COVID-19’lu Hastalardaki Prognostik Faktörlerin Değerlendirilmesi: Pandemik Bir Merkez Olan Ankara Şehir Hastanesi Deneyimi

Öz

ÖZ Amaç: Klinik serviste ve yoğun bakımda takip edilen COVID-19’lu hastalarda temel klinik karakteristikler ve laboratuvar indekslerini sistematik olarak analiz ederek erken dönemde hastalığın olası seyri hakkında ön görüde bulunabilmek amaçlandı. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışma 1 Nisan ile 31 Mayıs 2020 tarihleri arasında Ankara Şehir Hastanesi'nde gerçekleştirilmiştir. Hastalar serviste ve yoğun bakımda takip edilen olmak üzere ikiye ayrıldı ve klinik veriler iki grup arasında karşılaştırıldı. Yoğun bakımdaki COVID-19 hastaları için bağımsız erken prediktörleri tanımlamak için tek değişkenli ve çok değişkenli lojistik regresyon analizi yapıldı. İnterlökin-6’nın yoğun bakımda yatışı öngörmesinde tanısal değerinin olup olmadığının belirlenebilmesi için ROC analizi yapıldı. Bulgular: Çok değişkenli lojistik regresyon analizine göre artan yaş (Odds oranı [OR] 1,1;%95 güven aralığı [GA] 1,06–1,14; p<0,001 ), lenfosit sayısının düşüklüğü ( OR= 0,1 ;%95 GA 0,03–0,30; p<0,001) ve yüksek interlökin 6 düzeyleri (OR= 1,01;%95 GA 1.00–1,02; p<0,001) bağımsız olarak yoğun bakımda yatan COVID-19’lu hastalarda önemli prediktörlerdendir. ROC eğrisinin altındaki alan 0,89 (%95 GA 0,85-0,94; p<0,001), sınır değer >19,85 pg/ml olarak tespit edildi. Sonuç: İleri yaş, lenfopeni ve yüksek interlökin 6 düzeyleri olan erken COVID-19’lu hastalarda progresyon daha ileri olup bu hastalar daha çok yoğun bakımda izlenmektedir. Eğer bir hasta bu üç kriterden birine sahipse hastalık sürecinin sürveyansı ve yoğun bakım önceliği artmaktadır. Kritik hastaların erken tespiti, COVID-19 salgınıyla mücadelede işleri kolaylaştıracaktır. Anahtar Sözcükler: COVID-19, SARS-CoV-2, Lenfopeni, İnterlökin-6, Tek değişkenli analiz, Çok değişkenli analiz

Anahtar Kelimeler

• COVID-19
• SARS-CoV-2
• Lenfopeni
• İnterlökin-6
• Tek değişkenli analiz
• Çok değişkenli analiz

Evaluation of Prognostic Factors in Patients with COVID-19: Ankara City Hospital Experience as a Pandemic Center

Abstract

ABSTRACT Objective: Aim of the study was to analyze systematically the basic clinical characteristics and laboratory indexes in patients with COVID-19 followed in clinical service and intensive care, and to predict the possible course of the disease in the early period. Methods: This retrospective, single-center study was conducted between April 1 and May 31, 2020 at Ankara City Hospital. The patients were divided into two groups: one received ordinary care, the other intensive therapy, and the clinical data were compared between the two groups.Univariate and multivariate logistic regression analysis were performed to identify independent early predictors for COVID-19 patients in intensive care. ROC analysis was performed to determine whether interleukin-6 has a diagnostic value in predicting hospitalization in intensive care. Results: Multivariable logistic regression analysis found that increasing age (adjusted odds ratio [OR], 1,1; 95% confidence interval [CI]; 1,06-1,14; p<0,001), lymphopenia (OR, 0,1; 95% CI: 0,03–0,30; p<0,001) and high levels of interleukin-6 (OR, 1,01;95% CI: 1,00-1,02; p<0,001) were the important predictors of COVID-19 independently hospitalized in intensive care. The area under ROC curve of interleukin-6 was 0,89 [95% CI 0,85-0,94; p<0,001] and cut-off value was >19,85 pg/ml. Conclusion: Progression is more advanced in patients with early COVID-19 with increasing age, lymphopenia and high interleukin 6 levels, and these patients are mostly followed in intensive care.If a patient has one of these three criteria, surveillance of the disease process and intensive care priority increases. Early identification of critical patients will make things easier in tackling the COVID-19 outbreak. Key Words: COVID-19, SARS-CoV-2, Lymphopenia, Interleukin-6, Univariate analysis, Multivariate analysis

Keywords

• COVID-19
• SARS-CoV-2
• Lymphopenia
• Interleukin-6
• Univariate analysis
• Multivariate analysis

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