Vnetni proces in možnost tromboemboličnega zapleta pri pacientih s covid-19

Osmani-Idrizi, Anida (author), Osredkar, Joško (mentor)

Konec leta 2019 se je na Kitajskem pojavilo več primerov atipične pljučnice, hitro se je izkazalo, da jo povzroča nov sev iz družine koronavirusov, ki so ga poimenovali SARS-CoV-2, bolezen pa COVID-19. Bolezen je lahko asimptomatska, najpogosteje pa poteka s simptomi, ki so podobni gripi, nekateri okuženi zbolijo za težjo obliko in potrebujejo hospitalizacijo na intenzivnih enotah. Z magistrsko nalogo smo želeli ugotoviti pomen vnetnega procesa v povezavi s tromboemboličnimi zapleti pri pacientih, ki so bili okuženi z virusom SARS-CoV-2 in hospitalizirani na oddelku intenzivne enote diagnostično terapevtskega servisa in sicer tako, da smo različne parametre primerjali z vrednostmi D-dimera. Meritve D-dimera smo izvedli na analazitorju BCS XP, vseh pacientov, vključenih v raziskavo, je bilo 272. Na podlagi rezultatov Mann-Whitneyevega U-testa smo statistično značilno povezavo uspeli ugotoviti med D-dimerom in smrtnostjo, saj je bil D-dimer približno 3,5-krat višji v skupini, kjer je prišlo do smrti. Povezavo smo našli tudi med vrednostmi D-dimera in uporabo deksametazona ter uporabo antibiotikov (v vseh primerih je bila p-vrednost < 0,05). S Spearmanovim koeficientom korelacije smo dokazali pozitivno korelacijo med vrednostmi D-dimera in prokalcitoninom ter C-reaktivnim proteinom (Spearmanov koeficient: prokalcitonin: 0,136, C-reaktivni protein: 0,176). Vrednosti D-dimera so bile statistično povezane tudi s procesom vnetja, hujše kot je bilo vnetje, višje so bile vrednosti D-dimera. Po drugi strani s pomočjo izračunov nismo uspeli dokazati statistično značilne povezave med vrednostmi D-dimera potekom bolezni, prav tako nismo dokazali povezave med vrednostmi D-dimera in sprejemom pacientov na enote intenzivne terapije (p > 0,05). Na podlagi izračunov smo ovrgli korelacijo med vrednostmi levkocitov in trombocitov ter D-dimerom. Razlik v vrednostih D-dimera nismo našli niti med skupinami, ki so za zdravljenje potrebovali dodatni kisik in med tistimi, ki kisika niso potrebovali. V povezavi s pljučnico, nismo uspeli potrditi razlik v vrednostih D-dimera med pacienti, ki so imeli »navadno« pljučnico in med tistimi, ki so imeli pljučnico kot posledico okužbe s SARS-CoV-2. Statistično značilnih razlik nismo našli niti pri pacientih, kjer se je na RTG slikanju pljuč pokazala pljučnica in tistimi kjer pljučnica ni bila vidna (p > 0,05). Skupaj s temi ugotovitvami naša raziskava prispeva k boljšemu razumevanju povezanosti med vrednostmi D-dimera, stopnjo vnetja in možnostjo tromboemboličnih zapletov pri pacientih s COVID-19.

• Language: Slovenian
• Keywords: D-dimer, SARS-CoV-2, COVID-19, analizator BCS XP
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-150942
• Publication date in RUL: 26.09.2023

Secondary language

• Language: English
• Title: Inflammation process and possibility of thromboembolic complication in patients with COVID-19

Abstract

At the end of 2019, several cases of atypical pneumonia emerged in China, and it quickly became apparent that it is caused by a new strain of the coronavirus family, which has been named SARS-CoV-2 that causes the disease named COVID-19. The disease can be asymptomatic, but most often it occurs with flu-like symptoms, but some infected people develop more severe form and need to be admitted to intensive care units (ICUs). In this master's thesis, we aimed to determine the importance of the inflammatory process in relation to thromboembolic complications in patient infected with SARS-CoV-2 which were hospitalised in the ICU at Ljubljana university medical center, by comparing various parameters with D-dimer values. D-dimer measurements were performed on the BCS XP analyser, and 272 patients were included in the study. Based on the results of the Mann Whitney U-test, we were able to find a statistically significant difference between D-dimer and mortality, as D-dimer was approximately 3.5 times higher in the group where death occurred. We also found a correlation between D-dimer values and the use of dexamethasone and also the same we found for antibiotics (in all cases the p-value was < 0.05). Spearman's correlation coefficient showed a positive correlation between D-dimer values and procalcitonin and D-dimer and C-reactive protein (Spearman's coefficient: procalcitonin: 0.136, C-reactive protein: 0.176). D-dimer values were also statistically correlated to the inflammation process, the more severe the inflammation, the higher the D-dimer values. On the other hand, the results of Mann-Whitney U test showed there was no statistical difference between D-dimer values and admission of patients to intensive care units (p > 0.05), and we also failed to show a connection between leukocyte and platelet values related to D-dimer. We also found no statistical differences in D-dimer values even between the groups that required supplemental oxygen for treatment and those that did not. In relation to pneumonia, we were unable to confirm statistical differences in D-dimer levels between patients who had “ordinary” pneumonia and those who had pneumonia as a result of SARS-CoV 2 infection. No statistically significant differences were found even in patients where pneumonia was shown on X-ray lung imaging and those where pneumonia was not visible (p > 0.05). Together with these findings, our research contributes to a better understanding of the relationship between D-dimer values, the level of inflammation and the possibility of thromboembolic complications in patients with COVID-19.

• Keywords: D-dimer, SARS-CoV-2, COVID-19, BCS XP analyzer