NOVEL BIOMARKERS AND ECHOCARDIOGRAPHIC FINDINGS IN ACUTE RHEUMATIC FEVER PATIENTS

Yıl 2023, , 514 - 521, 31.05.2023

Naıla Gasımova , Ahmet Sert

https://doi.org/10.16899/jcm.1233400

Cited By: 1

Öz

Aim: Acute rheumatic fever (ARF) is an inflammatory disease that develops after Group A Streptococcal (GAS) tonsillopharyngitis in genetically susceptible individuals. We aimed to examine the clinical, laboratory, and echocardiographic findings of the patients diagnosed and followed up with ARF.
Methods: 55 patients under the age of 18 who were hospitalized and followed up with the diagnosis of ARF between January 2017 and January 2019 were included in this retrospective study. All cases were diagnosed with ARF according to the 2015 revised Jones criteria according to the intermediate-risk group. Gender, age, time of admission, physical examination findings, laboratory findings, echocardiographic findings, and data meeting major and minor diagnostic criteria of all patients diagnosed with ARF were recorded. Echocardiography and electrocardiography were performed on all patients. Inflammatory biomarkers were calculated using laboratory parameters. The data before the treatment and at the 8th week of the treatment were compared.
Results: 31 (56.4%) of the patients were female and 24 (43.6%) were male, the mean age was 13.70±2.44 years (7-18 years). The highest number of patients was in the 9-14 age group. The most frequent hospital admission season was winter. Arthritis and carditis were the most common major criteria. Post-treatment body weight, height, body mass index, and systolic and diastolic blood pressure values of the patients were statistically significantly higher than before treatment (p<0.001). WBC, NE, MO, EO, PLT, MPV, MCHC, PCT, CRP, ESH, NLR, NMO, TLO, SII values were significantly decreased after treatment. MCH, RDW, PDW, L/CRP values increased significantly after treatment. Pre-treatment MPV and TLR (p: 0.045, r: -0.2712), MPV and LMO (p: 0.041, r: -0.2762), MPV/L were moderately positive (p: 0.001, r: 0.431), WBC with pretreatment SII (p: 0.001, r: 0.652), NE with SII (p: 0.001, r: 0.759). There was a positive high (p: 0.001, r: 0.882) correlation between SII and NLR, and a moderate (p: 0.001, r: 0.598) positive correlation between TLR. Aortic valve regurgitation was shown to be significantly reduced with treatment. There was no significant difference in LVM and LVMI values after treatment (p:0.143, p: 0.672, respectively).
Conclusion: Our results suggests that there is no adverse effect on LV remodeling after treatment in patients with ARF. We believe that inflammation can be followed easily by using inflammatory parameters in the acute and post-treatment periods of the disease.

Anahtar Kelimeler

Acute Rheumatic Fever, Childhood, Echocardiography, Inflammation, Rheumatic Heart Disease., Akut Romatizmal Ateş, Çocukluk Çağı, Ekokardiyografi, Romatizmal Kalp Hastalığı.

AKUT ROMATİZMAL ATEŞ HASTALARINDA YENİ BİYOMARKERLER VE EKOKARDİYOGRAFİK BULGULAR

Öz

Amaç: Akut romatizmal ateş (ARA) Grup A Streptokok (GAS) tonsillofarenjiti geçiren genetik olarak duyarlı bireylerde, enfeksiyonu takiben gelişen inflamatuvar bir hastalıktır. Bu çalışmada ARA tanısı ile takip edilen hastaların klinik, laboratuar ve ekokardiyografik bulgularının incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışmaya Ocak 2017-Ocak 2019 tarihleri arasında 18 yaş altı ARA tanısı ile yatırılarak takip edilen 55 hasta dahil edildi. Tüm olgularda ARA tanısı 2015 yılı revize Jones kriterleri ile orta-risk grubuna göre konuldu. ARA tanısı konan tüm hastaların; cinsiyeti, yaşı, başvuru zamanı, fizik muayene bulguları, laboratuar bulguları, ekokardiyografi bulguları, major ve minör tanı kriterleri sağlayan verileri kaydedildi. Tüm hastalara ekokardiyografi ve elektrokardiyografi yapıldı. Laboratuvar parametreleri kullanarak inflamatuar biyobelirteçler hesaplandı. Tedavi öncesi ve tedavinin 8. haftasındaki veriler kıyaslandı.
Bulgular: Hastaların 31’i (%56,4) kız ve 24’ü (%43,6) erkek, yaş ortalaması 13,70±2,44 yıl (7-18 yıl) idi. En fazla hasta 9-14 yaş arasında görüldü. En sık hastaneye başvuru mevsimi kış idi. Major kriterlerden en sık kardit ve artrit görüldü. Hastaların tedavi sonrası vücut ağırlığı, vücut kitle indeksi, sistolik ve diyastolik kan basıncı değerleri tedavi öncesine göre istatistiksel olarak anlamlı yüksek bulundu (p<0,001). WBC, NE, MO, EO, PLT, MPV, MCHC, PCT, CRP, ESH, NLO, NMO, TLO, SII değerleri tedavi sonrasında anlamlı olarak azalmıştı. MCH, RDW, PDW, L/CRP değerleri tedavi sonrasında anlamlı olarak artmıştı. Hastaların tedavi öncesi MPV ile TLO (p: 0,045, r: -0,2712), MPV ile LMO (p: 0,041, r: -0,2762), MPV/L arasında pozitif yönde orta (p: 0,001, r: 0,431), tedavi öncesi SII ile WBC (p: 0,001, r: 0,652), SII ile NE (p: 0,001, r: 0,759). SII ile NLO arasında pozitif yönde yüksek (p: 0,001, r: 0,882), TLO arasında pozitif yönde orta (p: 0,001, r: 0,598) korelasyon görüldü. Tedavi ile aort kapak yetmezliğinin anlamlı olarak azalmış olduğu gösterildi. Tedavi sonrasında LVM ve LVMI değerlerinde ise anlamlı fark tespit edilmedi (sırasıyla p:0,143, p: 0,672).
Sonuç: Çalışmamızdakı hastaların klinik bulgularının sıklığı literatürle benzerdir. ARA’lı hastalarda tedavi sonrası LV remodeling üzerinde olumsuz etki olmadığını düşündürmektedir. Hastalığın akut ve tedavi sonrası sürecinde inflamatuar parametreler kullanılarak inflamasyon takibinin kolaylıkla yapılabileceğini düşünmekteyiz.

Anahtar Kelimeler

Akut Romatizmal Ateş, Çocukluk Çağı, Ekokardiyografi, Romatizmal Kalp Hastalığı.

Kaynakça

• 1. Andrew Steer, M., PhD, FRACPAllan Gibofsky, MD, JD, FACP, FCLM, Acute rheumatic fever: Clinical manifestations and diagnosis. 2021.
• 2. Lawrence, J.G., et al., Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circulation, 2013. 128(5): p. 492-501.
• 3. Carapetis, J.R., M. McDonald, and N.J. Wilson, Acute rheumatic fever. The Lancet, 2005. 366(9480): p. 155-168.
• 4. Örün, U.A., et al., Acute rheumatic fever in the Central Anatolia Region of Turkey: a 30-year experience in a single center. European journal of pediatrics, 2012. 171(2): p. 361-368.
• 5. Carapetis, J.R., et al., The global burden of group A streptococcal diseases. The Lancet infectious diseases, 2005. 5(11): p. 685-694.
• 6. Gewitz, M.H., et al., Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation, 2015. 131(20): p. 1806-1818.
• 7. Gürses, D., et al., Incidence and clinical characteristics of acute rheumatic fever in Turkey: Results of a nationwide multicentre study. Journal of Paediatrics and Child Health, 2021. 57(12): p. 1949-1954.
• 8. Gürses, D., et al., Incidence and clinical characteristics of acute rheumatic fever in Turkey: Results of a nationwide multicentre study. Journal of Paediatrics and Child Health, 2021.
• 9. Jafary, F.H., Devereux formula for left ventricular mass–be careful to use the right units of measurement. Journal of the American Society of Echocardiography, 2007. 20(6): p. 783.
• 10. Kayaalp, E., Akut romatizmal ateşli hastalarda plazmada mikrorna profillemesi (mir-101, mir-1183 ve mir-1299). 2018.
• 11. Boyarchuk, O., S. Boytsanyuk, and T. Hariyan, Acute rheumatic fever: clinical profile in children in western Ukraine. Journal of medicine and life, 2017. 10(2): p. 122.
• 12. Ozer, S., et al., Childhood acute rheumatic fever in Ankara, Turkey. Turk J Pediatr, 2005. 47(2): p. 120-4.
• 13. Vinker, S., et al., Incidence and clinical manifestations of rheumatic fever: a 6 year community-based survey. IMAJ-Israel Medical Association Journal, 2010. 12(2): p. 78.
• 14. Giannoulia‐Karantana, A., et al., Childhood acute rheumatic fever in Greece: experience of the past 18 years. Acta paediatrica, 2001. 90(7): p. 809-812.
• 15. Shah, B. and N. Ganguly, Epidemiology of group A streptococcal pharyngitis & impetigo: a cross-sectional & follow up study in a rural community of northern India. Indian J Med Res, 2009. 130: p. 765-771.
• 16. Olgunturk, R., et al., Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria. International journal of cardiology, 2006. 112(1): p. 91-98.
• 17. Gurses, D., et al., Incidence and clinical characteristics of acute rheumatic fever in Turkey: Results of a nationwide multicentre study. Journal Of Paediatrics And Child Health, 2021.
• 18. Güngör, Ş., et al., Retrospective evaluation of patients with the diagnosis of acute rheumatic fever: A single center experience of 5 years. 2014.
• 19. Zaidi, A.K. and D.A. Goldman, Rheumatic fever in The Nelson Textbook of Pediatrics, Kliegman RM, Behrman RE, Jenson HB, Stanton BF eds. WB Saunders Company, 2007. 18: p. 1140-1145.
• 20. Carapetis, J.R. and B.J. Currie, Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Archives of Disease in childhood, 2001. 85(3): p. 223-227.
• 21. Sert, A., E. Aypar, and D. Odabas, Mean platelet volume in acute rheumatic fever. Platelets, 2013. 24(5): p. 378-382.
• 22. Chockalingam, A., et al., Clinical spectrum of chronic rheumatic heart disease in India. The Journal of heart valve disease, 2003. 12(5): p. 577-581.
• 23. Örün, U.A., et al., Acute rheumatic fever in the Central Anatolia Region of Turkey: a 30-year experience in a single center. European journal of pediatrics, 2012. 171: p. 361-368.
• 24. Alqanatish, J., et al., Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia. Journal of the Saudi Heart Association, 2019. 31(4): p. 273-281.
• 25. Karacan, M., N. Ceviz, and H. Olgun, Heart rate variability in children with acute rheumatic fever. Cardiology in the Young, 2012. 22(3): p. 285-292.
• 26. Sethi, S., et al., Anti-streptolysin O titers in normal healthy children of 5-15 years. Indian pediatrics, 2003. 40(11): p. 1068-1071.
• 27. Werner, J., et al., Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia. The Journal of pediatrics, 1992. 120(2): p. 286-291.
• 28. Miranda-Mallea, J., et al., Hypertrophic cardiomyopathy in preterm infants treated with dexamethasone. European journal of pediatrics, 1997. 156: p. 394-396.
• 29. Feniman De Stefano, G.M.M., et al., Aldosterone is associated with left ventricular hypertrophy in hemodialysis patients. Therapeutic Advances in Cardiovascular Disease, 2016. 10(5): p. 304-313.
• 30. Wang, S., et al., Evaluating the use of serum inflammatory markers for preoperative diagnosis of infection in patients with nonunions. BioMed research international, 2017. 2017.
• 31. Clarke, D., et al., Effects of interleukin 6 administration on platelets and haemopoietic progenitor cells in peripheral blood. Cytokine, 1996. 8(9): p. 717-723.
• 32. Aşık, A., N.S. Duru, and M. Elevli, An evaluation of platelet parameters and neutrophil/lymphocyte ratios in children with acute rheumatic fever. J Pediatr Res, 2019. 6(1): p. 37-43.
• 33. Çelik, S.F. and E. Çelik, The neutrophil-to-lymphocyte ratio and mean platelet volume can be associated with severity of valvular involvement in patients with acute rheumatic carditis. Cardiovascular Journal of Africa, 2018. 29(5): p. 296-300.
• 34. Giray, D. and O. Hallioglu, Are there any novel markers in acute rheumatic fever: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio: Novel Indexes in Acute Rheumatic Fever? Cardiology in the Young, 2020. 30(5): p. 717-721.