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COVID-19 Hastalarının Prognozunu Etkileyen Faktörler: Tek Merkez Deneyimi

Year 2024, , 71 - 79, 16.08.2024
https://doi.org/10.55694/jamer.1444875

Abstract

Amaç: COVID-19 pandemisi tüm dünyada milyonlarca insanı etkiledi. Bu çalışmada, merkezimizde takip edilen COVID-19 tanılı
hastaların klinik özellikleri ve tedavileri ele alınarak prognozu etkileyen faktörlerin tanımlanması amaçlanmıştır.
Gereç ve Yöntemler: Bu çalışma retrospektif gözlemsel bir kohort çalışma olarak yapıldı. Eylül 2020 - Şubat 2021 tarihleri
arasında COVID-19 tanısı konmuş hastanemizde yatarak takip ve tedavi edilen hastaların demografik ve klinik özellikleri, labo -
ratuvar ve radyolojik bulguları ile aldıkları tedaviler kaydedildi. Hastaların klinik ağırlıkları ve 28. gün mortalite gelişimi kayıt
altına alındı. Hafif-orta ve şiddetli-kritik seyir gösteren hastalar ile ölen ve sağ kalan hastalar arasında demografik veriler, altta
yatan hastalıklar, laboratuvar bulguları, akciğer tutulum yüzdeleri ve tedaviler karşılaştırıldı. Bu parametrelerden hastalık seyri
ve mortalite açısından yüksek risk faktörü olanlar belirlendi.
Bulgular: Çalışmaya 500 hasta dahil edildi. Hastaların yaş ortalaması 63.01±14.25 yıl olup çoğunluğunu %63.8 (n=319) erkek -
ler oluşturmaktaydı. En sık saptanan semptom nefes darlığı %68.2 (n=341), en sık altta yatan hastalık diabetes mellitus %43.6
(n=218) idi. İleri yaş mortaliteyi arttırıcı risk faktörü olarak bulundu (OR: 1.048, %95 CI, 1.026-1.070, p<0.001). Akciğer tutulum
derecesi ortanca %40 (10-90) olan hastalar, %30 (5-90) olanlara göre mortalite açısından artmış riske sahipti (OR: 1.036, %95
CI, 1.024-1.049, p<0.001). Kortikosteroid tedavisi mortaliteyi azaltıcı faktör olarak saptandı (OR: 0.484, %95 CI, 0.270-0.870,
p=0.015).
Sonuç: İleri yaş ve akciğer tutulum oranı yüksekliği mortalite artışı ile ilişkilidir. Antiviral tedaviler ile mortalite arasında anlam-
lı bir ilişki bulunmazken, kortikosteroid tedavisinin mortaliteyi azaltıcı etkisi olduğu gözlendi.idir

References

  • 1. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20133 UK patients in hospital with COVID-19 using the ISARIC WHO clinical characterisation protocol: Prospective observational cohort study. BMJ. 2020;369:m1985.
  • 2. Yang L, Liu S, Liu J, Zhang Z, Wan X, Huang B, et al. COVID-19: immunopathogenesis and immunotherapeutics. Signal Transduction and Targeted Therapy. 2020 Jul 25;5(1):128.
  • 3. Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VC, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19. Clin Infect Dis. 2020 Apr 27:ciaa478.
  • 4. Ruch Y, Kaeuffer C, Ohana M, Labani A, Fabacher T, Bilbault P,et al. CT lung lesions as predictors of early death or ICU admission in COVID-19 patients. Clinical Microbiology and Infection. 2020 Oct 1;26(10):1417.e5-1417.e8.
  • 5. Starke KR, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: A systematic review with meta-analysis. BMJ Global Health. 2021 Dec 1;6(12):e006434.
  • 6. CDC COVID-19 Response team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, february 12-March 16, 2020. Morbidity and Mortality Weekly Report. 2020 Mar 27;69(12):343-346.
  • 7. Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: A systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infectious Diseases. 2021 Aug 21;21(1):855.
  • 8. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug 20;584(7821):430-436.
  • 9. Goronzy JJ, Weyand CM. Successful and maladaptive T cell aging. Immunity. 2017 Mar 21;46(3):364-378.
  • 10. Li L, Yang L, Gui S, Pan F, Ye T, Liang B, et al. Association of clinical and radiographic findings with the outcomes of 93 patients with COVID-19 in Wuhan, China. Theranostics. 2020 May 15;10(14):6113.
  • 11. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al; Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020 Oct 6;324(13):1307-1316.
  • 12. Sterne JA, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, et al. Association between administration of systemic corticosteroids and mortality among critically Ill patients with COVID-19: A metaanalysis. JAMA. 2020 Oct 6;324(13):1330-1341.
  • 13. Brattsand R, Linden M. Cytokine modulation by glucocorticoids: mechanisms and actions in cellular studies. Alimentary Pharmacology & Therapeutics. 1996;10 (Sup2):81-90.
  • 14. Horby PW, Pessoa-Amorim G, Peto L, Brightling CE, Sarkar R, Thomas K, et al. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): preliminary results of a randomised, controlled, open-label, platform trial RECOVERY Collaborative Group. medRxiv 2021;02(11):21249258.
  • 15. Sarfraz A, Sarfraz Z, Sarfraz M, Aftab H, Pervaiz Z. Tocilizumab and COVID-19: A meta-analysis of 2120 patients with severe disease and implications for clinical trial methodologies. Turkish Journal of Medical Sciences. 2021 Jun 28;51(3):890-897.
  • 16. Celik I, Eryilmaz Eren E, Kilinc- oker A, Eren D, Yildiz M, Kanat A, et al. Low-dose tocilizumab is associated with improved outcome and a low risk of secondary infection in severe COVID-19 pneumonia. International Journal of Clinical Practice. 2021 Dec;75(12):e14997.

Factors Affecting the Prognosis of COVID-19 Patients: Single-Center Experience

Year 2024, , 71 - 79, 16.08.2024
https://doi.org/10.55694/jamer.1444875

Abstract

Abstract
Aim: The COVID-19 pandemic has affected million people all over the world. This study aimed to describe the factors affecting the clinical characteristics, treatments and prognosis of patients with COVID-19 followed in our center.

Methods: This study was conducted as a retrospective observational cohort study. The demographic and clinical characteristics, laboratory and radiological findings, and treatments given of the patients diagnosed with COVID-19 and treated in our hospital between September 2020 and February 2021 were recorded. The clinical weights of the patients and the development of mortality on the 28th day were recorded. Demographic data, underlying diseases, laboratory findings, lung involvement percentages and treatments were compared between mild-moderate and severe-critical patients and between deceased and surviving patients. From these parameters, those with risk factors for disease course and mortality were determined.

Results: 500 patients were included in the study. The average age of the patients was 63.01±14.25 years and the majority [63.8% (n=319)] were men. The most common symptom was shortness of breath [68.2% (n=341)], and the most common underlying disease was diabetes mellitus (DM) [ 43.6% (n=218) ].
Advanced age was found to be a risk factor increasing mortality (OR: 1.048, 95% CI, 1.026-1.070, p<0.001). Patients with a median degree of lung involvement of 40% (10-90) had an increased risk of mortality compared to those with a median degree of lung involvement of 30% (5-90) (OR: 1.036, 95% CI, 1.024-1.049, p<0.001). Corticosteroid treatment was found to be a factor reducing mortality (OR: 0.484, 95% CI, 0.270-0.870, p = 0.015).

Conclusions: In this study, advanced age and high lung involvement rate were found to be associated with increased mortality. While there was no significant relationship between antiviral treatments and mortality, it was observed that corticosteroid treatment had a mortality-reducing effect. It is important to closely monitor patients with these parameters in terms of severe-critical course and mortality.

References

  • 1. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20133 UK patients in hospital with COVID-19 using the ISARIC WHO clinical characterisation protocol: Prospective observational cohort study. BMJ. 2020;369:m1985.
  • 2. Yang L, Liu S, Liu J, Zhang Z, Wan X, Huang B, et al. COVID-19: immunopathogenesis and immunotherapeutics. Signal Transduction and Targeted Therapy. 2020 Jul 25;5(1):128.
  • 3. Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VC, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19. Clin Infect Dis. 2020 Apr 27:ciaa478.
  • 4. Ruch Y, Kaeuffer C, Ohana M, Labani A, Fabacher T, Bilbault P,et al. CT lung lesions as predictors of early death or ICU admission in COVID-19 patients. Clinical Microbiology and Infection. 2020 Oct 1;26(10):1417.e5-1417.e8.
  • 5. Starke KR, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: A systematic review with meta-analysis. BMJ Global Health. 2021 Dec 1;6(12):e006434.
  • 6. CDC COVID-19 Response team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, february 12-March 16, 2020. Morbidity and Mortality Weekly Report. 2020 Mar 27;69(12):343-346.
  • 7. Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: A systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infectious Diseases. 2021 Aug 21;21(1):855.
  • 8. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug 20;584(7821):430-436.
  • 9. Goronzy JJ, Weyand CM. Successful and maladaptive T cell aging. Immunity. 2017 Mar 21;46(3):364-378.
  • 10. Li L, Yang L, Gui S, Pan F, Ye T, Liang B, et al. Association of clinical and radiographic findings with the outcomes of 93 patients with COVID-19 in Wuhan, China. Theranostics. 2020 May 15;10(14):6113.
  • 11. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al; Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020 Oct 6;324(13):1307-1316.
  • 12. Sterne JA, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, et al. Association between administration of systemic corticosteroids and mortality among critically Ill patients with COVID-19: A metaanalysis. JAMA. 2020 Oct 6;324(13):1330-1341.
  • 13. Brattsand R, Linden M. Cytokine modulation by glucocorticoids: mechanisms and actions in cellular studies. Alimentary Pharmacology & Therapeutics. 1996;10 (Sup2):81-90.
  • 14. Horby PW, Pessoa-Amorim G, Peto L, Brightling CE, Sarkar R, Thomas K, et al. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): preliminary results of a randomised, controlled, open-label, platform trial RECOVERY Collaborative Group. medRxiv 2021;02(11):21249258.
  • 15. Sarfraz A, Sarfraz Z, Sarfraz M, Aftab H, Pervaiz Z. Tocilizumab and COVID-19: A meta-analysis of 2120 patients with severe disease and implications for clinical trial methodologies. Turkish Journal of Medical Sciences. 2021 Jun 28;51(3):890-897.
  • 16. Celik I, Eryilmaz Eren E, Kilinc- oker A, Eren D, Yildiz M, Kanat A, et al. Low-dose tocilizumab is associated with improved outcome and a low risk of secondary infection in severe COVID-19 pneumonia. International Journal of Clinical Practice. 2021 Dec;75(12):e14997.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Infectious Diseases
Journal Section Makale
Authors

Yekta Özkılıç 0000-0002-2435-0051

Esma Eryılmaz Eren 0000-0002-2712-9694

Zeynep Türe 0000-0001-6895-0318

İhami Çelik 0000-0002-2604-3776

Publication Date August 16, 2024
Submission Date February 29, 2024
Acceptance Date August 5, 2024
Published in Issue Year 2024

Cite

Vancouver Özkılıç Y, Eryılmaz Eren E, Türe Z, Çelik İ. COVID-19 Hastalarının Prognozunu Etkileyen Faktörler: Tek Merkez Deneyimi. JAMER. 2024;9(2):71-9.