Risk Factors Associated with Severe Disease in COVID-19

Öz

Aim: The aim of this study was to determine the characteristics and risk factors associated with severe disease in COVID-19. Materials and Methods: A total of 186 adult patients (97 female) hospitalized with a diagnosis of COVID-19 (laboratory-confirmed cases, SARS-CoV-2-RNA detected with the molecular method) between March 2020-May 2020 were included in the study. The possible risk factors evaluated were age, gender, comorbidities, smoking, symptoms, and laboratory parameters at the time of admission to the hospital. Results: The patients comprised 97 (52.2%) females, evaluated as severe COVID-19 in 43 (23.1%) cases and non-severe COVID-19 in 143 (76.9%) cases. Multivariate logistic regression analysis identified risk factors for severe COVID-19 to be age >65 years (odds ratio (OR)=5.289, 95% confidence interval (CI):1.680-16.651, p:0.004), and elevated levels of LDH (OR=8.521, 95% CI:2.445-29.702, p:0.001), ferritin (OR=7.436, 95% CI:2.171-25.468, p:0.001), D-dimer (OR=10.076, 95% CI: 2.758-36.813, p<0.001), CK-MB (OR=5.916, 95% CI:1.833-19.089, p:0.003), and troponin (OR=9.201, 95% CI:11.886-44.888, p:0.006). Conclusion: The results of this study examining possible risk factors for severe COVID-19 demonstrated that age>65 years, and elevated LDH, ferritin, D-dimer, CK-MB, and troponin levels are independent risk factors. Clinicians should consider these potential risk factors for progression to severe disease when treating COVID-19 patients.

Anahtar Kelimeler

• COVID-19
• pandemic
• risk factor
• severe disease

COVID-19'da Ciddi Hastalıkla İlişkili Risk Faktörleri

Öz

Amaç: Çalışmamızın amacı COVID-19’da şiddetli hastalık ile ilişkili özellikler ve risk faktörlerinin belirlenmesidir. Gereç ve Yöntem: Mart 2020-Mayıs 2020 tarihleri arasında COVID-19 (moleküler yöntemle SARS-CoV-2-RNA tespit edilen olgular) tanısı ile hastaneye yatırılan toplam 186 yetişkin hasta (97 kadın) çalışmaya dahil edildi. Olası risk faktörleri olarak yaş, cinsiyet, komorbidite, sigara kullanımı, semptomlar ve yatış sırasındaki bazı laboratuvar parametreleri irdelendi. Bulgular: Hastaların 97’si (%52,2) kadın olup, 43 (%23,1) olgu şiddetli COVID-19 ve 143 (%76,9) olgu şiddetli olmayan COVID-19 olarak değerlendirildi. Çoklu değişkenli lojistik regresyon analizinde; 65 yaş üzeri (odds oranı (OR)=5.289, %95 güven aralığı (CI) 1.680-16.651, p=0.004), artmış LDH (OR=8.521, 95% CI:2.445-29.702, p:0.001), ferritin (OR=7.436, 95% CI:2.171-25.468, p:0.001), D-dimer (OR=10.076, 95% CI: 2.758-36.813, p<0.001), CK-MB (OR=5.916, 95% CI:1.833-19.089, p:0.003) ve troponin seviyesi (OR=9.201, 95% CI:11.886-44.888, p:0.006) şiddetli COVID-19 için risk faktörleri olarak tanımlandı. Sonuç: Ciddi COVID-19 için olası risk faktörlerini incelediğimiz bu çalışmada 65 yaş üstü, yükselmiş LDH, ferritin, D-dimer, CK-MB ve troponin düzeylerinin bağımsız risk faktörleri olduğunu bulduk. Klinisyenler, COVID-19 hastalarının tedavisi sırasında ciddi hastalığa ilerleme için bu potansiyel risk faktörlerini dikkate almalıdır.

Anahtar Kelimeler

• COVID-19
• pandemi
• risk faktörü
• şiddetli hastalık

Kaynakça

1. Reference1 1. Lai CC, Wang CY, Wang YH, et al. Global epidemiology of coronavirus disease 2019 (COVID19): disease incidence, daily cumulative index, mortality, and their association with country health care resources and economic status. Int J Antimicrob Agents 2020 Mar 19;105946.
2. Reference2. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a Report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.
3. Reference3. Cai H, Chen Y, Chen Z, et al. Handbook of COVID-19 prevention and treatment. 1st ed. Liang T, editor. China: The First Affiliated Hospital, Zhejiang University School of Medicine 2020. p. 1-84.
4. Reference4. Ou M, Zhu J, Ji P, et al. Risk factors of severe cases with COVID-19: a meta-analysis. Epidemiol Infect 2020 Aug 12;148:e175.
5. Reference5. National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Available from:https://covid19treatmentguidelines.nih.gov
6. Reference6. Huang C , Wang Y , Li X , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223):497–506. 6. Huang C, Wang Y , Li X , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223):497–506.
7. Reference7. İlgili Ö, Kutsal YG. Impact Of Covid-19 Among The Elderly Population. Turkish Journal of Geriatrics 2020; 23(4):419-23.
8. Reference8. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229): 1054-62.

9. Reference9. Zhang JJ, Cao YY, Tan G, et al. Clinical, radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients. Allergy 2021;76:533-50.
10. Reference10. Ebinger JE, Achamallah N, Ji H, et al. Pre-existing traits associated with Covid-19 illness severity. PLoS One 2020;15(7):e0236240.
11. Reference11. Castle SC, Uyemura K, Fulop T, Makinodan T. Host resistance and immune responses in advanced age. Clinics in geriatric medicine 2007;23(3),463-79.
12. Reference12. Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, et al. Evidence for the domains supporting the construct of intrinsic capacity. The Journals of Gerontology. Series A 2018; 73(12),1653-60.
13. Reference13. Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. The New England Journal of Medicine 2020;382, 872–4.
14. Reference14. Bao J, Li C, Zhang K, Kang H, Chen W, Gu B. Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clin Chim Acta 2020;509:180-94.
15. Reference15. Wu C, Chen X, Cai Y, 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.
16. Reference 16. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology 2020;146(1),110-8.
17. Reference 17. Han Y, Zhang H, Mu S, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging (Albany NY) 2020;12(12),11245.
18. Reference 18. Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID‐19 patients: a review. Allergy 2021;76(2),428-55.
19. Reference 19. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis 2020;14:1753466620937175.
20. Reference20. Rosário C, Zandman-Goddard G, Meyron-Holtz EG, D’Cruz DP, Shoenfeld Y. The Hyperferritinemic Syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med 2013;11:185.
21. Reference21. Lala A, Johnson KW, Januzzi JL, et al. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol 2020;76(5):533-46.
22. Reference22. Zhang L, Yan X, Fan Q, et al. D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19. Journal of Thrombosis and Haemostasis 2020;18(6),1324-9.
23. Reference23. Aktoz M, Altay H, Aslanger E, et al. Turk kardiyoloji derneği uzlaşı raporu: COVID-19 pandemisi ve kardiyovaskuler hastalıklar konusunda bilinmesi gerekenler. Turk Kardiyol Dern Ars 2020;48 Suppl 1:1-87.
24. Reference24. Zeng JH, Wu WB, Qu JX, et al. Cardiac manifestations of COVID-19 in Shenzhen, China. Infection 2020;48(6),861-70.
25. Reference25. Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi 2020;48(7):567-71.
26. Reference26. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China. JAMA 2020;323:1061‐9.
27. Reference27. Li JW, Han TW, Woodward M, et al. The impact of 2019 novel coronavirus on heart injury: a systematic review and meta‐analysis. Prog Cardiovasc Dis 2020;63(4):518-24.