COVID-19 hastalarında dalak boyutu ve hematolojik parametrelerinin klinik önemi

Yıl 2022, , 402 - 409, 20.12.2022

Pinar Yürük Atasoy , Engin Beydoğan

https://doi.org/10.22312/sdusbed.1137983

Öz

Amaç: Şiddetli akut solunum sendromu koronavirüs 2'nin (SARS-CoV-2) neden olduğu COVID-19, sistemik tutuluma neden olur ve dalak hedef organlardan biri olabilir. Bu çalışmamızda COVID-19 hastalarının hastane başvurusu sırasında çekilen bilgisayarlı tomografi (BT) kesitlerindeki dalak boyutu ve laboratuvar parametrelerinin COVID-19'un sonlanımı üzerine etkisini değerlendirmeyi amaçladık.
Materyal-Metot: Bu retrospektif kohort çalışmasına Nisan ve Aralık 2020 tarihleri arasında hastanemize başvuran 644 COVID-19 hastası alındı. Hastaların medikal kayıtları toplandı ve başvuru anında çekilen Toraks BT kesitlerinde dalağın tümünün değerlendirilebildiği Toraks BT’ler gözden geçirildi.
Bulgular: Çalışma popülasyonu, medyan yaşı 59 (45 – 69 yıl) olan 644 hastayı (387 erkek, 57 kadın) içermektedir. COVID-19 ile ilişkili en yaygın üç sistemik hastalık hipertansiyon (%28), diabetes mellitus (%22.2) ve kalp hastalığıydı (%18.6). Başvuru sırasında en sık görülen aktif şikayet nefes darlığı (%57,5) ve öksürükdü (%46). 644 hastann 109’u mortal seyretti. Başvuru sırasında, mortalitesi olan hastalarda medyan lökosit sayısı daha yüksek olmasına rağmen (8.9'a karşı 6.5, p<0.001), lenfosit sayısı (1.3'e karşı 1.0, p<0.001) ve trombosit sayısı (200'e karşı 187, p= 0.035) mortalitesi olmayan hastalarda daha yüksekti. Çalışma popülasyonunun 173'ünde (%26,9) splenomegali vardı ve mortalitesi olmayan hastalarda splenomegali oranı oldukça yüksekti (%31'e karşı %6,4, p<0,001).
Sonuç: COVID-19 özellikle erken dönemde akciğer tutulumu ile kendini gösterse de sistemik tutuluma da neden olur ve hedefteki organlarından biri dalak olabilir. Ayrıca hastaların başvuru anındaki lenfosit, monosit ve trombosit sayıları COVID-19'un ilerlemesini öngörebilir. Çalışmamızın sonuçları dalak boyutu artışının COVID-19 sonlanımı açısından dikkate alınması gereken bir belirteç olabileceğini düşündürmektedir.

Anahtar Kelimeler

SARS-CoV-2, dalak boyutu, Laboratuvar, CT-SS, pandemi

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Clinical Significance of Spleen Size and Hematological Parameters in COVID-19 Patients

Öz

Objective: COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes systemic involvement and the spleen may be one of the target organs. In this study, we aimed to evaluate the effect of spleen size and laboratory parameters in computed tomography (CT) sections taken during hospital admission of COVID-19 patients on the outcome of COVID-19.
Material-Method: This retrospective cohort study included 644 COVID-19 patients admitted to our hospital between April and December 2020. The medical records of the patients were collected, and the thorax CT scans in which the entire spleen could be evaluated in the thorax CT sections taken at the time of admission were reviewed.
Results: The study population included 644 patients (387 men, 257 women) with a median age of 59 (45 – 69 years). The three most common systemic diseases associated with COVID-19 were hypertension (28%), diabetes mellitus (22.2%), and heart disease (18.6%). The most common active complaints at admission were shortness of breath (57.5%) and cough (46%). 109 of 644 patients were mortal. At admission, patients with mortality had higher median leukocyte count (8.9 vs 6.5, p<0.001), lymphocyte count (1.3 vs 1.0, p<0.001) and platelet count (187 vs 200, p=0.001). 0.035) was higher in patients without mortality. Of the study population, 173 (26.9%) had splenomegaly, and the rate of splenomegaly was significantly higher in patients without mortality (31% vs. 6.4%, p<0.001).
Conclusion: Although COVID-19 manifests itself with lung involvement especially in the early period, it also causes systemic involvement and one of the target organs may be the spleen. In addition, the lymphocyte, monocytes and platelet counts of the patients at the time of admission can predict the progression of COVID-19. The results of our study suggest that increased spleen size may be a marker that should be considered in terms of COVID-19 outcome.

Anahtar Kelimeler

SARS-CoV-2, spleen size, Laboratory, CT-SS, pandemic

Proje Numarası

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Kaynakça

• 1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–44.
• 2. Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta. 2020 Sep;508:254–66.
• 3. Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63(3):457–60.
• 4. Li M-Y, Li L, Zhang Y, Wang X-S. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis poverty. 2020 Apr 28;9(1):45.
• 5. Basso C, Leone O, Rizzo S, De Gaspari M, van der Wal AC, Aubry M-C, et al. Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study. Eur Heart J. 2020 Oct;41(39):3827–35.
• 6. Xu X, Chang XN, Pan HX, Su H, Huang B, Yang M, et al. [Pathological changes of the spleen in ten patients with coronavirus disease 2019(COVID-19) by postmortem needle autopsy]. Zhonghua bing li xue za zhi = Chinese J Pathol. 2020 Jun 8;49(6):576–82.
• 7. Han Q, Wen X, Wang L, Han X, Shen Y, Cao J, et al. Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms. J Clin Lab Anal. 2020 May 4;34(5).
• 8. Haigh K, Syrimi ZJ, Irvine S, Blanchard TJ, Pervaiz MS, Toth AG, et al. Hyperinflammation with COVID-19: The key to patient deterioration? Clin Infect Pract. 2020 Oct;7:100033.
• 9. Tahtabasi M, Hosbul T, Karaman E, Akin Y, Konukoglu O, Sahiner F. Does COVID-19 cause an increase in spleen dimensions? Possible effects of immune activation, hematopoietic suppression and microthrombosis. Clin Imaging. 2021 Nov;79:104–9.
• 10. Kucybała I, Ciuk S, Tęczar J. Spleen enlargement assessment using computed tomography: which coefficient correlates the strongest with the real volume of the spleen? Abdom Radiol. 2018 Sep 19;43(9):2455–61.
• 11. Gu J, Gong E, Zhang B, Zheng J, Gao Z, Zhong Y, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005 Aug 1;202(3):415–24.
• 12. Tabatabaei SMH, Talari H, Moghaddas F, Rajebi H. CT Features and Short-term Prognosis of COVID-19 Pneumonia: A Single-Center Study from Kashan, Iran. Radiol Cardiothorac imaging. 2020 Apr;2(2):e200130.
• 13. 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 Feb;395(10223):507–13.
• 14. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical Characteristics of Refractory Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2021 Dec 6;73(11):e4208–13.