Alanya’da yatarak tedavi gören COVID-19 hastalarının geriye dönük analizi

Öz

Amaç: SARS-CoV-2’nin etkeni olduğu COVID-19 pandemisi dünya genelinde ciddi morbidite ve mortaliteye neden olmaktadır. Bu çalışmada XXXXX’de yatarak takip ettiğimiz COVID-19 olguları geriye dönük irdelendi. Yöntemler: Mart 2020-Mayıs 2021tarihleri arasında COVID-19 tanısı ile yatırılarak takip ettiğimiz hastalar retrospektif olarak tarandı. Gerçek-zamanlı polimeraz zincir reaksiyonu (RT-PCR) ile SARS CoV-2 viral nükleik asit testi pozitif olan hastalar çalışmaya dahil edildi. Çalışmaya dahil edilen olguların hastane bilgi yönetim sistemi üzerindeki kayıtları ve dosyaları retrospektif olarak tarandı. Hastaların demografik, klinik ve laboratuvar değerleri hazırlanan formlara işlendi. Hastalığın derecesi hafif, orta, ciddi ve kritik olarak sınıflandırıldı. Bulgular: Onaltı hafif/orta, 34 ciddi/kritik hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 58±15.9 yıl olup %64’ü erkek idi. Hipertansiyon (%28) ve Diabetes mellitus (DM) (%28) en sık saptanan komorbid hastalıklardı. Ciddi ve kritik hastalarda ileri yaş, DM, solunum sıkıntısı, derin lenfopeni (<800), d-dimer yüksekliği, C-reaktif protein (CRP) normal sınırın >20 kat yüksekliği, prokalsitonin yüksekliği (>0.25ng/ml) istatiksel olarak (p<0.05) anlamlı bulundu. Hastaların 46’sında favipiravir, 18’inde deksametazon (6 mg/gün, 5-10 gün), 3’ünde IL-6 reseptör blokeri ve 2’sinde immün plazma tedavisi verildi. Hafif vakalar dışında tüm hastalara proflaktik veya tedavi dozunda düşük molekül ağırlıklı heparin verildi. Mortalite gelişen beş olgunun hepsi erkek ve 50 yaş ve üzerinde olup en az bir komorbidetesi vardı. Sonuçlar: Ciddi ve kritik seyreden olgularda ileri yaş, DM, derin lenfopeni, d-dimer yüksekliği, CRP’nin normal sınırın 20 kat yüksekliği ve prokalsitonin yüksekliği anlamlı bulundu. COVID-19 hastalarında antiibiyotik tedavisinin düzenlenmesinde prokalsitonin önemli bir biyobelirteçtir.

Anahtar Kelimeler

• Koronavirüs
• COVID-19
• SARS-COV-2
• Pandemi

Retrospective analysis of clinical features in hospitalized COVID-19 cases in Alanya

Abstract

Objective: COVID-19 pandemic caused by SARS-CoV-2 has resulted in serious morbidity and mortality around the world. In this study, COVID-19 patients hospitalized in xxxx were examined. Methods: A retrospective analysis was performed for COVID-19 patients hospitalized between March 2020 and May 2021. The definitive diagnosis was made by the detection of SARS-CoV-2 nucleic acid by RT-PCR. The demographic, clinic and laboratory values were obtained through the medical records. The degree of the illness was classified as mild, moderate, severe and critical. Results: Sixteen mild/moderate and 34 severe/critically ill patients were included. The mean age was 58±15.9 years, 64% being males. Hypertension (28%) and Diabetes mellitus (DM) (28%) were the most common comorbidities. Being elderly, DM, dyspnea, profound lymphopenia, elevated d-dimer level, CRP being 20 times higher than the upper limit of normal, and high procalcitonin levels were statistically significant (p<0.05) in severe and critically ill patients. Ninety two percent received favipravir. Eighteen received dexamethasone (6 mg/day, 5-10 days), 3 received IL-6 receptor blockers, and 2 received immune plasma treatment. All patients received low-molecular-weight heparin in prophylactic or therapeutic doses except mild cases. Five patients that had developed mortality were male gender, elderly and had at least one comorbidity. Conclusion: Severe and critically ill patients were significantly more likely to have old age, DM, elevated d-dimer level, profound lymphopenia, CRP being 20 times more than the upper limits of normal, and high levels of procalcitonin. Procalcitonin is an important biomarker to guide the need for antimicrobial chemotherapy in COVID-19 patients.

Keywords

• Coronavirus
• COVID-19
• SARS-CoV-2
• Pandemic

Kaynakça

1. 1- Alp Ş, Ünal S. Yeni koronavirüs (SARS-CoV-2) kaynaklı pandemic: Gelişmeler ve güncel durum. FLORA 2020; 25 (28 Mayıs 2020).
2. 2- Erensoy S. COVID-19 pandemisinde SARS-CoV-2 ve mikrobiyolojik tanı dinamikleri. Mikrobiyol Bul 2020;54(3):497-509
3. 3- Karakoç ZÇ, Pınarbaşı-Şimşek B, Asil R, et al. First wave in COVİD-19 pandemic: A single center experience. Klimik Derg 2020; 33(3):223-9.4
4. 4-TC Sağlık Bakanlığı COVID-19 bilgilendirme sayfası. 1 Şubat 2021 https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html
5. 5- WHO. 6 Şubat 2021 https://www.who.int/csr/don/31-december-2020-sars-cov2-variants/en/
6. 6- CDC: Emerging SARS-CoV-2 Variants. Update January, 28, 2021. 6 Şubat 2021.https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/scientific-brief-emerging-variants.html
7. 7- The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
8. 8- NIH COVID-19 treatment guidelines. 6 Şubat 2021 https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/

9. 9- Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. 6 Şubat 2021 https://www.idsociety.org/globalassets/idsa/practice-guidelines/covid-19/treatment/idsa-covid-19-gl-tx-and-mgmt-v3.7.0.pdf
10. 10- TC Sağlık Bakanlığı COVID-19 rehberi. 6 Şubat 2021.https://covid19.saglik.gov.tr/Eklenti/39297/0/covid19rehberiagirpnomoniardssepsisveseptiksokyontemipdf.pdf
11. 11- European Centre for Disease Prevention and Control, case definition for coronavirus disease 2019 (COVID-19). 6 Şubat 2021. https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition
12. 12- Chen Y, Klein SL, Garibaldi BT, et al. Aging in COVID-19: Vulnerability, immunity and intervention. Ageing Res Rev. 2021; 65: 101205.
13. 13- Mukherjee S, Pahan K. Is COVID-19 Gender-sensitive? Journal of Neuroimmune Pharmacology (https://doi.org/10.1007/s11481-020-09974-z)
14. 14- Bastard P, Rosen LB, Zhang Q, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science. 2020 Oct 23;370(6515):eabd4585.
15. 15- Kumar A, Arora A, Sharma P, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr Clin Res Rev. 2020;14:535–545.
16. 16- Zhu L, She Z, Cheng X, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31:1–10.
17. 17- Carrasco-Sánchez FJ, López-Carmona MD, Martínez-Marcos FJ, et al. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med. 2021;53(1):103-116.
18. 18- Günal Ö, Türe E, Bayburtlu M, et al. COVID-19 tanılı hastaların risk faktörleri açısından değerlendirilmesi. Mikrobiyol Bul 2020;54(4):575-582.
19. 19- Ersan G, Akkiraz Baç G, Yüksel Ö, et al. The Demographic and Clinical Features of 479 COVID-19 Patients: A Single-center Experience. Mediterr J Infect Microb Antimicrob. 2020;9:9.
20. 20- Wang F, Nie J, Wang H, et al, Characteristics of Peripheral Lymphocyte Subset Alteration in COVID-19 Pneumonia, The Journal of Infectious Diseases, 2020; 221 (11): 1762–1769, https://doi.org/10.1093/infdis/jiaa150
21. 21- Mackman N, Antoniak S, Wolberg AS, Kasthuri R, Key NS. Coagulation Abnormalities and Thrombosis in Patients Infected With SARS-CoV-2 and Other Pandemic Viruses. Arterioscler Thromb Vasc Biol. 2020;40(9):2033-2044.
22. 22- Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382:1708-20.
23. 23- Huang M, Yang Y, Shang F, et al. Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study. Am J Med Sci. 2020;360(2):120-128.
24. 24- Joshi S, Parkar J, Ansari A, et al. Role of favipiravir in the treatment of COVID-19. Int J Infect Dis. 2021;102:501-508.
25. 25- Lou Y, Liu L, Yao H, et al. Clinical Outcomes and Plasma Concentrations of Baloxavir Marboxil and Favipiravir in COVID-19 Patients: An Exploratory Randomized, Controlled Trial. Eur J Pharm Sci. October 2020:105631.
26. 26- Severe outcomes among patients with coronavirus disesase 2019 (COVID-19)- United States, February 12-March 16, 2020. MMWR Morb Mort Wkly Rep 2020; 69:343-346.
27. 27- Zhang L, Huang B, Xia H, et al. Retrospective analysis of clinical features in 134 coronavirus disease 2019 cases. Epidemiol Infect. 2020;148:e199.