Can Platelet Mass Index Be Used as a Prognostic Marker in Children Diagnosed with Multisystem Inflammatory Syndrome Associated with Coronavirus?

Yıl 2023, Cilt: 17 Sayı: 4, 257 - 262, 25.07.2023

İbrahim Eker , Ayşegül Bükülmez , Ayhan Pektas , Yeter Düzenli Kar , Nilgün Eroğlu , Mehmet Çelegen , Yiğit Şenol , Ayşe Çıtak , Baran Gül , Begüm Soyalan , Deniz Durmuş , Melissa Karataş

https://doi.org/10.12956/tchd.1180080

Öz

Objective: We’ve aimed at evaluating whether the platelet mass index (PMI) can be a prognostic marker for children diagnosed with MIS-C.
Material and Methods: 31 children diagnosed with MIS-C and treated at our university hospital between March 2020 and November 2021 were included. Demographic data, clinical findings and laboratory values at the time of hospitalization, admission to the intensive care unit and duration of hospitalization were evaluated retrospectively. PMI of each patient at the time of hospitalization was calculated and recorded.
Results: There was a statistically significant negative correlation between PMI and ferritin (r= -0.635, moderate, p<0.001), CRP (r= -0.377, weak, p= 0.036), and procalcitonin (r= -0.481, weak, p=0.006) levels. There was a statistically significant positive relationship between PMI and leukocyte count (r=0.367, weak, p=0.042) and lymphocyte count (r=0.384, weak, p=0.033). Median PMI values of the patients requiring intensive care (1701.35 fl/nl) were lower, compared to the median PMI values of the patients not requiring intensive care (2523.94 fl/nl), however, statistical results could not be reached due to the low (4 of 31) number of patients requiring intensive care. Median PMI values of the patients whose ferritin level was >400 ng/ml (1415.2; 533.4 – 3600.5) were statistically lower compared to the median PMI values of the patients whose ferritin level was ≤400 ng/ml (2705.7; 1395.2 – 9167.6).Conclusion: The findings in our study demonstrate that low PMI levels identified in children with MIS-C at the time of diagnosis may be with more severe clinical courses

Anahtar Kelimeler

Child, Coronavirus Disease, Mass ındex, Multisystem Inflammatory Syndrome, Platelet, Prognosis

Koronavirus ile İlişkili Multisistem İnflamatuar Sendrom Tanılı Çocuklarda Trombosit Kitle İndeksi Prognostik Bir Belirteç Olarak Kullanılabilir mi?

Öz

Amaç: Trombosit kitle indeksinin (TKİ) MIS-C tanısı alan çocuklarda prognostik bir belirteç olup olmadığının değerlendirilmesi.
Gereç ve Yöntemler: Mart 2020 ile Kasım 2021 tarihleri arasında üniversite hastanemizde MIS-C tanısı konan ve tedavi gören 31 çocuk çalışmaya dahil edildi. Hastaneye yatış anındaki, yoğun bakıma yatış anındaki ve hastanedeki yatış süresince demografik veriler, klinik bulgular ve laboratuvar değerleri retrospektif olarak değerlendirildi. Her hastanın yatış anındaki TKİ değerleri hesaplandı ve kaydedildi.
Bulgular: TKİ ile ferritin (r= -0.635, orta, p<0.001), CRP (r= -0.377, zayıf, p= 0.036) ve prokalsitonin (r= -0.481, zayıf, p= 0.006) düzeyleri arasında istatistiksel olarak anlamlı negatif korelasyon bulundu. TKİ ile lökosit sayısı (r= 0.367, zayıf, p= 0.042) ve lenfosit sayısı (r= 0.384, zayıf, p= 0.033) arasında istatistiksel olarak anlamlı pozitif ilişki bulundu. Yoğun bakım gerektiren hastaların ortanca TKİ değerlerinin (1701.35 fl/nl), yoğun bakım gerektirmeyen hastaların ortanca TKİ değerlerinden (2523.94 fl/nl) istatistiksel olarak daha düşük olduğu saptandı (p= 0.005). Ferritin düzeyi >400 ng/ml olan hastaların ortanca TKİ değerlerinin (1415.2; 533.4 – 3600.5), ferritin düzeyi ≤400 ng/ml olan hastaların ortalama TKİ değerlerinden (2705.7; 1395.2 – 9167.6) istatistiksel olarak daha düşük olduğu saptandı (p= 0.005).
Sonuç: Çalışmamızdaki bulgular, MIS-C’li çocuklarda tanı anında tespit edilen düşük TKİ düzeylerinin, daha şiddetli klinik seyire yol açabileceğini ortaya koymaktadır.

Anahtar Kelimeler

çocuk, Koronavirüs Hastalığı, Kitle İndeksi, Multisistem İnflamatuar Sendrom, Trombosit, Prognoz

Kaynakça

• Referances1. Liu YC, Kuo RL, Shih SR. COVID-19: The first documented coronavirus pandemic in history. Biomed J. 2020 Aug;43(4):328-333. doi: 10.1016/j.bj.2020.04.007. Epub 2020 May 5. PMID: 32387617; PMCID: PMC7199674.
• Referances2. Centers for Disease Control and Prevention. MIS-C and COVID-19. Available at: https://www.cdc.gov/mis-c/ (Accessed March 29, 2021).
• Referances3. Perez-Toledo M, Faustini SE, Jossi SE, Shields AM, Kanthimathinathan HK, Allen JD, et al. Serology confirms SARSCoV-2 infection in PCR-negative children presenting with Paediatric Inflammatory Multi-System Syndrome. MedRxiv. 2020. doi: 10.1101/2020.06.05.20123117.
• Referances4. Ekemen Keles Y, Yilmaz Ciftdogan D. Çocuklarda çoklu sistemik inflamatuvar sendrom. Çocuk Dergisi - Journal of Child 2021;21(1):74-82.
• Referances5. Abrams JY, Oster ME, Godfred-Cato SE, Bryant B, Datta SD, Campbell AP, Leung JW, Tsang CA, Pierce TJ, Kennedy JL, Hammett TA, Belay ED. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. Lancet Child Adolesc Health. 2021 May;5(5):323-331. doi: 10.1016/S2352-4642(21)00050-X. Epub 2021 Mar 10. PMID: 33711293; PMCID: PMC7943393.
• Referances6. Yardımcı AC, Yıldız S, Ergen E, Ballı H, Ergene E, Guner YS, Karnap M, Demırbas Keskın D, Yuksel H, Bocutoglu F, Akbel VC, Kalyoncu D. Association between platelet indices and the severity of the disease and mortality in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2021 Nov;25(21):6731-6740. doi: 10.26355/eurrev_202111_27118. PMID: 34787878.
• Referances7. Zhong Q, Peng J. Mean platelet volume/platelet count ratio predicts severe pneumonia of COVID-19. J Clin Lab Anal 2021; 35: e23607.
• Referances8. Guclu E, Kocayigit H, Okan HD, Erkorkmaz U,Yurumez Y, Yaylaci S, Koroglu M, Uzun C, Karabay O. Effect of COVID-19 on platelet count and its indices. Rev Assoc Med Bras (1992) 2020; 66: 1122-1127.
• Referances9. Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, Long D, Yu L. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelet 2020; 31: 490-496.
• Referances10. Ilhan O, Bor M. Platelet mass index and prediction of severity of transient tachypnea of the newborn. Pediatr Int. 2019 Jul;61(7):697-705. doi: 10.1111/ped.13899. Epub 2019 Jul 9. PMID: 31140210.
• Referances11. T.C. Sağlık Bakanlığı COVID-19 (SARS-CoV-2 enfeksiyonu) çocuk hasta yönetimi ve tedavi rehberi. Bilimsel Danışma Kurulu Çalışması, T.C Sağlık Bakanlığı, 06 Ocak 2022.
• Referances12. Graciano-Machuca O, Villegas-Rivera G, López-Pérez I, Macías-Barragán J, Sifuentes-Franco S. Multisystem Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Role of Oxidative Stress. Front Immunol. 2021 Oct 19;12:723654. doi: 10.3389/fimmu.2021.723654. PMID: 34737740; PMCID: PMC8560690.
• Referances13. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, Behrens EM, Ferris A, Kernan KF, Schulert GS, Seo P, Son MBF, Tremoulet AH, Yeung RSM, Mudano AS, Turner AS, Karp DR, Mehta JJ. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol. 2021 Apr;73(4):e13-e29. doi: 10.1002/art.41616. Epub 2021 Feb 15. PMID: 33277976; PMCID: PMC8559788.
• Referances14. Soha Eldessouki Ibrahim, Caroline S. Morad, Naglaa Farouk, Amir Louis, Platelet indices as markers of inflammation in systemic sclerosis patients: Relation to vascular endothelial growth factor and flow mediated dilatation, The Egyptian Rheumatologist, Volume 40, Issue 4, 2018, Pages 239-242.
• Referances15. Gu SX, Tyagi T, Jain K, Gu VW, Lee SH, Hwa JM, Kwan JM, Krause DS, Lee AI, Halene S, Martin KA, Chun HJ, Hwa J. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol. 2021 Mar;18(3):194-209. doi: 10.1038/s41569-020-00469-1. Epub 2020 Nov 19. PMID: 33214651; PMCID: PMC7675396.
• Referances16. Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, Roguski K, Wallace B, Prezzato E, Koumans EH, Lee EH, Geevarughese A, Lash MK, Reilly KH, Pulver WP, Thomas D, Feder KA, Hsu KK, Plipat N, Richardson G, Reid H, Lim S, Schmitz A, Pierce T, Hrapcak S, Datta D, Morris SB, Clarke K, Belay E; California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1074-1080.