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Kocaturk M, Saril A, Oz AD, Rubio CP, Ceron JJ, Yilmaz Z. Neutrophil-to-lymphocyte ratio and red blood cell distribution width to platelet ratio and their relationships with inflammatory and antioxidant status in dogs with different stages of heart failure due to myxomatous mitral valve disease. Vet Res Commun 2024; 48:2477-2487. [PMID: 38849636 PMCID: PMC11315729 DOI: 10.1007/s11259-024-10431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
We aimed to evaluate the red blood cell distribution width-to-platelet ratio (RDW/PLT) with other complete blood cell count (CBC) indices and their correlations with serum proinflammatory cytokines, acute phase proteins (APPs), and antioxidant biomarkers in dogs at different stages of heart failure (HF). A total of 29 dogs were divided into four groups according to the ACVIM Consensus Statement: stage-A (healthy/controls, n = 8), stage-B2 (n = 6), stage-C (n = 10), and stage-D (n = 5). Seventeen CBC indices were calculated and correlated with the measurements of inflammatory, APPs, and antioxidant biomarkers, as well as selected echocardiographic variables in all dogs. At stage-C, CBC indices were evaluated 14 days after the treatment. Statistically significant changes were observed only for RDW/PLT and neutrophil-to-lymphocyte ratio (NLR) between groups. NLR increased, but RDW/PLT deceased in dogs with HF, compared to controls (P < 0.05). There were no statistically differences between pre- and post-treatment CBC indices. There were significantly positive and negative correlations between the CBC indices, serum parameters and selected echocardiographic variables in dogs with HF(P < 0.05). ROC analysis showed the best sensitivity (57% and 68%) and specificity (100% and 57%) for NLR > 5.8 and RDW/PLT ≤ 0.057 for predicting the severity of HF, respectively. Results showed that NLR and RDW/PLT may have potential for monitoring severity of the disease and the effect of treatment in dogs with HF. Imbalances between indices of circulating blood cells can contribute to immunoinflammatory and antioxidant responses in pathogenesis of canine HF, which may provide us alternative targets to develop new diagnostic and therapeutic strategies in veterinary medicine.
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Affiliation(s)
- Meriç Kocaturk
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey.
| | - Ahmet Saril
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Abdullah Doğukan Oz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
| | - Camila Peres Rubio
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, 30100, Espinardo, Murcia, Spain
| | - Jose Joaquin Ceron
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, 30100, Espinardo, Murcia, Spain
| | - Zeki Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Bursa Uludag University, 16059, Bursa, Turkey
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Seyfi S, Azadmehr A, Ezoji K, Nabipour M, Babazadeh A, Saleki K, Mahmoodi M, Pouladi AH. Mortality in ICU COVID-19 Patients Is Associated with Neutrophil-to-Lymphocyte Ratio (NLR): Utility of NLR as a Promising Immunohematological Marker. Interdiscip Perspect Infect Dis 2023; 2023:9048749. [PMID: 38025794 PMCID: PMC10653951 DOI: 10.1155/2023/9048749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Achieving a suitable medical laboratory index is very important for the prediction of clinical outcome of COVID-19 patients hospitalized to the intensive care unit (ICU). The correlation between neutrophil-to-lymphocyte ratio (NLR) and unfavorable outcome of COVID-19 patients hospitalized to ICU was the aim of this study. Methods We evaluated a cross-sectional study of 312 COVID-19 patients who were hospitalized to the ICU (confirmed by PCR and CT-Scan), in Babol city, Mazandaran province. WBC, RBC, lymphocyte, neutrophil, monocyte, platelet count, NLR, C-reactive protein (CRP), ESR, MCV, MHC, and other factors were evaluated. Results Our findings indicated that all patients aged 56 to 69 years with COVID-19 had a significant difference (P < 0.05) in neu, lymph, PLT count, NLR, ESR, Hb, and CRP. Also, NLR was significantly (P < 0.05) correlated with the death or discharge of the ICU hospitalized patients. The cut-off of NLR was 7.02 and the mean of NLR was 11.3 ± 10.93 and 5.8 ± 7.45 in death and discharge COVID-19 patients hospitalized to ICU, respectively. ROC curve indicated that, for NLR, the area under curve was 0.76. Conclusions Our findings showed that NLR can be utilized as a clinical laboratory predictive parameter for mortality of COVID-19 patients admitted to ICU.
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Affiliation(s)
- Shahram Seyfi
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran
| | - Abbas Azadmehr
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Khadijeh Ezoji
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Majid Nabipour
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Department of Infectious Disease, Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- Department of e-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Mahmoodi
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran
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Ueda Y, Yokogawa N, Murata K, Kashiyama T. C-reactive protein and the neutrophil-to-lymphocyte ratio on admission predicting bacteraemia with COVID-19. Ann Med 2023; 55:2278618. [PMID: 37939245 PMCID: PMC10653696 DOI: 10.1080/07853890.2023.2278618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Bacteraemia can co-occur with COVID-19. The present study aimed to determine the cut-off value for C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) for predicting bacteraemia in patients with COVID-19. METHODS Patients admitted to Tokyo Metropolitan Tama Medical Centre for COVID-19 treatment between 1 April 2020 and 30 October 2022 were included. Patients transferred from other hospitals and those whose CRP and/or neutrophil count was not measured at admission were excluded. Community-acquired bacteraemia was diagnosed if true bacteraemia was diagnosed in patients via a blood culture performed within 72 h of admission. The cut-off value for CRP and the NLR for community-acquired bacteraemia were determined using receiver operating characteristic analysis. RESULTS Among 2989 patients hospitalized for COVID-19 treatment, 19 received the diagnosis of community-acquired bacteraemia, for which CRP ≥ 6.3 was determined to be the cut-off value. The sensitivity and specificity of the cut-off was 89.5% and 73.3%, respectively. The NLR cut-off value was ≥ 7.7, which had a sensitivity and specificity of 84.2% and 84.0%, respectively. CONCLUSIONS Considering the possibility of the co-occurrence of bacteraemia with COVID-19, a blood culture should be performed when CRP is ≥ 6.3 or the NLR is ≥ 7.7.
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Affiliation(s)
- Yoshitaka Ueda
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Naoto Yokogawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kengo Murata
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuya Kashiyama
- Department of Emergency and Critical Care, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Beceren NG, Armağan HH, Oğuzlar FÇ, Cesur E, Gürdal O, Tomruk Ö. Can mean platelet volume be a prognosis predictor in viral infections: An example of Covid-19. Heliyon 2023; 9:e21983. [PMID: 38034669 PMCID: PMC10682631 DOI: 10.1016/j.heliyon.2023.e21983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose This study revealed the utility of mean platelet volume (MPV) as a mortality marker in SARS-CoV-2 infection, as well as its connection with other inflammatory indicators such as procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR). Methods A total of 1528 patients (853 males and 653 females; mean age: 64.33 ± 16.36 years; range, 18-100 years) were hospitalized with COVID-19 between March 2020 and December 2022. The patients' demographic and clinical information, including ward and critical care data, were gathered from their medical records. On the first and last days, the PCT, NLR, and MPV values of the patients, who were divided into groups based on their hospitalization and outcomes, were analyzed. Results When the relevant laboratory data from the first and last days were compared, each group was statistically significant (p < 0.05). There was a moderate association between the final MPV values and the PCT and NLR values of the patients admitted to the ward (r = 0.448 and r = 0.397, respectively, where p < 0.01). There was also a substantial and moderate correlation between the final MPV levels and the PCT and NLR values of patients admitted to the intensive care unit (r = 0.613 and r = 0.361, respectively, p < 0.01). When compared to the patients' outcomes, the MPV had greater specificity and AUC values than the PCT and NLR (94.4 %, 0.968, 80.6 %, 0.923, 81 %, 0.845, respectively). Conclusion In patients hospitalized with COVID-19, the specificity of MPV values at the point of sickness severity and outcome was shown to be greater than PCT and NLR values, and MPV values may be a more accurate predictor of mortality than PCR and NLR.
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Affiliation(s)
- Nesrin Gökben Beceren
- Medical Faculty of Suleyman Demirel University, Emergency Medicine Department, Turkey
| | - Hamit Hakan Armağan
- Medical Faculty of Suleyman Demirel University, Emergency Medicine Department, Turkey
| | - Furkan Çağrı Oğuzlar
- Medical Faculty of Suleyman Demirel University, Emergency Medicine Department, Turkey
| | - Ezgi Cesur
- Medical Faculty of Suleyman Demirel University, Emergency Medicine Department, Turkey
| | - Osman Gürdal
- Medical Faculty of Suleyman Demirel University, Department of Bioistatistics and Medical Informatics, Turkey
| | - Önder Tomruk
- Medical Faculty of Suleyman Demirel University, Emergency Medicine Department, Turkey
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Li J, Zhang K, Zhang Y, Gu Z, Huang C. Neutrophils in COVID-19: recent insights and advances. Virol J 2023; 20:169. [PMID: 37533131 PMCID: PMC10398943 DOI: 10.1186/s12985-023-02116-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can lead to acute respiratory distress syndrome (ARDS), multi-organ failure and death, posing significant threat to human health. Studies have found that pathological mechanisms, such as cytokine storms caused by uncontrolled innate immune system activation, release of damage-associated molecular patterns during tissue injury and a high incidence of thrombotic events, are associated with the function and dysfunction of neutrophils. Specifically, the increased formation of low-density neutrophils (LDNs) and neutrophil extracellular traps (NETs) has been shown to be closely linked with the severity and poor prognosis in patients with COVID-19. Our work focuses on understanding the increased number, abnormal activation, lung tissue infiltration, and elevated neutrophil-to-lymphocyte ratio in the pathogenesis of COVID-19. We also explore the involvement of NETs and LDNs in disease progression and thrombosis formation, along with potential therapeutic strategies targeting neutrophil and NETs formation.
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Affiliation(s)
- Jiayu Li
- Department of Infectious Diseases, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, 710038, China
| | - Kegong Zhang
- Department of Infectious Diseases, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, 710038, China
| | - Ye Zhang
- Department of Infectious Diseases, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, 710038, China
| | - Ziyang Gu
- Department of Infectious Diseases, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, 710038, China
| | - Changxing Huang
- Department of Infectious Diseases, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, 710038, China.
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Khadzhieva MB, Gracheva AS, Belopolskaya OB, Chursinova YV, Redkin IV, Pisarev MV, Kuzovlev AN. Serial Changes in Blood-Cell-Count-Derived and CRP-Derived Inflammatory Indices of COVID-19 Patients. Diagnostics (Basel) 2023; 13:diagnostics13040746. [PMID: 36832234 PMCID: PMC9955197 DOI: 10.3390/diagnostics13040746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
The aim of the study was to investigate the serial changes in inflammatory indices derived from blood cell counts and C-reactive protein (CRP) levels in COVID-19 patients with good and poor outcomes. We retrospectively analyzed the serial changes in the inflammatory indices in 169 COVID-19 patients. Comparative analyses were performed on the first and last days of a hospital stay or death and serially from day 1 to day 30 from the symptom onset. On admission, non-survivors had higher CRP to lymphocytes ratio (CLR) and multi-inflammatory index (MII) values than survivors, while at the time of discharge/death, the largest differences were found for the neutrophil to lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and MII. A significant decrease in NLR, CLR, and MII by the time of discharge was documented in the survivors, and a significant increase in NLR was documented in the non-survivors. The NLR was the only one that remained significant from days 7-30 of disease in intergroup comparisons. The correlation between the indices and the outcome was observed starting from days 13-15. The changes in the index values over time proved to be more helpful in predicting COVID-19 outcomes than those measured on admission. The values of the inflammatory indices could reliably predict the outcome no earlier than days 13-15 of the disease.
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Affiliation(s)
- Maryam B. Khadzhieva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, 117997 Moscow, Russia
- Correspondence: ; Tel.: +7-963-674-20-99
| | - Alesya S. Gracheva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Olesya B. Belopolskaya
- Resource Center “Bio-Bank Center”, Research Park of St. Petersburg State University, 198504 St. Petersburg, Russia
| | - Yulia V. Chursinova
- Federal Scientific and Clinical Center of Medical Rehabilitation and Balneology of the Federal Medical and Biological Agency of Russia, 127410 Moscow, Russia
| | - Ivan V. Redkin
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
| | - Mikhail V. Pisarev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
| | - Artem N. Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia
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Tufa A, Gebremariam TH, Manyazewal T, Asrat Y, Getinet T, Hundie TG, Webb DL, Hellström PM, Genet S. Limited value of neutrophil-to-lymphocyte ratio and serum creatinine as point-of-care biomarkers of disease severity and infection mortality in patients hospitalized with COVID-19. PLoS One 2022; 17:e0275391. [PMID: 36201435 PMCID: PMC9536552 DOI: 10.1371/journal.pone.0275391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In hospitalized COVID-19, neutrophil-to-lymphocyte ratio (NLR) and serum creatinine is sometimes measured under assumption they predict disease severity and mortality. We determined the potential value of NLR and serum creatinine as predictors of disease severity and mortality in COVID-19. METHODS Prospective cohort study of COVID-19 patients admitted to premier COVID-19 treatment hospitals in Ethiopia. Predictive capability of biomarkers in progression and prognosis of COVID-19 was analyzed using receiver operating characteristics. Survival of COVID-19 patients with different biomarker levels was computed. Logistic regression assessed associations between disease severity and mortality on NLR and serum creatinine adjusted for odds ratio (AOR). RESULTS The study enrolled 126 adults with severe (n = 68) or mild/moderate (n = 58) COVID-19, with median age 50 [interquartile range (IQR 20-86)]; 57.1% males. The NLR value was significantly higher in severe cases [6.68 (IQR 3.03-12.21)] compared to the mild/moderate [3.23 (IQR 2.09-5.39)], with the NLR value markedly associated with disease severity (p<0.001). Mortality was higher in severe cases [13 (19.1%)] compared to mild/moderate cases [2 (3.4%)] (p = 0.007). The NLR value was significantly higher in non-survivors [15.17 (IQR 5.13-22.5)] compared to survivors [4.26 (IQR 2.40-7.90)] (p = 0.002). Serum creatinine was significantly elevated in severe cases [34 (50%)] compared with mild/moderate [11 (19%)] (p<0.001). Disease severity [AOR 6.58, 95%CI (1.29-33.56), p = 0.023] and NLR [AOR 1.07, 95%CI (1.02-1.12), p = 0.004)] might be associated with death. NLR had a sensitivity and specificity of 69.1% and 60.3% as predictor of disease severity (cut-off >4.08), and 86.7% and 55.9% as prognostic marker of mortality (cut-off >4.63). CONCLUSION In COVID-19, NLR is a biomarker with only modest accuracy for predicting disease severity and mortality. Still, patients with NLR >4.63 are more likely to die. Monitoring of this biomarker at the earliest stage of the disease may predict outcome. Additionally, high creatinine seems related to disease severity and mortality.
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Affiliation(s)
- Abdisa Tufa
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Haile Gebremariam
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yidnekachew Asrat
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Getinet
- School of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Dominic-Luc Webb
- Gastroenterology and Hepatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per M. Hellström
- Gastroenterology and Hepatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Solomon Genet
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gozdas HT, Kayis SA, Damarsoy T, Ozsari E, Turkoglu M, Yildiz I, Demirhan A. Multi-inflammatory Index as a Novel Mortality Predictor in Critically Ill COVID-19 Patients. J Intensive Care Med 2022; 37:1480-1485. [PMID: 35538901 PMCID: PMC9096173 DOI: 10.1177/08850666221100411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim Systemic inflammation has a crucial role in the pathogenesis and mortality of
Coronavirus disease 2019 (COVID-19). Multi-inflammatory index (MII) is a
novel index related with systemic inflammation. In this study, we
investigated the relationship between MII and in-hospital mortality in
COVID-19 patients admitted to the intensive care unit (ICU). Methods We retrospectively analyzed the medical records of COVID-19 patients
followed-up in the ICU of our institution between 01.04.2020 and 01.10.2021.
Patients were classified into two groups according to mortality status as
survivors and non-survivors. Various inflammatory parameters of the groups
were compared and their efficacy in predicting mortality was
investigated. Results Out of 348 study patients, 86 cases (24.7%) were in the survived group and
262 cases (75.3%) were in the dead group. The median age of the mortal group
was significantly higher than that of the survived group (65.5 vs 76,
P < .001). Multiple logistic regression analysis
revealed that among all the included inflammatory parameters, MII showed the
best efficacy for predicting mortality (OR: 0.999; 95% CI: 0.9991-0.9998;
P = .003). Conclusion MII, a new combination of Neutrophil to lymphocyte ratio (NLR) and C-reactive
protein (CRP), is a simple and practical biomarker that can help us in the
prediction of mortality in COVID-19 patients followed-up in the ICU.
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Affiliation(s)
- Hasan Tahsin Gozdas
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 52942Abant Izzet Baysal University, Bolu, Turkey
| | - Seyit Ali Kayis
- Department of Biostatistics, Faculty of Medicine, 52942Abant Izzet Baysal University, Bolu, Turkey
| | - Tugce Damarsoy
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 52942Abant Izzet Baysal University, Bolu, Turkey
| | - Emine Ozsari
- Department of Chest Diseases, Faculty of Medicine, 52942Abant Izzet Baysal University, Bolu, Turkey
| | - Mustafa Turkoglu
- Department of Anesthesiology and Reanimation, Izzet Baysal State Hospital, Bolu, Turkey
| | - Isa Yildiz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, 52942Abant Izzet Baysal University, Bolu, Turkey
| | - Abdullah Demirhan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, 52942Abant Izzet Baysal University, Bolu, Turkey
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