MIS-C tanısı alan hastalarda c-reaktif protein (CRP)/albümin oranının prognostik değerinin belirlenmesi
Determination of the prognostic value of C-reaktive protein (CRP)/albumin ratio in patients diagnosed with MİS-C
- Tez No: 764867
- Danışmanlar: DOÇ. DR. SEHER ERDOĞAN
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Albüminler, C reaktif protein, COVID 19, Multisistem inflamatuar sendrom, SARS virüsü, Çocuklar, İnflamasyon, MIS-C, covid-19, CRP, albumin, Albumins, C reactive protein, COVID 19, Multisystem inflammatory syndrome, SARS virus, Children, Inflammation
- Yıl: 2022
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: İstanbul Ümraniye Eğitim ve Araştırma Hastanesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: Belirtilmemiş.
Özet
AMAÇ: Koronavirüs hastalığı 2019, çocuklarda erişkinlere kıyasla daha az sıklıkla görülmekte ve daha hafif bulgularla seyretmektedir. Fakat Avrupa'da Nisan 2020'nin sonlarında SARS-CoV-2 enfeksiyonu geçiren bazı çocuklarda ateş, karın ağrısı, şok, miyokardiyal yetmezlik ve yoğun bakımı ihtiyacı geliştiği görülmüş ve bu yeni hastalığa Çoklu Sistemik İnflamatuvar Sendrom (MIS-C) adı verilmiştir. Hastalığın patogenezi net değildir, immün sistemin kontrolsüz inflamasyonu sonucunda çoklu organ tutulumuna ait bulgularla seyretmekte ve hatta ölüme neden olmaktadır. Bu hastaların hızlı bir şekilde tanı almaları ve tedavilerine zaman kaybedilmeden başlanması mortalite ve morbiditenin önlenmesi açısından büyük önem taşımaktadır. Çoklu sistemik inflamatuvar sendromunda inflamatuvar belirteçlerde aşırı bir yanıt görülebilir. Serum C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH), fibrinojen, D-dimer, ferritin, laktat dehidrogenaz (LDH), interlökin 6 (IL-6), nötrofil sayısında artış görülürken lenfopeni, trombositopeni, albümin ve kan sodyum düşüklüğü saptanabilir. MIS-C yeni tanımlandığı ve uzun süreli hastaların izlemi yapılmadığından prognozu halen belirsizdir. Pek çok çalışmada, kritik hastalarda prognozu belirlemede biyobelirteçlerin rolü araştırılmıştır. Biz de bu çalışmada; MIS-C hastalarının klinik, demografik ve laboratuvar verilerini değerlendirmeyi, CRP/Albümin oranının hastalığın klinik seyrine olan etkisini ve çocuk yoğun bakım ünitesi (ÇYBÜ) ihtiyacını tahmin etmedeki rolünü araştırmayı amaçladık. GEREÇ ve YÖNTEM: Çalışmamızda Kasım 2020-Mart 2022 tarihleri arasında Sağlık Bilimleri Üniversitesi Ümraniye Eğitim ve Araştırıma Hastanesi Çocuk Sağlığı ve Hastalıkları servisi ve Çocuk Yoğun Bakım Ünitesi'nde (ÇYBÜ) MIS-C tanısı alan 1 ay-l8 yaş arası hastaların izlem dosyalarından klinik bulguları, demografik özellikleri, eşlik eden ek hastalık varlığı, servis ve ÇYBÜ yatış günleri,
Özet (Çeviri)
OBJECTIVE: Coronavirus disease 2019 is seen less frequently in children compared to adults and progresses with milder symptoms. However, in Europe in late April 2020, some children who had SARS-CoV-2 infection developed fever, abdominal pain, shock, myocardial failure and the need for intensive care, and this new disease was named Multiple Systemic Inflammatory Syndrome (MIS-C). The pathogenesis of the disease is not clear, it progresses with findings of multi-organ involvement as a result of uncontrolled inflammation of the immune system and even causes death. The rapid diagnosis of these patients and the initiation of their treatment without delay are of great importance in terms of preventing mortality and morbidity. An excessive response of inflammatory markers may be seen in multiple systemic inflammatory syndrome. Serum C reactive protein (CRP), erythrocyte sedimentation rate (ESH), fibrinogen, D-dimer, ferritin, lactate dehydrogenase (LDH), interleukin 6 (IL-6), increased neutrophil count, lymphopenia, thrombocytopenia, low albumin and blood sodium detectable. The prognosis is still uncertain as MIS-C has been newly defined and long-term patients have not been followed up. In many studies, the role of biomarkers in determining the prognosis of critically ill patients has been investigated. In this study, we also; We aimed to evaluate the clinical, demographic and laboratory data of MIS-C patients, to investigate the effect of CRP/Albumin ratio on the clinical course of the disease and its role in estimating the need for PICU. MATERIALS and METHODS: In our study, the clinical findings and demographic characteristics of the patients aged 1 month to 18 years who were diagnosed with MIS-C in the Health Sciences University Ümraniye Training and Research Hospital Pediatrics and Pediatric Intensive Care Unit (PICU) between November 2020 and March 2022. , presence of comorbid disease, hospitalization xi days in the service and PICU, pediatric mortality risk score (PRISM score) within the first 24 hours of hospitalization, need for mechanical ventilator and number of days, need for inotropic drug infusion, need for CRRT and/or ECMO, and during hospitalization. Other treatments applied and prognosis were examined. RESULTS: A total of 147 patients were included in the study. The mean age of the patients was 90.4±62.8 months, 57 of them were girls. 25 of the patients had comorbidities, RT-PCR positivity rate was 10.2%, serology positivity was 86%. Fever was found to be the most common complaint at admission. It was observed that the gastrointestinal system was most frequently involved (57.8%), followed by the mucocutaneous system (49%), the cardiovascular system (27.2%), the respiratory system (12.2%) and the neurological system (9.5%). 45.6% of the patients were lymphopenic, 19% were thrombocytopenic, and the CRP/Albumin ratio was 3.08. Ferritin level >500 ng/mL in 51 (34.7%) patients, D-dimer≥1500 ng/mL in 104 (71.2%), CRP >5 mg/dL in 116 (78.9%) patients PCT was >0.05 ng/dL, 87.8%, and hyponatremia was detected in 68 patients (46.3%). Respiratory support was given to 12.2% of the patients, IVIG treatment was applied to 125 patients, 101 (68.7%) patients were given systemic glucocorticoid, 90 (61.2%) patients were given aspirin as anticoagulant treatment, and 92 (62.6%) patients were given enoxaparin. 21 (14.1%) patients required vasopressor medication. Therapeutic plasma exchange was applied to 19 (12.9%) patients, continuous renal replacement therapy to 4 patients, and extracorporeal membrane oxygenation to 1 patient. While 99 of the patients were followed in the pediatric service, 46 (31.3%) were hospitalized and treated in the pediatric intensive care unit. Patients with Kawasaki-like disease had a lower mean age, higher lymphocyte count and troponin level, and a higher rate of TPE, and a shorter hospital stay. The neutrophil percentage of the patients hospitalized in the PICU was higher (p<0.001), the lymphocyte count, hemoglobin level and platelet count were lower than in the ward patients. The median NLR was 8.46 in PICU admissions and 4.20 in ward patients (p=0.001). CRP, ferritin, D-dimer, troponin, ALT, AST, urea and creatinine levels were higher in the PICU hospitalized patient group. Similarly, the CRP/Albumin ratio was significantly higher in the PICU hospitalized patient group, p<0.001). When the groups of patients who were xii hospitalized in the PICU for <5 days and ≥5 days were compared, it was found that the triglyceride levels of the patients who were hospitalized for ≥5 days were lower (p=0.04). The PRISM, PELOD and VIS scores of the patients who underwent TPE were found to be significantly higher (p<0.001). While thrombocyte count, sedimentation rate, albumin and fibrinogen levels were lower in patients who underwent TPD; ferritin, troponin, proBNP and D-dimer, AST, ALT, urea, creatinine, LDH levels were found to be higher (p values: <0.05). ROC curves were created to predict CRP/Albumin ratio, PICU admission, TPD application, and mechanical ventilation. ROC curve created for PICU admission was found to be significant. Accordingly, the cut-off point was 4.55 and the sensitivity, specificity, PPD and NPD were 63%, 77%, 56% and 82%, respectively. A positive and weak linear correlation was found between the CRP/Albumin ratio and the PRISM score and PELOD score (r:0.3, p<0.001). It was determined that high ferritin and D-dimer increased the risk of PICU hospitalization by 1 fold (p=.014 and p=.001, respectively), and high NLR ratio increased 1.069 times (p<.001). CONCLUSION: The findings of our study supported that the CRP/Albumin ratio could be a good indicator in determining the need for intensive care in patients diagnosed with MISC. The CRP/Albumin ratio has the advantages of being a simple, inexpensive and easily applicable method. It can be used as a good prognostic marker in determining the severity of the disease in MISC patients. It should also be considered that patients with high ferritin, D-dimer and NLR levels may need PICU, and these laboratory parameters should be closely monitored.
Benzer Tezler
- Primer nefrotik sendromlu hastalarda akut faz reaksiyonunun tedaviye yanıt ve kısa süreli renal prognoz üzerine etkisi
Acute phase reactions of patient with primary nephrotic syndrome response to treatment and short time effect on prognosis
İRFAN URUÇ
Tıpta Uzmanlık
Türkçe
2005
NefrolojiAnkara Üniversitesiİç Hastalıkları Ana Bilim Dalı
PROF.DR. KENAN ATEŞ
- Çocuklarda çoklu sistemik inflamatuvar sendrom (MIS-C) ve kawasaki hastalığı olgularının retrospektif karşılaştırılması
Retrospective comparison of multisystem inflammatory syndrome in children (MIS-C) and kawasaki disease cases
NEŞE ÜNLÜ
Tıpta Uzmanlık
Türkçe
2023
Çocuk Sağlığı ve HastalıklarıSağlık Bilimleri ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
DR. ABDULRAHMAN ÖZEL
- Çocukluk çağında toplum kökenli pnömoni tanısı ile hastaneye yatırılan hastalarda serum prokalsitonin düzeylerinin klinik ve radyolojik korelasyonu
Clinical and radiological correlations of serum procalcitonin levels in patients who are hospitalized with community acquired pneumonia in childhood
MAHMUT GÖKÇE
Tıpta Uzmanlık
Türkçe
2007
Çocuk Sağlığı ve HastalıklarıÇukurova ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
PROF.DR. EMİNE KOCABAŞ
- Çocukluk çağında etkeni mycoplasma pneumoniae saptanan pnömoni olgularının epidemiyolojik, klinik ve radyolojik özelliklerinin değerlendirilmesi
Evaluation of the epidemiological, clinical and radiological features of pneumonia cases with mycoplasma pneumoniae in childhood
SEDA HANÇERLİ DEMİRBAŞ
Tıpta Uzmanlık
Türkçe
2022
Çocuk Sağlığı ve HastalıklarıAnkara ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
DOÇ. DR. HALİL ÖZDEMİR
- Diyabetik hastalarda makula ödemi ve retinopati evresi ile oküler anjiogenezis ile ilişkili faktörlerin serum ve vitreus düzeyleri arasındaki korelasyon
The correlation between retinopathy stages and macular oedema with serum and vitreous levels of the ocular angiogenesis related factors in diabetic patients
ONUR POLAT
Tıpta Uzmanlık
Türkçe
2014
Göz HastalıklarıAfyon Kocatepe ÜniversitesiGöz Hastalıkları Ana Bilim Dalı
PROF. DR. ÜMİT ÜBEYT İNAN