COVID-19 Nedeniyle Takip Edilen Hastalarda Kan Parametrelerindeki Zamansal Anormalliklerin Sağkalım Üzerine Etkisi: Retrospektif Bir Çalışma

Year 2021, Volume: 5 Issue: 3, 391 - 400, 25.12.2021

Müzeyyen Aslaner Ak , Birsen Sahip , Güven Çelebi , Emre Horuz , Şehmus Ertop

https://doi.org/10.29058/mjwbs.984490

Cited By: 1

Abstract

Amaç: Bu çalışmada, hastanede yatarak tedavi gören Covid-19 hastalarında, özellikler trombosit
parametrelerindeki değişimlerin diğer periferik kan parametreleri ve zamansal değişimle birlikte sağ
kalım üzerine etkisi araştırılmıştır
Gereç ve Yöntemler: Covid-19 tanısı ile hastaneye yatırılarak tedavi edilen 149 hasta çalışmaya dahil edildi. Başvuru anında, hastaneye
yatışın üçüncü, yedinci ve son günlerinde ve taburculuk sonrası birinci ayda kaydedilen laboratuvar parametreleri, hemoglobin (Hb, g/dL),
hematokrit (%), beyaz kan hücresi (lökositx109/L), trombosit (hücre/mm3) sayımı, lenfosit (hücre/μL) sayımı, ortalama trombosit hacmi (fL),
trombosit dağılım genişliği (%), plateletkrit (%) ve platelet lenfosit oranı idi.
Bulgular: Toplamda, 139 hasta (%93,9) taburculuk sonrası birinci ayda hayatta idi. Hayatta kalan hastalarda, hayatta olmayanlara göre
ilk başvuru (13,3 ve 12,2 g/dL, p=0,023) ve yatışın üçüncü (12,6 ve 11,7 g/dL, p=0,033) ve yedinci (12,5 ve 9,8 g/dL, p=0,014) günlerinde
saptanan medyan Hb düzeyleri ile ilk başvuru (1200 ve 800 hücre/μL, p=0, 014) ve üçüncü yatış gününe (1400 ve 1200 hücre/μL, p=0,043)
ait lenfosit sayıları anlamlı şekilde daha yüksekti. Hayatta kalan hastalarda, ilk başvuru (5800 ve 7900 x109/L, p=0, 014), hastaneye yatışın
üçüncü (5400 ve 6047 x109/L, p=0,007), yedinci (6100 ve. 8400 x109/L, p=0, 040) ve son (6200 ve 17700 x109/L, p=0, 018) günlerinde
saptanan lökosit değerleri ve ilk başvuru (165 ve 294,5, p=0,002) ve yatışın üçüncü günü (150 ve 223, p=0.003) saptanan PLR değerleri
anlamlı şekilde daha düşük bulundu.
Sonuç: Sonuç olarak, bulgularımız periferik kandaki değişimlerin, özellikle de platelet/lenfosit oranının takibinin klinik önemine ve kötü
prognostik seyirli COVID-19 hastaların tespitinde hekimlere öngörüde bulunma açısından yararlı olabileceğine işaret etmektedir.

Keywords

COVID-19, hospitalizasyon, periferik kan

Abnormalities of Peripheral Blood Parameters in Hospitalized Patients with COVID-19: A Temporal Change Analysis in Relation to Survival

Abstract

Aim: This study aimed to investigate the abnormalities and temporal changes in peripheral blood
parameters, with particular emphasis on platelet indices, in relation to survival status among hospitalized
COVID-19 patients.
Material and Methods: A total of 149 patients hospitalized with the diagnosis of COVID-19 were included.
Laboratory parameters were recorded on initial admission, 3rd, 7th and last day of hospitalization, and
post-discharge first month and included hemoglobin (Hb, g/dL), hematocrit (%), white blood cell (WBC)
(x109/L), platelet (cells/mm3) and lymphocyte counts (cells/μL), mean platelet volume (MPV, fL), platelet
distribution width (PDW, %), plateletcrit (PCT,%) and platelet-to-lymphocyte ratio ( PLR), and analysed.
Results: Overall, 139 (93.9%) patients survived. Survivors vs. non-survivors had significantly higher
median levels for Hb at initial admission (13.3 vs. 12.2 g/dL, p=0.023), 3rd day (12.6 vs. 11.7 g/dL,
p=0.033) and 7th day of hospitalization (12.5 vs. 9.8 g/dL, p=0.014) and for lymphocyte counts at
initial admission (1200 vs. 800 cells/μL, p=0.014) and 3rd day (1400 vs. 1200 cells/μL, p=0.043) of
hospitalization. They also had significantly lower WBC counts at initial admission (5800 vs. 7900 x109/L,
p=0.014), 3rd day (5400 vs. 6047 x109/L, p=0.007) and 7th day (6100 vs. 8400 x109/L, p=0.040) and
last day (6200 vs. 17700 x109/L, p=0.018) of hospitalization and lower PLR at initial admission (165 vs.
294.5, p=0.002) and 3rd hospitalization day (150 vs. 223, p=0.003).
Conclusion: In conclusion, our findings emphasize clinical significance of dynamic monitoring of
peripheral blood parameters, as combined with PLR, in assisting clinicians to identify COVID-19 patients
with increased risk of worse outcomes.

Keywords

COVID-19, hospitalization, peripehral blood, survival

References

• Referans1 Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95:834-847.
• Referans2 Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, Liu XY, Liu HM, Guo Z, Ren H, Wang Q. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020;92:1533-1541.
• Referans3 Xu Z, Shi L, Wang Y , Zhang J, Huang L, Zhang C, Liu S, Zhao P, Liu H, Zhu L, Tai Y, Bai C, Gao T, Song J, Xia P, Dong J, Zhao J, Wang FS. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8:420-422.
• Referans4 Ramana CV, DeBerge MP, Kumar A, Alia CS, Durbin JE, Enelow RI. Inflammatory impact of IFN-γ in CD8+ T cell-mediated lung injury is mediated by both Stat1-dependent and -independent pathways. Am J Physiol Lung Cell Mol Physiol. 2015;308:650-657.
• Referans5 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-1720.
• Referans6 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. 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.
• Referans7 Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O. Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect. 2007;55:136-140.
• Referans8 Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, Long D, Yu L. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020;31:490-496.
• Referans9 Ok F, Erdogan O, Durmus E, Carkci S, Canik A. Predictive values of blood urea nitrogen/creatinine ratio and other routine blood parameters on disease severity and survival of COVID-19 patients. J Med Virol. 2021;93:786-793.
• Referans10 Jenne CN, Kubes P. Platelets in inflammation and infection. Platelets. 2015;26:286-292.
• Referans11 Rayes J, Bourne JH, Brill A, Watson SP. The dual role of platelet innate immune cell interactions in thrombo-inflammation. Res Pract Thromb Haemost. 2019;4:23-35.
• Referans12 Ouyang SM, Zhu HQ, Xie YN, Zou ZS, Zuo HM, Rao YW, Liu XY, Zhong B, Chen X. Temporal changes in laboratory markers of survivors and non-survivors of adult inpatients with COVID-19. BMC Infect Dis. 2020;20:952.
• Referans13 Sun S, Cai X, Wang H, He G, Lin Y, Lu B, Chen C, Pan Y, Hu X. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020;507:174-180.
• Referans14 Ding X, Yu Y, Lu B, Huo J, Chen M, Kang Y, Lou J, Liu Z. Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019. Clin Chem Lab Med. 2020;58:1365-1371.
• Referans15 Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan. China JAMA. 2020;323:1061-1069.
• Referans16 Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC, Chen H, Mubareka S, Gubbay JB, Chan WCW. Diagnosing COVID-19: The Disease and Tools for Detection. ACS Nano. 2020;14:3822-3835.
• Referans17 Seyit M, Avci E, Nar R, Senol H, Yilmaz A, Ozen M, Oskay A, Aybek H. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. Am J Emerg Med. 2021;40:110-114.
• Referans18 Akbari H, Tabrizi R, Lankarani KB, Aria H, Vakili S, Asadian F, Noroozi S, Keshavarz P, Faramarz S. The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Life Sci. 2020;258:118167.
• Referans19 Ghahramani S, Tabrizi R, Lankarani KB, Kashani SMA, Rezaei S, Zeidi N, Akbari M, Heydari ST, Akbari H, Nowrouzi-Sohrabi P, Ahmadizar F. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. Eur J Med Res. 2020;25:30.
• Referans20 Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71:762-768.
• Referans21 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
• Referans22 Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L, Wang K, Leng F, Wei S, Chen L, Liu HG. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chin Med J (Engl). 2020;133:1261-1267.
• Referans23 Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, Wang Q, Miao H. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther. 2020;5:33.