{"id":23677,"date":"2021-11-10T18:32:04","date_gmt":"2021-11-10T15:32:04","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=23677"},"modified":"2023-11-06T08:55:09","modified_gmt":"2023-11-06T05:55:09","slug":"covid-19da-temel-laboratuvar-parametreleri","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/11\/10\/covid-19da-temel-laboratuvar-parametreleri\/","title":{"rendered":"COVID-19’da Temel Laboratuvar Parametrelerinin Tan\u0131sal Faydas\u0131 ve Prognostik De\u011feri"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/b><\/h2>\n

Koronavirusler, so\u011fuk alg\u0131nl\u0131\u011f\u0131 gibi toplumda yayg\u0131n g\u00f6r\u00fclen ve kendini s\u0131n\u0131rlayan hafif infeksiyon tablolar\u0131ndan, Ortado\u011fu Solunum Sendromu (\u201cMiddle East respiratory syndrome,\u201d MERS) ve A\u011f\u0131r Akut Solunum Sendromu (\u201csevere acute respiratory syndrome,\u201d SARS) gibi daha ciddi infeksiyon tablolar\u0131na neden olabilen b\u00fcy\u00fck bir virus ailesidir (1). Aral\u0131k 2019\u2019da, \u00c7in\u2019in Hubei eyaletinde bulunan Vuhan \u015fehrinde, etyolojisi bilinmeyen pn\u00f6moni olgular\u0131 bildirilmi\u015ftir. Etken, Ocak 2020\u2019de, daha \u00f6nce insanlarda tespit edilmemi\u015f yeni bir koronavirus (2019-nCoV) olarak tan\u0131mlanm\u0131\u015f ve hastal\u0131\u011f\u0131n ad\u0131 koronavirus hastal\u0131\u011f\u0131 2019 (COVID-2019) olarak kabul edilmi\u015f; virus, SARS CoV\u2019e benzerli\u011finden dolay\u0131 SARS-CoV-2 olarak adland\u0131r\u0131lm\u0131\u015ft\u0131r. Hastal\u0131\u011f\u0131n, Vuhan \u015fehri ba\u015fta olmak \u00fczere \u00c7in Halk Cumhuriyeti\u2019nin di\u011fer eyaletlerine ve d\u00fcnyaya h\u0131zla yay\u0131lm\u0131\u015f olmas\u0131 nedeniyle D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), 30 Ocak 2020 tarihi itibariyle \u201cUluslararas\u0131 Kamu\u00a0 <\/span>Sa\u011fl\u0131\u011f\u0131 Acil Durumu\u201d ilan edildi\u011fini duyurdu. Salg\u0131n, halen t\u00fcm d\u00fcnyada halk sa\u011fl\u0131\u011f\u0131 tehdidi olu\u015fturmaya devam etmektedir\u00a0 <\/span>(2).\u00a0<\/span><\/p>\n

Bula\u015f\u0131c\u0131l\u0131\u011f\u0131 y\u00fcksek olan COVID-19\u2019un patofizyolojisi hen\u00fcz tam olarak anla\u015f\u0131lamam\u0131\u015ft\u0131r. Sitokin f\u0131rt\u0131nas\u0131, SARS, MERS\u00a0 <\/span>ve influenza A virusu infeksiyonlar\u0131nda \u00f6nemli bir \u00f6l\u00fcm nedenidir (3, 4). COVID-19\u2019un da baz\u0131 hastalarda \u015fiddetli sitokin f\u0131rt\u0131nas\u0131 ile \u00f6l\u00fcme yol a\u00e7abilece\u011fi bildirilmi\u015ftir (5). Birka\u00e7 \u00e7al\u0131\u015fma, serumdaki proinflamatuar sitokinlerin artan miktarlar\u0131n\u0131n pulmoner inflamasyon ve\u00a0 <\/span>yayg\u0131n akci\u011fer hasar\u0131 ile ili\u015fkili oldu\u011funu g\u00f6stermi\u015ftir (1). Sitokin f\u0131rt\u0131nas\u0131n\u0131n \u015fiddeti, COVID-19\u2019un olu\u015fumu, geli\u015fimi ve prognozunda rol alan mekanizmalardan biri olabilir (6). Tam kan say\u0131m\u0131 parametreleri, inflamatuar s\u00fcrecin g\u00f6stergesi olarak bir\u00e7ok hastal\u0131kta ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r (7, 8).\u00a0 <\/span>C-reaktif protein (CRP) \u00f6nemli bir inflamatuar parametre ve hastal\u0131k progresyon predikt\u00f6r\u00fcd\u00fcr (9). COVID-19 hastalar\u0131nda imm\u00fcn yan\u0131t\u0131n d\u00fczensizli\u011finin de virusun patolojik s\u00fcrecinde rol alabilece\u011fi bildirilmi\u015ftir (10, 11). Bu \u00e7al\u0131\u015fman\u0131n amac\u0131, laboratuvarda rutin \u00e7al\u0131\u015f\u0131lan tam kan say\u0131m\u0131 parameterlerinin, CRP\u2019nin ve parametrelerin oranlar\u0131n\u0131n COVID-19\u2019daki tan\u0131sal ve prognostik kriterler olarak etkinliklerini incelemektir.<\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

Hastalar ve \u00c7al\u0131\u015fma Tasar\u0131m\u0131<\/b><\/h3>\n

Bu \u00e7al\u0131\u015fmada, 01 Nisan 2020 ve 15 May\u0131s 2020 tarihleri aras\u0131nda, bir e\u011fitim ve ara\u015ft\u0131rma hastanesinin COVID-19 poliklini\u011fine ba\u015fvuran hastalar retrospektif olarak incelendi. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Bilimsel Dan\u0131\u015fma Kurulu taraf\u0131ndan olu\u015fturulan COVID-19 Rehberi\u2019ne g\u00f6re\u00a0 <\/span>olas\u0131 olgu kriterlerine uyan semptomlara (ate\u015f, \u00f6ks\u00fcr\u00fck, nefes darl\u0131\u011f\u0131, bo\u011faz a\u011fr\u0131s\u0131, ba\u015f a\u011fr\u0131s\u0131, kas a\u011fr\u0131s\u0131, tat ve koku kayb\u0131 veya ishal) sahip hastalar de\u011ferlendirildi (12). Semptomlar\u0131 hastaneye ba\u015fvurmadan \u00f6nceki son be\u015f g\u00fcn i\u00e7erisinde ba\u015flayan, 18-99 ya\u015flar\u0131 aras\u0131ndaki, kad\u0131n ve erkek hastalar \u00e7al\u0131\u015fmaya dahil edildi. Hastal\u0131\u011f\u0131n tan\u0131s\u0131 infeksiyon hastal\u0131klar\u0131 ve klinik mikrobiyoloji ve g\u00f6\u011f\u00fcs hastal\u0131klar\u0131 doktorlar\u0131 taraf\u0131ndan koyuldu.\u00a0<\/span><\/p>\n

Bu \u00e7al\u0131\u015fmaya hastal\u0131k tan\u0131s\u0131 ger\u00e7ek zamanl\u0131 polimeraz zincir reaksiyonu (RT-PCR) sonucu ile do\u011frulanm\u0131\u015f, 339 COVID-19 hastas\u0131 dahil edildi. Nazal ve faringeal s\u00fcr\u00fcnt\u00fc numuneleri, COVID-19 poliklini\u011finde,\u00a0 <\/span>DS\u00d6 Rehberleri\u2019ne g\u00f6re topland\u0131 (13). Laboratuvar parametrelerinin tan\u0131sal de\u011ferlerinin saptanmas\u0131 i\u00e7in sonu\u00e7lar, 399 ki\u015fiden olu\u015fan kontrol hasta grubu ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. Kontrol grubu hastalar\u0131, COVID-19 hastalar\u0131 ile ayn\u0131 tarih aral\u0131\u011f\u0131nda poliklini\u011fine ba\u015fvuran, olas\u0131 olgu kriterlerine uygun semptomlar\u0131 olan, semptomlar\u0131 hastaneye ba\u015fvurmadan son be\u015f g\u00fcn \u00f6nce ba\u015flam\u0131\u015f, RT-PCR testi negatif ve akci\u011fer bilgisayarl\u0131 tomografi (BT) g\u00f6r\u00fcnt\u00fcleri normal olarak raporlanan, 18-99 ya\u015flar\u0131 aras\u0131nda, kad\u0131n ve erkek hastalardan rastgele se\u00e7ildi.<\/p>\n

RT-PCR testi COVID-19 i\u00e7in pozitif olan t\u00fcm hastalar hastaneye yat\u0131r\u0131lm\u0131\u015ft\u0131. Hastalar\u0131n ya\u015f\u0131, cinsiyeti, hastanede yat\u0131\u015f s\u00fcresi, ek hastal\u0131klar\u0131, yo\u011fun bak\u0131ma yat\u0131\u015flar\u0131, sa\u011fkal\u0131mlar\u0131 ve akci\u011fer BT verileri retrospektif olarak hastane bilgi i\u015fletim sisteminden tarand\u0131. Hasta ve kontrol grubunun hemogram parametreleri, CRP de\u011ferleri ve bu de\u011ferlerin oranlar\u0131 [n\u00f6trofil\/lenfosit oran\u0131 (NLR), trombosit \/lenfosit oran\u0131 (PLR) ve CRP\/lenfosit oran\u0131 (CLR)] incelendi. Hastalar\u0131n ilk poliklinik ba\u015fvurusu s\u0131ras\u0131nda al\u0131nan kan tetkik sonu\u00e7lar\u0131 de\u011ferlendirilmeye al\u0131nd\u0131. Ay\u0131r\u0131c\u0131 tan\u0131da COVID-19 d\u00fc\u015f\u00fcn\u00fclen t\u00fcm hastalar\u0131n ilk poliklinik ba\u015fvurular\u0131nda akci\u011fer BT g\u00f6r\u00fcnt\u00fclemesi yap\u0131lm\u0131\u015ft\u0131r. Bu \u00e7al\u0131\u015fma i\u00e7in etik kuruldan onay al\u0131nm\u0131\u015f olup tek merkezli bir \u00e7al\u0131\u015fmad\u0131r.<\/p>\n

\u0130statistiksel analizler \u201cIBM SPSS Statistics for Windows. Version 22.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, ABD)\u201d\u00a0 <\/span>kullan\u0131larak yap\u0131ld\u0131. Tan\u0131mlay\u0131c\u0131 istatistikler, kategorik de\u011fi\u015fkenler i\u00e7in say\u0131 ve y\u00fczde, s\u00fcrekli de\u011fi\u015fkenler i\u00e7in ortalama \u00b1 standard sapma, ortanca (minimum de\u011fer – maksimum de\u011fer) olarak sunulmu\u015ftur. S\u00fcrekli de\u011fi\u015fkenler i\u00e7in normal da\u011f\u0131l\u0131m analitik y\u00f6ntemlerle (Kolmogorov-Smirnov ve Shapiro-Wilk testi) de\u011ferlendirildi. Normal da\u011f\u0131l\u0131ma uymayan verilerde iki ba\u011f\u0131ms\u0131z grup aras\u0131nda kar\u015f\u0131la\u015ft\u0131rmal\u0131 analiz i\u00e7in Mann-Whitney U testi kullan\u0131ld\u0131. Kategorik de\u011fi\u015fkenler i\u00e7in ba\u011f\u0131ms\u0131z gruplar aras\u0131nda kar\u015f\u0131la\u015ft\u0131rma analizleri ki-kare testi ile yap\u0131lm\u0131\u015ft\u0131r. Tedavi \u00f6ncesi NLR, PLR ve CRP\/L\u2019nin tan\u0131sal ve prognostik de\u011ferleri ROC analizi kullan\u0131larak de\u011ferlendirildi. Yo\u011fun bak\u0131ma yat\u0131\u015fla ili\u015fkili ba\u011f\u0131ms\u0131z fakt\u00f6rleri de\u011ferlendirmek i\u00e7in \u00e7ok de\u011fi\u015fkenli lojistik regresyon analizi yap\u0131ld\u0131. p<\/i> < 0.05 istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n

BULGULAR<\/b><\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> COVID-19\u2019lu Hastan\u0131n Demografik \u00d6zellikleri ve Klinik Verileri<\/p><\/div>\n

\u00c7al\u0131\u015fmada de\u011ferlendirilen hastalar\u0131n ya\u015f ortalamas\u0131 49.16\u00b117.01 (ya\u015f aral\u0131\u011f\u0131: 18-93) y\u0131ld\u0131. Hasta grubunun t\u00fcm\u00fcnde COVID-19 i\u00e7in RT- PCR testi pozitif saptanm\u0131\u015ft\u0131 ve %87.6\u2019s\u0131n\u0131n akci\u011fer BT\u2019sinde viral pn\u00f6moni bulgular\u0131 vard\u0131. Hastalar\u0131n %12.4\u2019\u00fcnde ise akci\u011fer BT normal iken RT-PCR pozitifli\u011fi vard\u0131. Hastalar\u0131n %26.3\u2019\u00fcn\u00fcn ek bir hastal\u0131\u011f\u0131 vard\u0131. En s\u0131k g\u00f6r\u00fclen \u00fc\u00e7 ek hastal\u0131k s\u0131ras\u0131yla; hipertansiyon (%12.4), diabetes mellitus (%8.3) ve koroner arter hastal\u0131\u011f\u0131yd\u0131 (%5.3). Hastanede yat\u0131\u015f s\u00fcreleri ortalama alt\u0131 (yat\u0131\u015f s\u00fcresi aral\u0131\u011f\u0131: 4.0-30.0) g\u00fcn olup %9.4\u2019\u00fc yo\u011fun bak\u0131m servisine yatm\u0131\u015ft\u0131. Hastalar\u0131n %4.1\u2019i eks olmu\u015ftu ve hepsi yo\u011fun bak\u0131m takibindeydi (Tablo 1).<\/p>\n

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Tablo 2.<\/strong> Vaka Kontrol Gruplar\u0131n\u0131n De\u011ferlendirilmesi<\/p><\/div>\n

\u00c7al\u0131\u015fmaya dahil edilen kontrol grubu ile hasta grubunun cinsiyet da\u011f\u0131l\u0131mlar\u0131 benzerken (p=0.589), hasta grubunun ya\u015f ortalamas\u0131 kontrol grubuna g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu (p<\/i><0.001). Ortalama trombosit hacmi (MPV) hari\u00e7 di\u011fer t\u00fcm laboratuvar parametrelerinde anlaml\u0131 farkl\u0131l\u0131k saptand\u0131. NLR, PLR ve CLR de\u011ferlerinin hasta grubunda kontrol grubuna g\u00f6re y\u00fcksekli\u011fi anlaml\u0131 bulundu (p<\/i><0.001). Hemoglobin (Hb) de\u011ferlerinde ise COVID-19 hasta grubunda, kontrol grubuna g\u00f6re istatistiksel olarak anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck olarak saptand\u0131 (p<\/i><0.001) (Tablo 2).\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 3.<\/strong> NLR, PLR ve CLR\u2019nin \u00d6ng\u00f6rd\u00fcr\u00fcc\u00fc De\u011ferlerinin Analizi<\/p><\/div>\n

NLR, PLR ve CLR de\u011ferlerinin, hasta ve kontrol grubu kar\u015f\u0131la\u015ft\u0131rma analizlerinde anlaml\u0131 farkl\u0131l\u0131klar g\u00f6stermesi \u00fczerine, her \u00fc\u00e7 parametrenin COVID-19 i\u00e7in tan\u0131sal \u00f6ng\u00f6rd\u00fcr\u00fcc\u00fcl\u00fc\u011f\u00fc ROC analizleri ile de\u011ferlendirildi.\u00a0<\/span>NLR ve PLR i\u00e7in elde edilen \u201carea under the ROC Curve (AUC)\u201d de\u011feri istatistiksel olarak anlaml\u0131yd\u0131 (AUC=0.651 ve 0.667) ve en <\/b>y\u00fcksek <\/b>d\u00fczeyde anlaml\u0131 olan AUC de\u011feri, CLR (AUC=0.795) i\u00e7in elde edildi (Tablo 3).\u00a0<\/b><\/p>\n

Analizler sonucu her \u00fc\u00e7 parametre i\u00e7in elde edilen \u201ccut-off\u201d de\u011ferler ve bu \u201ccut-off\u201d de\u011ferlere ait duyarl\u0131l\u0131k, \u00f6zg\u00fcll\u00fck, \u201cpositive likelihood ratio\u00a0<\/b>(+LR)<\/b>\u201d, \u201cpositive predictive value\u00a0(PPV)\u201d ve \u201cnegative predictive value (NPV)\u201d de\u011ferleri incelendi\u011finde; CLR\u2019nin 2.89 ve \u00fczerindeki de\u011ferlerinin COVID-19 i\u00e7in tan\u0131sal \u00f6ng\u00f6rd\u00fcr\u00fcc\u00fcl\u00fc\u011f\u00fcn\u00fcn di\u011fer iki parametreye g\u00f6re daha iyi oldu\u011fu saptand\u0131 (Duyarl\u0131l\u0131k =%67.8, \u00f6zg\u00fcll\u00fck =%79.4, +LR=3.29, PPV=73.6% ve NPV=74.2).\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 4.<\/strong> Yo\u011fun Bak\u0131m Yat\u0131\u015f\u0131 Olan ve Olmayan Hastalar\u0131n Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

COVID-19 hastalar\u0131ndan yo\u011fun bak\u0131m yat\u0131\u015f\u0131 olan ve olmayan hastalar\u0131n ya\u015f, cinsiyet ve laboratuvar parametreleri kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. \u0130ki grubun cinsiyet da\u011f\u0131l\u0131mlar\u0131 benzer iken (p<\/i>=0.490), yo\u011fun bak\u0131ma yat\u0131r\u0131lan hastalarda yo\u011fun bak\u0131m yat\u0131\u015f\u0131 olmayanlara g\u00f6re, 65 ya\u015f ve \u00fcst\u00fc hasta say\u0131s\u0131 ile ek hastal\u0131\u011fa sahip olan hasta say\u0131s\u0131 anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu (p<\/i><0.001, p<\/i><0.001). NLR, PLR ve CLR de\u011ferleri, yo\u011fun bak\u0131m yat\u0131\u015f\u0131 olan hasta grubunda, yo\u011fun bak\u0131mda yat\u0131\u015f\u0131 olmayan hasta grubuna g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksekti (p<\/i><0.001, p<\/i>=0.005, p<\/i><0.001). Hb de\u011ferinin ise yo\u011fun bak\u0131ma yatan hastalarda, yatmayan hastalara g\u00f6re anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck oldu\u011fu g\u00f6r\u00fcld\u00fc (p<\/i><0.001). Yo\u011fun bak\u0131ma yatan t\u00fcm hastalar\u0131n akci\u011fer BT\u2019leri COVID-19 ile uyumlu raporlanm\u0131\u015ft\u0131 (Tablo 4).<\/p>\n

Ayr\u0131ca yo\u011fun bak\u0131ma yatan hastalar\u0131n %84.4\u2019\u00fcnde <\/b>NLR\u2265 2.36, %81.1\u2019inde PLR\u2265 130.4 ve %93.8\u2019inde CLR\u22652.89 olarak tespit edildi; bu de\u011ferler istatistiksel olarak anlaml\u0131yd\u0131 (p<\/i>=0.008, p<\/i>=0.016, p<\/i><0.001).\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 5.<\/strong> Yo\u011fun Bak\u0131m Yat\u0131\u015f\u0131 \u00dczerine Etkili Risk Fakt\u00f6rlerinin \u00c7ok De\u011fi\u015fkenli Lojistik Regresyon Analizi ile De\u011ferlendirilmesi<\/p><\/div>\n

Tek de\u011fi\u015fkenli analizler sonucunda; ya\u015f, ek hastal\u0131k \u00f6yk\u00fcs\u00fc, Hb, NLR, PLR ve CLR de\u011ferleri a\u00e7\u0131s\u0131ndan yo\u011fun bak\u0131m yat\u0131\u015f\u0131 durumuna g\u00f6re, gruplar aras\u0131nda istatistiksel olarak anlaml\u0131 fark bulundu (p<\/i><0.05). Tek de\u011fi\u015fkenli analizler sonucu anlaml\u0131 bulunan bu de\u011fi\u015fkenler \u00e7ok de\u011fi\u015fkenli lojistik regresyon modeline dahil edildi. Kurulan \u00e7ok de\u011fi\u015fkenli lojistik regresyon analizi modeli sonucu, ek hastal\u0131k \u00f6yk\u00fcs\u00fc olanlar\u0131n (OR: 6.03; p<\/i><0.001), 65 ya\u015f ve \u00fczerinde olanlar\u0131n (OR: 3.21; p<\/i>=0.020) ve CLR art\u0131\u015f\u0131 bulunanlar\u0131n yo\u011fun bak\u0131ma yat\u0131r\u0131lma a\u00e7\u0131s\u0131ndan riskli oldu\u011fu saptand\u0131 (Tablo 5).\u00a0<\/span><\/p>\n

\u0130RDELEME<\/b><\/h2>\n

COVID-19 tan\u0131l\u0131 339 hastay\u0131 inceledi\u011fimiz bu \u00e7al\u0131\u015fmada; NLR, PLR ve CLR de\u011ferleri hem COVID-19 tan\u0131s\u0131nda, hem de yo\u011fun bak\u0131ma yat\u0131\u015f\u0131 \u00f6ng\u00f6rmede istatistiksel olarak anlaml\u0131 bulundu. Bu parametreler daha \u00f6nce farkl\u0131 \u00e7al\u0131\u015fmalarda ayr\u0131 ayr\u0131 de\u011ferlendirilmi\u015f ve tan\u0131 veya prognozdaki rolleri ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r (11, 14). \u00c7al\u0131\u015fmam\u0131zda bu parametrelerin hepsini kapsayacak \u015fekilde hem tan\u0131n\u0131n hem de prognozun \u00f6ng\u00f6r\u00fclebilirli\u011fi incelendi. De\u011ferlendirilen 339 hastan\u0131n ya\u015f ortalamas\u0131 46 y\u0131l olup COVID-19 olmayanlara g\u00f6re ortalamas\u0131 daha y\u00fcksekti. COVID-19\u2019un ya\u015fl\u0131 erkeklerde ortaya \u00e7\u0131kma olas\u0131l\u0131\u011f\u0131n\u0131n daha y\u00fcksek oldu\u011fu baz\u0131 \u00e7al\u0131\u015fmalarda tespit edilmi\u015ftir (15, 16). Liu ve ark.\u2019n\u0131n (14) \u00e7al\u0131\u015fmas\u0131nda ise hastalar\u0131n % 53.4\u2019\u00fc ve \u00c7in\u2019de yap\u0131lan, 1049 hastay\u0131 i\u00e7eren ba\u015fka bir \u00e7al\u0131\u015fmada ise hastalar\u0131n %54\u2019\u00fc kad\u0131n olarak bildirilmi\u015ftir (17). \u00c7al\u0131\u015fmam\u0131zda erkek hastalar\u0131n oran\u0131 daha y\u00fcksek olmakla birlikte cinsiyet oranlar\u0131 aralar\u0131nda istatiksel olarak fark yoktu. Yo\u011fun bak\u0131ma yatan hastalar\u0131n %68.8\u2019i 65 ya\u015f ve \u00fcst\u00fcyd\u00fc; bu y\u00fckseklik istatiksel olarak anlaml\u0131yd\u0131. Teker ve ark.\u2019n\u0131n (18) \u00e7al\u0131\u015fmas\u0131nda ya\u015fla beraber COVID-19 hastal\u0131\u011f\u0131n\u0131n seyrinin a\u011f\u0131rla\u015ft\u0131\u011f\u0131 ve \u00f6l\u00fcmlerin artt\u0131\u011f\u0131 belirlenmi\u015ftir. Ya\u015fl\u0131 hastalarda infeksiyona zemin haz\u0131rlayan \u00e7ok say\u0131da risk fakt\u00f6r\u00fc vard\u0131r ve imm\u00fcn fonksiyonlarda zay\u0131flama bunlardan biridir (19). Bu durum yo\u011fun bak\u0131ma yatan hastalar\u0131n ya\u015f ortalamas\u0131n\u0131n daha y\u00fcksek olmas\u0131n\u0131n bir nedeni olabilir. Ayn\u0131 zamanda ya\u015fl\u0131larda kronik hastal\u0131klar\u0131n artmas\u0131, \u00f6ks\u00fcr\u00fck refleksi, dola\u015f\u0131m ve yara iyile\u015fmesinde azalma gibi fizyolojik fonksiyonlar da infeksiyona zemin haz\u0131rlayan fakt\u00f6rlerden baz\u0131lar\u0131d\u0131r (19).\u00a0 <\/span>Wang\u00a0 <\/span>ve ark. (20), ya\u015fl\u0131 insanlar\u0131n kronik hastal\u0131klar ve infeksiyonlar i\u00e7in daha y\u00fcksek risk alt\u0131nda oldu\u011funu, hipertansiyon ve koroner kalp hastal\u0131\u011f\u0131 olanlarda COVID-19\u2019a ba\u011fl\u0131 mortalitenin artt\u0131\u011f\u0131n\u0131 bildirmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda hipertansiyon, diabetes mellitus ve koroner arter hastal\u0131\u011f\u0131 en s\u0131k g\u00f6r\u00fclen ek hastal\u0131klard\u0131 ve yo\u011fun bak\u0131ma yatan hastalar\u0131n %65.6\u2019s\u0131n\u0131n ek hastal\u0131\u011f\u0131 vard\u0131. Bu durum ek hastal\u0131klar\u0131n ba\u011f\u0131\u015f\u0131kl\u0131k sistemini zay\u0131flatmas\u0131na ba\u011fl\u0131 olabilece\u011fi gibi COVID-19\u2019lu ya\u015fl\u0131larda zaten ek hastal\u0131klar\u0131n daha fazla olmas\u0131 ile de ilgili olabilir.<\/p>\n

COVID-19 poliklini\u011fine ba\u015fvuran hastalar\u0131n %12.4\u2019\u00fcnde RT-PCR testi pozitif iken akci\u011fer BT bulgular\u0131 do\u011fald\u0131. Bu durumda hastalar, PCR sonu\u00e7lar\u0131 \u00e7\u0131kana kadar hastal\u0131\u011f\u0131 yayma riski olu\u015fturuyor. Ayr\u0131ca, Karako\u00e7 ve ark.\u2019n\u0131n (21) \u00e7al\u0131\u015fmas\u0131nda da RT-PCR testlerinin duyarl\u0131l\u0131\u011f\u0131n\u0131n, COVID-19\u2019un tan\u0131s\u0131nda ve tedavisinin y\u00f6nlendirilmesinde yeterli olmad\u0131\u011f\u0131 belirtilmi\u015fti. Bu da pandemi kontrol\u00fc a\u00e7\u0131s\u0131ndan \u00f6nemli bir dezavantaj olup bize erken tan\u0131da yol g\u00f6sterecek ba\u015fka parametrelerin ihtiyac\u0131n\u0131 g\u00f6stermi\u015ftir. Ferrari ve ark. (22), RT-PCR testi yapma imkan\u0131 s\u0131n\u0131rl\u0131 olan geli\u015fmekte olan \u00fclkelerde, basit hematolojik testlerin COVID-19 tan\u0131s\u0131nda kullan\u0131labilece\u011fini belirtmi\u015flerdir. Ayr\u0131ca\u00a0 <\/span>her ne kadar genetik olarak aralar\u0131nda farklar olsa da, hala fiziksel ve kimyasal olarak bir\u00e7ok benzerlik ta\u015f\u0131yan SARS-CoV ile ilgili \u00e7al\u0131\u015fmalarda da, hematolojik parametrelerin \u00f6nemi vurgulanm\u0131\u015ft\u0131r (1, 3). SARS hastalar\u0131n\u0131n retrospektif bir analizinde, tan\u0131 alan hastalar\u0131n %68 ile %90\u2019\u0131n\u0131nda lenfositopeni, %20 ile %45\u2019inde trombositopeni ve %20 ile %34\u2019\u00fcnde l\u00f6kopeni saptand\u0131\u011f\u0131 bildirilmi\u015ftir (23). \u00c7al\u0131\u015fmam\u0131zda, COVID-19 hastalar\u0131nda Hb de\u011feri kontrol grubuna g\u00f6re anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck bulundu. Zheng ve ark. (29), COVID-19 hastalar\u0131n\u0131n %21.75\u2019inde anemi bulundu\u011funu bildirirken, Li ve ark. (24), Hb d\u00fczeyinin kontrol grubuna g\u00f6re farkl\u0131 olmad\u0131\u011f\u0131n\u0131 bildirmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda, yo\u011fun bak\u0131ma yatan hastalar\u0131n Hb de\u011feri de yo\u011fun bak\u0131m yat\u0131\u015f\u0131 olmayan hastalara g\u00f6re daha d\u00fc\u015f\u00fckt\u00fc. Bu durum ya\u015fl\u0131 ve komorbitesi y\u00fcksek olan hastalarda s\u0131kl\u0131kla kronik hastal\u0131k anemisi g\u00f6r\u00fclmesine ba\u011fl\u0131 olabilir. Ayr\u0131ca Hb d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcn\u00fcn, COVID-19\u2019da k\u00f6t\u00fc prognoz parametrelerden biri olabilece\u011fini de d\u00fc\u015f\u00fcnd\u00fcrm\u00fc\u015ft\u00fcr. Bunun i\u00e7in virusun patogenezini a\u00e7\u0131klamaya y\u00f6nelik kapsaml\u0131 \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r.\u00a0<\/span><\/p>\n

RDW, eritrositlerin heterojenitesini g\u00f6steren bir parametredir ve sistemik inflamasyon RDW art\u0131\u015f\u0131na neden olabilmektedir (25). Lu ve ark. (26) taraf\u0131ndan,\u00a0 <\/span>COVID-19 hastalar\u0131n\u0131n laboratuvar parametrelerinin incelendi\u011fi \u00e7al\u0131\u015fmada RDW de\u011ferinin artt\u0131\u011f\u0131 belirtilmi\u015ftir. Gong ve ark. (27) ise RDW art\u0131\u015f\u0131 ile COVID-19 \u015fiddetinin ili\u015fkili oldu\u011funu belirtmi\u015ftir. Bizim \u00e7al\u0131\u015fmam\u0131zda RDW, COVID-19 hastalar\u0131nda kontrol grubuna g\u00f6re ve yo\u011fun bak\u0131ma yatan hastalarda da yatmayanlara g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksekti. Bu da RDW\u2019nin pratikte tan\u0131sal ve prognozu \u00f6ng\u00f6rme ama\u00e7l\u0131 kullan\u0131labilece\u011fini ortaya koymu\u015ftur. \u00a0<\/span><\/p>\n

Lenfopeni, COVID-19 hastalar\u0131nda yayg\u0131n bir anomali olarak bildirilmi\u015ftir (11, 24). Apoptozunun bir sonucu olarak, MERS infeksiyonunda da klinik tablosu k\u00f6t\u00fc olan hastalarda lenfopeni saptanm\u0131\u015ft\u0131r (28). Qin ve ark.\u2019n\u0131n (11) yapt\u0131klar\u0131 bir \u00e7al\u0131\u015fmada, COVID-19 hastalar\u0131nda lenfositlerin neredeyse yar\u0131 yar\u0131ya azald\u0131\u011f\u0131 bildirilmi\u015ftir ve koronaviruslar\u0131n \u00f6zellikle T-lenfositlerin say\u0131s\u0131n\u0131 azaltarak etki g\u00f6sterdi\u011fi belirtilmi\u015ftir. \u00c7in\u2019de 141 COVID-19 hastas\u0131n\u0131n incelendi\u011fi bir \u00e7al\u0131\u015fmada, hastalar\u0131n yakla\u015f\u0131k yar\u0131s\u0131nda (%46.8) ba\u015fvuru s\u0131ras\u0131nda lenfopeni varken, bu oran \u015fiddetli hastalarda % 82.8\u2019i olarak saptanm\u0131\u015f olup klinik tablo a\u011f\u0131rla\u015ft\u0131k\u00e7a lenfopeninin belirginle\u015fti\u011fi rapor edilmi\u015ftir (29). \u00c7al\u0131\u015fmam\u0131zda da hasta grubunda anlaml\u0131 olarak lenfopeni saptand\u0131.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, COVID-19 hastalar\u0131nda, hastal\u0131k olmayanlara g\u00f6re n\u00f6trofil ve l\u00f6kosit say\u0131s\u0131 anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck iken yo\u011fun bak\u0131mda yatan hastalarda yo\u011fun bak\u0131ma yatmayanlara g\u00f6re n\u00f6trofil ve l\u00f6kosit say\u0131s\u0131 anlaml\u0131 olarak daha y\u00fcksekti. \u0130talya\u2019da, 105 COVID-19 hastas\u0131n\u0131n, 102 kontrol grubu hastas\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada sadece l\u00f6kosit say\u0131s\u0131nda anlaml\u0131 d\u00fczeyde fark g\u00f6r\u00fclm\u00fc\u015f ve bu sonucun hasta say\u0131s\u0131n\u0131n azl\u0131\u011f\u0131ndan kaynaklanabilece\u011fi belirtilmi\u015ftir (22). Li ve ark.\u2019n\u0131n (24), 989 hastay\u0131 inceledikleri \u00e7al\u0131\u015fmada ise COVID-19 hastalar\u0131nda l\u00f6kopeni varl\u0131\u011f\u0131 istatistiksel olarak anlaml\u0131 bulunmu\u015ftur. Lagunas-Rangel\u2019in (30) \u00e7al\u0131\u015fmas\u0131nda ise ciddi COVID-19 hastalar\u0131nda, NLR\u2019nin anlaml\u0131 d\u00fczeyde y\u00fcksek oldu\u011fu ve sitokin f\u0131rt\u0131nas\u0131n\u0131n bir sonucu olarak n\u00f6trofili olabilece\u011fi bildirilmi\u015ftir. Bu sonu\u00e7, hastalarda klinik durum k\u00f6t\u00fcle\u015ftik\u00e7e n\u00f6trofil say\u0131s\u0131n\u0131n artmas\u0131na veya lenfosit say\u0131s\u0131n\u0131n azalmas\u0131na ba\u011flanabilir. Bu sonucu do\u011frulamak i\u00e7in d\u00fczenli olarak laboratuvar de\u011ferlerinin takip edildi\u011fi geni\u015f \u00e7apl\u0131 \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r. NLR, sistemik inflamasyon ve bakteriyel infeksiyon i\u00e7in \u00f6ng\u00f6r\u00fcc\u00fc olarak kabul edilmektedir (31). Qin ve ark.\u2019n\u0131n (11), 452 COVID-19 hasta ile yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, NLR\u2019nin hastal\u0131\u011f\u0131n \u015fiddeti ile korelasyon g\u00f6sterdi\u011fi bulunmu\u015f ve hastal\u0131\u011f\u0131n patogenezinde hiperinflamatuar yan\u0131t\u0131n rol alabilece\u011fi bildirilmi\u015ftir. G\u00fcneysu ve ark. (32),\u00a0 <\/span>COVID-19 hastalar\u0131nda NLR\u2019nin mortaliteyi belirlemek i\u00e7in kullan\u0131labilece\u011fini belirtmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda NLR de\u011feri, hem COVID-19 hastalar\u0131nda tan\u0131sal olarak anlaml\u0131 bulundu, hem de yo\u011fun bak\u0131ma yatan hastalarda daha y\u00fcksek saptand\u0131. NLR\u2019nin pratikte kullan\u0131labilecek bir parametre oldu\u011fu sonucuna vard\u0131k. Hou ve ark.\u2019n\u0131n (33) yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada, \u015fiddetli COVID-19\u2019da, n\u00f6trofil say\u0131lar\u0131n\u0131n, sitokin konsantrasyonlar\u0131n\u0131n (IL-2R, IL-6, IL-8, IL-10 ve TNF-a) ve CRP\u2019nin artt\u0131\u011f\u0131 bildirilmi\u015ftir.<\/p>\n

CRP, sepsisin infeksiy\u00f6z ve non-infeksiy\u00f6z nedenlerini ay\u0131rt etmede kullan\u0131labilen bir parametredir (34). SARS\u2019da mortalite ile CRP\u2019nin ili\u015fkili oldu\u011fu g\u00f6sterilmi\u015ftir (10).\u00a0 <\/span>Ayn\u0131 zamanda, IL-6, IL-8 ve TNF-alfa gibi sitokinlerin h\u0131zl\u0131 \u015fekilde y\u00fckselmesinin, akut solunum s\u0131k\u0131nt\u0131s\u0131 sendromu (ARDS) geli\u015fiminde rol oynad\u0131\u011f\u0131 ve bu sitokinler ile CRP y\u00fcksekli\u011finin SARS\u2019da akci\u011fer infiltrasyonu ile ili\u015fkili oldu\u011fu bildirilmi\u015ftir (9). \u0130ran\u2019da COVID-19 tan\u0131l\u0131 100 hastan\u0131n de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, komorbid durumlar\u0131n, y\u00fcksek CRP d\u00fczeylerinin ve d\u00fc\u015f\u00fck lenfosit say\u0131s\u0131n\u0131n artm\u0131\u015f \u00f6l\u00fcm riski ile ili\u015fkili oldu\u011funu bildirilmi\u015ftir (35). Mardani ve ark.\u2019n\u0131n (36) laboratuvar parametlerinin tan\u0131 g\u00fcc\u00fcn\u00fc ara\u015ft\u0131rd\u0131klar\u0131 \u00e7al\u0131\u015fmas\u0131nda, COVID-19 i\u00e7in tan\u0131 koymada CRP\u2019nin g\u00fc\u00e7l\u00fc oldu\u011fu fakat lenfosit de\u011ferinin olmad\u0131\u011f\u0131 bildirilmi\u015ftir. Bizim \u00e7al\u0131\u015fmam\u0131zda ise hasta grubunda ve yo\u011fun bak\u0131m yat\u0131\u015f\u0131 olanlarda, CRP anlaml\u0131 d\u00fczeyde y\u00fcksek olup lenfosit anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fckt\u00fc.<\/p>\n

\u00c7in\u2019de yap\u0131lan, alt\u0131 \u00e7al\u0131\u015fman\u0131n derlendi\u011fi ve 828 hastay\u0131 i\u00e7eren bir meta-analizde ise hastalar\u0131n 407\u2019si a\u011f\u0131r\/\u015fiddetli hasta olarak de\u011ferlendirilmi\u015f ve bu hastalarda a\u011f\u0131r olmayan hasta grubuna g\u00f6re CLR de\u011ferindeki fark anlaml\u0131 bulunmu\u015ftur (30). \u00c7al\u0131\u015fmam\u0131zda, COVID-19 hastas\u0131 olanlarda, kontrol grubuna g\u00f6re ve yo\u011fun bak\u0131ma yatanlarda yatmayanlara g\u00f6re, CLR\u2019de anlaml\u0131 d\u00fczeyde y\u00fckseklik tespit edildi; COVID-19 tan\u0131s\u0131nda en y\u00fcksek duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fck CRL\u2019ye aitti. CLR ayn\u0131 zamanda yo\u011fun bak\u0131ma yat\u0131\u015f i\u00e7in risk fakt\u00f6r\u00fc olarak bulundu. Bu sonu\u00e7larla, olas\u0131 olgu kriterlerine sahip semptomlarla polikliniklere ba\u015fvuran hastalarda, CLR de\u011ferinin tan\u0131da kullan\u0131labilece\u011fini ve CLR>2.89 olan hastalarda COVID-19 ihtimalinin di\u011fer hastalara g\u00f6re daha y\u00fcksek olabilece\u011fini saptad\u0131k. Ayn\u0131 zamanda RT-PCR ile COVID-19 tan\u0131s\u0131 kesinle\u015fmi\u015f olgularda CLR>2.89 de\u011ferinin yo\u011fun bak\u0131ma yat\u0131\u015f i\u00e7in risk fakt\u00f6r\u00fc kabul edilerek k\u00f6t\u00fc prognostik fakt\u00f6r olarak de\u011ferlendirilebilece\u011fi sonucuna vard\u0131k.<\/p>\n

Trombositlerin, n\u00f6trofillerin ve di\u011fer inflamatuar h\u00fccrelerin inflamatuar yan\u0131tta \u00f6nemli g\u00f6revleri vard\u0131r (37). Daha \u00f6nce yap\u0131lm\u0131\u015f baz\u0131 \u00e7al\u0131\u015fmalar, \u015fiddetli infeksiyonlar\u0131n ve ba\u011f\u0131\u015f\u0131kl\u0131k ile ili\u015fkili fakt\u00f6rlerin trombosit say\u0131s\u0131nda h\u0131zl\u0131 bir d\u00fc\u015f\u00fc\u015fe ve sekonder trombositopeniye neden oldu\u011funu g\u00f6stermi\u015ftir (38). PLR art\u0131\u015f\u0131n\u0131n, prognoz ile ili\u015fkili oldu\u011fu ve potansiyel bir inflamatuar belirte\u00e7 olarak kullan\u0131labilece\u011fi de bildirilmi\u015ftir (39). SARS infeksiyonunda, trombositopeninin \u00f6ne \u00e7\u0131kan laboratuvar bulgular\u0131ndan biri oldu\u011fu ve prognoz ile ili\u015fkili olabilece\u011fi raporlanm\u0131\u015ft\u0131r (40). \u00c7in\u2019de yap\u0131lan ve 141 hastan\u0131n incelendi\u011fi bir \u00e7al\u0131\u015fmada \u015fiddetli COVID-19 hastalar\u0131nda trombosit say\u0131s\u0131n\u0131n anlaml\u0131 d\u00fczeyde daha d\u00fc\u015f\u00fck oldu\u011fu ve klinik durum k\u00f6t\u00fcle\u015ftik\u00e7e trombosit say\u0131s\u0131n\u0131n daha da d\u00fc\u015ft\u00fc\u011f\u00fc rapor edilmi\u015ftir (29). Qu ve ark. (37) ise, COVID-19 hastalar\u0131nda PLR de\u011ferinin, \u00f6zellikle ciddi seyirli ve ya\u015fl\u0131 hastalarda daha d\u00fc\u015f\u00fck oldu\u011funu ve ciddi durumdaki hastalar i\u00e7in ba\u011f\u0131ms\u0131z fakt\u00f6r oldu\u011funu belirtmi\u015flerdir. \u00c7al\u0131\u015fmam\u0131zda ise COVID-19 hastalar\u0131nda, kontrol grubuna g\u00f6re trombosit say\u0131s\u0131nda anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fckl\u00fck vard\u0131 fakat yo\u011fun bak\u0131ma yat\u0131\u015f\u0131 olanlarla yat\u0131\u015f\u0131 olmayanlar aras\u0131nda anlaml\u0131 d\u00fczeyde fark tespit edilmedi. Bu sonu\u00e7 bize trombosit say\u0131s\u0131n\u0131n, hastal\u0131\u011f\u0131n seyrindeki \u00f6ng\u00f6r\u00fcc\u00fc etkisinin saptanmas\u0131 i\u00e7in daha fazla hasta ile yap\u0131lan ve hastanedeki takip s\u00fcrecine yay\u0131lan \u00e7al\u0131\u015fmalara gereksinim oldu\u011funu g\u00f6stermi\u015ftir.\u00a0 <\/span>PLR ise literat\u00fcr verileri ile uyumlu bir \u015fekilde hem hasta grubunda kontrol grubuna g\u00f6re hem de yo\u011fun bak\u0131ma yatan hastalarda, yatmayanlara g\u00f6re daha y\u00fcksekti. PLR\u2019nin tan\u0131sal \u00f6ng\u00f6r\u00fcc\u00fcl\u00fc\u011f\u00fc istatistiksel olarak anlaml\u0131yd\u0131 ve PLR \u2265130.4 olan olas\u0131 olgularda COVID-19 tan\u0131s\u0131n\u0131n \u00f6n planda d\u00fc\u015f\u00fcn\u00fclerek k\u00f6t\u00fc prognoz a\u00e7\u0131s\u0131ndan dikkat edilmesi gerekti\u011fi sonucuna ula\u015f\u0131ld\u0131.<\/p>\n

COVID-19 hastalar\u0131nda prognozu \u00f6ng\u00f6rebilmek b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r. Ciddi seyirli olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclen hastalar daha erken d\u00f6nemde hastaneye yat\u0131r\u0131l\u0131r, yak\u0131n medikal destek ve tedavi sa\u011flan\u0131r. Bu da mortalitenin azalt\u0131lmas\u0131nda etkili olabilir. \u00c7al\u0131\u015fmam\u0131zda NLR, PLR ve CLR gibi basit tetkikler\u00a0 <\/span>hem COVID-19 tan\u0131s\u0131nda hem de yo\u011fun bak\u0131m yat\u0131\u015f\u0131nda\u00a0 <\/span>\u00f6nemli belirleyiciler olarak bulunmu\u015ftur.<\/p>\n

\u00c7al\u0131\u015fman\u0131n k\u0131s\u0131tl\u0131 y\u00f6nleri<\/b><\/h3>\n

\u00c7al\u0131\u015fmam\u0131z tek merkezli bir \u00e7al\u0131\u015fmad\u0131r. COVID-19\u2019da tan\u0131sal g\u00fcc\u00fc de\u011ferlendirebilmek i\u00e7in hastalar\u0131n poliklinikteki ilk ba\u015fvuru laboratuvar de\u011ferleri dikkate al\u0131nm\u0131\u015f olup hastanedeki yat\u0131\u015f s\u00fcreci boyunca olu\u015fan laboratuvar parametrelerindeki de\u011fi\u015fiklikler takip edilmemi\u015ftir. Ayr\u0131ca, laboratuvar sonu\u00e7lar\u0131 bakteriyel koinfeksiyonlardan etkilenmi\u015f olabilir.\u00a0<\/span><\/p>\n

Sonu\u00e7<\/b><\/h3>\n

Neredeyse her laboratuvarda yap\u0131lan tam kan say\u0131m\u0131 ve CRP kullan\u0131larak hastal\u0131\u011f\u0131n tan\u0131s\u0131 ve ciddiyeti \u00f6ng\u00f6r\u00fclebilir. Bu kapsamda, NLR, PLR ve CLR\u2019nin pratikte yard\u0131mc\u0131 olmas\u0131n\u0131n yan\u0131 s\u0131ra 65 ya\u015f \u00fcst\u00fc olmak, ek hastal\u0131k ve CLR k\u00f6t\u00fc prognostik fakt\u00f6rler olarak de\u011ferlendirilebilir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Koronavirusler, so\u011fuk alg\u0131nl\u0131\u011f\u0131 gibi toplumda yayg\u0131n g\u00f6r\u00fclen ve kendini s\u0131n\u0131rlayan hafif infeksiyon tablolar\u0131ndan, Ortado\u011fu Solunum Sendromu (\u201cMiddle East respiratory syndrome,\u201d MERS) ve A\u011f\u0131r Akut Solunum Sendromu (\u201csevere acute respiratory syndrome,\u201d SARS) gibi daha ciddi infeksiyon tablolar\u0131na neden olabilen b\u00fcy\u00fck bir virus ailesidir (1). Aral\u0131k 2019\u2019da, \u00c7in\u2019in Hubei eyaletinde bulunan Vuhan \u015fehrinde, etyolojisi bilinmeyen pn\u00f6moni […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5296,5174,5298,5299,5297],"class_list":["post-23677","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-c-reaktif-protein","tag-covid-19","tag-notrofil-lenfosit-orani","tag-tam-kan-sayimi","tag-trombosit-lenfosit-orani"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23677","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=23677"}],"version-history":[{"count":5,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23677\/revisions"}],"predecessor-version":[{"id":27752,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23677\/revisions\/27752"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=23677"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=23677"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=23677"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}