Post-COVID kortikosteroid kullanımı ve pulmoner fibrozis: 1 yıllık izlem

Year 2022, Volume: 47 Issue: 3, 1306 - 1314, 30.09.2022

Efraim Güzel , Oya Baydar Toprak

https://doi.org/10.17826/cumj.1139209

Abstract

Amaç: COVID-19 hastalığının yaygınlığı ve ağırlığına bağlı olarak post-COVID dönemde pulmoner sekeller ve fibrotik akciğer hastalığı hastalar için önemli problemler oluşturmaya devam etmektedir. Biz de çalışmamızda post-COVID hasta yönetimi ile pulmoner sekel ve fibrozis için risk faktörlerini belirlemeyi amaçladık.
Gereç ve Yöntem: COVID-19 nedeni ile hastaneden düşük doz kortikosteroid (0,5 mg/kg/gün metilprednisolon) ile taburcu edilen 67 post-COVID hasta çalışmaya dahil edildi. Hastaların sosyo-demografik verileri, radyolojik ve laboratuvar bulguları kayıt altına alındı. Taburculuk sonrası tüm hastalar 3,6 ve 12. ayda takipleri yapılarak ayrıntılı biyokimyasal kan tetkikleri ve yüksek rezolüsyonlu bilgisayarlı tomografi (HRCT) ile değerlendirilerek pulmoner fibrozis tanısı HRCT bulgularına göre konuldu.
Bulgular: Altmış yedi hastanın 34 (50,7%)’ü erkek ve yaş ortalaması 57±16,33 yıl (min.19–max.90) idi. Üçüncü ayda 59 (%88,1), 6. ayda 28 (%41,8) ve 12. ayda 21 (%31,3) hastada anormal toraks bilgisayarlı tomografi (BT) bulguları vardı. On ikinci ay takibinde toraks BT bulgularına göre toplam 9 (%13,4) hastada pulmoner fibrozis saptandı.
Sonuç: Araştırmamızda post-COVID pulmoner fibrosis gelişimi için en önemli risk faktörleri yoğun bakım ünitesi (YBÜ) takibi, lenfosit sayısının <500, ferritinin ≥300 olması şeklinde tespit edildi. Bu nedenle özellikle hastanede YBÜ’de tedavi gören hastaların taburculuk sonrası düzenli ve sık aralıklarla takibi gerekmektedir.

Keywords

Kortikosteroid, COVID-19, post-COVID, pulmoner fibrosis, radiolojik bulgular, risk faktörleri.

Post-COVID corticosteroid use and pulmonary fibrosis: 1 year follow-up

Abstract

Purpose: Depending on the prevalence and severity of COVID-19 disease, pulmonary sequelae and fibrotic lung disease continue to pose significant problems for patients in the post-COVID period. In our study, we aimed to determine the risk factors for pulmonary sequelae and fibrosis with post-COVID patient management.
Materials and Methods: The study comprised 67 post-COVID patients who were released from the hospital after receiving low-dose corticosteroids (0.5 mg/kg daily methylprednisolone) as a result of COVID-19. Socio-demographic data, radiological and laboratory findings of the patients were recorded. All patients were followed up at 3, 6, and 12 months after discharge, and the diagnosis of pulmonary fibrosis was made according to high resolution computed tomography (HRCT) findings, by evaluating with detailed biochemical blood tests and HRCT.
Results: Thirtyfour (50.7%) of the 67 patients were male and the mean age was 57±16.33 (min.19–max.90). At 3 months, there were 59 patients (88.1%) with aberrant thoracic computed tomography (CT) findings, 28 (41.8%) at 6 months, and 21 (31.3%) at 12 months. In the 12th month follow-up, pulmonary fibrosis was detected in a total of 9 (13.4%) patients according to thorax CT findings.
Conclusion: In our study, the most important risk factors for the development of post-COVID pulmonary fibrosis were intensive care unit (ICU) follow-up, lymphocyte count <500 and ferritin ≥300. For this reason, patients who are treated in the ICU, especially in the hospital, should be followed up regularly and frequently after discharge.

Keywords

Corticosteroid, COVID-19, post-COVID, pulmonary fibrosis, radiological findings, risk factors

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