Kovid-19 Hastalarında NLR, D-Dimer ve MPV Değerleri Mortaliteyi ve Klinik Ciddiyeti Öngörebilir Mi?

Öz

Amaç: Bu çalışmada amacımız Kovid-19 hastalarında nötrofil/lenfosit oranı (NLR), D-dimer ve ortalama trombosit hacmi (MPV) parametrelerinin mortalite ve klinik ciddiyet ile olan ilişkisini tespit etmektir. Materyal ve Metot: Retrospektif olarak planlanan bu çalışmaya Mart 2020 ile Eylül 2020 tarihleri arasında acil servise başvuran Kovid-19 hastaları dahil edildi. Hastaların sosyodemografik özellikleri, laboratuvar parametreleri ve görüntüleme sonuçları hastanenin elektronik kayıt sisteminden elde edildi. Hastalar mortalite gelişimine ve klinik takip şekline göre gruplandırıldı. Bulgular: Çalışmaya 700 hasta alınmış olup hastaların yaş ortalaması 49,1±18,2 yıldı. Hastaların %5,4’ünde (n=38) mortalite gelişti. Mortalite gelişen hastaların NLR, D-dimer ve MPV düzeyleri sağ kalanlardan daha yüksekti (p<0,001; p<0,001 ve p=0,035 sırasıyla). ROC analizinde >6 NLR düzeylerinin ((%71,05 sensitivite ve %92,15 spesifite; AUC: 0,900 (%95 GA 0,858-0,941, p<0,001)), >8,45 MPV düzeylerinin (%68,4 sensitivite ve %53,9 spesifite; AUC: 0,601 (%95 GA 0,564-0,638, p=0,019)) ve >0,57 D-dimer düzeylerinin (%81,6 sensitivite ve %73,9 spesifite; AUC:0,841 (%95 GA 0,812-0,867 p<0,001)) mortalite için belirleyici olduğu görüldü. Sonuç: Kovid-19 hastalarında başvuru anında alınan NLR, D-dimer ve MPV düzeylerindeki yükseklik mortalite için bir gösterge olarak kullanılabilir. NLR ve D-dimer düzeylerindeki yükseklikler hastalığın ciddiyetini ve klinik takip şeklini belirlemede kullanışlıdır.

Anahtar Kelimeler

• -dimer
• kovid-19
• mortalite
• nötrofil/lenfosit oranı
• ortalama trombosit hacmi

Can NLR, D-Dimer, and MPV Values Predict Mortality and Clinical Severity in Covid-19 Patients?

Abstract

Objective: In this study, we aim to determine the relationship between neutrophil/lymphocyte ratio (NLR), D-dimer, and mean platelet volume (MPV) parameters with mortality and clinical severity in Covid-19 patients. Materials and Methods: This retrospectively planned study included Covid-19 patients admitted to the emergency department between March 2020 and September 2020. Sociodemographic characteristics, laboratory parameters, and imaging results of the patients were obtained. The patients were grouped according to the development of mortality and clinical follow-up. Results: Seven hundred patients were included in the study and the mean age of the patients was 49.1±18.2 years. Mortality developed in 5.4% (n=38) of the patients. NLR, D-dimer, and MPV levels of patients who developed mortality were higher than those who survived (p<0.001; p <0.001 and p=0.035, respectively). In ROC analysis, >6 NLR levels, >8.45 MPV levels, and >0.57 D-dimer levels were found to be predictive for mortality (p<0.001; p=0.019; p <0.001, respectively). Conclusions: The high NLR, D-dimer, and MPV levels obtained at the time of admission in Covid-19 patients can be used as an indicator of mortality. Elevated NLR and D-dimer levels are useful in determining the severity of the disease and clinical follow-up.

Keywords

• Covid-19
• D-dimer
• mean platelet volume
• mortality
• neutrophil/lymphocyte ratio

Kaynakça

1. 1. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modeling study. Lancet. 2020;395(10225):689-697. doi:10.1016/S0140-6736(20)30260-9
2. 2. Deng SQ, Peng HJ. Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. J Clin Med. 2020;9(2):575. doi:10.3390/jcm9020575
3. 3. WHO. Coronavirus disease (COVID-2019) situation reports. Situation report–51. 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-Covid-19 .pdf?sfvrsn=1ba62e57_10. Accessed March 11, 2020.
4. 4. 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(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
5. 5. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med. 2013;33(2):105-110. doi:10.3343/alm.2013.33.2.105
6. 6. Liu J, Liu Y, Xiang P, et al.Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020 May 20;18(1):206. doi:10.1186/s12967-020-02374-0
7. 7. Gorjipour F, Totonchi Z, Gholampour Dehaki M, et al. Serum levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, renal function biochemical parameters and clinical outcomes in pediatric cardiopulmonary bypass surgery. Perfusion. 2019;34(8):651-659. doi:10.1177/0267659119842470
8. 8. Inoue Arita Y, Akutsu K, Yamamoto T, et al. A fever in acute aortic dissection is caused by endogenous mediators that influence the extrinsic coagulation pathway and do not elevate procalcitonin. Intern Med. 2016;55(14):1845-1852. doi:10.2169/internalmedicine.55.5924

9. 9. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4. doi:10.1186/s40779-020-0233-6
10. 10. Ciaccio M, Agnello L. Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis (Berl). 2020;7(4):365-372. doi:10.1515/dx-2020-0057
11. 11. Henry BM, De Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021–1028. doi:10.1515/cclm-2020-0369
12. 12. Ponti G, Maccaferri M, Ruini C, et al. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci. 2020;57(6):389-399. doi:10.1080/10408363.2020.1770685
13. 13. Huang C, Wang Y, Li X and et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
14. 14. Chen FF, Zhong M, Liu Y, et al. The characteristics and outcomes of 681 severe cases with COVID-19 in China. J Crit Care. 2020;60:32-37. doi:10.1016/j.jcrc.2020.07.003
15. 15. Zeng ZY, Feng SD, Chen GP, Wu JN. Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study. BMC Infect Dis. 2021;21(1):80. doi:10.1186/s12879-021-05796-3
16. 16. Alkhatip AAAMM, Kamel MG, Hamza MK, et al. The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis. Expert Rev Mol Diagn. 2021;21(5):505-514. doi:10.1080/14737159.2021.1915773
17. 17. Santotoribio JD, Nuñez-Jurado D, Lepe-Balsalobre E. Evaluation of routine blood tests for diagnosis of suspected coronavirus disease 2019. Clin Lab. 2020;66(9). doi:10.7754/Clin.Lab.2020.200522
18. 18. Düz ME, Balcı A, Menekşe E. D-dimer levels and COVİD-19 severity: systematic review and meta-analysis. Tuberk Toraks. 2020;68(4):353-360. doi:10.5578/tt.70351
19. 19. Yao Y, Cao J, Wang Q, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020;8:49. doi:10.1186/s40560-020-00466-z
20. 20. Miesbach W, Makris M. COVID-19: coagulopathy, risk of thrombosis, and the rationale for anticoagulation. Clin Appl Thromb Hemost. 2020; 26: 1076029620938149. doi:10.1177/1076029620938149
21. 21. Thachil J, Srivastava A. SARS-2 coronavirus associated hemostatic lung abnormality in COVID-19: is it pulmonary thrombosis or pulmonary embolism?. Semin Thromb Hemost. 2020; 46: 777-780. doi:10.1055/s-0040-1712155
22. 22. Aktas A, Sener K, Yılmaz N, Tunc M, Yolcu S. Is mean platelet volume useful for predicting the prognosis of COVID-19 diagnosed patients?. IJSR. 2020;5(7):8-11.
23. 23. Aydınyılmaz F, Aksakal E, Pamukcu HE, et al. Significance of MPV, RDW and PDW with the severity and mortality of COVID-19 and effects of acetylsalicylic acid use. Clin Appl Thromb Hemost. 2021;27:10760296211048808. doi:10.1177/10760296211048808