COVID19 Hastalarında Serum Ferritin Düzeyleri, Akciğer Tutulumu ve Tedavi Yöntemleri Arasındaki İlişkinin Araştırılması: Retrospektif Bir Çalışma

Öz

Amaç: COVID-19 hastalığı, 2019 yılında Çin’de menşei bilinmeyen pnömoni vakaları olarak tanımlanmıştır. Covid 19 virüsü vücuda girdikten sonra ,bağışıklık sistemi hücreleri aşırı aktif hale gelir, yoğun sitokin salınımına sebep olur ve buna bağlı klinik tablo kötüleştiği bildirilmiştir. Ayrıca ferritin düzeyi ile sitokin salınımı arasında da bir ilişki vardır. Sunulan çalışmada acil serviste Covid 19 teşhisi konulan olguların akciğer tutulumu varlığı, tedavi şekilleri ile ferritin düzeyleri arasındaki ilişkinin incelenmesi amaçlanmıştır. Materyal ve Metot: Acil serviste SARS-CoV-2 PCR pozitifliği saptanan, 18 yaş ve üzeri olgular çalışmaya dahil edilmiştir. Olguların demografik özellikleri, serum ferritin seviyeleri, akciğer tomografi raporları (Co-Rads Sınıflandırması) ve tedavi yöntemleri (ayakta tedavi, serviste yatarak tedavi ve yoğun bakımda tedavi) bakım ünitesi incelenmiştir. Bulgular: Akciğer tutulumu olan hastaların yoğun bakımda tedavi edilme oranlarının arttığı belirlendi (p<0,001). Hastanede serviste yatarak tedavi edilen hastaların serum ferritin düzeyi,ayaktan tedavi edilen hastalara göre anlamlı derecede dah yüksek olduğu saptandı (p<0,001). Yoğun bakımda yatarak tedavi gören olguların serum ferritin düzeyleri de serviste yatarak tedavi olan diğer olgulara göre anlamlı derecede yüksek bulundu (p<0,001). Sonuç: Covid 19 hastalarında sitokin fırtınası görülür. Bu durum hastaların klinik durumlarının kötüleşmesine ve serum ferritin seviyesinin artmasına sebep olur. Akciğer tutulumu olan hastalarda serum ferritin seviyeleri yükselir ve hastalığın şiddeti ile artar. Covid 19 hastalarının rutin takiplerinde serum ferritin düzeylerinin ölçülmesi önerilir.

Anahtar Kelimeler

• Covid-19
• akciğer tomografisi
• ferritin
• Covid 19 tedavisi

Investigation of the Relationship between Serum Ferritin Levels, Lung Involvement and Treatment Methods in COVID 19 Patients: A Retrospective Study

Abstract

Aim: COVID-19 disease was identified as cases of pneumonia of unknown origin in China in 2019. It has been reported that after the Covid 19 virus entered the body, the immune system cell was over-activated and there was an intense release of cytokines and the clinical picture worsened accordingly. In addition there is a relationship between ferritin level and cytokine release. In the present study, it was aimed to examine the relationship between the presence of lung involvement and treatment and ferritin levels in cases diagnosed with Covid 19 in the emergency department. Material and Methods: Cases aged 18 years and older who applied to the emergency department with positive SARS-CoV-2 PCR analysis were included in the study. Demographic characteristics, serum ferritin levels, lung tomography reports (according to the Co-Rads Classification) and treatment modalities (outpatient treatment, inpatient treatment in the service and treatment in the intensive care unit) of the cases were examined. Results: It was determined that patients with pulmonary involvement had an increased treated in intensive care (p<0.001). It was determined that the serum ferritin level of the patients treated in the service was significantly higher than those of the outpatients (p<0.001). The serum ferritin levels of the patients treated in the intensive care unit were also found to be significantly higher than the serum ferritin levels of the inpatient group (p<0.001). Conclusion: Cytokine storm is seen in Covid 19 patients. This situation worsens the clinical condition of the patients and causes an increase ferritin level. Serum ferritin levels are increased in patients with lung involvement and increased with severity of the disease. It is recommended to measure serum ferritin levels in the routine follow-ups of Covid 19 patients.

Keywords

• Covid-19
• Lung Tomography
• Ferritin
• Covid 19 Treatment
• Covid-19, Lung Tomography, Ferritin, Covid 19 Treatment

Kaynakça

1. 1.Zhou P, Yang X, Wang X, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. nature 2020; 579.7798: 270-273.
2. 2.Saribas MS, Tomakin M, Ozkay I. Retrospective analysis of lactate levels, lung i̇nvolvement and treatment methods of patients with COVID-19 who applied to the emergency department. Int Target Med J. 2022;1(1):5-9.
3. 3.Akcay S, Özlü T, Yılmaz A. Radiological approaches to COVID-19 pneumonia. Turk J Med Sci. 2020;50:604-610.
4. 4.Gormüs Uzay. Covid-19: Molecular and Clinical Approach.
5. 5.Pekcevik Y, Belet U. Patient Management in the Radiology Department, the Role of Chest Imaging During the SARS-CoV-2 Pandemic and Chest CT Findings Related to COVID-19 Pneumonia. Journal of Tepecik Education and Research Hospital 2020; 30 (Supplementary issue): 195-212
6. 6. Mehta P, McAuley DF, Brown M, et al. COVID-19: Consider cytokine storm syndromes and immunosuppression.Lancet. 2020; 395 (10229):1033–34.
7. 7. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55.
8. 8. Moore BJB, June CH. Cytokine release syndrome in severe COVID‐19. Science. 2020;368(6490):473–474. 10.1126/science.abb8925

9. 9. Fan L, Liu S. CT and COVID-19: Chinese experience and recommendations concerning detection, staging and follow-up. Eur Radiol. 2020;30:5214–5216
10. 10. Bao C, Liu X, Zhang H, et al.Coronavirus Disease 2019 (COVID-19) CT Findings: a systematic review and meta-analysis. J Am Coll Radiol. 2020;17:P701–709
11. 11. Prokop M, van Everdingen W, van Rees Vellinga T, et al.COVID-19 standardized reporting working group of the dutch radiological society. Radiology. 2020;296:97-104.
12. 12.Bellini D, Panvini N, Rengo M, et al. Diagnostic accuracy and interobserver variability of CO-RADS in patients with suspected coronavirus disease-2019: a multireader validation study. Eur Radiol. 2021;31:1932–1940.
13. 13. Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019; 133 (1):40–50.
14. 14. Zhou F, Yu T, Du R, et al. 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. 10.1016/S0140-6736(20)30566-3
15. 15. Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe‐ or critical‐type 2019 novel coronavirus pneumonia. Lab Invest. 2020;100:794‐800. 10.1038/s41374-020-0431-6
16. 16. Kernan KF, Carcillo JA. Hiperferritinemi ve inflamasyon. Int. immünol. 2017; 29 :401–409. doi: 10.1093/intimm/dxx031.
17. 17. Colafrancesco S, Alessandri C, Conti F, Priori R. COVID-19 has gone bad: A new character on the spectrum of hyperferritinemic syndrome? autoimmune. Rev.2020; 19 :102573. doi: 10.1016/j.atrev.2020.102573.
18. 18. Taneri PE, Gómez-Ochoa SA, Llanaj E, et al. Anemia and iron metabolism in COVID-19: A systematic review and meta-analysis. Avro. J. Epidemiol. 2020; 35 :763–773. doi: 10.1007/s10654-020-00678-5