Turkiye Klinikleri Archives of Lung

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COVID-19 Nedeniyle Hastaneye Yatırılarak Tedavi Edilen Hastaların Demografik ve Klinik Özelliklerinin Prognozla İlişkisi: Kesitsel Çalışma
The Relationship Between Demographic and Clinical Characteristics of Hospitalized COVID-19 Patients with Prognosis: Cross-Sectional Study
Serdanur ÖZDEMİRa, Bilge YILMAZ KARAb, Aziz GÜMÜŞb, Uğur KESİMALc
aSağlık Bilimleri Üniversitesi Ahi Evren Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları ABD, Trabzon, Türkiye
bRecep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları ABD, Rize, Türkiye
cAnkara Eğitim ve Araştırma Hastanesi, Radyoloji ABD, Ankara, Türkiye
Turkiye Klinikleri Arch Lung. 2022;21(2):51-8
doi: 10.5336/archlung.2022-90348
Article Language: TR
Full Text
ÖZET
 Amaç: Milyonlarca ölüme neden olan koronavirüs hastalığı-2019'un [coronavirus disease-2019 (COVID-19)] kesin tedavisi henüz bilinmediğinden, mortalite açısından yüksek riskli grupların ve prognoza etki eden faktörlerin belirlenmesi önemlidir. Çalışmamızda, hastaneye yatırılarak izlenen COVID-19 olgularının demografik, klinik ve laboratuvar verilerinin değerlendirilmesi; prognoza ve mortaliteye etkili faktörlerin saptanması amaçlandı. Gereç ve Yöntemler: Pandemi servisi veya yoğun bakım ünitesinde yatarak tedavi almış, polimeraz zincir reaksiyonu testi pozitif hastaların demografik, klinik ve laboratuvar özellikleri retrospektif olarak incelendi. Pnömoni şiddeti, yatış süresi, mortalite verileri incelendi. Mortalite ilişkili faktörler değerlendirildi. Bulgular: Çalışmadaki 165 hastanın yaş ortalaması 59±16 (%58 erkek) yıldı. Hastaların %57'si hiç sigara içmemişken, %43'ü eski veya aktif içiciydi. En sık görülen komorbid hastalıklar hipertansiyon (%50,3) ve diyabetti (%25,5). İleri yaş, erkek cinsiyet, sigara kullanımı, yüksek modifiye Charlson Komorbidite İndeksi, geliş oksijen satürasyon düşüklüğü, yüksek tomografi skoru ve uzun yatış süresinin mortaliteyi öngördüğü belirlendi. Nötrofil, nötrofil lenfosit oranı, üre, laktat dehidrogenaz, C-reaktif protein (CRP), ferritin yüksekliği ve albümin düşüklüğü ile mortalite arasında pozitif korelasyon izlendi. Nötrofil değerleri 4.000/μL ve üzerinde olması, CRP düzeyinin 50 mg/L'nin üzerinde olması ve ferritin değerinin 700 ng/mL'nin üzerinde olması mortalite riskinde sırasıyla 9 kat 5,7 kat ve 3,8 kat artışa neden olmaktadır. Takipte, tedavisine steroid eklenmek zorunda kalınan hastaların mortalitesinin daha fazla olduğu saptanmıştır. Sonuç: Komorbiditesi yüksek, yaşlı, erkek, başlangıçta oksijen satürasyonu düşük, tomografi skoru yüksek ve laboratuvar parametreleri bozulmuş hastalarda mortalite daha fazladır. İlk tedaviye yanıtsızlık, takipte steroid tedavisi gereksinimi, yoğun bakım ihtiyacı ve uzun süreli yatış diğer kötü prognostik faktörlerdir.

Anahtar Kelimeler: COVID-19; modifiye Charlson Komorbidite İndeksi; prognoz; mortalite
ABSTRACT
 Objective: It is critical to identify factors affecting prognosis in coronavirus disease-2019 (COVID-19). In this study, we aimed to evaluate the demographic, clinical and laboratory data of hospitalized patients with COVID-19 and to determine the factors affecting the prognosis and survival. Material and Methods: Demographic, clinical and laboratory findings of polymerase chain reaction-positive inpatients were evaluated and recorded retrospectively. Pneumonia severity, length of hospital stay, and mortality data were analyzed. Results: The mean age of the 165 patients was 59±16 (58% male) years. While 57% of the patients were non-smokers, 43% were quitters or smokers. The most common comorbid diseases were hypertension(50,3%) and diabetes (25,5%). Advanced age, male gender, smoking, high modified Charlson Comorbidity Index, low oxygen saturation, high computed tomography (CT) score at admission was related to mortality. There was a positive correlation between mortality and high neutrophil counts, neutrophil lymphocyte ratio, urea, lactate dehydrogenase, C-reactive protein (CRP), ferritin and low albumin levels. When the neutrophil counts are ≥4,000/μL, there is 9-fold increase in the risk of mortality. CRP levels >50 mg/L causes a 5.7-fold, and ferritin values >700 ng/mL causes a 3.8-fold increase in the mortality risk. Mortality was higher in patients who need add-on steroid theraphy during follow-up. Conclusion: The mortality rate is higher in patients with COVID-19 who are elderly, male and who have manycomorbidities, low oxygen saturation, high CT score and impaired laboratory parameters. Other factors associated with poor prognosis are unresponsiveness to first treatment, long-term hospitalization and the need for add-on steroids or intensive care admission.

Keywords: COVID-19; modified Charlson Index; prognosis; mortality
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