The Effect of Comorbidities on Survival of COVİD-19 Patients in the İntensive Care Unit

Öz

Background: Coronavirus Disease-2019, which affects all parts of the body, is associated with increased mortality. In this study, we aimed to investigate the comorbidities affecting survival in geriatric patients infected with SARS-CoV-2 and admitted to intensive care. Materials and Methods: The medical records of 184 patients hospitalized in the isolated intensive care unit of the Balıkesir University Health Practice and Research Hospital between November 2020 and April 2022 were retrospectively examined. Patients discharged from the intensive care were classified into group 1 and those who died were classified into group 2. The mean age of the 57 patients in group 1 was under 75 years old (74.07±6.86) and was different from group 2. Results: No significant differences in the distribution of chronic obstructive pulmonary disease, coronary artery disease, hypertension, or diabetes mellitus were observed between the groups. Mean ferritin, C-reactive protein, D-dimer, and procalcitonin levels were significantly higher in group 2 than in group 1. No significant differences in fibrinogen levels were observed between the groups. In Group 2, the mean lymphocyte count and number of patients vaccinated against SARS-CoV-2 were significantly lower. Conclusions: We concluded that age is an important determinant of survival. Although vaccination aga-inst the virus is an important factor that increases the likelihood of discharge, it loses its effect if the hospital stay is prolonged.

Yoğun Bakım Ünitesindeki İleri Yaş COVİD-19 Hastalarında Komorbiditelerin Sağkalım Üzerine Etkisi

Öz

Amaç: Vücudun tüm bölgelerini etkileyen Koronavirüs Hastalığı-2019, artmış mortalite ile ilişkilidir. Bu çalışmada, SARS-CoV-2 ile enfekte olmuş ve yoğun bakıma alınmış yaşlı hastalarda sağkalımı etkileyen komorbiditelerin araştırılması amaçlanmıştır. Materyal ve metod: Kasım 2020 ve Nisan 2022 tarihleri arasında XXX Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi'nin izole yoğun bakım ünitesinde yatan 184 hastanın tıbbi kayıtları retrospektif olarak incelendi. Yoğun bakımdan taburcu edilen hastalar grup 1, hayatını kaybedenler ise grup 2 olarak sınıflandırıldı. Bulgular: Grup 1'deki 57 hastanın ortalama yaşı 75'in altındaydı (74,07±6,86) ve grup 2'den farklıydı. Gruplar arasında kronik obstrüktif akciğer hastalığı, koroner arter hastalığı, hipertansiyon veya diyabetes mellitus dağılımında anlamlı bir fark gözlenmedi. Ortalama ferritin, C-reaktif protein, D-dimer ve prokalsitonin düzeyleri grup 2'de grup 1'e göre anlamlı derecede yüksekti. Gruplar arasında fibrinojen düzeylerinde anlamlı bir fark gözlenmedi. Grup 2'de ortalama lenfosit sayısı ve SARS-CoV-2'ye karşı aşılanmış hasta sayısı anlamlı derecede düşüktü. Sonuç: Yaşın sağkalımın önemli bir belirleyicisi olduğu sonucuna vardık. Virüse karşı aşılanma taburcu olma olasılığını artıran önemli bir faktör olmakla birlikte, hastanede kalış süresinin uzaması durumunda etkisini kaybetmektedir.

Anahtar Kelimeler

• yoğun bakım
• COVİD-19
• Komorbidite
• SARS-CoV-2

Kaynakça

1. 1. Bösmüller H, Matter M, Fend F, Tzankov A. The pulmonary pathology of COVID- 19. Virchows Arch 2021;478(1):137-50.
2. 2. Garg S, Kim L, Whitaker M, O'Halloran A, Cummings C, Holstein R, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory- Confirmed Coronavi-rus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. US Department of Health and Human Services/Centers for Disease Control and Prevention Morbidity and Mortality We-ekly Report. 2020;69(15):458–64.
3. 3. Wu Z, McGoogan JM. Characteristics of and Important Les-sons From the Coronavirus Disease 2019 (COVID-19) Outb-reak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239-1242.
4. 4. Alsaad S, Addweesh A, Beyari M, Alkhateb M, Alswat A, Alshabnan A, et al. Comorbidities associated with risk of ICU admission in elderly patients with COVID-19: Data from aca-demic hospital in Saudi Arabia. Medicine 2022;101:39.
5. 5. Rehatta NM, Chandra S, Sari D, Lestari MI, Senapathi TGA, Nurdin H, et al. Comorbidities and COVID-19 status influence the survival rate of geriatric patients in intensive care units: a prospective cohort study from the Indonesian Society of Anaesthesiology and Intensive Therapy. BMC Geriatr. 2022; 22:523.
6. 6. Girgin S, Aksun M, Tüzen AS, Şencan A, Şanlı O, Kırbaş G, et al. Effects of comorbidities associated with COVID-19 cases in Intensive Care Unit on mortality and disease progression. European Review for Medical and Pharmacological Sciences. 2023;27(8):3753-3765.
7. 7. Ersan G, Rollas K, Atalay S, Singil S, Mert K, Abakay H, ve ark. SARS-CoV-2 PCR Pozitifliği Nedeniyle Hastaneye Yatan 65 Yaş ve Üzeri Tam Doz İnaktif Aşılı ve Aşısız Olguların İrde-lenmesi. Klimik Dergisi 2022; 35:64-7.
8. 8. Ciarambino T, Crispino P, Buono P, Giordano V, Trama U, Iodice V, et al. Efficacy and Safety of Vaccinations in Geriat-ric Patients: A Literature Review. Vaccines (Basel). 2023 Aug 24;11(9):1412.

9. 9. Landi F, Barillaro C, Bellieni A, Brandi V, Carfi A, Cipriani MA, et al. The Geriatrician: The Frontline Specialist in the Treat-ment of COVID-19 Patients. Journal of the American Medical Directors Association. 2020;(7):937-938.
10. 10. Sungurtekin H, Sargın F, Kılınç M, Kahramanoğlu M, Akbulut M, Ayoğlu F, ve ark. APACHE-II, SOFA, ISARIC/WHO 4C Mor-talite Skoru ve CO-RADS’nin Kritik Koronavirüs Hastalığı-2019 Hastalarının Mortalite Tahmininde Kullanımı. J Turk Soc In-tens Care 2023;21(2):100-109
11. 11. Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. International Immunology. 2017;29(9):401-9.
12. 12. Kazan ED, Orhan S, Korkmaz D, Sarı A, Kazan S. The effect of lymphocyte blood levels on mortality of COVID- 19 patients under intensive care unit follow-up. European Review for Medical and Pharmacological Sciences. 2022;26(19):7290-7296.
13. 13. Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunology Letters 2020;225:31-2.
14. 14. Varghese G, John R, Manesh A, Karthik R, Abraham O. Clini-cal management of COVID-19. Indian J Med Res 2020;151(5):401-10.
15. 15. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet.2020;395(10223):473-475.
16. 16. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of COVID-19: Fi-nal report. N Engl J Med 2020;383(19):1813-1826.
17. 17. COVID-19 Türkiye Cumhuriyeti Sağlık Bakanlığı Bilim Kurulu. COVID-19'lu yetişkin hastalar için kılavuz. Ankara: Türkiye Sağlık Bakanlığı; Nisan 2022. [İnternet]: https://covid19.saglik.gov.tr/TR-66926/eriskin-hasta-tedavisi.html. Accessed: 07.01.2024.
18. 18. Hamid S, Mir MY, Rohela GK. Novel coronavirus disease (COVID-19): a pandemic (epidemiology, pathogenesis and potential therapeutics). New microbes new Infect. 2020;35 100679.
19. 19. Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, Hernández M, Gea A, Arruti E, et al. Clinical features, venti-latory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med 2020;46(12):2200-2211.
20. 20. Guérin C, Albert RK, Beitler J, Gattinoni L, Jaber S, Marini JJ, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 2020; 46(12): 2385–2396.
21. 21. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–43.