.: ORİJİNAL ARAŞTIRMA
Yoğun Bakım Gerektirmeyen Hipoksemik Multilober COVID-19 Pnömoni Risk Faktörlerinin Kesitsel Bir Çalışma ile Değerlendirilmesi
Evaluation of Risk Factors for Non-ICU Hypoxemic Multilobar COVID-19 Pneumonia: A Cross-Sectional Study
Turkiye Klinikleri Arch Lung. 2024;23(1):1-8
doi: 10.5336/archlung.2024-103801
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] enfeksiyonu Çin'de nedeni bilinmeyen pnömoni vakaları olarak bildirildi. Hastalık asemptomatik bir süreçten, pnömoni, akut solunum sıkıntısı sendromu ve ölüme kadar geniş bir yelpaze gösteriyordu. Birçok çalışma COVID-19'un prognozu ve mortalitesini etkileyen faktörleri araştırmıştır. Çalışmamızda yoğun bakım gerekliliği olmayan, hipoksemik, toraks bilgisayarlı tomografisinde multilober tutulum izlenen COVID-19 olguları için risk faktörlerini belirlemek istedik. Gereç ve Yöntemler: Olgular Dünya Sağlık Örgütü ve Sağlık Bakanlığımız sınıflamasıyla uyumlu olarak toraks bilgisayarlı tomografisinde (BT) lokal buzlucam tutulumu olup hipoksemisi olmayan hafif pnömonililer (lokal grup) ve multilober tutulumlu hipoksemik ağır pnömonililer (multilober grup) olarak iki gruba ayrıldı. Hastaların demografik özellikleri, eşlik eden hastalıkları, laboratuvar sonuçları, nötrofil lenfosit oranı (NLO), C-reaktif protein (CRP), prokalsitonin, D-dimer, fibrinojen, laktat dehidrogenaz (LDH), ferritin ve troponin sonuçları retrospektif olarak incelendi. Bulgular: Gruplar arasında yaş ortalaması 57±17, 65±12 (p=0,005), diabetes mellitus (DM) sıklığı %33,3, %66,7 (p=0,032), komorbidite sayısı 0,5, 1 (p=0,001), LogWBC 3,7607±0,15054, 3,8423±0,19578 (p=0,013), NLO 2,24, 5,30 (p=0,000), LogCRP 1,04, 1,92 (p=0,000)), prokalsitonin 0,04 µ/L, 0,11µ/L (p=0,000), LogFerritin 2,0137±0,46330, 2,5747±0,39441 (p=0,000), LDH 188 U/L, 309 U/L (p=0,000), LogD-dimer 2,3511±0,41071, 2,5828±0,34924 (p=0,001), fibrinojen 435 mg/dL, 568 mg/dL (p=0,000), troponin 0,003 ng/L, 0,009 ng/L (p=0,000) anlamlı farklılık gösterdiği saptandı. Sonuç: Yaşlı, DM ve koroner arter hastalığı eşlik eden, birden çok hastalığı olan, artmış inflamatuar ve koagülatif faktörlere sahip COVID-19 hastaları multilober hipoksemik pnömoni için artmış riske sahiptir.
Anahtar Kelimeler: COVID-19; pnömoni; hipoksemi; risk faktörleri
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] enfeksiyonu Çin'de nedeni bilinmeyen pnömoni vakaları olarak bildirildi. Hastalık asemptomatik bir süreçten, pnömoni, akut solunum sıkıntısı sendromu ve ölüme kadar geniş bir yelpaze gösteriyordu. Birçok çalışma COVID-19'un prognozu ve mortalitesini etkileyen faktörleri araştırmıştır. Çalışmamızda yoğun bakım gerekliliği olmayan, hipoksemik, toraks bilgisayarlı tomografisinde multilober tutulum izlenen COVID-19 olguları için risk faktörlerini belirlemek istedik. Gereç ve Yöntemler: Olgular Dünya Sağlık Örgütü ve Sağlık Bakanlığımız sınıflamasıyla uyumlu olarak toraks bilgisayarlı tomografisinde (BT) lokal buzlucam tutulumu olup hipoksemisi olmayan hafif pnömonililer (lokal grup) ve multilober tutulumlu hipoksemik ağır pnömonililer (multilober grup) olarak iki gruba ayrıldı. Hastaların demografik özellikleri, eşlik eden hastalıkları, laboratuvar sonuçları, nötrofil lenfosit oranı (NLO), C-reaktif protein (CRP), prokalsitonin, D-dimer, fibrinojen, laktat dehidrogenaz (LDH), ferritin ve troponin sonuçları retrospektif olarak incelendi. Bulgular: Gruplar arasında yaş ortalaması 57±17, 65±12 (p=0,005), diabetes mellitus (DM) sıklığı %33,3, %66,7 (p=0,032), komorbidite sayısı 0,5, 1 (p=0,001), LogWBC 3,7607±0,15054, 3,8423±0,19578 (p=0,013), NLO 2,24, 5,30 (p=0,000), LogCRP 1,04, 1,92 (p=0,000)), prokalsitonin 0,04 µ/L, 0,11µ/L (p=0,000), LogFerritin 2,0137±0,46330, 2,5747±0,39441 (p=0,000), LDH 188 U/L, 309 U/L (p=0,000), LogD-dimer 2,3511±0,41071, 2,5828±0,34924 (p=0,001), fibrinojen 435 mg/dL, 568 mg/dL (p=0,000), troponin 0,003 ng/L, 0,009 ng/L (p=0,000) anlamlı farklılık gösterdiği saptandı. Sonuç: Yaşlı, DM ve koroner arter hastalığı eşlik eden, birden çok hastalığı olan, artmış inflamatuar ve koagülatif faktörlere sahip COVID-19 hastaları multilober hipoksemik pnömoni için artmış riske sahiptir.
Anahtar Kelimeler: COVID-19; pnömoni; hipoksemi; risk faktörleri
ABSTRACT
Objective: The coronavirus disease-2019 (COVID-19) infection, was reported as pneumonia cases without a known causes. It has been reported that the disease can present a wide range of clinical manifestations from asymptomatic form to pneumonia, acute respiratory distress syndrome and death. Many studies have investigated the factors affecting the prognosis and mortality of COVID-19. In our study we want to describe risk factors for multober hypoxemic pneumonia cases without intensive care unit requirement. Material and Methods: The cases were divided into two groups as with local groundglass involvement without hypoxemia (local group) and with multilober and hypoxemia (multilobar group) according to World Health Organization and Turkish Health ministery suggestions. Demografics, comorbidities and laboratory results neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin, D-dimer, fibrinogen, lactate dehydrogenase (LDH), ferritin and troponin were analyzed retrospectively. Results: Between local and multilober groups age 57±17, 65±12 (p=0.005), diabetes mellitus (DM) frequency 33.3%, 66.7% (p=0.032), Comorbidity number 0.5, 1 (p=0.001), LogWBC 3.7607±0.15054, 3.8423±0.19578 (p=0.013), NLR 2.24, 5.30 (p=0.000), LogCRP 1.04, 1.92 (p=0.000), procalcitonin 0.04 µ/L, 0.11µ/L (p=0.000), LogFerritin 2.0137±0.46330, 2.5747±0.39441 (p=0.000), LDH 188 U/L, 309 U/L (p=0.000), LogDdimer 2.3511±0.41071, 2.5828±0.34924 (p=0.001), fibrinogen 435 mg/dL, 568 mg/dL (p=0.000), troponin 0.003 ng/L, 0.009 ng/L (p=0.000) were found signicantly different. Conclusion: Patients with advanced age, DM, coronary artery disease, concomitant multiple diseases, increased inflammatory and coagulative factors have increased risk for multilober hypoxemic pneumonia.
Keywords: COVID-19; pneumonia; hypoxemia; risk factors
Objective: The coronavirus disease-2019 (COVID-19) infection, was reported as pneumonia cases without a known causes. It has been reported that the disease can present a wide range of clinical manifestations from asymptomatic form to pneumonia, acute respiratory distress syndrome and death. Many studies have investigated the factors affecting the prognosis and mortality of COVID-19. In our study we want to describe risk factors for multober hypoxemic pneumonia cases without intensive care unit requirement. Material and Methods: The cases were divided into two groups as with local groundglass involvement without hypoxemia (local group) and with multilober and hypoxemia (multilobar group) according to World Health Organization and Turkish Health ministery suggestions. Demografics, comorbidities and laboratory results neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin, D-dimer, fibrinogen, lactate dehydrogenase (LDH), ferritin and troponin were analyzed retrospectively. Results: Between local and multilober groups age 57±17, 65±12 (p=0.005), diabetes mellitus (DM) frequency 33.3%, 66.7% (p=0.032), Comorbidity number 0.5, 1 (p=0.001), LogWBC 3.7607±0.15054, 3.8423±0.19578 (p=0.013), NLR 2.24, 5.30 (p=0.000), LogCRP 1.04, 1.92 (p=0.000), procalcitonin 0.04 µ/L, 0.11µ/L (p=0.000), LogFerritin 2.0137±0.46330, 2.5747±0.39441 (p=0.000), LDH 188 U/L, 309 U/L (p=0.000), LogDdimer 2.3511±0.41071, 2.5828±0.34924 (p=0.001), fibrinogen 435 mg/dL, 568 mg/dL (p=0.000), troponin 0.003 ng/L, 0.009 ng/L (p=0.000) were found signicantly different. Conclusion: Patients with advanced age, DM, coronary artery disease, concomitant multiple diseases, increased inflammatory and coagulative factors have increased risk for multilober hypoxemic pneumonia.
Keywords: COVID-19; pneumonia; hypoxemia; risk factors
REFERANSLAR:
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. Erratum in: Lancet. 2020;395(10223):496. [Crossref] [PubMed] [PMC]
- 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]
- Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses. 2020;12(4):372. [Crossref] [PubMed] [PMC]
- T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (Sars-Cov-2 enfeksı̇yonu) Ağır Pnömonı̇, ARDS, Sepsı̇s ve Septı̇k Şok Yönetı̇mı̇. Ankara: T.C. Sağlık Bakanlığı; 2021. [Link]
- Available from: [Link] Erişim tarihi: 01.06.2021
- Hemraj SK, Jacob MJ, Kotian V, K SD, G GR, Veliath LB. Chest CT Findings and Their Temporal Evolution in COVID-19 Pneumonia. Cureus. 2022;14(6):e26021. [Crossref] [PubMed] [PMC]
- Zhou M, Zhang X, Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front Med. 2020;14(2):126-35. [Crossref] [PubMed] [PMC]
- Wu X, Liu L, Jiao J, Yang L, Zhu B, Li X. Characterisation of clinical, laboratory and imaging factors related to mild vs. severe covid-19 infection: a systematic review and meta-analysis. Ann Med. 2020;52(7):334-44. [Crossref] [PubMed] [PMC]
- Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR Am J Roentgenol. 2020;214(5):1072-7. [Crossref] [PubMed]
- Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. Erratum in: BMJ. 2020;368:m1295. [Crossref] [PubMed] [PMC]
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. Erratum in: JAMA. 2021;325(11):1113. [Crossref] [PubMed] [PMC]
- Cesari M, Montero-Odasso M. COVID-19 and Older Adults. Lessons Learned from the Italian Epicenter. Can Geriatr J. 2020;23(1):155-9. [Crossref] [PubMed] [PMC]
- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. [Crossref] [PubMed]
- Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020;36(7):e3319. [Crossref] [PubMed] [PMC]
- Özdemir S, Yılmaz Kara B, Gümüş A, Kesimal U. COVID-19 nedeniyle hastaneye yatırılarak tedavi edilen hastaların demografik ve klinik özelliklerinin prognozla ilişkisi: kesitsel çalışma [The relationship between demographic and clinical characteristics of hospitalized COVID-19 patients with prognosis: cross-sectional study]. Turkiye Klinikleri Arch Lung. 2022;21(2):51-8. [Crossref]
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. [Crossref] [PubMed] [PMC]
- Herold T, Jurinovic V, Arnreich C, Lipworth BJ, Hellmuth JC, von Bergwelt-Baildon M, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020;146(1):128-36.e4. [Crossref] [PubMed] [PMC]
- Yang P, Wang P, Song Y, Zhang A, Yuan G, Cui Y. A retrospective study on the epidemiological characteristics and establishment of an early warning system of severe COVID-19 patients. J Med Virol. 2020;92(10):2173-80. [Crossref] [PubMed] [PMC]
- Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Respir Res. 2020;21(1):169. [Crossref] [PubMed] [PMC]
- Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-6. [Crossref] [PubMed] [PMC]
- Bi X, Su Z, Yan H, Du J, Wang J, Chen L, et al. Prediction of severe illness due to COVID-19 based on an analysis of initial fibrinogen to albumin ratio and platelet count. Platelets. 2020;31(5):674-9. [Crossref] [PubMed] [PMC]
- Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis. 2020;95:304-7. [Crossref] [PubMed] [PMC]
- Dahan S, Segal G, Katz I, Hellou T, Tietel M, Bryk G, et al. Ferritin as a marker of severity in COVID-19 patients: a fatal correlation. Isr Med Assoc J. 2020;22(8):494-500. [PubMed]
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