Koroner arter hastalığı tanısı alan COVID-19 hastalarında hastane içi mortalite ile inflamasyon belirteçleri arasındaki ilişki

Yıl 2021, , 267 - 271, 24.05.2021

Uğur Küçük , Sevil Alkan Çeviker , Alper Şener

https://doi.org/10.16899/jcm.869095

Cited By: 4

Öz

Giriş: Enflamasyon, koroner arter hastalıklarının temelinde ve olumsuz sonlanımlarında önemli rol oynar. Nötrofil-lenfosit oranı (NLR), sistemik immün inflamasyon indeksi (SII) ve CRP ise inflamatuar durumu yansıtan basit ve kullanışlı belirteçlerdir. Çalışmamızın amacı bu belirteçlerin koroner arter hastalığı tanılı COVID-19 hastalarında hastane içi mortaliteyi öngörmede kullanılabilirliğini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmamız 111 (48 erkek, 63 kadın) yeni tanı COVID-19 hastasından oluşuyordu. Nötrofil (N), lenfosit (L) değerleri kullanılarak NLR (N/L) ve N,L ve trombosit (P) değerleri kullanılarak sistemik immün inflamasyon indeksi SII (NxP / L) elde edildi. NLR, SII ve CRP değerlerinin hastane içi mortaliteyle olan ilişkileri incelendi.
Bulgular: Tedavi sürecinde 16 hastada ölüm izlendi. N, L ve P değerleri hayatını kaybenler ve şifa ile taburcu olan grup arasında kıyaslandığında istatiksel farklılıklar izlenmedi ( p= 0.971, p=0.256, p=0.759 sırasıyla). Bunların kombinasyonu ile elde edilen SII ve NLR değerleri içinde gruplar arasında istatiksel farklılıklar izlenmezken (p=0.872, p=0.979 sırasıyla), CRP değerlerinde ise hastane içi ölüm izlenen grupta istatiksel anlamlıydı (p<0.001). Logistik regresyon analizinde, CRP’nin (odds oranı [OO]= 1.078 ,%95 güven aralığı [GA]: 1.0225-1.133, p= 0.003) hastane içi mortaliteyle ilşkili olduğu gösterildi. ROC analizinde hastane içi mortaliteyi tahmin etmede CRP için 3.1 mg/dL kestirim değerleri %87 hassasiyet ve %58 özgüllük ile anlamlı bulundu (p<0.001).
Sonuç: Koroner girişim öyküsü olan koroner arter hastalığı tanılı COVID-19 hastalarında CRP seviyeleri hastane içi ölümle ilişkilidir.

Anahtar Kelimeler

COVID-19, ölüm, koroner arter hastalığı

Relationship between in-hospital mortality and inflammation markers in COVID-19 patients with the diagnosis of coronary artery disease

Öz

Introduction: Inflammation plays an important role in the basis of coronary artery diseases and their adverse outcomes. Neutrophil-lymphocyte ratio (NLR), Systemic Immune Inflammation Index (SII) and C-reactive protein (CRP) are simple and useful markers that reflect the inflammatory state. Our study evaluated the usability of these markers in predicting in-hospital mortality in patients with COVID-19 with the diagnosis of coronary artery disease.
Material and Method: Our study population consisted of 111 (48 male, 63 female) newly diagnosed patients with COVID-19. Neutrophil-lymphocyte ratio (NLR) was estimated using neutrophil (N), and lymphocyte (L) counts and the systemic immune inflammation index SII (NxP / L) was calculated using N, L and platelet (P) values. The relationship of NLR, SII and CRP values with in-hospital mortality was investigated.
Results: During the treatment process, 16 patients exited. Any statistically significant intergroup difference was not observed as for SII and NLR values obtained by their use in combination (p = 0.872, p = 0.979, respectively), CRP values were statistically significant in the group with in-hospital mortality (p <0.001). In logistic regression analysis, CRP (odds ratio [OR] = 1.078, 95% confidence interval [CI]: 1.0225-1.133, p = 0.003) was associated with in-hospital mortality. In ROC analysis, the cut-off values of 3.1 mg / dL, for CRP were significant with 87% sensitivity and 58% specificity in predicting in-hospital mortality (p <0.001).
Conclusions: CRP levels are associated with in-hospital mortality in patients with COVID-19 who had also received coronary artery disease with a history of coronary intervention.

Anahtar Kelimeler

COVID-19, mortality, coronary artery disease

Kaynakça

• Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-73.
• 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;395:497–506. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On be- half of the working group on Sepsis-related problems of the European society of intensive care medicine. Intensive Care Med. 1996;22:707-10.
• Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-47.
• Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008;94:16–26.
• Habib SS, Kurdi MI, Aseri ZA, Suriya MO. CRP levels are higher in patients with ST elevation than non-ST elevation acute coronary syndrome. Arq Bras Cardiol 2011;961:13–7.
• Baiyewu O, Elugbadebo O, Oshodi Y. Burden of COVID-19 on mental health of older adults in a fragile healthcare system: the case of Nigeria: dealing with inequalities and inadequacies. Int Psychogeriatr. 2020;32(10):1181-85.
• Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142.
• Schiffrin EL, Flack JM, Ito S, Muntner P, Webb RC. Hypertension and COVID-19. Am J Hypertens. 2020;33(5):373-74.
• Villa E, Saccocci M, Messina A, Maffeo D, Pitì A, Bianchetti F, et al. COVID-19 e coronaropatia: uso selettivo e collaborativo delle risorse durante le crisi sanitarie [COVID-19 and coronary artery disease: selective and collaborative use of resources during public health crisis]. G Ital Cardiol (Rome). 2020;21(5):360-63.
• Swiatkiewicz I, Kozinski M, Magielski P, Fabiszak T, Sukiennik EP, Navarese EP, et al. Value of CRP in predicting left ventricular remodeling in patients with a first ST-segment elevation myocar- dial infarction. Mediators Inflamm 2012;2012:250867.
• Dursun I, Kul S, Bayraktar A, Erkan H, Turan T, Sayin MR, et al. Association of Aortic Valve Sclerosis and Clinical Factors in Patients With Acute Myocardial Infarction. Am J Med Sci. 2019;357(6):474-82.
• Luo F, Feng C, Zhuo C. C-Reactive Protein and All-Cause Mortality in Patients with Stable Coronary Artery Disease: A Secondary Analysis Based on a Retrospective Cohort Study. Med Sci Monit. 2019;25:9820-28.
• Yang Y, Xu Y, Wang J, Zhai X, Jiang H. Predictive efficacy of neutrophil-to-lymphocyte ratio for long-term prognosis in new onset acute coronary syndrome: a retrospective cohort study. BMC Cardiovasc Disord. 2020;20(1):500.
• Chen JH, Zhai ET, Yuan YJ, Wu KM, Xu JB, Peng JJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23(34):6261-272.
• Yang, X., Yang, Q., Wang, Y., Wu, Y., Xu, J., Yu, Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1469-72. Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-08.