{"id":27262,"date":"2023-09-29T00:14:09","date_gmt":"2023-09-28T21:14:09","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=27262"},"modified":"2023-09-30T17:11:18","modified_gmt":"2023-09-30T14:11:18","slug":"covid-19-hastalarinda-pcr-dongu-esik-degerleri","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/09\/29\/covid-19-hastalarinda-pcr-dongu-esik-degerleri\/","title":{"rendered":"COVID-19 Hastalar\u0131n\u0131n Ger\u00e7ek Zamanl\u0131 PCR D\u00f6ng\u00fc E\u015fik De\u011ferleri ile Klinik Seyir, Mortalite ve Laboratuvar Parametrelerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131"},"content":{"rendered":"

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

COVID-19\u2019un kesin tan\u0131s\u0131, solunum yolu \u00f6rneklerinde ger\u00e7ek zamanl\u0131 revers-transkriptaz polimeraz zincir reaksiyonu (rRT-PCR) ile SARS-CoV-2 RNA\u2019s\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131 sonucu konulmaktad\u0131r; rRT-PCR\u2019da RdRp, ORF1, S, N, E gen b\u00f6lgeleri hedeflenmektedir. Hastal\u0131\u011f\u0131n ba\u015flang\u0131\u00e7 evresinde nazofarinks ve orafarinks s\u00fcr\u00fcnt\u00fc \u00f6rnekleri tercih edilirken ileri evrelerinde alt solunum yolu \u00f6rnekleri tercih edilmektedir (1).<\/span><\/p>\n

Ger\u00e7ek zamanl\u0131 revers-transkriptaz PCR d\u00f6ng\u00fc e\u015fik (cycle threshold – Ct) de\u011feri, viral RNA\u2019n\u0131n saptanabilir bir seviyeye ula\u015fmas\u0131 i\u00e7in gereken d\u00f6ng\u00fc say\u0131s\u0131n\u0131 ifade eder. Ct de\u011feri viral y\u00fck ve SARS-CoV-2\u2019nin in vitro<\/i> b\u00fcy\u00fcme yetene\u011fi ile ters orant\u0131l\u0131d\u0131r (2). Ct de\u011ferindeki her birim art\u0131\u015f\u0131n\u0131n, virusun izolasyon olas\u0131l\u0131\u011f\u0131n\u0131 %33 azaltt\u0131\u011f\u0131; Ct de\u011feri >35 oldu\u011funda ise virus izolasyon oran\u0131n\u0131n %8 oldu\u011fu g\u00f6sterilmi\u015ftir (3). Yap\u0131lan bir \u00e7al\u0131\u015fmada, Ct de\u011feri 13-17 olan \u00f6rneklerde in vitro<\/i> k\u00fclt\u00fcrde \u00fcreme saptan\u0131rken; Ct de\u011feri >33 oldu\u011funda \u00fcremenin %12 azald\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (4). Ct de\u011feri; hastal\u0131\u011f\u0131n \u015fiddetini ve ilerlemesini tahmin etmek, bula\u015ft\u0131r\u0131c\u0131l\u0131\u011f\u0131n\u0131 belirlemek ve aktif viral replikasyonunu uzun s\u00fcreli virus sa\u00e7\u0131l\u0131m\u0131ndan ay\u0131rt etmek i\u00e7in kullan\u0131lm\u0131\u015ft\u0131r (2).<\/p>\n

COVID-19 hastalar\u0131nda hastal\u0131\u011f\u0131n ciddiyetini tahmin etmede C-reaktif protein (CRP), ferritin ve PCT kullan\u0131labilmektedir. Kritik hastalarda CRP, ferritin ve PCT de\u011ferlerinin ayaktan hastalara g\u00f6re daha y\u00fcksek seviyede oldu\u011fu g\u00f6sterilmi\u015ftir (5). Ayr\u0131ca d\u00fc\u015f\u00fck alb\u00fcmin ve y\u00fcksek laktat dehidrogenaz (LDH) seviyeleri de k\u00f6t\u00fc prognoz g\u00f6stergesi olarak kabul edilmektedir (6). Ayr\u0131ca COVID-19\u2019a e\u015flik eden ba\u015fka bir kronik hastal\u0131\u011f\u0131n olmas\u0131 da k\u00f6t\u00fc prognoz g\u00f6stergesidir. Diabetes mellitus (DM) ve hipertansiyon (HT)\u2019un da COVID-19\u2019a e\u015flik etti\u011fi takdirde mortaliteyi art\u0131rabildi\u011fi g\u00f6sterilmi\u015ftir (7).<\/p>\n

Bu \u00e7al\u0131\u015fmada, COVID-19 hastalar\u0131nda rRT-PCR Ct de\u011feri ile klinik
\nseyir, mortalite ve laboratuvar parametrelerinin ili\u015fkisinin de\u011ferlendirilmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fma kapsam\u0131nda, 01 Temmuz – 01 A\u011fustos 2020 tarihleri aras\u0131nda SARS-CoV-2 rRT-PCR testi yap\u0131lan hastalar retrospektif olarak tarand\u0131 ve test sonucu pozitif olanlar \u00e7al\u0131\u015fmaya dahil edildi. \u0130leri tetkik ve tedavi i\u00e7in ba\u015fka merkeze sevk edilen, ba\u015fka bir nedenden dolay\u0131 hastanede yatmakta iken SARS-CoV-2 rRT-PCR test sonucu pozitif \u00e7\u0131kan ve COVID-19 tan\u0131s\u0131 ile serviste yatmakta iken yo\u011fun bak\u0131ma al\u0131nan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131. \u0130lk ba\u015fvuruda yo\u011fun bak\u0131ma al\u0131nan hastalar yo\u011fun bak\u0131m hasta grubu olarak de\u011ferlendirildi. \u00c7al\u0131\u015fmaya d\u00e2hil edilen hastalar; ayaktan, servis ve yo\u011fun bak\u0131mda tedavi g\u00f6renler olarak grupland\u0131r\u0131ld\u0131. Ayaktan tedavi g\u00f6ren hastalar\u0131n hastaneye ilk ba\u015fvurular\u0131nda yap\u0131lan rRT-PCR testi Ct de\u011ferleri kullan\u0131ld\u0131; yatarak tedavi g\u00f6ren hastalarda ise servis ya da yo\u011fun bak\u0131m yat\u0131\u015f\u0131n\u0131n ilk 24 saatindeki de\u011ferler kullan\u0131ld\u0131. Hastalar\u0131n; ya\u015f, cinsiyet, hastane yat\u0131\u015f s\u00fcresi, sa\u011fkal\u0131m ve komorbid hastal\u0131k durumu hastane bilgi siteminden elde edildi. Altta yatan hastal\u0131klar; HT, DM, kardiyovask\u00fcler hastal\u0131klar, respiratuar sistem hastal\u0131klar\u0131, maligniteler ve santral sinir sistemi hastal\u0131klar\u0131 olarak alt\u0131 gruba ayr\u0131ld\u0131. Ayr\u0131ca yatarak tedavi g\u00f6ren hastalar\u0131n hastaneye yat\u0131\u015ftan sonraki ilk 24 saatte \u00f6l\u00e7\u00fclen CRP, ferritin, alb\u00fcmin, LDH, PCT ve demir de\u011ferleri de retrospektif olarak tarand\u0131. Hastalar\u0131n Ct de\u011ferleri bak\u0131lan her parametre ile ayr\u0131 ayr\u0131 k\u0131yasland\u0131.<\/p>\n

COVID-19 laboratuvar tan\u0131s\u0131; viral transport besiyeri ya da viral n\u00fckleik asit tamponu (vNAT) i\u00e7eren t\u00fcplere al\u0131nan nazofarengeal ve orofarengeal s\u00fcr\u00fcnt\u00fc \u00f6rneklerinden, vNAT sol\u00fcsyonu ile izole edilen viral RNA\u2019lar\u0131n rRT-PCR testi ile yap\u0131lm\u0131\u015ft\u0131. Testlerde, Bio-speedy SARS-CoV-2 rRT-PCR kitleri (Bioeksen, T\u00fcrkiye) ve \u201cCFX96 Touch Real-Time PCR Detection System\u201d (Bio-Rad Laboratuvarlar\u0131, ABD) cihaz\u0131 kullan\u0131lm\u0131\u015ft\u0131. SARS-CoV-2 tespitinde, SARS-CoV-2\u2019ye spesifik a\u00e7\u0131k okuma b\u00f6lgesi (Open Reading Frame – ORF) 1Ab ve N (nucleocapsid) genleri ile internal kontrol olarak insan RNase P (ribon\u00fckleaz P) geni hede\ufb02eyen kit kullan\u0131lm\u0131\u015f olup SARS-CoV-2 gen hedefleri i\u00e7in Ct de\u011ferleri <38 olan sonu\u00e7lar i\u00e7in pozitif kabul edilmi\u015fti. C-reaktif protein, LDH, ferritin, demir, alb\u00fcmin testleri BS-2000 (Mindray, \u00c7in) cihaz\u0131 ile PCT testi Getein 1600 (Getein Biotech, \u00c7in) cihaz\u0131 ile serum \u00f6rneklerinden \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131. S\u00f6z konusu testlerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda test sonucu olmayan hastalar istatistiksel analize d\u00e2hil edilmedi.<\/p>\n

Verilerin analizi, SPSS (Statistical Package for the Social Sciences) versiyon 20.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile yap\u0131ld\u0131.\u00a0Gruplar\u0131n normal da\u011f\u0131l\u0131ma uyumlulu\u011fu Shapiro-Wilk testi ile de\u011ferlendirildi. Normal da\u011f\u0131l\u0131m g\u00f6steren gruplar\u0131n verilerinin ifadesinde \u201cortalama\u00b1standart sapma\u201d, normal da\u011f\u0131l\u0131ma uymayan gruplar\u0131n verilerinin ifadesinde ise \u201cmedyan [25. y\u00fczdelik-75. y\u00fczdelik]\u201d kullan\u0131ld\u0131. Normal da\u011f\u0131l\u0131ma uyan gruplar\u0131n kantitatif verilerinin kar\u015f\u0131la\u015ft\u0131rmas\u0131nda Student\u00a0 <\/span>t testi kullan\u0131ld\u0131. Normal da\u011f\u0131l\u0131ma uymayan iki grubun kantitatif verilerinin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda Mann-Whitney U testi ve ikiden fazla grubun kar\u015f\u0131la\u015ft\u0131rmas\u0131nda Kruskal-Wallis testi kullan\u0131ld\u0131. Kantitatif verilerin korelasyon analizinde Pearson korelasyon testi kullan\u0131ld\u0131. Testlerin p<\/i> de\u011ferlerinin 0.05\u2019ten k\u00fc\u00e7\u00fck olmas\u0131 durumu istatistiksel olarak anlaml\u0131 d\u00fczey kabul edildi.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in Van B\u00f6lge E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 01 Haziran 2022 tarih ve 2022\/12-01 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n

BULGULAR<\/h2>\n

\u00c7al\u0131\u015fmaya SARS-CoV-2 rRT-PCR testi pozitif \u00e7\u0131kan 1339 hasta d\u00e2hil edildi. Hastalar\u0131n 703 (%52.5)\u2019\u00fc erkek, 636 (%47.5)\u2019s\u0131 kad\u0131nd\u0131. Erkek hastalar\u0131n Ct medyan de\u011feri 25.64 [22.14-28.9], kad\u0131n hastalar\u0131n ise 25.35 [22.02-28.53] idi. Kad\u0131n ve erkek hastalar\u0131n Ct de\u011feri aras\u0131nda anlaml\u0131 d\u00fczeyde fark saptanmad\u0131 (p<\/i>=0.335) (Tablo1). Hastalar\u0131n ya\u015f medyan de\u011feri 47 [31-61] y\u0131l olarak bulundu. Ct de\u011feri ile ya\u015f aras\u0131nda korelasyon analizi yap\u0131ld\u0131 ve anlaml\u0131 korelasyon olmad\u0131\u011f\u0131 tespit edildi (p<\/i>=0.398).<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> Hastalar\u0131n Cinsiyet ve Tedavi G\u00f6rd\u00fckleri Yere G\u00f6re D\u00f6ng\u00fc E\u015fik Medyan De\u011ferlerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Komorbid Hastal\u0131\u011f\u0131 Olan Hastalar ile Olmayan Hastalar\u0131n D\u00f6ng\u00fc E\u015fik De\u011ferlerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> Ct De\u011feri ile Biyokimyasal Parametreler, Hastane Yat\u0131\u015f S\u00fcresi ve Ya\u015f Korelasyonu<\/p><\/div>\n

Hastalar\u0131n 774 (%58)\u2019\u00fcn\u00fcn ayaktan, 548 (%41)\u2019inin serviste, 17 (%1)\u2019sinin yo\u011fun bak\u0131mda tedavi g\u00f6rd\u00fc\u011f\u00fc tespit edildi. D\u00f6ng\u00fc e\u015fik medyan de\u011feri; ayaktan tedavi g\u00f6ren hastalarda 25.31 [22.00-29.10], serviste 25.27 [22.20-28.44] ve yo\u011fun bak\u0131mda 24.44 [22.73-27.68] olarak bulundu. Gruplar\u0131n Ct de\u011ferleri istatistiksel olarak kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda hi\u00e7bir grup aras\u0131nda anlaml\u0131 d\u00fczeyde fark bulunmad\u0131 (p<\/i>=0.723) (Tablo 1).<\/p>\n

Yo\u011fun bak\u0131m hastalar\u0131n\u0131n 16 (%94.1)\u2019s\u0131 ve servis hastalar\u0131n\u0131n 34 (%5.8)\u2019\u00fc olmak \u00fczere toplam 50 (%3.7) hasta vefat etmi\u015fti. Vefat eden hastalar\u0131n ortalama mortalite g\u00fcn\u00fc 11 [6.5-18] olarak bulundu. Vefat eden hastalar\u0131n Ct medyan de\u011feri 24.18 [21.81-26.26], ya\u015fayan hastalar\u0131n ise 25.34 [22.1-28.80] idi. Vefat eden hastalar\u0131n Ct de\u011ferleri ya\u015fayan hastalar\u0131nkinden anlaml\u0131 d\u00fczeyde daha d\u00fc\u015f\u00fck saptand\u0131 (p<\/i>=0.019).<\/p>\n

\u00c7al\u0131\u015fmaya dahil edilen hastalar\u0131n 306 (%22.8)\u2019s\u0131nda komorbid hastal\u0131k oldu\u011fu g\u00f6r\u00fcld\u00fc; 222 (%16.5)\u2019sinde HT, 80 (%5.9)\u2019inde DM, 47 (%3.5)\u2019sinde respiratuar sistem hastal\u0131klar\u0131 vard\u0131. Komorbid hastal\u0131\u011f\u0131 olan hastalar ile olmayan hastalar\u0131n Ct de\u011ferleri kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda hi\u00e7bir grup aras\u0131nda anlaml\u0131 d\u00fczeyde fark saptanmad\u0131 (p<\/i>=0.850) (Tablo 2).<\/p>\n

Sadece hastane yat\u0131\u015f\u0131 olan hastalardan laboratuvar tetkiki istenmi\u015f olup tetkik istenenlerin medyan de\u011ferleri; CRP i\u00e7in 22.75 [7.37-57.67] mg\/lt, ferritin i\u00e7in 135 [64-249] \u00b5mol\/lt, LDH\u00a0 <\/span>i\u00e7in 241.5 [195.25-296.25] \u00dc\/lt, PCT i\u00e7in 0.06 [0.03-0.1] ng\/ml, demir i\u00e7in 6 [4-9] \u00b5mol\/lt ve alb\u00fcmin i\u00e7in 4 [3.7-4.3] g\/dl idi. Laboratuvar parametreleri ile Ct de\u011ferleri aras\u0131nda korelasyon analizi yap\u0131ld\u0131 ve anlaml\u0131 bir korelasyon bulunmad\u0131 (Tablo 3).<\/span><\/p>\n

Hastanede yatarak tedavi g\u00f6ren hastalar\u0131n hastane yat\u0131\u015f medyan s\u00fcresi 5 [3-9] g\u00fcn olarak hesapland\u0131 ve Ct de\u011feri ile aras\u0131nda anlaml\u0131 bir korelasyon saptanmad\u0131 (p<\/i>=0.797) (Tablo 3).<\/p>\n

\u0130RDELEME<\/h2>\n

D\u00f6ng\u00fc e\u015fik de\u011feri, bir hastal\u0131\u011f\u0131n \u015fiddetini ve ilerlemesini tahmin etmek, bula\u015ft\u0131r\u0131c\u0131l\u0131\u011f\u0131n\u0131 belirlemek ve aktif viral replikasyonunu uzun s\u00fcreli virus sa\u00e7\u0131l\u0131m\u0131ndan ay\u0131rt etmek i\u00e7in kullan\u0131lmaktad\u0131r. Daha \u00f6nce yap\u0131lan \u00e7al\u0131\u015fmalarda Ct de\u011feri, hastalar\u0131n ent\u00fcbe olma riski ve mortalite ile ili\u015fkili bulunmu\u015ftur; Ct de\u011feri <25 olan hastalarda ent\u00fcbe olma riskinin 3 kat, mortalite riskinin ise 5-6 kat fazla oldu\u011fu bildirilmi\u015ftir (8,9). Ancak yap\u0131lan farkl\u0131 \u00e7al\u0131\u015fmalarda, rRT-PCR Ct de\u011feri ile hastan\u0131n klini\u011finin aras\u0131nda bir ili\u015fki olmamas\u0131n\u0131n yan\u0131 s\u0131ra asemptomatik ve semptomatik hastalar\u0131n Ct de\u011ferleri aras\u0131nda da anlaml\u0131 fark olmad\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (10-12). Ayr\u0131ca yap\u0131lan bir \u00e7al\u0131\u015fmada da orta derece hastal\u0131k ile ciddi hastal\u0131k viral y\u00fckleri aras\u0131nda anlaml\u0131 fark olmad\u0131\u011f\u0131 bildirilmi\u015ftir (13). <\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda vefat eden hastalar\u0131n Ct de\u011ferlerinin ya\u015fayan hastalardan anlaml\u0131 d\u00fczeyde daha d\u00fc\u015f\u00fck oldu\u011fu tespit edildi. Benzer \u015fekilde vefat eden hastalar\u0131n Ct de\u011ferlerinin ya\u015fayan hastalardan anlaml\u0131 d\u00fczeyde daha d\u00fc\u015f\u00fck oldu\u011funu bildiren ba\u015fka \u00e7al\u0131\u015fmalar da mevcuttur (14,15). Ancak bu konu ile ilgili \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada Ct de\u011ferinin mortalite ile ili\u015fkisi olmad\u0131\u011f\u0131 tespit edilmi\u015ftir (16). Camargo ve arkada\u015flar\u0131 (2) da \u00e7al\u0131\u015fmalar\u0131nda, vefat eden hastalar ile ya\u015fayan hastalar\u0131n Ct de\u011ferleri aras\u0131nda anlaml\u0131 d\u00fczeyde fark olmad\u0131\u011f\u0131n\u0131 bildirmi\u015ftir.<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda ayaktan hastalar, servis hastalar\u0131 ve yo\u011fun bak\u0131m hastalar\u0131n\u0131n Ct de\u011ferleri aras\u0131nda anlaml\u0131 d\u00fczeyde fark bulunmad\u0131. Camargo ve arkada\u015flar\u0131 (2) ise ayaktan hastalar\u0131n Ct de\u011ferlerini yatan hastalardan anlaml\u0131 d\u00fczeyde daha y\u00fcksek bildirirken, orta ve ciddi hastal\u0131\u011fa sahip hastalar\u0131n Ct de\u011ferleri aras\u0131nda anlaml\u0131 d\u00fczeyde fark bildirmemi\u015ftir. Yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada asemptomatik, orta ve ciddi hastal\u0131\u011fa sahip hastalar\u0131n Ct de\u011ferleri aras\u0131nda anlaml\u0131 d\u00fczeyde fark bulunmam\u0131\u015ft\u0131r (3). Demir-\u00d6nder ve arkada\u015flar\u0131 (17) da yo\u011fun bak\u0131m ihtiyac\u0131 olan hastalar ile olmayan hastalar\u0131n Ct de\u011ferlerini kar\u015f\u0131la\u015ft\u0131rm\u0131\u015f ve anlaml\u0131 d\u00fczeyde fark saptamam\u0131\u015ft\u0131r. Yine \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada hafif-orta klinik seyirli hastalar ile \u015fiddetli seyirli hastalar aras\u0131nda Ct de\u011ferleri a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde fark olmad\u0131\u011f\u0131 bildirilmi\u015ftir (16). Ancak \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada asemptomatik hastalar\u0131n semptomatik hastalardan daha y\u00fcksek Ct de\u011ferleri g\u00f6sterdi\u011fi bildirilmi\u015ftir (18).<\/span><\/p>\n

Bir meta-analiz \u00e7al\u0131\u015fmas\u0131na g\u00f6re komorbid hastal\u0131\u011f\u0131 bulunan COVID-19 hastalar\u0131nda hastal\u0131\u011f\u0131n daha a\u011f\u0131r ge\u00e7ti\u011fi bildirilmi\u015ftir (19). Yang ve arkada\u015flar\u0131 (20) da \u00e7al\u0131\u015fmalar\u0131nda, COVID-19 hastalar\u0131nda en s\u0131k e\u015flik eden komorbid hastal\u0131klar\u0131; HT (%21), DM (%9.7) kardiyovask\u00fcler hastal\u0131klar (%8.4) ve respiratuar sistem hastal\u0131klar\u0131 (%1.5) olarak bildirmi\u015ftir. Ayr\u0131ca ayn\u0131 \u00e7al\u0131\u015fmada a\u011f\u0131r hastalarda; HT, respiratuar sistem ve kardiyovask\u00fcler sistem hastal\u0131klar\u0131n\u0131n daha y\u00fcksek oranda g\u00f6r\u00fcld\u00fc\u011f\u00fc bildirilmi\u015ftir. Bu da komorbid hastal\u0131\u011f\u0131 olan hastalar\u0131n olmayan hastalara g\u00f6re viral y\u00fcklerinin farkl\u0131 olabilece\u011fi fikrini ortaya \u00e7\u0131karm\u0131\u015f ve \u00e7al\u0131\u015fmam\u0131zda komorbid hastal\u0131k ile Ct de\u011feri ili\u015fkisi incelenmi\u015ftir. \u00c7al\u0131\u015fmam\u0131za dahil edilen hastalar\u0131n 306 (%22.8)\u2019s\u0131nda komorbid hastal\u0131k oldu\u011fu tespit edildi. Ancak komorbid hastal\u0131\u011f\u0131 olan hastalar\u0131n Ct de\u011ferleri ile olmayan hastalar\u0131n Ct de\u011ferleri aras\u0131nda anlaml\u0131 fark bulunamad\u0131. Bayram ve arkada\u015flar\u0131n\u0131n (21) sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131 inceledikleri \u00e7al\u0131\u015fmalar\u0131nda, \u00e7al\u0131\u015fmam\u0131zla benzer \u015fekilde komorbid hastal\u0131k ile Ct de\u011feri aras\u0131nda anlaml\u0131 ili\u015fki bildirilmemi\u015ftir (21). <\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda Ct de\u011feri ile CRP, LDH, PCT, alb\u00fcmin, ferritin, demir de\u011ferleri, ya\u015f ve hastane yat\u0131\u015f s\u00fcresi aras\u0131nda anlaml\u0131 korelasyon bulunmad\u0131. Ancak Ramirez ve arkada\u015flar\u0131 (22) Ct de\u011feri ile ferritin, AST ve LDH de\u011ferleri aras\u0131nda anlaml\u0131 korelasyon oldu\u011funu bildirmi\u015ftir. Liu ve arkada\u015flar\u0131 (23) \u00e7al\u0131\u015fmalar\u0131nda, CRP de\u011feri ile Ct de\u011feri aras\u0131nda negatif korelasyon; alb\u00fcmin, n\u00f6trofil ve lenfosit oranlar\u0131 ile Ct de\u011ferleri aras\u0131nda ise anlaml\u0131 bir korelasyon oldu\u011funu bildirmi\u015ftir. Yuan ve arkada\u015flar\u0131 (24) ise CRP de\u011feri ile Ct de\u011feri aras\u0131nda anlaml\u0131 bir korelasyon saptamam\u0131\u015f ve viral y\u00fck ile LDH aras\u0131nda negatif korelasyon oldu\u011funu bildirmi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fman\u0131n aksine Ge\u00e7kil ve arkada\u015flar\u0131 (25) taraf\u0131ndan \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada, Ct de\u011feri ile CRP, ferritin, l\u00f6kosit, n\u00f6trofil, lenfosit say\u0131s\u0131, n\u00f6trofil\/lenfosit oran\u0131, alb\u00fcmin ve kalsiyum aras\u0131nda anlaml\u0131 d\u00fczeyde ili\u015fki oldu\u011fu bildirilmi\u015ftir. Demir-\u00d6nder ve arkada\u015flar\u0131n\u0131n (17) yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada ise Ct de\u011feri ile COVID-19 hastalar\u0131nda k\u00f6t\u00fc prognostik laboratuvar belirte\u00e7ler olarak kabul edilen n\u00f6trofil\/lenfosit oran\u0131, CRP, D-dimer ve lenfosit say\u0131s\u0131 ve yo\u011fun bak\u0131m yat\u0131\u015f s\u00fcresi ve ya\u015f aras\u0131nda anlaml\u0131 korelasyon olmad\u0131\u011f\u0131 bildirilmi\u015ftir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n en \u00f6nemli k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 retrospektif ve tek merkezli olmas\u0131d\u0131r. Sadece yatarak tedavi g\u00f6ren hastalar\u0131n laboratuvar parametrelerine bak\u0131labilmesi de Ct de\u011feri ile laboratuvar parametrelerinin ili\u015fkisinin de\u011ferlendirilmesi a\u00e7\u0131s\u0131ndan \u00f6nemli bir k\u0131s\u0131tl\u0131l\u0131k yaratt\u0131. Ayr\u0131ca rRT-PCR testi Ct de\u011ferleri ayaktan hastalar i\u00e7in hastaneye ilk ba\u015fvuruda, yatarak tedavi g\u00f6ren hastalar i\u00e7inse yat\u0131\u015ftan sonraki ilk 24 saatte tespit edilebildi\u011fi i\u00e7in hastalar\u0131n viral y\u00fck de\u011fi\u015fikli\u011finin klinik seyir \u00fczerindeki etkisi de\u011ferlendirilemedi.<\/p>\n

Sonu\u00e7 olarak; \u00e7al\u0131\u015fmam\u0131zda ayaktan hastalar\u0131n, servis hastalar\u0131n\u0131n ve yo\u011fun bak\u0131m hastalar\u0131n\u0131n Ct de\u011ferleri aras\u0131nda anlaml\u0131 d\u00fczeyde fark bulunmad\u0131. Ayr\u0131ca hastalar\u0131n hastane yat\u0131\u015f s\u00fcresi, ya\u015f, CRP, LDH, ferritin, PCT, alb\u00fcmin ve demir de\u011ferleri ile Ct de\u011feri aras\u0131nda da anlaml\u0131 bir korelasyon tespit edilmedi. Ancak hayat\u0131n\u0131 kaybeden hastalar\u0131n ya\u015fayan hastalardan daha d\u00fc\u015f\u00fck Ct de\u011ferlerine sahip oldu\u011fu g\u00f6r\u00fcld\u00fc. Bu da bize Ct de\u011feri ile mortalite aras\u0131nda bir ili\u015fki olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrd\u00fc. Ancak literat\u00fcrde konu ile ilgili farkl\u0131 sonu\u00e7lar\u0131n olmas\u0131 nedeniyle mortaliteyi tahmin etmede, Ct de\u011ferinin tek ba\u015f\u0131na kullanmas\u0131 yerine hastan\u0131n klini\u011fini ve laboratuvar verilerini de i\u00e7eren multifakt\u00f6riyel bir yakla\u015f\u0131m daha do\u011fru olacakt\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e COVID-19\u2019un kesin tan\u0131s\u0131, solunum yolu \u00f6rneklerinde ger\u00e7ek zamanl\u0131 revers-transkriptaz polimeraz zincir reaksiyonu (rRT-PCR) ile SARS-CoV-2 RNA\u2019s\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131 sonucu konulmaktad\u0131r; rRT-PCR\u2019da RdRp, ORF1, S, N, E gen b\u00f6lgeleri hedeflenmektedir. Hastal\u0131\u011f\u0131n ba\u015flang\u0131\u00e7 evresinde nazofarinks ve orafarinks s\u00fcr\u00fcnt\u00fc \u00f6rnekleri tercih edilirken ileri evrelerinde alt solunum yolu \u00f6rnekleri tercih edilmektedir (1). Ger\u00e7ek zamanl\u0131 revers-transkriptaz PCR d\u00f6ng\u00fc e\u015fik (cycle […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5174,5476,5478,2997],"class_list":["post-27262","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-covid-19","tag-ct-degeri","tag-klinik-seyir","tag-mortalite"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27262","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=27262"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27262\/revisions"}],"predecessor-version":[{"id":27459,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27262\/revisions\/27459"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27262"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27262"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}