COVID-19’DA KLİNİK VE LABORATUVAR BULGULARININ MORTALİTE GOSTERGESİ OLARAK DEĞERİ, TEK MERKEZ KOHORT ÇALIŞMASI, YÜKSEK NOTROFİL/LENFOSİT ORANI, CRP, GGT, KREATİNİN DEĞERLERİ VE ARTMIŞ MORTALİTE RİSKİ

Abstract

Amaç: Koronavirüs hastalığı 2019 (COVID-19) tanısı ile takip edilen hastalarda mortalite riskinin erken tespiti önemlidir. COVID-19’da farklı klinik ve laboratuvar parametrelerin hastalık şiddeti ve mortalite göstergesi olarak değerinin saptanması hedeflenmiştir. Gereç ve Yöntem: COVID-19 tanısı ile hastaneye yatırılan hastalar retrospektif olarak değerlendirilmiştir. Hastaların yatış tarihi, taburculuk tarihi, yoğun bakıma sevk ve ölüm tarihleri, başvuru sırasındaki semptomları, başvuru anındaki klinik ve laboratuvar parametreleri kaydedilmiştir. Bulgular: Çalışmaya 168’i (%48,4) kadın olmak üzere toplam 347 hasta dahil edildi. Hastaların yaş ortalaması 59,69±16,87 (14-97) %40,9’u (n=142) 65 yaşın üzerindeydi. Hastaların %10,1’i (n=35) yoğun bakım ünitesine transfer edildi ve %8.4’ü (n=29) öldü. Başvuru anındaki klinik paremetreler değerlendirildiğinde, oksijen saturasyonu ölen grupta (79,51±6,95) sağ kalanlara göre daha düşüktü (88,78±6,11) (p<0,001). Erkek cinsiyet (p=0,05), ileri yaş (p<0,001), pozitif PCR sonucu (p=0,036), şiddetli toraks BT tutulumu (p<0,001) ve en az bir komorbidite varlığı (p=0,003) mortalite grubunda daha fazlaydı. Çok değişkenli analizlerde artmış nötrofil/lenfosit oranı (HR: 1,04, %95 GA: 1,00-1,08), kreatinin (OR: 1,37, %95 CI: 1,13-1,66), CRP (=-0,18, OR: 0,98, 95) % GA: 0,97-0,99), GGT (OR: 1,006, %95 GA: 1,001-1,012), yaş (OR: 5,67, %95 GA: 2,24-14,38), erkek cinsiyet (OR: 2,38, %95 GA: 0,98 -5,75) ve komorbidite varlığı (OR: 5,23, %95 GA: 2,08-13,13) mortalite ile ilişkili bulundu. Sonuç: COVID-19’da ileri yaş, erkek cinsiyet, komorbidite varlığı ve başvuru anındaki artmış NLR, GGT, CRP ve kreatinin değerleri gibi çeşitli klinik ve laboratuvar parametreler mortaliteyi öngörmede yardımcı olabilir. Başvuru anında elde edilen bu parametrelerle belirlenen hastaların daha yakın klinik ve laboratuvar takibi mortalitenin azaltılmasına katkı sağlayacaktır.

Keywords

• COVID-19
• mortalite
• mortalite misk maktörleri
• gama-glutamil transferaz
• nötrofil/lenfosit oranı
• SARSCoV- 2

PREDICTIVE RELEVANCE OF DIFFERENT CLINICAL AND LABORATORY FINDINGS FOR HIGHER MORTALITY IN PATIENTS WITH COVID-19 IN A SINGLE CENTER COHORT: NEUTROPHIL/ LYMPHOCYTE RATIO, HIGH CRP, GGT AND CREATININE LEVELS ARE ASSOCIATED WITH HIGH MORTALITY

Abstract

Objective: Early detection of mortality risk is important in patients diagnosed with of coronavirus disease 2019 (COVID-19). Therefore, we aimed to evaluate the predictive value of different clinical and laboratory parameters in disease severity and mortality in patients with COVID-19. Materials and Methods: Patients admitted to hospital with a diagnosis of COVID-19 were evaluated retrospectively. The patients’ admission date, discharge date, intensive care transfer/ death date, contact history, smoking, symptoms at the time admission, vital markers at admission, and laboratory parameters were recorded. Results: The study included a total of 347 patients, of whom 168 (48.4%) were women. The mean age of the patients was 59.69±16.87 (14-97) years, while 40.9% (n=142) were aged over 65 years. Overall, 10.1% (n=35) of the patients required transfer to an intensive care unit and 8.4% (n=29) were deceased. When clinical parameters were evaluated at the time of admission, oxygen saturation was found to be lower in the group that died. (79.51±6.95) compared to the survivors (88.78±6.11) (p<0.001). Additionally, male gender (p=0.05), advanced age (p<0.001), positive PCR result (p=0.036), congestive heart failure (p=0.044), severe COVID-19 involvement on thorax CT (p<0.001), and presence of at least one comorbidity (p=0.003) were observed at a higher rate in the mortality group. In the multivariate analyses, increased values of the NLR (HR: 1.04, 95% CI: 1.00-1.08), creatinine (OR: 1.37, 95% CI: 1.13-1.66), CRP (=-0.18, OR: 0.98, 95% CI: 0.97-0.99), GGT (OR: 1.006, 95% CI: 1.001-1.012), age (OR: 5.67, 95% CI: 2.24-14.38), male gender (OR: 2.38, 95% CI: 0.98-5.75), and presence of any comorbidity (OR: 5.23, 95% CI: 2.08-13.13) were associated with mortality. Conclusions: Several clinical and laboratory parameters, such as advanced age, male gender, presence of any comorbidity, and NLR, GGT, CRP and creatinine levels at the time of admission can predict mortality in COVID-19 patients. These parameters obtained at the time of admission can contribute to the reduction of mortality through a closer clinical and laboratory follow-up in these patients.

Keywords

• COVID-19
• mortality
• mortality risk factors
• gamma- glutamyl transferase
• neutrophil/lymphocyte ratio
• SARSCoV- 2

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