THE RELATIONSHIP BETWEEN NEUTROPHIL / LYMPHOCYTE RATIO AND VITAMİN D LEVELS AND MORTALITY IN COVID-19 PATIENTS
Öz
OBJECTIVE: Coronavirus Disease 2019 (COVID-19) may also lead to a clinical picture accompanied by acute respiratory failure and may result in death. Although the Polymerase Chain Reaction (PCR) test is the gold standard for diagnosing COVID-19, faster and less costly techniques are being sought to diagnose the disease. In terms of treatment, it is suggested that treatment methods aimed at strengthening the immune systems of patients may be effective in alleviating the clinical course of COVID-19. Our main aim in the study is to research and compare vitamin D levels and neutrophil/lymphocyte ratio (NLR) ratios in COVID-19 patients. In addition, we aim to research whether vitamin D and NLR can be predictive for mortality in COVID-19 patients.
MATERIAL AND METHODS: In this retrospective study, 317 COVID-19 patients who applied to the emergency department and were later admitted to the intensive care unit were included. A demographic information form was created for each patient, which was recorded by the physician responsible for the patient. All recorded data of the patients were compared with vitamin D and NLR ratios.
RESULTS: In the study, the relationship between vitamin D levels and the length of hospital stay, computed tomography (CT) findings and mortality of COVID-19 patients was examined. As a result of the analysis, no relationship was found between vitamin D levels and the above-mentioned parameters. Similarly, the relationship between NLR and patients' length of stay in hospital, CT findings and mortality was examined, and no significant relationship was found.
CONCLUSIONS: When we look at the results of this study, it can be said that vitamin D and NLR levels are not helpful in predicting the length of hospital stay or in-hospital mortality of patients diagnosed with COVID-19. However, there are studies showing that both vitamin D and NLR levels are associated with length of hospital stay and in-hospital mortality. Therefore, we think that more randomized controlled studies and large-scale cohort studies are necessary to test these hypotheses.
Anahtar Kelimeler
Kaynakça
- 1. Shakoor H, Feehan J, Al Dhaheri AS, et al. Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?. Maturitas. 2021;143: 1-9.
- 2. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures. Journal of Medical Virology. 2020;92(6):568-576.
- 3. Pereira M, Dantas Damascena A, Galvão Azevedo LM, et al. Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Critical reviews in food Science and Nutrition. 2020;1-9.
- Gruplar Vitamin D Toplam X2 p 10 Altı - Şiddetli Eksiklik 10 ile 20 arası - Eksiklik 20 ile 30 arası - Yetersizlik 30 üzeri - Normal BT Corads 1 4 4 0 0 8 11,30 0,50 Corads 2 20 13 3 2 38 Corads 3 12 21 8 2 43 Corads 4 42 51 11 11 115 Corads 5 46 47 14 6 113 Toplam 124 136 36 11 Note: BT, bilgisayar tomografi; X2, ki-kare.
- 4. Sharifi A, Vahedi H, Nedjat S, et al. Effect of single‐dose injection of vitamin D on immune cytokines in ulcerative colitis patients: a randomized placebo‐controlled trial. Apmis. 2019;127(10):681-687.
- 5. Grant WB, Lahore H, McDonnell SL, et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020;12(4):988.
- 6. Udugama B, Kadhiresan P, Kozlowski HN, et al. Diagnosing COVID-19: the disease and tools for detection. ACS nano. 2020;14(4):3822-3835.
- 7. Qin C , Zhou L , Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America.2020.
- 8. Faria SS, Fernandes JrPC, Silva MJB, et al. The neutrophiltolymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702.
- 9. Kim H, Baek S, Hong SM, et al. 1,25-Dihydroxy vitamin D3 and interleukin-6 blockade synergistically regulate rheumatoid arthritis by suppressing interleukin-17 production and osteoclastogenesis.J Korean Med Sci. 2020;35(6):40.
- 10. Rondanelli M, MicconoA, Lamburghinis S,et al. Self-care for common colds: the pivotal role of vitamin D, vitamin C, zinc and Echinacea in three main immune interactive clusters (physicalbarriers, innateandadaptiveimmunity) involvedduring an episode of common colds- Practical advice on dosages and on the time to take the senutrients/botanicals in order to prevent or treat common colds. Evid-Based Complement Alternat Med. 2018;2018:5813095.
- 11. Panagiotou G, Tee SA, Ihsan Y, et al. Low serum 25 hydroxyvitamin D (25[OH]D) levels inpatients hospitalized with COVID-19 are associated with greaterdisease severity. Clin Endocrinol (Oxf).2020;93(4):508-11.
- 12. Raharusun P, Priambada S, Budiarti C, Agung E, Budi C. Patterns of COVID-19 mortality and vitamin D: an Indonesian study 2020.
- 13. Ling SF, Broad E, Murphy R, et al. High Dose Cholecalciferol Booster Therapy is Associated with a Reduced Risk of Mortality in Patients with COVID-19: A Cross-Sectional Multi-Centre Observational Study. Nutrients. 2020;12(12): 3799.
- 14. Murai IH, Fernandes AL, Sales LP, et al. Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial. JAMA. 2021;325(11):1053-60.
- 15. Seyit M, Avci E, Nar R, et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. The American Journal of Emergency Medicine. 2021;40:110-114.
- 16. Shang W, Dong J, Ren Y, et al. The value of clinical parameters inpredicting the severity of COVID-19. Journal of Medical Virolgy. 2020;92:2188-2192.
- 17. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin in Immunopathology. 2017;39:529-539.
- 18. Xia X, Wen M, Zhan S, He J, Chen W. An increased neutrophil/lymphocyte ratio Is an early Warning signal of severe COVID-19. Nan Fang Yi Ke Da Xue Xue Bao. 2020;40:333-336.
- 19. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81:6-12
Öz
AMAÇ: Koronavirüs Hastalığı 2019 (COVID-19) akut solunum yetmezliğinin eşlik ettiği ve ölümle sonuçlanabilen bir klinik tabloya yol açabilir. Her ne kadar Polimeraz Zincir Reaksiyon (PCR) testi COVID-19’un teşhisinde altın standart olsa da, hastalığın teşhisini koymak için daha hızlı ve düşük maliyetli teknikler araştırılmaktadır. Tedavi açısından ise hastaların immün sistemlerini güçlendirmeyi amaçlayan tedavi yöntemlerinin, COVID-19'un klinik seyrini hafifletmede etkili olabileceği ileri sürülmektedir. Çalışmadaki ana amacımız COVID-19 hastalarında vitamin D düzeyleri ile nötrofil/lenfosit oranı(NLR) oranlarını araştırmak ve karşılaştırmaktır. Ayrıca çalışmada COVID-19 hastalarında vitamin D ve NLR'nin mortalite için öngörücü olup olamayacağını da araştırmayı hedefliyoruz.
GEREÇ VE YÖNTEM: Retrospektif olarak yapılan bu çalışmaya acil servise başvuran, daha sonrasında yoğun bakım yatış kararı verilen 317 COVID-19 hastası alındı. Her hasta için hastadan sorumlu hekim tarafından kaydedilen bir demografik bilgi formu oluşturuldu. Hastalara ait kaydedilen verilerin hepsi vitamin D ve NLR oranları ile karşılaştırıldı.
BULGULAR: Çalışmada vitamin D düzeyleri ile COVID-19 hastalarının hastanede kalış süreleri, bilgisayarlı tomografi (BT) bulguları ve mortalitesi arasındaki ilişki incelendi. Analiz sonucunda vitamin D düzeyleri ve yukarıda bahsedilen parametreler arasında bir ilişki bulunamamıştır. Benzer şekilde NLR ile hastalarının hastanede kalış süreleri, BT bulguları ve mortalitesi arasındaki ilişki incelenmiş olup, anlamlı bir ilişki saptanmamıştır.
SONUÇ: Bu çalışmanın sonuçlarına baktığımızda vitamin D ve NLR düzeylerinin COVID-19 tanısı alan hastaların hastanede yatış süresini veya hastane içi mortalitesini öngörmede yardımcı olmadığı söylenebilir. Ancak hem vitamin D hem de NLR düzeylerinin hastanede yatış süresi ve hastane içi mortalite ile ilişkili olduğunu gösteren çalışmalarda vardır. Bu nedenle bu hipotezleri test etmek için daha fazla randomize kontrollü çalışmalar ve büyük ölçekli kohort çalışmalarının gerekli olduğunu düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- 1. Shakoor H, Feehan J, Al Dhaheri AS, et al. Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?. Maturitas. 2021;143: 1-9.
- 2. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures. Journal of Medical Virology. 2020;92(6):568-576.
- 3. Pereira M, Dantas Damascena A, Galvão Azevedo LM, et al. Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Critical reviews in food Science and Nutrition. 2020;1-9.
- Gruplar Vitamin D Toplam X2 p 10 Altı - Şiddetli Eksiklik 10 ile 20 arası - Eksiklik 20 ile 30 arası - Yetersizlik 30 üzeri - Normal BT Corads 1 4 4 0 0 8 11,30 0,50 Corads 2 20 13 3 2 38 Corads 3 12 21 8 2 43 Corads 4 42 51 11 11 115 Corads 5 46 47 14 6 113 Toplam 124 136 36 11 Note: BT, bilgisayar tomografi; X2, ki-kare.
- 4. Sharifi A, Vahedi H, Nedjat S, et al. Effect of single‐dose injection of vitamin D on immune cytokines in ulcerative colitis patients: a randomized placebo‐controlled trial. Apmis. 2019;127(10):681-687.
- 5. Grant WB, Lahore H, McDonnell SL, et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020;12(4):988.
- 6. Udugama B, Kadhiresan P, Kozlowski HN, et al. Diagnosing COVID-19: the disease and tools for detection. ACS nano. 2020;14(4):3822-3835.
- 7. Qin C , Zhou L , Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America.2020.
- 8. Faria SS, Fernandes JrPC, Silva MJB, et al. The neutrophiltolymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702.
- 9. Kim H, Baek S, Hong SM, et al. 1,25-Dihydroxy vitamin D3 and interleukin-6 blockade synergistically regulate rheumatoid arthritis by suppressing interleukin-17 production and osteoclastogenesis.J Korean Med Sci. 2020;35(6):40.
- 10. Rondanelli M, MicconoA, Lamburghinis S,et al. Self-care for common colds: the pivotal role of vitamin D, vitamin C, zinc and Echinacea in three main immune interactive clusters (physicalbarriers, innateandadaptiveimmunity) involvedduring an episode of common colds- Practical advice on dosages and on the time to take the senutrients/botanicals in order to prevent or treat common colds. Evid-Based Complement Alternat Med. 2018;2018:5813095.
- 11. Panagiotou G, Tee SA, Ihsan Y, et al. Low serum 25 hydroxyvitamin D (25[OH]D) levels inpatients hospitalized with COVID-19 are associated with greaterdisease severity. Clin Endocrinol (Oxf).2020;93(4):508-11.
- 12. Raharusun P, Priambada S, Budiarti C, Agung E, Budi C. Patterns of COVID-19 mortality and vitamin D: an Indonesian study 2020.
- 13. Ling SF, Broad E, Murphy R, et al. High Dose Cholecalciferol Booster Therapy is Associated with a Reduced Risk of Mortality in Patients with COVID-19: A Cross-Sectional Multi-Centre Observational Study. Nutrients. 2020;12(12): 3799.
- 14. Murai IH, Fernandes AL, Sales LP, et al. Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial. JAMA. 2021;325(11):1053-60.
- 15. Seyit M, Avci E, Nar R, et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. The American Journal of Emergency Medicine. 2021;40:110-114.
- 16. Shang W, Dong J, Ren Y, et al. The value of clinical parameters inpredicting the severity of COVID-19. Journal of Medical Virolgy. 2020;92:2188-2192.
- 17. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin in Immunopathology. 2017;39:529-539.
- 18. Xia X, Wen M, Zhan S, He J, Chen W. An increased neutrophil/lymphocyte ratio Is an early Warning signal of severe COVID-19. Nan Fang Yi Ke Da Xue Xue Bao. 2020;40:333-336.
- 19. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81:6-12
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler-Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 5 Nisan 2023 |
| Kabul Tarihi | 4 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 24 Sayı: 2 |
Kaynak Göster
