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Kritik COVID-19 Hastalarında C-Reaktif Protein/Albumin Oranının Prediktif Rolü

Yıl 2021, Cilt 18, Sayı 3, 361 - 364, 29.12.2021
https://doi.org/10.35440/hutfd.1001970

Öz

Amaç: COVID-19 hastalarının yönetimindeki önemli gelişmelere rağmen, tedaviyi yönlendirecek, hastalık şid-detini öngören belirteçlere ihtiyaç vardır. Biz de bu çalışmada; C-reaktif protein/Albumin (CRP/Alb) oranının hastalık şiddeti ile ilişkisini ve yoğun bakım ihtiyacını tahmin etmedeki rolünü değerlendirmeyi amaçladık.
Materyal ve metod: Ocak 2021 ile Haziran 2021 tarihleri arasında hastanemizde COVID-19 enfeksiyonu nede-niyle takip edilen hastaların klinik bulguları, laboratuar sonuçları ve akciğer bilgisayarlı tomografisi retrospektif olarak incelendi. Toplam 131 hasta ve benzer yaş ve cinsiyetteki 81 sağlıklı kontrol grubu çalışmaya dahil edildi. CRP, albumin ve CRP/Alb oranı verileri analiz edildi ve COVID-19 hastaları ile sağlıklı kontrol grubu arasında kar-şılaştırıldı.
Bulgular: COVID-19 hastaları ile sağlıklı kontrol grubunun yaş ortalaması ve cinsiyet dağılımı benzerdi (sırası ile p= 0.1 p= 0.31). COVID-19 hastalarının CRP/Alb oranı kontrol grubuna göre anlamlı yüksekti (p< 0.009). COVID-19 hastaları klinik durumlarına göre kritik ve non-kritik olarak sınıflandırıldığında; kritik hastalar non-kritik has-talara göre daha yaşlı (p< 0.001) ve CRP/Alb oranı daha yüksekti (p<0.001). Yapılan ROC analizinde CRP/Alb oranı cut-off 14.7 mg/dl alındığında 89% duyarlılıkla ve 91% özgüllük ile COVID-19 kritik klinik durumu predikte etti.
Sonuç: Sonuç olarak, CRP/Alb oranı, rutin olarak kullanılabilecek pratik, ucuz ve kolay erişilebilir bir testdir. Ça-lışmamızda; CRP/Alb oranı yoğun bakım ihtiyacı olan kritik COVID-19 hastalarını ayırt etmede potansiyel bir pa-rametre olarak tespit edilmiştir.
Anahtar Kelimeler: COVID-19, C-reaktif protein/Albumin, Prediktif

Kaynakça

  • 1. Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome -coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19). Clinical and experimental pediatrics. 2020;63(4):119-24.
  • 2. Hoehl S, Rabenau H, Berger A, Kortenbusch M, Cinatl J, Bojkova D, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. The New England journal of medicine. 2020;382(13):1278-80.
  • 3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England). 2020;395(10223):507-13.
  • 4. 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 (London, England). 2020;395(10223):497-506.
  • 5. 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. Journal of medical virology. 2020;92(7):791-6.
  • 6. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thrombosis research. 2020;192:3-8.
  • 7. Bi X, Su Z, Yan H, Du J, Wang J, Chen L, et al. Prediction of severe illness due to COVID-19 based on an analysis of initial Fibrinogen to Albumin Ratio and Platelet count. Platelets. 2020;31(5):674-9.
  • 8. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2020;127:104370.,
  • 9. Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Critical care (London, England). 2020;24(1):255.
  • 10. Sayar S, Kurbuz K, Kahraman R, Caliskan Z, Atalay R, Ozturk O, et al. A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio. Northern clinics of Istanbul. 2020;7(1):49-55.
  • 11. Yang WM, Zhang WH, Ying HQ, Xu YM, Zhang J, Min QH, 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 albumin ratio. International immunopharmacology. 2018;62:293-8.
  • 12. Xu HJ, Ma Y, Deng F, Ju WB, Sun XY, Wang H. The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis. OncoTargets and therapy. 2017;10:3059-70.
  • 13. Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7(10).
  • 14. El-Shabrawy M, Alsadik ME, El-Shafei M, Abdelmoaty AA, Alazzouni AS, Esawy MM, et al. Interleukin-6 and C-reactive protein/albumin ratio as predictors of COVID-19 severity and mortality. The Egyptian Journal of Bronchology. 2021;15(1):1-7.
  • 15. 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 patients. International immunopharmacology. 2021;91:107285.
  • 16. Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19. Journal of infection in developing countries. 2021;15(8):1086-93.
  • 17. Liang T. Handbook of COVID-19 prevention and treatment. The First Affiliated Hospital, Zhejiang University School of Medicine Compiled According to Clinical Experience. 2020;68.
  • 18. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. The New England journal of medicine. 2020;382(18):1708-20.
  • 19. Nehring SM, Goyal A, Bansal P, Patel BC. C reactive protein (CRP). Treasure Island, FL: StatPearls. 2020.
  • 20. Chen W, Zheng KI, Liu S, Yan Z, Xu C, Qiao Z. Plasma CRP level is positively associated with the severity of COVID-19. Annals of clinical microbiology and antimicrobials. 2020;19(1):18.
  • 21. Yap FH, Joynt GM, Buckley TA, Wong EL. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesthesia and intensive care. 2002;30(2):202-7.
  • 22. 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. 2021;35(2):139-42.
  • 23. Moon JS, Ahn SS, Park YB, Lee SK, Lee SW. C-Reactive Protein to Serum Albumin Ratio Is an Independent Predictor of All-Cause Mortality in Patients with ANCA-Associated Vasculitis. Yonsei medical journal. 2018;59(7):865-71.
  • 24. Kaplan M, Duzenli T, Tanoglu A, Cakir Guney B, Onal Tastan Y, Bicer HS. Presepsin:albumin ratio and C-reactive protein:albumin ratio as novel sepsis-based prognostic scores : A retrospective study. Wiener klinische Wochenschrift. 2020;132(7-8):182-7.
  • 25. Wang X, Xu Y, Huang H, Jiang D, Zhou C, Liao H, et al. An increased pretreatment C-reactive protein-to albumin ratio predicts severe novel corona virus infected pneumonia. Research Square. 2020;5.

Predictive Role of C-Reactive Protein/Albumin Ratio in Patients with Critical COVID-19 Patients

Yıl 2021, Cilt 18, Sayı 3, 361 - 364, 29.12.2021
https://doi.org/10.35440/hutfd.1001970

Öz

Background: Despite important advances in the management of COVID-19 patients, markers that can predict its severity and guide its treatment are needed. This study aimed to evaluate the relation of C-reactive protein/albumin ratio (CRP/Alb) with the disease severity and its role in prediction of the need for intensive care. Material and Methods: Clinical findings, laboratory results and chest tomography of the COVID-19 patients followed in our hospital between January and June 2021 were retrospectively reviewed. A hundred and thirty-one COVID-19 patients and 81 age- and gender-matched healthy individuals were included in the study. Data about CRP and albumin levels and CRP/Alb was analyzed and obtained findings were compared between COVID-19 patients and healthy individuals. Results: COVID-19 patients and healthy controls were similar in terms of the mean age and gender distribution (p= 0.1 and p= 0.31 respectively). CRP/Alb was significantly higher in the patients than in the controls (p< 0.009). When the patients were classified into critical and non-critical groups based on their clinical status, the critical group was significantly older (p< 0.001) and had a significantly higher CRP/Alb (p<0.001). According to ROC curve analysis, CRP/Alb was predictive of critical clinical picture based on the cut-off value of 14.7 mg/dl, sensitivity of 89% and specifity of 91%. Conclusion: CRP/Alb is practical, inexpensive and easily available and can be used routinely. This study showed that CRP/Alb is a potential parameter that can be utilized to identify patients with critical COVID-19.

Kaynakça

  • 1. Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome -coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19). Clinical and experimental pediatrics. 2020;63(4):119-24.
  • 2. Hoehl S, Rabenau H, Berger A, Kortenbusch M, Cinatl J, Bojkova D, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. The New England journal of medicine. 2020;382(13):1278-80.
  • 3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England). 2020;395(10223):507-13.
  • 4. 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 (London, England). 2020;395(10223):497-506.
  • 5. 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. Journal of medical virology. 2020;92(7):791-6.
  • 6. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thrombosis research. 2020;192:3-8.
  • 7. Bi X, Su Z, Yan H, Du J, Wang J, Chen L, et al. Prediction of severe illness due to COVID-19 based on an analysis of initial Fibrinogen to Albumin Ratio and Platelet count. Platelets. 2020;31(5):674-9.
  • 8. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2020;127:104370.,
  • 9. Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Critical care (London, England). 2020;24(1):255.
  • 10. Sayar S, Kurbuz K, Kahraman R, Caliskan Z, Atalay R, Ozturk O, et al. A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio. Northern clinics of Istanbul. 2020;7(1):49-55.
  • 11. Yang WM, Zhang WH, Ying HQ, Xu YM, Zhang J, Min QH, 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 albumin ratio. International immunopharmacology. 2018;62:293-8.
  • 12. Xu HJ, Ma Y, Deng F, Ju WB, Sun XY, Wang H. The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis. OncoTargets and therapy. 2017;10:3059-70.
  • 13. Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7(10).
  • 14. El-Shabrawy M, Alsadik ME, El-Shafei M, Abdelmoaty AA, Alazzouni AS, Esawy MM, et al. Interleukin-6 and C-reactive protein/albumin ratio as predictors of COVID-19 severity and mortality. The Egyptian Journal of Bronchology. 2021;15(1):1-7.
  • 15. 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 patients. International immunopharmacology. 2021;91:107285.
  • 16. Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19. Journal of infection in developing countries. 2021;15(8):1086-93.
  • 17. Liang T. Handbook of COVID-19 prevention and treatment. The First Affiliated Hospital, Zhejiang University School of Medicine Compiled According to Clinical Experience. 2020;68.
  • 18. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. The New England journal of medicine. 2020;382(18):1708-20.
  • 19. Nehring SM, Goyal A, Bansal P, Patel BC. C reactive protein (CRP). Treasure Island, FL: StatPearls. 2020.
  • 20. Chen W, Zheng KI, Liu S, Yan Z, Xu C, Qiao Z. Plasma CRP level is positively associated with the severity of COVID-19. Annals of clinical microbiology and antimicrobials. 2020;19(1):18.
  • 21. Yap FH, Joynt GM, Buckley TA, Wong EL. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesthesia and intensive care. 2002;30(2):202-7.
  • 22. 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. 2021;35(2):139-42.
  • 23. Moon JS, Ahn SS, Park YB, Lee SK, Lee SW. C-Reactive Protein to Serum Albumin Ratio Is an Independent Predictor of All-Cause Mortality in Patients with ANCA-Associated Vasculitis. Yonsei medical journal. 2018;59(7):865-71.
  • 24. Kaplan M, Duzenli T, Tanoglu A, Cakir Guney B, Onal Tastan Y, Bicer HS. Presepsin:albumin ratio and C-reactive protein:albumin ratio as novel sepsis-based prognostic scores : A retrospective study. Wiener klinische Wochenschrift. 2020;132(7-8):182-7.
  • 25. Wang X, Xu Y, Huang H, Jiang D, Zhou C, Liao H, et al. An increased pretreatment C-reactive protein-to albumin ratio predicts severe novel corona virus infected pneumonia. Research Square. 2020;5.

Ayrıntılar

Birincil Dil Türkçe
Konular Tıp
Bölüm Araştırma Makalesi
Yazarlar

Sanem KAYHAN (Sorumlu Yazar)
University of Health Sciences, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Department of Internal Medicine
0000-0001-7736-2681
Türkiye


Hatıce KOZAN
Unıversity of Health Sciences, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Department of Internal Medicine
0000-0003-2356-0513
Türkiye

Yayımlanma Tarihi 29 Aralık 2021
Yayınlandığı Sayı Yıl 2021, Cilt 18, Sayı 3

Kaynak Göster

Vancouver Kayhan S. , Kozan H. Kritik COVID-19 Hastalarında C-Reaktif Protein/Albumin Oranının Prediktif Rolü. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021; 18(3): 361-364.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty