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COVID-19 Pandemisinde Acil Servise Başvuran Hastaların Kan Parametrelerinin Hastalığı Öngörmedeki Başarısının Değerlendirilmesi

Year 2021, , 479 - 488, 22.09.2021
https://doi.org/10.31832/smj.930242

Abstract

Amaç: Çalışmamızda pandemi süresince acil servise Covid-19 şüphesi ile başvuran hastaların klinik, laboratuvar ve görüntülemelerinin ilk başvuru sırasında hastalığı öngörmedeki başarısının ortaya konması amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışma 17 Mart - 1 Mayıs 2020 tarihleri arasında SEAH’a Covid-19 şüphesi ile başvuran 1400 hasta ile gerçekleştirilmiştir. Çalışma kapsamında demografik özellikler, şikayetler, laboratuvar sonuçları, PCR testi, görüntüleme yöntemleri ve hastaneye yatış gereksinimleri elektronik tıbbi kayıtlardan elde edildi. Hastalar dört gruba ayrılarak da incelendi. Buna göre; Grup 1 [43 hasta]: BT pozitif PCR pozitif, Grup 2 [199 hasta]: BT pozitif PCR negatif, Grup 3 [154hasta]: BT negatif PCR pozitif, Grup 4 [644 hasta]: BT negatif PCR negatif
Bulgular: Covid-19 hastalığı şüphesi olan 1040 hastanın verileri ile yapılan analize göre, başvuran hastaların ortalama yaşı 45,15 ± 18,14 ve hastaların %57,8’i erkek olarak tespit edildi. En sık başvuru şikâyetlerinin ise sırasıyla öksürük (40,4%) ve ateş (20,9%) olduğu saptandı. Covid-19 şüphesi nedeniyle acil serviste değerlendirilen hastalarda en sık görülen ek hastalıklar ise HT (16,7%) ve DM (11,3%) oldu. Laboratuvar parametreleri arasından gruplar arasında analiz yapıldığında WBC, lenfosit, NLR, CRP, d-Dimer, troponin, prokalsitonin, ferritin ve LDH değerleri açısından istatistiksel anlamlı fark saptandı (sırasıyla p=0.013, p=0.000, p=0.000, p=0.000, p=0.005, p=0.009, p=0.000, p=0.000, p=0.000).
Sonuç: İlk başvuru esnasında Covid-19 hastalarını tanıyacak spesifik klinik özellikler ve laboratuvar parametreleri henüz saptanmamıştır. Pandemi yönetiminde izolasyon kararında klinik tablonun tam olarak oturmadığı, pnömoninin eşlik etmediği hasta grubu acil servis başvurularında laboratuvar ve görüntüleme yöntemlerinin klinisyenlere yardımcı olmadığını düşünmekteyiz.

References

  • 1. Garcia-Castrillo L, Petrino R, Leach R, Dodt C, Behringer W, Khoury A, et al. European Society For Emergency Medicine position paper on emergency medical systems' response to COVID-19. Eur J Emerg Med 2020;27(3):174-177.
  • 2. WHO Coronavirus Disease (COVID-19) Dashboard. [cited 21 July 2020] Available from: https://covid19.who.int
  • 3. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020;382:1199-1207.
  • 4. Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. Journal of Medical Virology 2020;92(7):797–806.
  • 5. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. J. Am. Med. Assoc 2020;323(15):1488-1494.
  • 6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA 2020 17;323(11):1061–9.
  • 7. CDC. Coronavirus Disease 2019 (COVID-19) – Symptoms. Centers for Disease Control and Prevention. 2020. [cited 28 July 2020] Available from: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
  • 8. Covid-19 Rehberi. 2020. [cited 21 July 2020] Available from: https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf
  • 9. Wee LE, Fua T-P, Chua YY, Ho AFW, Sim XYJ, Conceicao EP, et al. Containing COVID-19 in the Emergency Department: The Role of Improved Case Detection and Segregation of Suspect Cases. Academic Emergency Medicine 2020;27(5):379–87.
  • 10. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41(2):145-151.
  • 11. Guneysu F, Yurumez Y, Guclu E, Koroglu M, Karacan A, Guner NG et al. The diagnostic process of COVID-19 in the emergency department: laboratory and ımaging methods. Revista da Associação Médica Brasileira 2020;66:58-64.
  • 12. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R. Holguin-Rivera Y., Escalera-Antezana, JP. et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
  • 13. Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol 2019;56(3):308–21.
  • 14. Jin J-M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health 2020;8:152.
  • 15. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. International Journal of Antimicrobial Agents 2020;55(5):105955.
  • 16. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. American Journal of Roentgenology 2020;215(2):338-343.
  • 17. Mao R, Qiu Y, He J-S, Tan J-Y, Li X-H, Liang J, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667–78.
  • 18. He L, Mäe MA, Muhl L, Nahar K, Liébanas EV, Fagerlund MJ, et al. Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19. bioRxiv 2020.
  • 19. Mutlu H, Sert ET, Kokulu K, Sarıtaş A. Anxiety Level in Pre-hospital Emergency Medical Services Personnel during Corona Virus Disease-2019 Pandemic. Eurasian J Emerg Med 2021;20(1):43-8
  • 20. Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med 2004;164(20):2206-2216.
  • 21. Cai G. Bulk and single-cell transcriptomics identify tobacco-use disparity in lung gene expression of ACE2, the receptor of 2019-nCov. medRxiv 2020:2020.02.05.20020107.
  • 22. Plebani M, Laposata M, Lippi G. A manifesto for the future of laboratory medicine professionals. Clin Chim Acta 2019;489:49–52.
  • 23. Yu B, Li X, Chen J, Ouyang M, Zhang H, Zhao X, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis 2020;50:1–10.
  • 24. Günther A, Mosavi P, Heinemann S, Ruppert C, Muth H, Markart P et al. Alveolar fibrin formation caused by enhanced procoagulant and depressed fibrinolytic capacities in severe pneumonia. Comparison with the acute respiratory distress syndrome. Am J Respir Crit Care Med 2000;161:454–462
  • 25. Leonard-Lorant I, Delabranche X, Severac F, Helms J, Pauzet C, Collange O, et al. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels. Radiology 2020;296(3):E189-E191.
  • 26. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res 2020;116(6):1097–100.
  • 27. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. Journal of Cardiac Failure 2020;26(6):470–5.
Year 2021, , 479 - 488, 22.09.2021
https://doi.org/10.31832/smj.930242

Abstract

References

  • 1. Garcia-Castrillo L, Petrino R, Leach R, Dodt C, Behringer W, Khoury A, et al. European Society For Emergency Medicine position paper on emergency medical systems' response to COVID-19. Eur J Emerg Med 2020;27(3):174-177.
  • 2. WHO Coronavirus Disease (COVID-19) Dashboard. [cited 21 July 2020] Available from: https://covid19.who.int
  • 3. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020;382:1199-1207.
  • 4. Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. Journal of Medical Virology 2020;92(7):797–806.
  • 5. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. J. Am. Med. Assoc 2020;323(15):1488-1494.
  • 6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA 2020 17;323(11):1061–9.
  • 7. CDC. Coronavirus Disease 2019 (COVID-19) – Symptoms. Centers for Disease Control and Prevention. 2020. [cited 28 July 2020] Available from: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
  • 8. Covid-19 Rehberi. 2020. [cited 21 July 2020] Available from: https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf
  • 9. Wee LE, Fua T-P, Chua YY, Ho AFW, Sim XYJ, Conceicao EP, et al. Containing COVID-19 in the Emergency Department: The Role of Improved Case Detection and Segregation of Suspect Cases. Academic Emergency Medicine 2020;27(5):379–87.
  • 10. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41(2):145-151.
  • 11. Guneysu F, Yurumez Y, Guclu E, Koroglu M, Karacan A, Guner NG et al. The diagnostic process of COVID-19 in the emergency department: laboratory and ımaging methods. Revista da Associação Médica Brasileira 2020;66:58-64.
  • 12. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R. Holguin-Rivera Y., Escalera-Antezana, JP. et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
  • 13. Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol 2019;56(3):308–21.
  • 14. Jin J-M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health 2020;8:152.
  • 15. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. International Journal of Antimicrobial Agents 2020;55(5):105955.
  • 16. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. American Journal of Roentgenology 2020;215(2):338-343.
  • 17. Mao R, Qiu Y, He J-S, Tan J-Y, Li X-H, Liang J, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667–78.
  • 18. He L, Mäe MA, Muhl L, Nahar K, Liébanas EV, Fagerlund MJ, et al. Pericyte-specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19. bioRxiv 2020.
  • 19. Mutlu H, Sert ET, Kokulu K, Sarıtaş A. Anxiety Level in Pre-hospital Emergency Medical Services Personnel during Corona Virus Disease-2019 Pandemic. Eurasian J Emerg Med 2021;20(1):43-8
  • 20. Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med 2004;164(20):2206-2216.
  • 21. Cai G. Bulk and single-cell transcriptomics identify tobacco-use disparity in lung gene expression of ACE2, the receptor of 2019-nCov. medRxiv 2020:2020.02.05.20020107.
  • 22. Plebani M, Laposata M, Lippi G. A manifesto for the future of laboratory medicine professionals. Clin Chim Acta 2019;489:49–52.
  • 23. Yu B, Li X, Chen J, Ouyang M, Zhang H, Zhao X, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis 2020;50:1–10.
  • 24. Günther A, Mosavi P, Heinemann S, Ruppert C, Muth H, Markart P et al. Alveolar fibrin formation caused by enhanced procoagulant and depressed fibrinolytic capacities in severe pneumonia. Comparison with the acute respiratory distress syndrome. Am J Respir Crit Care Med 2000;161:454–462
  • 25. Leonard-Lorant I, Delabranche X, Severac F, Helms J, Pauzet C, Collange O, et al. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels. Radiology 2020;296(3):E189-E191.
  • 26. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res 2020;116(6):1097–100.
  • 27. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. Journal of Cardiac Failure 2020;26(6):470–5.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Fatih Güneysu 0000-0002-8433-3763

Ensar Durmuş 0000-0001-7722-6639

Yusuf Yurumez 0000-0003-3917-9434

Publication Date September 22, 2021
Submission Date April 30, 2021
Published in Issue Year 2021

Cite

AMA Güneysu F, Durmuş E, Yurumez Y. COVID-19 Pandemisinde Acil Servise Başvuran Hastaların Kan Parametrelerinin Hastalığı Öngörmedeki Başarısının Değerlendirilmesi. Sakarya Tıp Dergisi. September 2021;11(3):479-488. doi:10.31832/smj.930242

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