COVİD-19 Hastalarında Toraks BT Skoru: Nötrofil-Lenfosit Oranı, Monosit, Laktat Dehidrojenaz, Albümin ve Ferritin Arasındaki İlişki

Yıl 2023, Cilt: 5 Sayı: 1, 10 - 16, 01.03.2023

Barış Çil , İbrahim Demir , Mehmet Kabak , İclal Hocanlı , Mahsuk Taylan , Mustafa Fidanten

https://doi.org/10.38175/phnx.1199180

Cited By: 1

Öz

Amaç: Lökopeni, lenfopeni, nötrofil/lenfosit oranı yükselmesi, laktat dehidrojenaz yüksekliği, D-dimer ve ferritin yüksekliği, düşük albümin gibi çeşitli laboratuvar ve hayati parametreler COVID-19 enfeksiyonunun tanı ve ciddiyetinin değerlendirilmesinde kullanılabilir.
Yöntemler: Toraks bilgisayarlı tomografi (BT) skorları, lenfopeni, nötrofil/lenfosit oranı, nötrofil, lenfosit, laktat dehidrojenaz, albümin, C-reaktif protein, beyaz kan hücreleri, trombositler, bazofil, eozinofil, monositler, prokalsitonin, D-dimer, COVID-19 tanısı konulan 693 hastanın ferritin, yaş, cinsiyet, yatış birimleri, oda havasında oksijensiz parmak ucu satürasyonları, ek hastalıkları ve semptomları kaydedildi. Hastaların parametreleri göğüs BT skorunun ciddiyetine göre karşılaştırıldı.
Bulgular: Bu çalışma sonucunda ağır grupta nötrofil/lenfosit oranı orta ve hafif gruba göre anlamlı derecede yüksek bulundu. Göğüs BT skoru arttıkça, laktat dehidrojenaz düzeyi, şiddetli grupta hafif gruba göre istatistiksel olarak anlamlı düzeyde daha yüksekti. Ağır grupta albümin düzeyleri hafif gruba göre istatistiksel olarak anlamlı düzeyde daha düşük bulundu. Şiddetli grupta monosit düzeyleri orta ve hafif gruplara göre istatistiksel olarak anlamlı düzeyde daha düşük bulundu. Ferritin düzeyi şiddetli grupta orta ve hafif gruplara göre istatistiksel olarak anlamlı düzeyde daha yüksekti. Hastaların göğüs BT skorlarına göre ciddi BT skoru olan hastaları ağır olmayan hastalardan ayırt etmek için hematolojik ve biyokimyasal parametrelerin kullanılmasının pratik etkinliği ROC Analizi kullanılarak incelendiğinde, nötrofil/lenfosit oranı değerinin yüksek olduğu görüldü. en güçlü tahmin yeteneği (AUC, 0.787, SD=0.057, P<0.001, %95 CI 0.682-0.683). nötrofil/lenfosit oranının cut-off değeri 5,58 olarak ayarlandığında %68,2 duyarlılığa ve %68,3 özgüllüğe sahip olduğu bulundu.
Sonuç: Nötrofil/lenfosit oranı, lenfosit, laktat dehidrojenaz, albümin, monosit ve ferritin incelenerek COVID-19'un akciğer tutulumunun arttığı öngörülerek yakın klinik ve laboratuvar takibine başlanabilir ve sağlık merkezlerinde erken tedaviye başlanabilir. göğüs BT taramasının mümkün olmadığı veya sık BT taramalarından kaçınmak için.

Anahtar Kelimeler

Nötrofil-lenfosit oranı, Göğüs BT skoru, COVID-19

Chest CT Score in COVID-19 Patients: The Relationship Between Neutrophil-Lymphocyte Ratio, Monocyte, Lactate Dehydrogenase, Albumin And Ferritin

Öz

Objective: Various Laboratory and vital parameters, including leukopenia, lymphopenia, neutrophil/lymphocyte ratio elevation, lactate dehydrogenase elevation, D-dimer and ferritin elevation, and low albumin can be used in the diagnosis and assessment of the severity of COVID-19 infection .
Methods: The chest computed tomography (CT) scores, lymphopenia, neutrophil/lymphocyte ratio, neutrophil, lymphocyte, lactate dehydrogenase, albumin, C-reactive protein, white blood cells, platelets, basophil, eosinophil, monocytes, procalcitonin, D-dimer, ferritin, ages, genders, hospitalization units, oxygen-free fingertip saturations in room air, additional diseases and symptoms of 693 patients diagnosed with COVID-19 were recorded. The parameters of the patients were compared according to the severity of the chest CT score.
Results: As a result of this study neutrophil/lymphocyte ratio was found to be significantly higher in the severe group when compared to the moderate group and the mild group. As chest CT score increased, lactate dehydrogenase level was higher at a statistically significant level in the severe group than in the mild group. Albumin levels were found to be lower in the severe group at a statistically significant level than in the mild group. Monocyte levels were found to be lower in the severe group at a statistically significant level when compared to the moderate and mild groups. Ferritin level was higher in the severe group at a statistically significant level when compared to the moderate and mild groups. When the practical effectiveness of using hematological and biochemical parameters to differentiate patients with severe CT scores from non-severe patients based on the chest CT score of the patients was examined by using the ROC Analysis, it was found that the neutrophil/lymphocyte ratio value had the strongest predictive ability (AUC, 0.787, SD=0.057, P<0.001, 95% CI 0.682-0.683). neutrophil/lymphocyte ratio was found to have 68.2% sensitivity and 68.3% specificity when the cut-off value was set at 5.58
Conclusion: Close clinical and laboratory follow-up can be started by examining neutrophil/lymphocyte ratio, lymphocyte, lactate dehydrogenase, albumin, monocyte and ferritin, predicting that the lung involvement of COVID-19 has increased and early treatment can be started in healthcare centers where chest CT scan is not possible or to avoid frequent CT scans.

Anahtar Kelimeler

Neutrophil-lymphocyte ratio, Chest CT score, COVID-19

Kaynakça

• Çoraplı M, Oktay C, Çil E, Çoraplı G, Bulut H. T. The Role of Teleradiology in the COVID-19 Pandemic. Cerrahpaşa Med J. 2021; 45(2):80-86.
• Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433. doi: 10.1016/j.jaut.2020.102433.
• 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. 2020;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7.
• Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology. 2020;295(1):202-207. doi: 10.1148/radiol.2020200230.
• Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296(2):E32-E40. doi: 10.1148/radiol.2020200642.
• Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. doi: 10.1016/j.intimp.2020.106504.
• 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(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.
• Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020;507:174-180. doi: 10.1016/j.cca.2020.04.024.
• Ng MY, Lee EYP, Yang J, Yang F, Li X, Wang H, et al. Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature Review. Radiol Cardiothorac Imaging. 2020;2(1):e200034. doi: 10.1148/ryct.2020200034.
• Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30(8):4407-4416. doi: 10.1007/s00330-020-06817-6.
• Kabak M, Çil B, Hocanlı I. Relationship between leukocyte, neutrophil, lymphocyte, platelet counts, and neutrophil to lymphocyte ratio and polymerase chain reaction positivity. Int Immunopharmacol. 2021;93:107390. doi: 10.1016/j.intimp.2021.107390.
• Zhang Y, Zou P, Gao H, Yang M, Yi P, Gan J, et al. Neutrophil-lymphocyte ratio as an early new marker in AIV-H7N9-infected patients: a retrospective study. Ther Clin Risk Manag. 2019;15:911-919. doi: 10.2147/TCRM.S206930.
• Man MA, Rajnoveanu RM, Motoc NS, Bondor CI, Chis AF, Lesan A, et al. Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and eosinophils correlation with high-resolution computer tomography severity score in COVID-19 patients. PLoS One. 2021;16(6):e0252599. doi: 10.1371/journal.pone.0252599.
• Zhang Y, Wu W, Du M, Luo W, Hou W, Shi Y, et al. Neutrophil-to-lymphocyte ratio may replace chest computed tomography to reflect the degree of lung injury in patients with corona virus disease 2019 (Covid-19). Research Square. 2020; Preprint (Version 1). doi:10.21203/rs.3.rs-23201/v1
• Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422. doi: 10.1016/S2213-2600(20)30076-X.
• Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia. Invest Radiol. 2020;55(6):327-331. doi: 10.1097/RLI.0000000000000672.
• Liu WJ, Zhao M, Liu K, Xu K, Wong G, Tan W, et al. T-cell immunity of SARS-CoV: Implications for vaccine development against MERS-CoV. Antiviral Res. 2017;137:82-92. doi: 10.1016/j.antiviral.2016.11.006.
• Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. 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. PMID: 32286245.
• Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi: 10.1056/NEJMoa2001017.
• Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia. Invest Radiol. 2020;55(6):327-331. doi: 10.1097/RLI.0000000000000672.
• Chang YC, Yu CJ, Chang SC, Galvin JR, Liu HM, Hsiao CH et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology. 2005;236(3):1067-75. doi: 10.1148/radiol.2363040958.
• Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. ; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi: 10.1056/NEJMoa2002032.
• Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 2020;30(8):4381-4389. doi: 10.1007/s00330-020-06801-0.
• Yilmaz A, Sabirli R, Seyit M, Ozen M, Oskay A, Cakmak V, et al. Association between laboratory parameters and CT severity in patients infected with Covid-19: A retrospective, observational study. Am J Emerg Med. 2021;42:110-114. doi: 10.1016/j.ajem.2021.01.040.
• Salvatore C, Roberta F, Angela L, Cesare P, Alfredo C, Giuliano G, et al. Clinical and laboratory data, radiological structured report findings and quantitative evaluation of lung involvement on baseline chest CT in COVID-19 patients to predict prognosis. Radiol Med. 2021;126(1):29-39. doi: 10.1007/s11547-020-01293-w.
• Sun D, Li X, Guo D, Wu L, Chen T, Fang Z, et al. CT Quantitative Analysis and Its Relationship with Clinical Features for Assessing the Severity of Patients with COVID-19. Korean J Radiol. 2020;21(7):859-868. doi: 10.3348/kjr.2020.0293.