Yüksek Sensitive Troponin-I ve C-Reaktif Protein ile KOVİD-19 Hastalarindaki Mortalite Arasindaki İlişki

Yıl 2022, , 85 - 91, 18.03.2022

Mahmut Akpek

https://doi.org/10.31832/smj.950632

Öz

Amaç: Bu çalışmanın amacı, başvuru sırasında ölçülen yüksek sensitif troponin-I (YsTrop-I) ve C-reaktif proteinin (CRP) düzeylerinin Koronavirüs 2019 hastalığına (KOVID-19) bağlı ölüm ile bağımsız ilişkili olup olmadığını araştırmaktır.
Gereç ve yöntemler: Retrospektif olarak tasarlanan bu kohort çalışma için, 01 Kasım 2020 ile 31 Ocak 2021 tarihleri arasında KOVID-19 tanısı konulmuş toplam 175 hasta tarandı. Sonuç olarak, 137 uygun hasta çalışmaya dâhil edildi. Hasta verileri hastanenin elektronik kayıtlarından ve ulusal sağlık bilgi bankasından kaydedildi.
Bulgular: Çalışma populasyonunun ortala yaşı 49.7 ± 14.8 yıl ve 88 (%64.2) hasta kadındı. KOVID-19 hastalarında başvuru anında ölçülen YsTrop-I değerinin ≥21.6 pg/ml olması mortaliteyi %86 duyarlılık ve %88 özgüllük ile öngörme gücüne sahipti. Başvuru anında ölçülen CRP değerinin ≥80.8 mg/l olması mortaliteyi %86 duyarlılık ve %95 özgüllük ile öngörme gücüne sahipti. Çoklu analizde; başvuru anında ölçülen YsTrop-I (Risk oranı (RO) 1.124,% 95 Güven aralığı (GA) 1.025–1.232; p=0.013) ve CRP (RO 1.060, %95 GA 1.021–1.100; p=0.002) KOVID-19 hastalarında mortalitenin bağımsız öngördürücüleriydi.
Sonuç: Başvuru anında kolaylıkla ölçülebilen YsTrop-I ve CRP değerleri KOVID-19 hastalığına bağlı mortalitenin bağımsız öngördürücüsüdür. Dolayısıyla, YsTrop-I ve CRP, kötüleşebilme potansiyeline sahip hastaların erken tespit edilmesinde ve sağlık kaynaklarının daha verimli kullanılmasında doktorlara yardımcı olabilir.

Anahtar Kelimeler

Koronavirüs, Yüksek sensitif troponin-I, Mortalite

Relation of High Sensitive Troponin-I and C-reactive Protein to Mortality in Patients with COVID-19

Öz

Objective: The aim of the present study is to investigate whether the high sensitive troponin-I (HsTrop-I) and C-reactive protein (CRP) level that measured on admission is an independent predictor of mortality in patients with coronavirus disease 2019 (COVID-19).
Materials and Methods: In this retrospective cohort study, a total of 175 consecutive patients with confirmed COVID-19 cases were screened from November 01, 2020 to January 31, 2021. Finally, 137 eligible patients were enrolled in to the study. Data of patients were recorded from the electronic medical records and National health data registry.
Results: Mean age of study population was 49.7 ± 14.8 year and 88 (64.2%) patients were female. A HsTrop-I level ≥21.6 pg/ml measured on admission had a 86% sensitivity and 88% specificity in predicting mortality. The CRP level ≥80.8 mg/l on admission predicted mortality with 86% sensitivity and 95% specificity in patients with COVID-19. In the multivariate analyzes, HsTrop-I (odds ratio (OR) 1.124, 95% confidence interval (CI) 1.025–1.232; p=0.013) and CRP (OR 1.060, 95% CI 1.021–1.100; p=0.002) on admission were independent predictors of mortality in patients with COVID-19.
Conclusion: HsTrop-I and CRP levels on admission which are easily measurable laboratory data were independent predictors of mortality in patients with COVID-19. Therefore, HsTrop-I and CRP levels could help to physicians for earlier triage of the patients that potentially worsening and may lead to provide the effective use of health resources.

Anahtar Kelimeler

Coronavirus, High sensitive troponin-I, Mortality

Kaynakça

• Referans 1. WHO. Coronavirus disease 2019 (COVID-19) Situation Dashboard [Internet]. Available at: https://covid19.who.int/ (Last accessed March 03, 2021).
• Referans 2. Dervisoglu P, Elmas B, Ozdemir O, Orhan MF. Evaluation of Electrocardiographic Changes and Laboratory Parameters in Pediatric COVID-19. Sakarya Med J 2020;4:541-8
• Referans 3. Cekic D, Senocak D, Issever K, Cekic S, Yaylaci S, Karabay O, et al. Is Hba1c and Lipid Profile A Predictor Of Determining Intensive Care Need and Mortality In Diabetic Covid-19 Patients? Sakarya Med J 2021;2:293-8.
• Referans 4. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost 2020;18:1324-9.
• Referans 5. Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L, et al. Relationships among lymphocyte subsets, cytokines, and the pulmonary inflammation index in coronavirus (COVID-19) infected patients. Br J Haematol 2020;189:428-37.
• Referans 6. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis 2020;71:762-8.
• Referans 7. Imam Z, Odish F, Gill I, O'Connor D, Armstrong J, Vanood A, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med 2020;288:469-76.
• Referans 8. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. 2020.
• Referans 9. Lazzeri C, Bonizzoli M, Batacchi S, Cianchi G, Franci A, Fulceri G,. et al. Cardiac Involvment in COVID-19-Related Acute Respiratory Distress Syndrome. Am J Cardiol 2020;132:147-9.
• Referans 10. Katar M, Beyhan M, Demir O. Could Eosinophil Cationic Protein Be A Useful Biomarker In The Diagnosis Of Covid-19? Sakarya Med J 2021;2:328-336.
• Referans 11. Shah P, Doshi R, Chenna A, Owens R, Cobb A, Ivey H, et al. Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients. Am J Cardiol 2020;135:150-3.
• Referans 12. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020;5:802-10.
• Referans 13. Pareek M, Singh A, Vadlamani L, Eder M, Pacor J, Park J, et al. Relation of Cardiovascular Risk Factors to Mortality and Cardiovascular Events in Hospitalized Patients With Coronavirus Disease 2019 (from the Yale COVID-19 Cardiovascular Registry). Am J Cardiol 2021 Feb 1:S0002-9149(21)00100-4.
• Referans 14. Malik P, Patel U, Patel NH, Somi S, Singh J. Elevated cardiac troponin I as a predictor of outcomes in COVID-19 hospitalizations: a meta-analysis. Infez Med 2020;28:500-6.
• Referans 15. Aghagoli G, Gallo Marin B, Soliman LB, Sellke FW. Cardiac involvement in COVID-19 patients: Risk factors, predictors, and complications: A review. J Card Surg 2020;35:1302-5.
• Referans 16. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020;181:271-80.
• Referans 17. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med 2020;14:185-92.
• Referans 18. Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res 2016;118:496‐514.
• Referans 19. Alhogbani T. Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus. Ann Saudi Med 2016;36:78-80.
• Referans 20. Barman HA, Atici A, Sahin I, Alici G, Aktas Tekin E, Baycan ÖF, et al. Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease. Coron Artery Dis 2020 Jun 19:10.1097/MCA.0000000000000914.