Factors Affecting the Prognosis of COVID-19 Patients: Single center experience

Year 2024, Volume: 9 Issue: 2, 71 - 79, 16.08.2024

Yekta Özkılıç Esma Eryılmaz Eren Zeynep Türe İhami Çelik

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.

Keywords

COVID-19, clinical course, mortality, SARS-CoV-2

COVID-19 Hastalarının Prognozunu Etkileyen Faktörler: Tek merkez deneyimi

Abstract

Amaç: COVID-19 pandemisi tüm dünyada milyonlarca insanı etkiledi. Bu çalışmada, merkezimizde takip edilen COVID-19’lu hastaların klinik özellikleri, tedavileri ve prognozu etkileyen faktörlerin tanımlanması amaçlanmıştır.

Yöntemler: Bu çalışma retrospektif gözlemsel bir kohort çalışma olarak yapıldı. Eylül 2020- Şubat 2021 tarihleri arasında COVID-19 tanısı ile hastanemizde yatarak takip ve tedavi edilen hastaların demografik ve klinik özellikleri, laboratuvar ve radyolojik bulguları ile verilen tedaviler kaydedildi. Hastaların klinik ağırlıkları ve 28. gün mortalite gelişimi kayıt altına alındı. Hafif-orta ve şiddetli-kritik seyreden 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 risk faktörü olanlar belirlendi.
Bulgular: Çalışmaya 500 hasta dahil edildi. Hastaların yaş ortalaması 63.01±14.25 yıl olup çoğunluğunu [%63.8 (n=319)] erkekler oluşturmaktaydı. En sık saptanan semptom nefes darlığı [%68.2 (n=341)], en sık altta yatan hastalık diabetes mellitus (DM) [ %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).

Sonuçlar: Bu çalışmada ileri yaş ve akciğer tutulum oranı yüksekliği mortalite artışı ile ilişkili olarak bulundu. Antiviral tedaviler ile mortalite arasında anlamlı bir ilişki bulunmazken, kortikosteroid tedavisinin mortaliteyi azaltıcı etkisi olduğu gözlendi. Bu parametrelere sahip olan hastaların şiddetli-kritik seyir ve mortalite açısından yakın takibi önemlidir

Keywords

COVID-19, klinik seyir, mortalite, SARS-CoV-2

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.