Can the Systemic Inflammatory Index, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Detect Pediatric Covid-19 Variants?

Öz

Background: Covid-19 has undergone many mutations over time. The most prominent variants have been the Alpha, Beta, Delta, Gamma, and finally, the Omicron variants. This study aims to determine the availability of neutrophil/lymphocyte rate (NLR), platelet/lymphocyte rate (PLR) and Systemic Inflammatory Index (SII), prog-nostic and diagnostic significance, in the differentiation of variants in pediatric Covid-19 patients. Materials and Methods: In this retrospective study, 141 pediatric patients who were found to be positive for Covid-19 in Harran University Medical Faculty Hospital between January 2021 and April 2022 were included. A control group was formed from 107 healthy children selected from among those who applied to the general pediatric outpatient clinic for routine health evaluations. Results: When the age distribution of the patients was examined, the median was 7.0 (0.1-18) years. When the variants were compared, there was a significant difference between lymphocyte values, while leukocyte, neu-trophil, C-reactive protein (CRP) and Mean Platelet Volume (MPV) did not change significantly. At the same time, there was a statistically significant difference between NLR, PLR and SII variants in Covid-19 positive patients (p<0.05); It was found that CRP, CRP/albumin rate (CAR), and MPV values did not change significantly between variants (p>0.05). It was observed that the NLR, PLR and SII delta variants increased significantly compared to the omicron variant (p<0.05). CRP and CAR were significantly increased in the severe clinical course compared to the asymptomatic group (p<0.05). Conclusions: In our study, it was seen that patients with delta variant had higher NLR, PLR and SII values compared to omicron variant when viewed from the point of view of Covid-19 variants. Therefore, we think that during the diagnosis of Covid-19 accompanied by these parameters, variant analysis can be performed, especially in terms of the delta variant, and it will shed light on the differential diagnosis, appropriate treatment, and measures to be taken by early and simple means.

Anahtar Kelimeler

• Covid-19
• delta variant
• Neutrophil/Lymphocyte Ratio
• Platelet/Lymphocyte Ratio
• Systemic Inflammatory Index

Sistemik İnflamatuar İndeks, Nötrofil-Lenfosit Oranı ve Trombosit-Lenfosit Oranı Pediatrik Covid-19 Varyantlarını Saptayabilir mi?

Öz

Amaç: Covid-19 zaman içinde pek çok mutasyona uğradı. En öne çıkan varyantlar Alfa, Beta, Delta, Gamma ve son olarak Omicron varyantları olmuştur. Bu çalışma, pediatrik Covid-19 hastalarında varyantların ayrımında NLR, PLR ve SII'nin varlığını, prognostik ve tanısal önemini belirlemeyi amaçlamaktadır. Materyal ve metod: Bu retrospektif çalışmaya Ocak 2021-Nisan 2022 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Hastanesi'nde Covid-19 pozitif olduğu tespit edilen 141 çocuk hasta dahil edildi. Genel pediatri polikliniğine rutin sağlık kontrolleri için başvuranlar arasından seçilen 107 sağlıklı çocuktan kontrol grubu oluşturuldu. Bulgular: Hastaların yaş dağılımı incelendiğinde ortancanın 7,0 (0,1-18) yıl olduğu görüldü. Varyantlar karşılaştırıldığında lenfosit değerlerinde anlamlı fark bulunurken lökosit, nötrofil, CRP ve MPV'de anlamlı değişiklik olmadı. Aynı zamanda Covid-19 pozitif hastalarda NLR, PLR ve SII varyantları arasında istatistiksel olarak anlamlı fark mevcuttu (p<0,05); CRP, CAR ve MPV değerlerinin varyantlar arasında anlamlı farklılık göstermediği belirlendi (p>0,05). NLR, PLR ve SII delta varyantlarının omikron varyantına göre anlamlı düzeyde arttığı görüldü (p<0,05). Ağır klinik seyirde asemptomatik gruba göre CRP ve CAR anlamlı düzeyde arttı (p<0,05). Sonuç: Çalışmamızda Covid-19 varyantları açısından bakıldığında delta varyantlı hastaların NLR, PLR ve SII değerlerinin omicron varyantına göre daha yüksek olduğu görüldü. Dolayısıyla bu parametreler eşliğinde Covid-19 tanısı sırasında özellikle delta varyantı açısından varyant analizi yapılabileceğini, erken ve basit yollarla ayırıcı tanı, uygun tedavi ve alınacak önlemler açısından ışık tutacağını düşünmekteyiz.

Anahtar Kelimeler

• Covid-19
• Nötrofil/Lenfosit Oranı
• Trombosit/Lenfosit Oranı
• delta varyantı
• Sistemik İnflamatuar İndeks

Kaynakça

1. 1. Eraslan E. Omicron’un Tanımı, Yazımı ve Okunuşuna Dair Düşünceler. Asya Studies.6(19):95-100.
2. 2. Suastika NKW, Suega K. Diagnostic Value of Neutrophil To Lymphocyte Ratio For Assessing The Disease Severity In Covid-19 Patients. Eastern Journal of Medicine. 2021;26(2):199-203.
3. 3. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. Journal of transla-tional medicine. 2020;18(1):1-12.
4. 4. Feng D-Y, Zhou Y-Q, Zhou M, Zou X-L, Wang Y-H, Zhang T-T. Risk factors for mortality due to ventilator-associated pneumonia in a Chinese hospital: a retrospective study. Medical science monitor: international medical journal of experimental and clinical research. 2019;25:7660.
5. 5. Hamidi N, Süer E, Gökçe Mİ, BEDÜK MY. Lokalize Renal Hücreli Kanser Nedeniyle Nefrektomi Yapılan Olgularda Ameliyat Öncesi Bakılan Nötrofil-Lenfosit Oranının Uzak Metastaz ve Hastalığa Özgü Sağ Kalım Üzerine Etkisi. Van Tıp Dergisi. 2017;24(3):135-40.
6. 6. Yodying H, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Yamada M, et al. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: a sys-tematic review and meta-analysis. Annals of surgical oncol-ogy. 2016;23(2):646-54.
7. 7. Tanriverdi Z, Gungoren F, Tascanov MB, Besli F, Altiparmak IH. Comparing the diagnostic value of the C-reactive protein to albumin ratio with other inflammatory markers in pa-tients with stable angina pectoris. Angiology. 2020;71(4):360-5.
8. 8. Wang C, Jin S, Xu S, Cao S. High systemic immune-inflammation index (SII) represents an unfavorable prog-nostic factor for small cell lung cancer treated with etopo-side and platinum-based chemotherapy. Lung. 2020;198(2):405-14.

9. 9. Hu B, Yang X-R, Xu Y, Sun Y-F, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clini-cal Cancer Research. 2014;20(23):6212-22.
10. 10. Gumus H, Demir A, Yükkaldıran A. Is mean platelet volume a predictive marker for the diagnosis of Covid‐19 in chil-dren? International Journal of Clinical Practice. 2021;75(4):e13892.
11. 11. Russell CD, Parajuli A, Gale HJ, Bulteel NS, Schuetz P, de Jager CP, et al. The utility of peripheral blood leucocyte rati-os as biomarkers in infectious diseases: a systematic review and meta-analysis. Journal of Infection. 2019;78(5):339-48.
12. 12. Bilen MA, Martini DJ, Liu Y, Lewis C, Collins HH, Shabto JM, et al. The prognostic and predictive impact of inflammatory biomarkers in patients who have advanced‐stage cancer treated with immunotherapy. Cancer. 2019;125(1):127-34.
13. 13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
14. 14. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospi-talized With Covid-19 in the New York City Area. Jama. 2020;323(20):2052-9.
15. 15. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe Covid‐19. 2020;92(7):791-6.
16. 16. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HH, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mor-tality in hospitalized patients with Covid-19. Journal of In-fection. 2020;81(1):e6-e12.
17. 17. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (Covid-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020;80(4):388-93.
18. 18. Chen L, Liu HG, Liu W, Liu J, Liu K, Shang J, et al. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):e005.
19. 19. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
20. 20. Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020;92(9):1533-41.
21. 21. Yang A-P, Liu J-p, Tao W-q, Li H-mJIi. The diagnostic and predictive role of NLR, d-NLR and PLR in Covid-19 patients. 2020;84:106504.
22. 22. Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán-González J, Lagunas-Alvarado MG, Martínez-Zavala N, Reyes-Franco I, et al. Systemic immune inflammatory index in sepsis. Me-dicina interna de México. 2017;33(3):303-9.
23. 23. Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prog-nosis in small cell lung cancer. The Tohoku journal of exper-imental medicine. 2015;236(4):297-304.
24. 24. Dong M, Shi Y, Yang J, Zhou Q, Lian Y, Wang D, et al. Prog-nostic and clinicopathological significance of systemic im-mune-inflammation index in colorectal cancer: a meta-analysis. Therapeutic advances in medical oncology. 2020;12:1758835920937425.
25. 25. Hirahara N, Matsubara T, Fujii Y, Kaji S, Kawabata Y, Hya-kudomi R, et al. Comparison of the prognostic value of im-munoinflammation-based biomarkers in patients with gas-tric cancer. Oncotarget. 2020;11(27):2625.
26. 26. Usul E, Şan İ, Bekgöz B, Şahin A. Role of hematological pa-rameters in Covid-19 patients in the emergency room. Bi-omarkers in Medicine. 2020;14(13):1207-15.
27. 27. Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, et al. Clinical characteristics of 82 cases of death from Covid-19. PloS one. 2020;15(7) e0235458.
28. 28. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregula-tion of immune response in patients with coronavirus 2019 (Covid-19) in Wuhan, China. Clinical infectious diseases. 2020;71(15):762-8.
29. 29. Nalbant A, Demirci T, Kaya T, Aydın A, Altındiş M, Güçlü E. Can prognostic nutritional index and systemic immune‐inflammatory index predict disease severity in Covid‐19? In-ternational Journal of Clinical Practice. 2021;75(10): e14544
30. 30. Yap F, Joynt G, Buckley T, Wong E. Association of serum albumin concentration and mortality risk in critically ill pa-tients. Anaesthesia and intensive care. 2002;30(2):202-7.
31. 31. Violi F, Cangemi R, Romiti GF, Ceccarelli G, Oliva A, Alessandri F, et al. Is albumin predictor of mortality in Covid-19? Antioxidants & redox signaling. 202: 139-142.
32. 32. Kayhan S, Kozan H. Kritik Covid-19 Hastalarında C-Reaktif Protein/Albumin Oranının Prediktif Rolü. Harran Üniversi-tesi Tıp Fakültesi Dergisi.18(3):361-4.
33. 33. Karakoyun I, Colak A, Turken M, Altin Z, Arslan FD, Iyilikci V, et al. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe Covid-19 pa-tients. International immunopharmacology. 2021;91:107285.