif protein/albumin oranı ile CURB-65 skorunun karşılaştırılmasıdır.
Gereç ve Yöntem: Çalışma 15 Mart-30 Nisan 2020 tarihleri arasında acil servis pandemi alanında toraks bilgisayarlı tomografisinde COVID-19 pnömonisi tespit edilerek hastaneye yatırılan 613 hastayı kapsamaktadır. Hastanede yatan hastalar pozitif ve negatif gerçek zamanlı polimeraz zincir reaksiyonu sonuçlarına göre gruplara ayrıldı.
Bulgular: Çalışmaya dahil edilen 613 hastanın %73,1'i (n:448) serviste yatarken, %26,9'u (n:165) yoğun bakımda yatmaktaydı. Toplam hastaların %8,6'sı (n:53) öldü. Ölen hastalarda CURB 65 skoru ortalama 4±1 ve C-reaktif protein/albümin oranı 5.6±4.2 idi.. Çok değişkenli lojistik regresyon analizi, CURB 65 skorunu) ve yüksek C-reaktif protein/albümin oranı olduğunu gösterdi.) COVID-19 pnömonisi için bağımsız risk faktörleri olarak göstermiştir.
Sonuç: C-reaktif protein/albumin oranı, kötü prognozlu COVID-19 pnömonisi olan hastaların erken tespitinde CURB 65 kadar duyarlı olup klinisyene yol gösterebilir.

References

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  • 23. Sahu B. R, Kampa R. K, Padhi A, Panda A. K. C-reactive protein: A promising biomarker for poor prognosis in COVID-19 infection. Clinica chimica acta. 2020;509:91-4.
  • 24. Gong J, Ou J, Qiu X, Jie Y, Chen Y, Yuan L, et al. A Tool to Early Predict Severe Corona Virus Disease 2019 (COVID-19): A Multicenter Study using the Risk Nomogram in Wuhan and Guangdong, China.Clinical infectious diseases. 2020. doi: 10.1093/cid/ciaa443
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  • 27. Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy. 2017;118 (9):513–516. doi:10.4149/BLL_2017_09926.
  • 28. Zhang H. F, Ge Y. L, Wang H. Y, et al. Neutrophil-to-lymphocyte ratio improves the accuracy and sensitivity of pneumonia severity index in predicting 30-day mortality of CAP patients. Clin Lab. 2019;65:10.
  • 29. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19 J. Inf. Secur. 2020; 80; 607-613
  • 30. Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: an overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev. 2020; 53; 25-32
  • 31. Ragab D, Eldin H. S, Taeimah M, Khattab R, Salem R. The COVID-19 cytokine storm; what we know so far. Front. Immunol. 2020; 11; 1446
  • 32. Nozoe T, Korenaga D, Futatsugi M, Saeki H, Maehara Y, Sugimachi K. Immunohistochemical expression of C-reactive protein in squamous cell carcinoma of the esophagus – significance as a tumor marker. Cancer Lett. 2003; 192(1), 89–95.
  • 33. Song Y, Liu Y, Zhou Z, Yang W, Zhou Y. The clinical study of serum hs-CRP, TNF-α, PCT and IL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease. Int J Clin Exp Med. 2017;10:13550–6.
  • 34. Wei-ming Y, Wei-heng Z, Hou-qun Y, Yan-mei X, Jing Z, Qinghua M, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: albumin to fibrinogen ratio and C-reactive protein to albümin ratio. Int Immunopharmacol. 2018; 62:293–8.
  • 35. Ranzani O. T, Zampieri F. G, Forte D. N, Azevedo L. C, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE. 2013; 8; e59321.
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  • 37. Park J. E, Chung K. S, Song J. H, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J. Clin. Med. 2018; 7; 333.
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  • 42. Cataudella E, Gira_a, C. M, Di Marca S, Pulvirenti A, et al. Neutrophil-to-Lymphocyte Ratio: An emerging marker predicting prognosis in elderly adults with Community-Acquired Pneumonia. J. Am. Geriatr. Soc. 2017;65;1796–1801
  • 43. Yang A. P, Liu J. P, Tao W. Q, Li H. M. 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
  • 44. Qin C, Zhou L, Hu Z,et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases. Clin Infect Dis. 2020; ciaa248. doi: 10.1093/cid/ciaa248
  • 45. Luo B, Sun M, Huo X, Wang Y. Two new inflammatory markers related to the CURB-65 score for disease severity in patients with community-acquired pneumonia: The hypersensitive C-reactive protein to albumin ratio and fibrinogen to albumin ratio. Open Life Sci. 2021 Jan 22;16(1):84-91. doi: 10.1515/biol-2021-0011.
  • 46. Li T. H, Yu H. Y, Hou W. N, Li Z. Y, et al. Evaluation of variation in coagulation among children with Mycoplasma pneumoniae pneumonia: a case-control study. J Int Med Res. 2017;45:2110–8.
  • 47. Chen L, Lu X. Y, Zhu C. Q. Prognostic value of albumin-red cell distribution width score in patients with severe community-acquired pneumonia. Ann Palliat Med. 2020;9(3):759–65.
  • 48. Feng D. Y, Zhou Y. Q, Zou X. L, Zhou M, Yang H. L, Chen X. X, et al. Elevated blood urea nitrogen-to-serum albumin ratio as a factor that negatively affects the mortality of patients with hospital-acquired pneumonia. Can J Infect Dis Med Microbiol. 2019;2019:1547405. https://doi.org/10.1155/2019/1547405.
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  • 50. Akpınar E. E. The role of albumin level and blood urea nitrogen/albumin ratio in prediction of prognosis of community acquired pneuomonia. https://doi. org/10.4172/2161-105X.1000159; 2013.
  • 51. Marwah M, Marwah S, Blann A, Morrissey H, Ball P, Wandroo FA. Analysis of laboratory blood parameter results for patients diagnosed with COVID-19, from all ethnic group populations: A single centre study. Int J Lab Hematol. 2021;00:1–9. https://doi. org/10.1111/ijlh.13538
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C-reactive protein to albumin ratio is associated with increased risk of mortality in COVID-19 pneumonia patients

Year 2021, Volume: 46 Issue: 4, 1449 - 1458, 30.12.2021
https://doi.org/10.17826/cumj.977050

Abstract

Purpose: The aim of this retrospective observational study is to compare C-reactive protein to albumin ratio and CURB-65 score in the emergency department in terms of predicting mortality in patients over the age of 18 who were hospitalized for COVID-19 pneumonia.
Materials and Methods: The study includes 613 patients hospitalized between March 15 and April 30, 2020 due to COVID-19 pneumonia detected on thorax computed tomography at the emergency department pandemic area. Hospitalized patients were divided into groups according to positive and negative real-time polymerase chain reaction results.
Results: While 73.1% (n: 448) of 613 patients included in the study were hospitalized in the ward, 26.9% (n: 165) were hospitalized in intensive care. 8.6% (n: 53) of the total patients died. In non-survivors patients the mean CURB 65 score was 4±1 (and C-Reactive Protein to Albumin Ratio was 5.6±4.2 Multivariate logistic regression analysis showed that CURB 65 and high C-Reactive Protein to Albumin Ratio are independent risk factors for COVID-19 pneumonia.
Conclusion: The C-reactive protein to albumin ratio is as sensitive as CURB 65 and can guide the clinician in the early detection of patients with poor prognosis COVID-19 pneumonia.

References

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  • 2. Feng D. Y, Zou X. L, Zhou Y. Q and et al. Combined Neutrophil-to-Lymphocyte Ratio and CURB-65 Score as an Accurate Predictor of Mortality for Community-Acquired Pneumonia in the Elderly. Int J Gen Med. 2021; 14:1133-1139. https://doi.org/10.2147/IJGM.S300776.
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  • 4. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. https://www.who.int/dg/speeches/detail/who-directorgeneral-s-opening-remarks-at-themedia-briefing-on-covid-19.
  • 5. Marti C, Garin N, Grosgurin O, et al. Prediction of severe community acquired pneumonia: a systematic review and meta-analysis. Crit. Care. 2012; 16;141. https://doi.org/10.1186/cc11447
  • 6. Charles P. G, Davis J. S, Grayson M. L. Rocket science and the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines for severe community-acquired pneumonia. Clin Infect Dis. 2009; 48(12):1796-1797. doi: 10.1086/599227
  • 7. Zhang Z. X, Yong Y, Tan W. C and et al. Prognostic factors for mortality due to pneumonia among adults from different age groups in Singapore and mortality predictions based on PSI and CURB-65. Singapore Med J. 2018; 59(4):190-198. doi:10.11622/smedj.2017079
  • 8. Noguchi S, Yatera K, Kawanami T and et al. Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis. Respiration. 2017; 93(6), 441–450. doi:10.1159/000470915
  • 9. Wang X, Jiao J, Wei R, and et al. A new method to predict hospital mortality in severe community acquired pneumonia. European Journal of Internal Medicine. 2017; 40, 56–63. doi:10.1016/j.ejim.2017.02.013
  • 10. Fujikura Y, Kawano S, Kouzaki Y, et al. Mortality and severity evaluation by routine pneumonia prediction models among Japanese patients with 2009 pandemic influenza A (H1N1) pneumonia. Respiratory investigation. 2014; 52: 280-287
  • 11. Satici C, Demirkol M. A, Altunok E. S and et al. Performance of Pneumonia Severity Index and CURB-65 in Predicting 30-day mortality in patients with COVID-19. International Journal of Infectious Diseases. 2020. https://doi.org/10.1016/j.ijid.2020.06.038
  • 12. Zhou F, Yu T, Du R, and 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(10229):1054–62.
  • 13. Wunderink R. G and Waterer G. Advances in the causes and management of community acquired pneumonia in adults. BMJ. 2017, 358, j247.
  • 14. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020. doi: 10.1148/radiol.2020200230.
  • 15. Ai T, Yang Z, Hou H, Zhan C, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020; 296;2. https://doi.org/10.1148/radiol.2020200642
  • 16. Huang P, Liu T, Huang L, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020. DOI: 10.1148/radiol.2020200330.
  • 17. Xie X, Zhong Z, Zhao W, et al. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 2020. doi: 10.1148/radiol.2020200343.
  • 18. Skevaki C, Fragkou P. C, Cheng C and et al. Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus. Journal of Infection. 2020, doi:10.1016/j.jinf.2020.06.039 19. Wu J, Liu J, Zhao X, et al. Clinical characteristics of imported cases of COVID19 in Jiangsu province: a multicenter descriptive study. Clin Infect Dis. 2020. doi: 10.1093/cid/ciaa199.
  • 20. 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. doi: 10.1016/S2213-2600(20)30079-5.
  • 21. Ji D, Qin E, Xu J, et al. Implication of non-alcoholic fatty liver diseases (NAFLD) in patients with COVID-19: a preliminary analysis. J Hepatol.2020. doi: 10.1016/j.jhep.2020.03.044
  • 22. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Inf Secur. 2020. https://doi.org/10.1016/j.jinf.2020.04.002.
  • 23. Sahu B. R, Kampa R. K, Padhi A, Panda A. K. C-reactive protein: A promising biomarker for poor prognosis in COVID-19 infection. Clinica chimica acta. 2020;509:91-4.
  • 24. Gong J, Ou J, Qiu X, Jie Y, Chen Y, Yuan L, et al. A Tool to Early Predict Severe Corona Virus Disease 2019 (COVID-19): A Multicenter Study using the Risk Nomogram in Wuhan and Guangdong, China.Clinical infectious diseases. 2020. doi: 10.1093/cid/ciaa443
  • 25. Tian W, Jiang W, Yao J, Nicholson CJ, Li RH, Sigurslid HH, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. Journal of medical virology. 2020. doi: 10.1002/jmv.26050
  • 26. Huang Y, Liu A, Liang L, et al. Diagnostic value of blood param- eters for community-acquired pneumonia. Int Immunopharmacol. 2018;64:10–15. doi:10.1016/j.intimp.2018.08.02225.
  • 27. Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy. 2017;118 (9):513–516. doi:10.4149/BLL_2017_09926.
  • 28. Zhang H. F, Ge Y. L, Wang H. Y, et al. Neutrophil-to-lymphocyte ratio improves the accuracy and sensitivity of pneumonia severity index in predicting 30-day mortality of CAP patients. Clin Lab. 2019;65:10.
  • 29. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19 J. Inf. Secur. 2020; 80; 607-613
  • 30. Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: an overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev. 2020; 53; 25-32
  • 31. Ragab D, Eldin H. S, Taeimah M, Khattab R, Salem R. The COVID-19 cytokine storm; what we know so far. Front. Immunol. 2020; 11; 1446
  • 32. Nozoe T, Korenaga D, Futatsugi M, Saeki H, Maehara Y, Sugimachi K. Immunohistochemical expression of C-reactive protein in squamous cell carcinoma of the esophagus – significance as a tumor marker. Cancer Lett. 2003; 192(1), 89–95.
  • 33. Song Y, Liu Y, Zhou Z, Yang W, Zhou Y. The clinical study of serum hs-CRP, TNF-α, PCT and IL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease. Int J Clin Exp Med. 2017;10:13550–6.
  • 34. Wei-ming Y, Wei-heng Z, Hou-qun Y, Yan-mei X, Jing Z, Qinghua M, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: albumin to fibrinogen ratio and C-reactive protein to albümin ratio. Int Immunopharmacol. 2018; 62:293–8.
  • 35. Ranzani O. T, Zampieri F. G, Forte D. N, Azevedo L. C, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE. 2013; 8; e59321.
  • 36. Kim, M. H. et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLoS One. 2015; 10; e0132109.
  • 37. Park J. E, Chung K. S, Song J. H, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J. Clin. Med. 2018; 7; 333.
  • 38. Sun R, Sun X, Yang H, Liu Q. Retrospective analysis of serum C-reactive protein/albumin ratio for the prognosis of the adult patients with sepsis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2016; 28, 413–417.
  • 39. Wang X, Xu Y, Huang H, et al. Increased pretreatment C-reactive protein-to-albumin ratio predicts severe coronavirus disease 2019. Research Square; 2020. doi: 10.21203/rs.3.rs-31723/v2.
  • 40. De Jager C.P.C, Wever P.C, Gemen E.F.A, Kusters R, et al. The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia. PLoS ONE. 2012; 7(10); e46561. doi:10.1371/journal.pone.0046561
  • 41. Song Y, Sun W, Dai D, Liu Y, et al. Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia. Expert Review of Respiratory Medicine. 2021; 15:5, 689-696. doi: 10.1080/17476348.2021.1865810
  • 42. Cataudella E, Gira_a, C. M, Di Marca S, Pulvirenti A, et al. Neutrophil-to-Lymphocyte Ratio: An emerging marker predicting prognosis in elderly adults with Community-Acquired Pneumonia. J. Am. Geriatr. Soc. 2017;65;1796–1801
  • 43. Yang A. P, Liu J. P, Tao W. Q, Li H. M. 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
  • 44. Qin C, Zhou L, Hu Z,et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases. Clin Infect Dis. 2020; ciaa248. doi: 10.1093/cid/ciaa248
  • 45. Luo B, Sun M, Huo X, Wang Y. Two new inflammatory markers related to the CURB-65 score for disease severity in patients with community-acquired pneumonia: The hypersensitive C-reactive protein to albumin ratio and fibrinogen to albumin ratio. Open Life Sci. 2021 Jan 22;16(1):84-91. doi: 10.1515/biol-2021-0011.
  • 46. Li T. H, Yu H. Y, Hou W. N, Li Z. Y, et al. Evaluation of variation in coagulation among children with Mycoplasma pneumoniae pneumonia: a case-control study. J Int Med Res. 2017;45:2110–8.
  • 47. Chen L, Lu X. Y, Zhu C. Q. Prognostic value of albumin-red cell distribution width score in patients with severe community-acquired pneumonia. Ann Palliat Med. 2020;9(3):759–65.
  • 48. Feng D. Y, Zhou Y. Q, Zou X. L, Zhou M, Yang H. L, Chen X. X, et al. Elevated blood urea nitrogen-to-serum albumin ratio as a factor that negatively affects the mortality of patients with hospital-acquired pneumonia. Can J Infect Dis Med Microbiol. 2019;2019:1547405. https://doi.org/10.1155/2019/1547405.
  • 49. Ugajin M, Yamaki K, Iwamura N, Yagi T, Asano T. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community acquired pneumonia. Int J Gen Med. 2012;5:583e9. https://doi.org/10.2147/ IJGM.S33628.
  • 50. Akpınar E. E. The role of albumin level and blood urea nitrogen/albumin ratio in prediction of prognosis of community acquired pneuomonia. https://doi. org/10.4172/2161-105X.1000159; 2013.
  • 51. Marwah M, Marwah S, Blann A, Morrissey H, Ball P, Wandroo FA. Analysis of laboratory blood parameter results for patients diagnosed with COVID-19, from all ethnic group populations: A single centre study. Int J Lab Hematol. 2021;00:1–9. https://doi. org/10.1111/ijlh.13538
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There are 51 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Selen Acehan 0000-0003-4390-6593

Müge Gülen 0000-0002-5080-3501

Cem Isikber 0000-0002-9904-0189

Adem Kaya 0000-0001-9529-1354

Nurdan Unlu This is me 0000-0002-0460-4472

Cagdas Ince This is me 0000-0002-5914-1460

Basak Toptas Firat 0000-0001-8327-8814

Gonca Koksaldı This is me 0000-0002-0550-3606

Hilmi Erdem Sümbül 0000-0002-7192-0280

Salim Satar 0000-0001-6080-4287

Publication Date December 30, 2021
Acceptance Date September 27, 2021
Published in Issue Year 2021 Volume: 46 Issue: 4

Cite

MLA Acehan, Selen et al. “C-Reactive Protein to Albumin Ratio Is Associated With Increased Risk of Mortality in COVID-19 Pneumonia Patients”. Cukurova Medical Journal, vol. 46, no. 4, 2021, pp. 1449-58, doi:10.17826/cumj.977050.