Turkiye Klinikleri Journal of Medical Sciences

.: REVIEW
A Narrative Review of the Evaluation of Biomarkers in COVID-19 Patients Indicating the Course of the Disease
COVID-19 Hastalarında Hastalığın Seyrini Gösteren Biyobelirteçlerin Değerlendirilmesine İlişkin Anlatısal Bir İnceleme
Sena ÖZCAN YILDIRIMa , Gülbu AYDINOĞLU IŞITMANGİLb
aUniversity of Health Sciences Hamidiye Institute of Health Sciences, Department of Immunology, İstanbul, Türkiye
bUniversity of Health Sciences Hamidiye Faculty of Medicine, Department of Microbiology, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2024;44(1):43-52
doi: 10.5336/medsci.2023-97930
Article Language: EN
Full Text
ABSTRACT
The global spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus has led to a widespread outbreak of coronavirus disease-2019 (COVID-19), resulting in a pandemic. Following the end of the pandemic, COVID-19 has transitioned into an endemic phase characterized by anticipated periodic surges. Therefore, the development of readily available prognostic biomarkers for COVID-19 patients continues to be a crucial field of study. Monitoring of blood biomarkers for patients with COVID-19 is a crucial component of patient care. Therefore, it is necessary to conduct hematological assessments such as leukocyte count, lymphocyte count, neutrophil count, neutrophil-lymphocyte ratio, and thrombocyte count. Additionally, inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, and procalcitonin should be measured. Immunological indicators including interleukin-6 and tumor necrosis factor-α should also be evaluated. Furthermore, biochemical tests such as aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and troponin levels should be assessed. Lastly, coagulation parameters such as D-dimer, fibrin degradation products, and fibrin levels should also be examined. The objective of this narrative review is to assess blood biomarkers that have the potential to be valuable in monitoring the progression and management of COVID-19. Studies published between 2020 and 2023 and scanned in PubMed, Ebsco and Google Scholar were used in the analysis. Keywords such as ''COVID19'', ''SARS-CoV2'', ''biomarkers'' and ''severe SARS-CoV-2 infection'' were used to restrict the search.

Keywords: COVID-19; SARS-CoV-2; biomarkers
ÖZET
Şiddetli akut solunum sendromu-koronavirüs-2 [severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)] virüsünün küresel yayılımı, yaygın bir koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] salgınına yol açarak bir pandemiye yol açmıştır. Pandeminin sona ermesinin ardından, COVID-19, beklenen periyodik artışlarla karakterize edilen endemik bir aşamaya geçmiştir. Bu nedenle, COVID-19 hastaları için kolaylıkla bulunabilen prognostik biyobelirteçlerin geliştirilmesi önemli bir çalışma alanı olmaya devam etmektedir. COVID-19 hastalarına yönelik kan biyobelirteçlerinin izlenmesi hasta bakımının çok önemli bir parçasıdır. Bu nedenle lökosit sayısı, lenfosit sayısı, nötrofil sayısı, nötrofil-lenfosit oranı, trombosit sayısı gibi hematolojik değerlendirmeler; C-reaktif protein, eritrosit sedimantasyon hızı ve prokalsitonin gibi inflamatuar belirteçler; interlökin-6 ve tümör nekroz faktörü-α gibi immünolojik göstergeler değerlendirilmelidir. Ayrıca aspartat aminotransferaz, alanin aminotransferaz, üre, kreatinin ve troponin düzeyleri gibi biyokimyasal testler; D-dimer, fibrin bozunma ürünleri, fibrin düzeyleri gibi pıhtılaşma parametreleri incelenmelidir. Bu geleneksel derlemenin amacı, COVID-19 hastalığının ve tedavisinin monitörizasyonu için faydalanabilecek kan biyobelirteçlerini değerlendirmektir. Analizde 2020 ile 2023 yılları arasında yayımlanan ve PubMed, Ebsco ve Google Scholar'da taranan çalışmalar kullanılmıştır. Aramayı kısıtlayabilmek için ''COVID-19'', ''SARS-CoV2'', ''biyobelirteçler'' ve ''şiddetli SARS-CoV2 enfeksiyonu'' gibi anahtar kelimeler kullanılmıştır.

Anahtar Kelimeler: COVID-19; SARS-CoV-2; biyobelirteçler
REFERENCES:
  1. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47. [Crossref]  [PubMed]  [PMC] 
  2. Karimi Shahri M, Niazkar HR, Rad F. COVID-19 and hematology findings based on the current evidences: A puzzle with many missing pieces. Int J Lab Hematol. 2021;43(2):160-8. [Crossref]  [PubMed]  [PMC] 
  3. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4. [Crossref]  [PubMed]  [PMC] 
  4. Mittal R, Chourasia N, Bharti VK, Singh S, Sarkar P, Agrawal A, et al. Blood-based biomarkers for diagnosis, prognosis, and severity prediction of COVID-19: Opportunities and challenges. J Family Med Prim Care. 2022;11(8):4330-41. [Crossref]  [PubMed]  [PMC] 
  5. Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet. 2020;395(10228):e52. [Crossref]  [PubMed]  [PMC] 
  6. Lee J, Park SS, Kim TY, Lee DG, Kim DW. Lymphopenia as a biological predictor of outcomes in COVID-19 patients: a nationwide cohort study. Cancers (Basel). 2021;13(3):471. [Crossref]  [PubMed]  [PMC] 
  7. Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Deng Y, et al. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. Int J Infect Dis. 2020;96:131-5. [Crossref]  [PubMed]  [PMC] 
  8. Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther. 2020;5(1):33. Erratum in: Signal Transduct Target Ther. 2020;5(1):61. [Crossref]  [PubMed]  [PMC] 
  9. Chan SSW, Christopher D, Tan GB, Chong VCL, Fan BE, Lin CY, et al. Peripheral lymphocyte subset alterations in COVID-19 patients. Int J Lab Hematol. 2020;42(5):e199-e203. [Crossref]  [PubMed]  [PMC] 
  10. Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett. 2020;225:31-32. [Crossref]  [PubMed]  [PMC] 
  11. Mazzoni A, Salvati L, Maggi L, Capone M, Vanni A, Spinicci M, et al. Impaired immune cell cytotoxicity in severe COVID-19 is IL-6 dependent. J Clin Invest. 2020;130(9):4694-703. [Crossref]  [PubMed]  [PMC] 
  12. Anurag A, Jha PK, Kumar A. Differential white blood cell count in the COVID-19: A cross-sectional study of 148 patients. Diabetes Metab Syndr. 2020;14(6):2099-102. [Crossref]  [PubMed]  [PMC] 
  13. Pozdnyakova O, Connell NT, Battinelli EM, Connors JM, Fell G, Kim AS. Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection. Am J Clin Pathol. 2021;155(3):364-75. [Crossref]  [PubMed]  [PMC] 
  14. Dubey DB, Mishra S, Reddy HD, Rizvi A, Ali W. Hematological and serum biochemistry parameters as a prognostic indicator of severally ill versus mild Covid-19 patients: A study from tertiary hospital in North India. Clin Epidemiol Glob Health. 2021;12:100806. [Crossref]  [PubMed]  [PMC] 
  15. Cavalcante-Silva LHA, Carvalho DCM, Lima ÉA, Galvão JGFM, da Silva JSF, Sales-Neto JM, et al. Neutrophils and COVID-19: The road so far. Int Immunopharmacol. 2021;90:107233. [Crossref]  [PubMed]  [PMC] 
  16. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8. [Crossref]  [PubMed]  [PMC] 
  17. Zhang D, Guo R, Lei L, Liu H, Wang Y, Wang Y, et al. Frontline Science: COVID-19 infection induces readily detectable morphologic and inflammation-related phenotypic changes in peripheral blood monocytes. J Leukoc Biol. 2021;109(1):13-22. [Crossref]  [PubMed]  [PMC] 
  18. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol. 2020;20(6):355-62. Erratum in: Nat Rev Immunol. 2020. [Crossref]  [PubMed]  [PMC] 
  19. Naoum FA, Ruiz ALZ, Martin FHO, Brito THG, Hassem V, Oliveira MGL. Diagnostic and prognostic utility of WBC counts and cell population data in patients with COVID-19. Int J Lab Hematol. 2021;43 Suppl 1(Suppl 1):124-8. [Crossref]  [PubMed]  [PMC] 
  20. Roca E, Ventura L, Zattra CM, Lombardi C. EOSINOPENIA: an early, effective and relevant COVID-19 biomarker? QJM. 2021;114(1):68-9. [Crossref]  [PubMed]  [PMC] 
  21. Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1469-72. [Crossref]  [PubMed]  [PMC] 
  22. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;506:145-8. [Crossref]  [PubMed]  [PMC] 
  23. Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-8. [Crossref]  [PubMed]  [PMC] 
  24. Pan Y, Ye G, Zeng X, Liu G, Zeng X, Jiang X, et al. Can routine laboratory tests discriminate SARS-CoV-2-infected pneumonia from other causes of community-acquired pneumonia? Clin Transl Med. 2020;10(1):161-8. [Crossref]  [PubMed]  [PMC] 
  25. Russo A, Tellone E, Barreca D, Ficarra S, Laganà G. Implication of COVID-19 on erythrocytes functionality: red blood cell biochemical implications and morpho-functional aspects. Int J Mol Sci. 2022;23(4):2171. [Crossref]  [PubMed]  [PMC] 
  26. Fei Y, Tang N, Liu H, Cao W. Coagulation dysfunction. Arch Pathol Lab Med. 2020;144(10):1223-9. [Crossref]  [PubMed] 
  27. Hadid T, Kafri Z, Al-Katib A. Coagulation and anticoagulation in COVID-19. Blood Rev. 2021;47:100761. [Crossref]  [PubMed]  [PMC] 
  28. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. [Crossref]  [PubMed]  [PMC] 
  29. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. [Crossref]  [PubMed]  [PMC] 
  30. Aboughdir M, Kirwin T, Abdul Khader A, Wang B. Prognostic value of cardiovascular biomarkers in COVID-19: a review. Viruses. 2020;12(5):527. [Crossref]  [PubMed]  [PMC] 
  31. Gacche RN, Gacche RA, Chen J, Li H, Li G. Predictors of morbidity and mortality in COVID-19. Eur Rev Med Pharmacol Sci. 2021;25(3):1684-707. [PubMed] 
  32. Ceci FM, Ferraguti G, Lucarelli M, Angeloni A, Bonci E, Petrella C, et al. Investigating biomarkers for COVID-19 morbidity and mortality. Curr Top Med Chem. 2023;23(13):1196-210. [Crossref]  [PubMed] 
  33. Bohn MK, Lippi G, Horvath A, Sethi S, Koch D, Ferrari M, et al. Molecular, serological, and biochemical diagnosis and monitoring of COVID-19: IFCC taskforce evaluation of the latest evidence. Clin Chem Lab Med. 2020;58(7):1037-52. [Crossref]  [PubMed] 
  34. Mosquera-Sulbaran JA, Pedreañez A, Carrero Y, Callejas D. C-reactive protein as an effector molecule in Covid-19 pathogenesis. Rev Med Virol. 2021;31(6):e2221. [Crossref]  [PubMed]  [PMC] 
  35. Gogate N, Lyman D, Bell A, Cauley E, Crandall KA, Joseph A, et al. COVID-19 biomarkers and their overlap with comorbidities in a disease biomarker data model. Brief Bioinform. 2021;22(6):bbab191. [Crossref]  [PubMed]  [PMC] 
  36. Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332-4. [Crossref]  [PubMed]  [PMC] 
  37. Smilowitz NR, Kunichoff D, Garshick M, Shah B, Pillinger M, Hochman JS, et al. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J. 2021;42(23):2270-9. [Crossref]  [PubMed]  [PMC] 
  38. Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia (Nathan). 2021;13(1):5. [Crossref]  [PubMed]  [PMC] 
  39. Stringer D, Braude P, Myint PK, Evans L, Collins JT, Verduri A, et al; COPE Study Collaborators. The role of C-reactive protein as a prognostic marker in COVID-19. Int J Epidemiol. 2021;50(2):420-9. [Crossref]  [PubMed]  [PMC] 
  40. Ahmed S, Jafri L, Hoodbhoy Z, Siddiqui I. Prognostic value of serum procalcitonin in COVID-19 Patients: a systematic review. Indian J Crit Care Med. 2021;25(1):77-84. [Crossref]  [PubMed]  [PMC] 
  41. Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, et al. Changes of hematological and immunological parameters in COVID-19 patients. Int J Hematol. 2020;112(4):553-9. [Crossref]  [PubMed]  [PMC] 
  42. Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475-82. [Crossref]  [PubMed]  [PMC] 
  43. Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017;29(9):401-9. [Crossref]  [PubMed]  [PMC] 
  44. Kaya T, Nalbant A, Kılıçcıoğlu GK, Çayır KT, Yaylacı S, Varım C. The prognostic significance of erythrocyte sedimentation rate in COVID-19. Rev Assoc Med Bras (1992). 2021;67(9):1305-10. [Crossref]  [PubMed] 
  45. Del Valle DM, Kim-Schulze S, Huang HH, Beckmann ND, Nirenberg S, Wang B, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med. 2020;26(10):1636-43. [Crossref]  [PubMed]  [PMC] 
  46. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol. 2021;31(1):1-10. [Crossref]  [PubMed]  [PMC] 
  47. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with coronavirus disease 2019: possible mechanisms. J Card Fail. 2020;26(6):470-5. [Crossref]  [PubMed]  [PMC] 
  48. Kaufmann CC, Ahmed A, Burger AL, Muthspiel M, Jäger B, Wojta J, et al. Biomarkers associated with cardiovascular disease in COVID-19. Cells. 2022;11(6):922. [Crossref]  [PubMed]  [PMC] 
  49. Güney T, Karataş A. Hepatoloji. Anılır E, Önal Z, İbrişim D, editörler. Karaciğer Fonksiyon Testleri ve Güncel Gelişmeler. 1. Baskı. Ankara: Akademisyen Kitabevi; 2020. p.167-76.
  50. Letelier P, Encina N, Morales P, Riffo A, Silva H, Riquelme I, et al. Role of biochemical markers in the monitoring of COVID-19 patients. J Med Biochem. 2021;40(2):115-28. [Crossref]  [PubMed]  [PMC] 
  51. Battaglini D, Lopes-Pacheco M, Castro-Faria-Neto HC, Pelosi P, Rocco PRM. Laboratory biomarkers for diagnosis and prognosis in COVID-19. Front Immunol. 2022;13:857573. [Crossref]  [PubMed]  [PMC] 
  52. Schneider M. The role of biomarkers in hospitalized COVID-19 patients with systemic manifestations. Biomark Insights. 2022;17:11772719221108909. [Crossref]  [PubMed]  [PMC] 
  53. Chaudhary R, Garg J, Houghton DE, Murad MH, Kondur A, Chaudhary R, et al. Thromboinflammatory Biomarkers in COVID-19: Systematic Review and Meta-analysis of 17,052 Patients. Mayo Clin Proc Innov Qual Outcomes. 2021;5(2):388-402. [Crossref]  [PubMed]  [PMC] 
  54. Chen CH, Lin SW, Shen CF, Hsieh KS, Cheng CM. Biomarkers during COVID-19: mechanisms of change and implications for patient outcomes. Diagnostics (Basel). 2022;12(2):509. [Crossref]  [PubMed]  [PMC] 
  55. Polat T, Dağlıoğlu G, Görür O, İnal TC. COVID-19 hastalarının tanı, tedavi ve takibinde klinik biyokimya laboratuvarlarının rolü [The role of clinical biochemistry laboratories in the diagnosis, treatment and follow-up of COVID-19 patie [Crossref] 

.: Up To Date

.: Process List

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com